MORBIDITY AND NEUROPSYCHIATRIC EVALUATION IN PATIENTS DISCHARGED FROM ICU AFTER RECOVERY FROM SARS-COV-2 INFECTION
Main Article Content
Keywords
SARS-CoV-2, COVID-19, Comorbidity, Neuropsychiatric Sequelae, Post-Covid Effect
Abstract
INTRODUCTION: The novel coronavirus SARS-CoV-2 causing COVID-19 disease is genetically similar to other strains of the coronavirus family, which are severe acute respiratory syndrome corona virus (SARS-CoV-1) and Middle-East respiratory syndrome corona virus includes (MERS-CoV). Nearly, 35% of symptomatic persons with positive outpatient SARS-CoV-2 test results who reported after 2-3 weeks after testing had not recovered to their prior level of health. Some individuals experience severe neuropsychiatric and musculoskeletal COVID-19 symptoms, including myalgia, psychosis, olfactory and gustatory deficits, and cerebrovascular accidents. Post-COVID syndrome symptoms that include neuropsychiatric and musculoskeletal include sleep disorders, encephalopathy, chronic headache, delirium, brain fog, and small joint arthritis.
AIM AND OBJECTIVE: To study the trend of comorbidities development in post COVID patients and neuropsychiatric, behaviour changes, new illnesses like Diabetes Mellitus, Hypertension, IHD, Cardiomyopathy and other co morbidities assessment in COVID recovered patients.
MATERIAL AND METHOD: Observational Cross-sectional study. Period of collection of data was 1 ½ year, 30 COVID discharged patients who were previously admitted under the Department of General Medicine, Dhiraj General Hospital, Smt. B K Shah Medical Institute and Research Centre, Piparia, Vadodara 391760.
DISCUSSION: The early identification of the medical and neuropsychiatric sequelae and its risk factors will help us prevent , early diagnosis and effective management of the post covid effects. Detailed history and findings of the clinical examination were collected in the proforma. Telephonic conversations were done with the patients regarding their well-being and current health status. Patient’s mental status post COVID recovery was assessed using the Hospital Anxiety and Depression scale (HADS).
CONCLUSION: Fatigue, was the most common finding, followed by anxiety/depression, PTSD, cognitive deficits, and sleep disturbances were commonly reported in most of the studies. This study, 18 (60%) had no comorbidities, 4 (13.33%) had Hypothyroid, 3 (10%) had diabetes and hypertension, 3 (10%) had Diabetes and 2 (6.6%) had hypertension. In this study, the mean value of Anxiety score in this study was 4.27 (± 2.5). The mean value of Depression score in the study was 4.27 (± 2.68) ranged between 2 and 12 and none of the subjects had Neuro deficit.
AIM AND OBJECTIVE: To study the trend of comorbidities development in post COVID patients and neuropsychiatric, behaviour changes, new illnesses like Diabetes Mellitus, Hypertension, IHD, Cardiomyopathy and other co morbidities assessment in COVID recovered patients.
MATERIAL AND METHOD: Observational Cross-sectional study. Period of collection of data was 1 ½ year, 30 COVID discharged patients who were previously admitted under the Department of General Medicine, Dhiraj General Hospital, Smt. B K Shah Medical Institute and Research Centre, Piparia, Vadodara 391760.
DISCUSSION: The early identification of the medical and neuropsychiatric sequelae and its risk factors will help us prevent , early diagnosis and effective management of the post covid effects. Detailed history and findings of the clinical examination were collected in the proforma. Telephonic conversations were done with the patients regarding their well-being and current health status. Patient’s mental status post COVID recovery was assessed using the Hospital Anxiety and Depression scale (HADS).
CONCLUSION: Fatigue, was the most common finding, followed by anxiety/depression, PTSD, cognitive deficits, and sleep disturbances were commonly reported in most of the studies. This study, 18 (60%) had no comorbidities, 4 (13.33%) had Hypothyroid, 3 (10%) had diabetes and hypertension, 3 (10%) had Diabetes and 2 (6.6%) had hypertension. In this study, the mean value of Anxiety score in this study was 4.27 (± 2.5). The mean value of Depression score in the study was 4.27 (± 2.68) ranged between 2 and 12 and none of the subjects had Neuro deficit.
References
1. WHO Coronavirus (COVID-19) Dashboard [Internet]. [cited 2022 Nov 10]. Available from: https://covid19.who.int
2. Frontiers | Comparative Review of SARS-CoV-2, SARS-CoV, MERS-CoV, and Influenza A Respiratory Viruses [Internet]. [cited 2022 Nov 10]. Available from: https://www.frontiersin.org/articles/10.3389/fimmu.2020.552909/full
3. Petrosillo N, Viceconte G, Ergonul O, Ippolito G, Petersen E. COVID-19, SARS and MERS: are they closely related? Clin Microbiol Infect. 2020 Jun;26(6):729–34.
4. Chung MK, Zidar DA, Bristow MR, Cameron SJ, Chan T, Harding CV, et al. COVID-19 and Cardiovascular Disease. Circ Res. 2021 Apr 16;128(8):1214–36.
5. B K A, Chaudhuri D. A Review of Acute Myocardial Injury in Coronavirus Disease 2019. Cureus. 12(6):e8426.
6. Mitrani RD, Dabas N, Goldberger JJ. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm. 2020 Nov;17(11):1984–90.
7. Long COVID: Long-Term Effects of COVID-19 | Johns Hopkins Medicine [Internet]. [cited 2022 Nov 11]. Available from: https://www.hopkinsmedicine.org/health/conditions-and- diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19
8. Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. Sn Compr Clin Med. 2020;2(8):1069–76.
9. Chippa V, Aleem A, Anjum F. Post Acute Coronavirus (COVID-19) Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Nov 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK570608/
10. CDC. Post-COVID Conditions [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Nov 11]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/long-term- effects/index.html
11. Mehandru S, Merad M. Pathological sequelae of long-haul COVID. Nat Immunol. 2022;23(2):194–202.
12. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo PA, Cuapio A, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021 Aug 9;11(1):16144.
13. Graham EL, Clark JR, Orban ZS, Lim PH, Szymanski AL, Taylor C, et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers.” Ann Clin Transl Neurol. 2021;8(5):1073–85.
14. Walia N, Lat JO, Tariq R, Tyagi S, Qazi AM, Salari SW, et al. Post-acute sequelae of COVID-19 and the mental health implications. Discoveries. 9(4):e140.
15. Meng ZQ, Leng Q, Wang X, Xu CH, Xu J, Liu Y. Comparative analysis of anxiety/depression scores in COVID-19 patients with disease severity, sleep patterns, and certain laboratory test results. Arch Med Sci. 2022 Sep 1;18(5):1262–70.
16. Rishi P. Rishi P, Rishi E, Maitray A, Agarwal A, Nair S, Gopalakrishnan S. Hospital anxiety and depression scale assessment of 100 patients before and after using low vision care: A prospective study in a tertiary eye-care setting. Indian J Ophthalmol 2017;65:1203-8. Indian J Ophthalmol. 2017 Nov 13;65:1203–8.
17. Bai F, Tomasoni D, Falcinella C, Barbanotti D, Castoldi R, Mulè G, et al. Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect. 2022 Apr;28(4):611.e9-611.e16.
18. Nakamura ZM, Nash RP, Laughon SL, Rosenstein DL. Neuropsychiatric Complications of COVID-19. Curr Psychiatry Rep. 2021;23(5):25.
19. Nie XD, Wang Q, Wang MN, Zhao S, Liu L, Zhu YL, et al. Anxiety and depression and its correlates in patients with coronavirus disease 2019 in Wuhan. Int J Psychiatry Clin Pract. 2021 Jun;25(2):109–14.
20. Ma YF, Li W, Deng HB, Wang L, Wang Y, Wang PH, et al. Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. J Affect Disord. 2020 Oct 1;275:145–8.
21. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020 Oct;89:594–600.
22. Han Q, Zheng B, Daines L, Sheikh A. Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms. Pathogens. 2022 Feb;11(2):269.
23. Kim Y, Kim SW, Chang HH, Kwon KT, Bae S, Hwang S. Significance and Associated Factors of Long-Term Sequelae in Patients after Acute COVID-19 Infection in Korea. Infect Chemother. 2021 Sep;53(3):463–76.
24. Abdelhafiz AS, Ali A, Maaly AM, Mahgoub MA, Ziady HH, Sultan EA. Predictors of post- COVID symptoms in Egyptian patients: Drugs used in COVID-19 treatment are incriminated. PLOS ONE. 2022 Mar 31;17(3):e0266175.
25. Naik S, Haldar SN, Soneja M, Mundadan NG, Garg P, Mittal A, et al. Post COVID-19 sequelae: a prospective observational study from Northern India. Drug Discov Ther. 2021;
26. Rizvi AA, Kathuria A, Al Mahmeed W, Al-Rasadi K, Al-Alawi K, Banach M, et al. Post-COVID syndrome, inflammation, and diabetes. J Diabetes Complications. 2022 Nov 1;36(11):108336.
27. 69. Scherer PE, Kirwan JP, Rosen CJ. Post-acute sequelae of COVID-19: A metabolic perspective. Zaidi M, editor. eLife. 2022 Mar 23;11:e78200.
28. 70. Raveendran AV, Misra A. Post COVID-19 Syndrome (“Long COVID”) and Diabetes: Challenges in Diagnosis and Management. Diabetes Metab Syndr. 2021;15(5):102235.
29. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708–20.
30. Schou TM, Joca S, Wegener G, Bay-Richter C. Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review. Brain Behav Immun. 2021 Oct 1;97:328–48.
31. Chopra N, Chowdhury M, Singh AK, Ma K, Kumar A, Ranjan P, et al. Clinical predictors of long COVID-19 and phenotypes of mild COVID-19 at a tertiary care centre in India. Drug Discov Ther. 2021;15(3):156–61.
32. Budhiraja S, Aggarwal M, Wig R, Tyagi A, Mishra RS, Mahajan M, et al. Long Term Health Consequences of COVID-19 in Hospitalized Patients from North India: A follow up study of upto 12 months [Internet]. medRxiv; 2021 [cited 2022 Nov 11]. p. 2021.06.21.21258543. Available from: https://www.medrxiv.org/content/10.1101/2021.06.21.21258543v2
33. Badenoch JB, Rengasamy ER, Watson C, Jansen K, Chakraborty S, Sundaram RD, et al. Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Commun. 2022 Feb 1;4(1):fcab297.
34. Fatima G, Bhatt D, Idrees J, Khalid B, Mahdi F. Elucidating Post-COVID-19 manifestations in India [Internet]. medRxiv; 2021 [cited 2022 Nov 11]. p. 2021.07.06.21260115. Available from: https://www.medrxiv.org/content/10.1101/2021.07.06.21260115v1
35. Kumar S, Veldhuis A, Malhotra T. Neuropsychiatric and Cognitive Sequelae of COVID-19. Front Psychol [Internet]. 2021 [cited 2022 Nov 11];12. Available from: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.577529
2. Frontiers | Comparative Review of SARS-CoV-2, SARS-CoV, MERS-CoV, and Influenza A Respiratory Viruses [Internet]. [cited 2022 Nov 10]. Available from: https://www.frontiersin.org/articles/10.3389/fimmu.2020.552909/full
3. Petrosillo N, Viceconte G, Ergonul O, Ippolito G, Petersen E. COVID-19, SARS and MERS: are they closely related? Clin Microbiol Infect. 2020 Jun;26(6):729–34.
4. Chung MK, Zidar DA, Bristow MR, Cameron SJ, Chan T, Harding CV, et al. COVID-19 and Cardiovascular Disease. Circ Res. 2021 Apr 16;128(8):1214–36.
5. B K A, Chaudhuri D. A Review of Acute Myocardial Injury in Coronavirus Disease 2019. Cureus. 12(6):e8426.
6. Mitrani RD, Dabas N, Goldberger JJ. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm. 2020 Nov;17(11):1984–90.
7. Long COVID: Long-Term Effects of COVID-19 | Johns Hopkins Medicine [Internet]. [cited 2022 Nov 11]. Available from: https://www.hopkinsmedicine.org/health/conditions-and- diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19
8. Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. Sn Compr Clin Med. 2020;2(8):1069–76.
9. Chippa V, Aleem A, Anjum F. Post Acute Coronavirus (COVID-19) Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Nov 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK570608/
10. CDC. Post-COVID Conditions [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Nov 11]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/long-term- effects/index.html
11. Mehandru S, Merad M. Pathological sequelae of long-haul COVID. Nat Immunol. 2022;23(2):194–202.
12. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo PA, Cuapio A, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021 Aug 9;11(1):16144.
13. Graham EL, Clark JR, Orban ZS, Lim PH, Szymanski AL, Taylor C, et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers.” Ann Clin Transl Neurol. 2021;8(5):1073–85.
14. Walia N, Lat JO, Tariq R, Tyagi S, Qazi AM, Salari SW, et al. Post-acute sequelae of COVID-19 and the mental health implications. Discoveries. 9(4):e140.
15. Meng ZQ, Leng Q, Wang X, Xu CH, Xu J, Liu Y. Comparative analysis of anxiety/depression scores in COVID-19 patients with disease severity, sleep patterns, and certain laboratory test results. Arch Med Sci. 2022 Sep 1;18(5):1262–70.
16. Rishi P. Rishi P, Rishi E, Maitray A, Agarwal A, Nair S, Gopalakrishnan S. Hospital anxiety and depression scale assessment of 100 patients before and after using low vision care: A prospective study in a tertiary eye-care setting. Indian J Ophthalmol 2017;65:1203-8. Indian J Ophthalmol. 2017 Nov 13;65:1203–8.
17. Bai F, Tomasoni D, Falcinella C, Barbanotti D, Castoldi R, Mulè G, et al. Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect. 2022 Apr;28(4):611.e9-611.e16.
18. Nakamura ZM, Nash RP, Laughon SL, Rosenstein DL. Neuropsychiatric Complications of COVID-19. Curr Psychiatry Rep. 2021;23(5):25.
19. Nie XD, Wang Q, Wang MN, Zhao S, Liu L, Zhu YL, et al. Anxiety and depression and its correlates in patients with coronavirus disease 2019 in Wuhan. Int J Psychiatry Clin Pract. 2021 Jun;25(2):109–14.
20. Ma YF, Li W, Deng HB, Wang L, Wang Y, Wang PH, et al. Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. J Affect Disord. 2020 Oct 1;275:145–8.
21. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020 Oct;89:594–600.
22. Han Q, Zheng B, Daines L, Sheikh A. Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms. Pathogens. 2022 Feb;11(2):269.
23. Kim Y, Kim SW, Chang HH, Kwon KT, Bae S, Hwang S. Significance and Associated Factors of Long-Term Sequelae in Patients after Acute COVID-19 Infection in Korea. Infect Chemother. 2021 Sep;53(3):463–76.
24. Abdelhafiz AS, Ali A, Maaly AM, Mahgoub MA, Ziady HH, Sultan EA. Predictors of post- COVID symptoms in Egyptian patients: Drugs used in COVID-19 treatment are incriminated. PLOS ONE. 2022 Mar 31;17(3):e0266175.
25. Naik S, Haldar SN, Soneja M, Mundadan NG, Garg P, Mittal A, et al. Post COVID-19 sequelae: a prospective observational study from Northern India. Drug Discov Ther. 2021;
26. Rizvi AA, Kathuria A, Al Mahmeed W, Al-Rasadi K, Al-Alawi K, Banach M, et al. Post-COVID syndrome, inflammation, and diabetes. J Diabetes Complications. 2022 Nov 1;36(11):108336.
27. 69. Scherer PE, Kirwan JP, Rosen CJ. Post-acute sequelae of COVID-19: A metabolic perspective. Zaidi M, editor. eLife. 2022 Mar 23;11:e78200.
28. 70. Raveendran AV, Misra A. Post COVID-19 Syndrome (“Long COVID”) and Diabetes: Challenges in Diagnosis and Management. Diabetes Metab Syndr. 2021;15(5):102235.
29. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708–20.
30. Schou TM, Joca S, Wegener G, Bay-Richter C. Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review. Brain Behav Immun. 2021 Oct 1;97:328–48.
31. Chopra N, Chowdhury M, Singh AK, Ma K, Kumar A, Ranjan P, et al. Clinical predictors of long COVID-19 and phenotypes of mild COVID-19 at a tertiary care centre in India. Drug Discov Ther. 2021;15(3):156–61.
32. Budhiraja S, Aggarwal M, Wig R, Tyagi A, Mishra RS, Mahajan M, et al. Long Term Health Consequences of COVID-19 in Hospitalized Patients from North India: A follow up study of upto 12 months [Internet]. medRxiv; 2021 [cited 2022 Nov 11]. p. 2021.06.21.21258543. Available from: https://www.medrxiv.org/content/10.1101/2021.06.21.21258543v2
33. Badenoch JB, Rengasamy ER, Watson C, Jansen K, Chakraborty S, Sundaram RD, et al. Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Commun. 2022 Feb 1;4(1):fcab297.
34. Fatima G, Bhatt D, Idrees J, Khalid B, Mahdi F. Elucidating Post-COVID-19 manifestations in India [Internet]. medRxiv; 2021 [cited 2022 Nov 11]. p. 2021.07.06.21260115. Available from: https://www.medrxiv.org/content/10.1101/2021.07.06.21260115v1
35. Kumar S, Veldhuis A, Malhotra T. Neuropsychiatric and Cognitive Sequelae of COVID-19. Front Psychol [Internet]. 2021 [cited 2022 Nov 11];12. Available from: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.577529
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Nov 1, 2023
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Dr Pooja Harshitha Karnayina, Dr Sanjaykumar Rathwa, Dr Niraj Chawda, Dr Prayans Shah, Dr Jayant Mayavanshi, & Dr Darsh Vaghani. (2023). MORBIDITY AND NEUROPSYCHIATRIC EVALUATION IN PATIENTS DISCHARGED FROM ICU AFTER RECOVERY FROM SARS-COV-2 INFECTION. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 1385–1400. https://doi.org/10.53555/jptcp.v30i18.3284
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Author Biographies
Dr Pooja Harshitha Karnayina
Senior Resident, Department of General Medicine, S.B.K.S. Medical Institute & Research centre,Sumandeep Vidyapeeth, Piparia, Vadodara.
Dr Sanjaykumar Rathwa
Assistant Professor, Department of General Medicine, S.B.K.S. Medical Institute & Research centre, Sumandeep Vidyapeeth, Piparia, Vadodara.Dr Niraj Chawda
Associate Professor, Department of General Medicine, S.B.K.S. Medical Institute & Research centre, Sumandeep Vidyapeeth, Piparia, Vadodara.
Dr Prayans Shah
Assistant Professor, Department of General Medicine, S.B.K.S. Medical Institute & Research centre, Sumandeep Vidyapeeth, Piparia, Vadodara.Dr Jayant Mayavanshi
Assistant Professor, Department of General Medicine, S.B.K.S. Medical Institute & Research centre, Sumandeep Vidyapeeth, Piparia, Vadodara.
Dr Darsh Vaghani
1st Year Resident, Department of General Medicine, S.B.K.S. Medical Institute & Research centre, Sumandeep Vidyapeeth, Piparia, Vadodara.