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Abstract

BackgroundCOVID-19 pandemic has led to widespread psychosocial distress. In addition to pandemic associated psychological distress, there is increasing evidence to suggest direct effects of the COVID- 19 virus itself and the subsequent host immunologic response on Central Nervous System manifesting in the form of wide range of neuropsychiatric complications in both acute and post recovery phase.Neuropsychiatric manifestationsThe data available from similar epidemics of SARS and MERS CoV, revealed common neuropsychiatric manifestations including (a) Neurological: Headache, Impaired sensorium ranging from mild drowsiness to delirium and coma, dysfunction of olfaction and taste sensation, seizures, encephalitis, encephalopathy, Guillain-Barre syndrome (GBS), acute cerebrovascular events, narcolepsy and other neuromuscular and demyelinating processes (b) Psychiatric: Depressed mood, anxiety, impaired memory and insomnia in acute phase and even in post-illness stage, depressed mood, insomnia, anxiety, irritability, memory impairment, fatigue, traumatic memories and sleep disorder were frequently reported.A diverse group of presentations, increasingly referred to as “long Covid,” is also being described in patients who reported with wide variety of symptoms including disabling fatigue and cognitive difficulties, persisting for many months after acute infection.Psychoneuroimmunology of COVID-19Though exact neurotropism of SARS-CoV-2 is unknown , the present available data based on laboratory studies on SARS-CoV-2 and research on its taxonomically similar coronaviruses such as SARS-COV and MERS-COV suggest its potential to enter the CNS via angiotensin converting enzyme 2 receptors. Other mechanisms causing CNS dysfunction include cytokine driven inflammatory responses and wider systemic effects such as endotheliopathy, breakdown of the blood-brain barrier, and clotting abnormalities. Additional mechanisms for neuropsychiatric disorders include autoimmunity and psychological trauma of life threatening illness and pandemic related socioeconomic stressors. The relative contributions of these mechanisms to neuropsychiatric sequelae remain largely unknown.Role of psychiatristPsychiatrist has an important role in not only managing concerns, fears, and misconceptions at the local community and broader public level but also in early identification, prevention, and treatment of COVID-19 related neuropsychiatric manifestations, and hence should be an integral part of COVID-19 treating team.ManagementThe management of neuropsychiatric complications of COVID requires a multidisciplinary team input due to the multisystemic nature of the illness, particularly in severe cases. Adopting bio-psychosocial strategies and judicious use of psychotropic medications is essential for better results.ConclusionCovid-19 is likely to have important neuropsychiatric effects in both the short and longer term. Although the mechanisms to neuropsychiatric complications is still under study, the better understanding will not only augment screening of at-risk individuals but also help in prevention and management of these neuropsychiatric complications.