A quantitative and qualitative study on the neuropsychiatric sequelae of acutely ill COVID-19 inpatients in isolation facilities

Fengyi Hao,Wanqiu Tan,Roger C.M Ho,Yiran Zou,Ling Zhang,Xinling Zhao,Roger S Mcintyre,Yirong Hu,Xiaojiang Jiang,Xi Luo,Wilson Tam,Li Jiang,Travis Quek,Hai Quang Pham,Zhisong Zhang,Cyrus S H Ho,Bach Xuan Tran,Xiaoyu Hu

doi:10.1038/s41398-020-01039-2

Abstract

This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients’ mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.

Highlights

Introduction The World HealthOrganization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak a pandemicCOVID-19 include general symptoms, such as fever; chills and malaise; respiratory symptoms including cough, breathing difficulty and coryza; gastrointestinal symptoms including vomiting and diarrhea; and neurological symptoms including headache and giddiness[3]
There is currently limited research on the neuropsychiatric sequalae and psychological impact of COVID-19 patients, with one study so far reporting that most clinically stable patients suffered from significant posttraumatic stress disorder (PTSD) symptoms[9]
The perceived threat, susceptibility, and illness severity coupled with physical discomfort, loneliness and psychosocial stressors may evoke emotional disturbances, such as anger, fear, hysteria, depression, anxiety, and other psychological issues, in patients acutely infected with COVID-19

Summary

Introduction

Introduction The World HealthOrganization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak a pandemicCOVID-19 include general symptoms, such as fever; chills and malaise; respiratory symptoms including cough, breathing difficulty and coryza; gastrointestinal symptoms including vomiting and diarrhea; and neurological symptoms including headache and giddiness[3]. The perceived threat, susceptibility, and illness severity coupled with physical discomfort, loneliness and psychosocial stressors may evoke emotional disturbances, such as anger, fear, hysteria, depression, anxiety, and other psychological issues, in patients acutely infected with COVID-19. These psychological factors may in turn reduce innate immunity through cell-mediated immune activation via the release of several inflammatory markers, such as IL-6, IL-12, and tumor necrosis factoralpha, which are implicated in the pathogenesis of depression[12] and PTSD13. This highlights a pertinent knowledge gap that needs to be addressed that is essential for holistic management

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