COVID-19 and its impact on the brain and Mind- A conceptual model and supporting evidence.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that is causing the ongoing coronavirus disease 2019 (COVID-19) pandemic, was first reported in late 2019. Since then, an unprecedented amount of new knowledge has emerged about this virus and its treatment. Although the reported symptoms of COVID-19 are primarily respiratory with acute respiratory distress syndrome, SARS-CoV-2 has also been shown to affect other organs, including brain, and there are growing reports of neuropsychiatric symptoms due to COVID-19. There are two suggested pathways for how COVID-19 can affect the brain and mind: the direct impact on the brain and impact mediated via stress. Direct impact on the brain is manifested as encephalitis/encephalopathy with altered mental status (AMS) and delirium. In this paper, we summarize evidence from studies of previous outbreaks and current data from the COVID-19 pandemic that describe how COVID-19 is associated with an increased prevalence of anxiety, stress, poor sleep quality, obsessive-compulsive symptoms, and depression among the general population during the pandemic. In addition, we summarize the current evidence that supports how COVID-19 can also impact the CNS directly and result in delirium, cerebrovascular events, encephalitis, unspecified encephalopathy, AMS, or peripheral neurologic disorders.

Exploring the role of inflammation in major depressive disorder: beyond the monoamine hypothesis.

Major depressive disorder affects approximately 8.4% of the United States population. The World Health Organization estimates that 280 million adults worldwide are suffering from depression. They have estimated that by 2030 it will be the second most serious condition. Current treatment relies on the monoamine hypothesis, however, one-third of patients with MDD do not respond to monoamine-based antidepressants. For years, it was hypothesized that the primary pathway of MDD involved serotonin as the main neurotransmitter. The monoamine hypothesis, a widely accepted theory, sought to explain the biological basis of MDD as being caused by the depletion of monoamine neurotransmitters, namely norepinephrine and serotonin. This hypothesis regarding monoamines as the pathophysiological basis of MDD led to the design and widespread use of selective serotonin reuptake inhibitors. However, given that only one-third of patients improve with SSRI it is reasonable to infer that the pathway involved is more complex than once hypothesized and there are more neurotransmitters, receptors, and molecules involved. The monoamine hypothesis does not explain why there is a delay in the onset of effect and action of SSRIs. Several studies have demonstrated that chronic stress is a risk factor for the development of MDD. Thus the monoamine hypothesis alone is not enough to fully account for the pathophysiology of MDD highlighting the need for further research involving the pathways of MDD. In this paper, we review the role of inflammation and cytokines on MDD and discuss other pathways involved in the development and persistence of depressive symptoms.

A closer look to neural pathways and psychopharmacology of obsessive compulsive disorder.

The intricate neural pathways involved in obsessive-compulsive disorder (OCD) affect areas of our brain that control executive functioning, organization, and planning. OCD is a chronic condition that can be debilitating, afflicting millions of people worldwide. The lifetime prevalence of OCD in the US is 2.3%. OCD is predominantly characterized by obsessions consisting of intrusive and unwanted thoughts, often with impulses that are strongly associated with anxiety. Compulsions with OCD encompass repetitive behaviors or mental acts to satisfy their afflicted obsessions or impulses. While these factors can be unique to each individual, it has been widely established that the etiology of OCD is complex as it relates to neuronal pathways, psychopharmacology, and brain chemistry involved and warrants further exploration.

Levetiracetam and Suicidality: A Case Report and Literature Review.

OBJECTIVE: To identify clinical characteristics common among epileptic patients prescribed levetiracetam who report suicidal ideation or who exhibit suicidal behavior. A case is also provided that highlights the need for increased vigilance for neuropsychiatric sequelae in fragile epileptic patients prescribed levetiracetam, especially post dosage adjustment. DATA SOURCES: PubMed was queried with no time limitation to December 2018 using a combination of controlled terms. Using the Boolean operators "AND" and "OR," the authors searched PubMed for case reports and case series on levetiracetam-related suicidal behavior. The search terms used were [levetiracetam] OR [Keppra] AND in combination with suicidal, suicide, suicidal ideation, suicide attempt, and suicidality. STUDY SELECTION: Relevant English-language human studies on levetiracetam and its effect on suicidal behavior were included. The search terms generated 78 results from the databases. After excluding all duplicates and applying the inclusion and exclusion criteria, a total of 14 clinical studies were retained for review. DATA EXTRACTION: Two reviewers independently extracted relevant data and assessed the methodological quality of each study. RESULTS: The included studies reveal a number of risk factors for suicide ideation, suicide-related behavior, and suicide attempt among individuals taking levetiracetam. These risk factors include a prior psychiatric disorder, a history of traumatic brain injury, a history of substance use disorder, and a structural brain abnormality. Patients with these risk factors constitute a specific subgroup of patients with epilepsy who have an increased vulnerability to suicidal ideation or behavior if prescribed levetiracetam. These patients should, therefore, be monitored closely. CONCLUSIONS: Suicidal behavior in epileptic patients appears to be multifactorial in etiology. Psychiatric disorders are more prevalent in epileptic patients than in the general population and contribute to this risk. In spite of the high risk of suicidal behavior with the use of antiepileptic drugs, studies have shown that the benefits of anticonvulsant therapy often outweigh the risks. Nevertheless, timely consultation with a psychiatrist is invaluable in the care of these patients, particularly those with multiple risk factors, as in the index case. The risk of suicidality should be balanced with the risk of uncontrolled seizures. Specifically, in the case of levetiracetam, it is important to be aware of the subgroup of individuals with prior severe psychiatric illness, a history of traumatic brain injury, or a history of substance use disorder who might be at an increased risk of developing suicide-related behavior and suicidal ideations once levetiracetam is started.

[Polysaccharide of Escherichia coli in the Prevention of Recurrent Urinary Tract Infection: An Evidence-Based Review]. / Polissacarídeo de Escherichia coli na Prevenção da Infeção do Trato Urinário Recorrente: Uma Revisão Baseada na Evidência.

INTRODUCTION: Recurrent urinary tract infection is frequent and it is related to morbidity, costs and growing antibiotic resistance. OM 8930 vaccine is composed by Escherichia coli polysaccharide and it is a possible prophylactic measure, but there is doubt as to its effectiveness. MATERIAL AND METHODS: We performed a systematic review in evidence-based medicine databases with rigorous bibliography selection. RESULTS: We found an effective decrease of recurrences in test groups. DISCUSSION: We recommend the administration of the vaccine as prophylaxis of recurrent cystitis. CONCLUSION: The vaccine has impact on the recurrent cystitis relapse rate. We suggest that more studies be carried out to evaluate the vaccine cost-benefit and its effectiveness in complicated urinary infections.

Introdução: A infeção do trato urinário recorrente é frequente e associa-se a morbilidade, custos e aquisição de resistências a antibióticos. A vacina OM 8930 é constituída por um polissacarídeo de Escherichia coli e é uma possível medida profilática, mas existe dúvida quanto à sua efetividade. Material e Métodos: Realizámos uma revisão sistemática das principais bases de dados de medicina baseada na evidência, com seleção criteriosa dos artigos encontrados. Resultados: Verificámos uma efetiva diminuição do número de recorrências nos grupos experimentais. Discussão: Admitimos a recomendação do uso da vacina como profilaxia da cistite recorrente. Conclusão: A vacina tem impacto na recidiva da cistite recorrente. Sugerimos a realização de mais estudos para avaliar o custo/benefício da vacina, bem como o seu efeito nas infeções urinárias complicadas.