ABSTRACT
Introduction: Factors such as coronavirus neurotropism, which is associated with a massive increase in pro-inflammatory molecules and neuroglial reactivity, along with experiences of intensive therapy wards, fears of pandemic, and social restrictions, are pointed out to contribute to the occurrence of neuropsychiatric conditions. Aim: The aim of this study is to evaluate the role of COVID-19 inflammation-related indices as potential markers predicting psychiatric complications in COVID-19. Methods: A total of 177 individuals were examined, with 117 patients from a temporary infectious disease ward hospitalized due to COVID-19 forming the experimental group and 60 patients from the outpatient department showing signs of acute respiratory viral infection comprising the validation group. The PLR index (platelet-to-lymphocyte ratio) and the CALC index (comorbidity + age + lymphocyte + C-reactive protein) were calculated. Present State Examination 10, Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment were used to assess psychopathology in the sample. Regression and Receiver operating characteristic (ROC) analysis, establishment of cutoff values for the COVID-19 prognosis indices, contingency tables, and comparison of means were used. Results: The presence of multiple concurrent groups of psychopathological symptoms in the experimental group was associated (R² = 0.28, F = 5.63, p < 0.001) with a decrease in the PLR index and a simultaneous increase in CALC. The Area Under Curve (AUC) for the cutoff value of PLR was 0.384 (unsatisfactory). For CALC, the cutoff value associated with an increased risk of more psychopathological domains was seven points (sensitivity = 79.0%, specificity = 69.4%, AUC = 0.719). Those with CALC > 7 were more likely to have disturbances in orientation (χ² = 13.6; p < 0.001), thinking (χ² = 7.07; p = 0.008), planning ability (χ² = 3.91; p = 0.048). In the validation group, an association (R²McF = 0.0775; p = 0.041) between CALC values exceeding seven points and the concurrent presence of pronounced anxiety, depression, and cognitive impairments was demonstrated (OR = 1.52; p = 0.038; AUC = 0.66). Discussion: In patients with COVID-19, the CALC index may be used for the risk assessment of primary developed mental disturbances in the context of the underlying disease with a diagnostic threshold of seven points.
ABSTRACT
Objective: This study is to determine the possible pathophysiological parameters associated with the development of anxiety and impaired consciousness in patients with acute coronavirus disease (COVID-19). Methods: Descriptive pathophysiological and pathopsychological data was collected from 89 patients hospitalized due to COVID-19 across 7 infectious hospitals, where 14 trainees in psychiatry and neurology collected data from December 2020 to June 2021. Contingency tables and logistic regression analyses were made to reveal associations and to detect predictors of patients' states of anxiety or impaired consciousness. Results: Anxiety and impaired consciousness were observed in 28 patients (31.50%); 22 (25.00%) presented with anxiety symptoms, and 7 (7.90%) had impaired consciousness. The degree of their association was low (Fisher's exact = 0.675 (df = 1), P = .495). Different pathophysiological mechanisms were shown to determine the development of anxiety or impaired consciousness within COVID-19. Predictors of anxiety were oxygen saturation (OR = 1.26; 95% CI, 1.04-1.54; P = .021), cardiovascular disorders (OR = 0.14; 95% CI, 0.04-0.52; P = .003), disorders of the nervous system (OR = 0.05; 95% CI, 0.01-0.84; P = .038), and urogenital system (OR = 0.13; 95% CI, 0.02-0.87; P = .035). The predictive power of the model was 80.23% (P ≤ .001). The development of impaired consciousness was associated with age (OR = 1.11; 95% CI, 1.01-1.21; P = .025) and C-reactive protein level (OR = 1.02; 95% CI, 0.99-1.04; P = .060), and the predictive power of the model was 94.52% (P ≤ .001). Conclusion: The prevalence of psychopathological disorders associated with acute COVID-19 was high: n = 28 (31.50%) for anxiety and impaired consciousness. Moreover, a 1.00% increase in the saturation index was associated with a 1.3-fold increase in the patient's risk of developing anxiety. Thus, anxiety symptoms may be considered within a personality rather than an infectious-inflammatory response to COVID-19.
ABSTRACT
Objectives: To investigate the relationship between changes in circadian patterns of melatonin and clinical manifestations of polymorbid cardiovascular pathology (PCVP) in young men and to analyze the effectiveness of their complex treatment. Materials and methods: We made the immunohistochemical (IHC) analysis of epiphysis tissues from autopsies of 25 men aged 32-44 with PCVP and metabolic syndrome (MS) who had died as a result of ischemic cardiomyopathy (IC) and 25 persons after the car accident as a control group. Then, 93 young men aged 35-44 with PCVP, metabolic syndrome, and depressive spectrum disorders (DSD) were divided into three groups: (1) standard therapy; (2) standard therapy and psychotherapy sessions; (3) standard therapy in combination with psychotherapeutic and psychophysiological visual and auditory correction sessions. The control group included 24 conditionally healthy male volunteers. Before and after the treatment, we studied the anthropometric status, lipid and carbohydrate metabolism indicators, the level of urinary 6-hydroxymelatonin sulfate, the degree of nocturnal decrease in blood pressure (BP), and the relationship of these indicators with circadian variations of melatonin excretion. Results: Young polymorbid patients who died from IC have a lower expression of melatonin type 1 and 2 receptors. All patients with PCVP showed a decrease in the nocturnal melatonin excretion fraction and a correlation with higher severity of depressive (r = -0.72) and anxiety (r = -0.66) symptoms. Reduced values of the 6-hydroxymelatonin sulfate (6-SM) in the 1st (r = 0.45), 2nd (r = 0.39), and 3rd (r = 0.51) groups before treatment was associated with periods of increased BP. The achievement of melatonin excretion reference values and normalization of biochemical parameters of carbohydrate and lipid metabolism, daily BP profile, and psychophysiological state were noted in all three patients' groups, with a more pronounced effect in group 3. Conclusion: Low nocturnal melatonin excretion levels are associated with greater severity of clinical symptoms and a higher risk of death in patients with PCVP. Therefore, comprehensive therapy may be more effective for correcting this disease.
ABSTRACT
Background: Repetitive transcranial magnetic stimulation (rTMS) is one of the high-potential non-pharmacological methods for migraine treatment. The purpose of this study is to define the neuroimaging markers associated with rTMS therapy in patients with migraine based on data from functional MRI (fMRI). Materials and Methods: A total of 19 patients with episodic migraine without aura underwent a 5-day course of rTMS of the fronto-temporo-parietal junction bilaterally, at 10 Hz frequency and 60% of motor threshold response of 900 pulses. Resting-state functional MRI (1.5 T) and a battery of tests were carried out for each patient to clarify their diagnosis, qualitative and quantitative characteristics of pain, and associated affective symptoms. Changes in functional connectivity (FC) in the brain's neural networks before and after the treatment were identified through independent components analysis. Results: Over the course of therapy, we observed an increase in FC of the default mode network within it, with pain system components and with structures of the visual network. We also noted a decrease in FC of the salience network with sensorimotor and visual networks, as well as an increase in FC of the visual network. Besides, we identified 5 patients who did not have a positive response to one rTMS course after the first week of treatment according to the clinical scales results, presumably because of an increasing trend of depressive symptoms and neuroimaging criteria for depressive disorder. Conclusions: Our results show that a 5-day course of rTMS significantly alters the connectivity of brain networks associated with pain and antinociceptive brain systems in about 70% of cases, which may shed light on the neural mechanisms underlying migraine treatment with rTMS.
