Neuropsychiatric post-acute sequelae of COVID-19: prevalence, severity, and impact of vaccination.

Publisher: Springer International Country of Publication: Germany NLM ID: 9103030 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1433-8491 (Electronic) Linking ISSN: 09401334 NLM ISO Abbreviation: Eur Arch Psychiatry Clin Neurosci Subsets: MEDLINE

Original Publication: Berlin ; New York : Springer International, c1990-

COVID-19*/complications ; COVID-19*/epidemiology ; COVID-19*/prevention & control ; Sleep Initiation and Maintenance Disorders*; Humans ; Adult ; Middle Aged ; COVID-19 Vaccines/adverse effects ; Prevalence ; Disease Progression ; Fatigue/epidemiology ; Fatigue/etiology

The potential long-term neuropsychiatric effects of COVID-19 are of global concern. This study aimed to determine the prevalence and predictors of neuropsychiatric post-acute sequelae of COVID-19 among Egyptian COVID-19 survivors and to study the impact of full vaccination before COVID-19 infection on the occurrence and severity of these manifestations. Three months after getting COVID-19 infection, 1638 COVID-19 survivors were screened by phone for possible neuropsychiatric sequelae. Subjects suspected to suffer from these sequelae were invited to a face-to-face interview for objective evaluation. They were requested to rate the severity of their symptoms using visual analogue scales (VAS). The mean age of participants was 38.28 ± 13 years. Only 18.6% were fully vaccinated before COVID-19 infection. Neuropsychiatric post-acute sequelae of COVID-19 were documented in 598 (36.5%) subjects, fatigue was the most frequent one (24.6%), followed by insomnia (16.4%), depression (15.3%), and anxiety (14.4%). Moderate and severe COVID-19 infection and non-vaccination increased the odds of developing post-COVID-19 neuropsychiatric manifestations by 2 times (OR 1.95, 95% CI = 1.415-2.683), 3.86 times (OR 3.86, 95% CI = 2.358-6.329), and 1.67 times (OR 1.67, 95% CI = 1.253-2.216), respectively. Fully vaccinated subjects before COVID-19 infection (n = 304) had significantly lesser severity of post-COVID-19 fatigue, ageusia/hypogeusia, dizziness, tinnitus, and insomnia (P value = 0.001, 0.008, < 0.001, 0.025, and 0.005, respectively) than non-vaccinated subjects. This report declared neuropsychiatric sequelae in 36.5% of Egyptian COVID-19 survivors, fatigue being the most prevalent. The effectiveness of COVID-19 vaccines in reducing the severity of some post-COVID-19 neuropsychiatric manifestations may improve general vaccine acceptance.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

worldometer. COVID-19 CORONAVIRUS PANDEMIC. 2022 [cited 2022 22 April]. https://www.worldometers.info/coronavirus/.
Nalbandian A et al (2021) Post-acute COVID-19 syndrome. Nat Med 27(4):601–615. (PMID: 33753937889314910.1038/s41591-021-01283-z)
Choutka J et al (2022) Unexplained post-acute infection syndromes. Nat Med 28(5):911–923. (PMID: 3558519610.1038/s41591-022-01810-6)
Callard F, Perego E (1982) How and why patients made Long Covid. Soc Sci Med 2021(268):113426.
World Health O (2021) A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. World Health Organization, Geneva.
Phillips S, Williams MA (2021) Confronting our next national health disaster—long-haul covid. N Engl J Med 385(7):577–579. (PMID: 3419242910.1056/NEJMp2109285)
Logue JK et al (2021) Sequelae in adults at 6 months after COVID-19 infection. JAMA Netw Open 4(2):e210830. (PMID: 33606031789619710.1001/jamanetworkopen.2021.0830)
Lechner-Scott J et al (2021) Long COVID or post COVID-19 syndrome. Mult Scler Relat Disord 55:103268. (PMID: 34601388844754810.1016/j.msard.2021.103268)
Chippa V, Aleem A, Anjum F (2022) Post acute coronavirus (COVID-19) syndrome. In: StatPearls. StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC, Treasure Island.
Yoo SM et al (2022) Factors associated with post-acute sequelae of SARS-CoV-2 (PASC) after diagnosis of symptomatic COVID-19 in the inpatient and outpatient setting in a diverse cohort. J Gen Intern Med 37(8):1988–1995. (PMID: 35391623898925610.1007/s11606-022-07523-3)
Alghamdi HY et al (2022) Neuropsychiatric symptoms in post-COVID-19 long haulers. Acta Neuropsychiatr 34:1–12. (PMID: 10.1017/neu.2022.13)
Efstathiou V et al (2022) Long COVID and neuropsychiatric manifestations (Review). Exp Ther Med 23(5):363. (PMID: 35493431901976010.3892/etm.2022.11290)
Busatto GF et al (2022) Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation. Psychol Med 52(12):2387–2398. (PMID: 3552175210.1017/S0033291722001374)
Department of H, Social C (2021) Optimising the COVID-19 vaccination programme for maximum short-term impact.
Bernal JL et al (2021) Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study. bmj:373.
Hall VJ et al (2021) COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Lancet 397(10286):1725–1735. (PMID: 33901423806466810.1016/S0140-6736(21)00790-X)
Hall V et al (2022) Protection against SARS-CoV-2 after Covid-19 vaccination and previous infection. N Engl J Med 386(13):1207–1220. (PMID: 3517205110.1056/NEJMoa2118691)
Wisnivesky JP et al (2022) Association of vaccination with the persistence of post-COVID symptoms. J Gen Intern Med 37(7):1748–1753. (PMID: 35266128890662610.1007/s11606-022-07465-w)
Notarte KI et al (2022) Impact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: a systematic review. EClinicalMedicine 53:101624. (PMID: 36051247941756310.1016/j.eclinm.2022.101624)
Ayoubkhani D et al (2022) Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study. BMJ 377:e069676. (PMID: 3558481610.1136/bmj-2021-069676)
Wynberg E et al (2022) The effect of SARS-CoV-2 vaccination on post-acute sequelae of COVID-19 (PASC): a prospective cohort study. Vaccine 40(32):4424–4431. (PMID: 35725782917053510.1016/j.vaccine.2022.05.090)
Centers for Disease Control P. Stay up to date with your vaccines. Updated January 16 cited 2022.
World Health O (2020) Clinical management of COVID-19: interim guidance, 27 May 2020. World Health Organization, Geneva.
Clayton EW (2015) Beyond myalgic encephalomyelitis/chronic fatigue syndrome: an IOM report on redefining an illness. JAMA 313(11):1101–1102. (PMID: 2566802710.1001/jama.2015.1346)
Terkawi AS et al (2017) Development and validation of Arabic version of the douleur neuropathique 4 questionnaire. Saudi J Anaesth 11(Suppl 1):S31. (PMID: 28616002546356510.4103/sja.SJA_97_17)
Olesen J, Bes A, Kunkel R, Lance JW, Nappi G, Pfaffenrath V, Rose FC, Schoenberg BS, Soyka D, Tfelt-Hansen P, Welch KM, The International Classification of Headache Disorders 3rd edition (beta version) (2013) Cephalalgia 33(9):629–808. (PMID: 10.1177/0333102413487610)
Michael B (2013) Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. J Nerv Ment Dis 201:727–729. (PMID: 10.1097/NMD.0b013e3182a2168a)
Dautzenberg G, Lijmer J, Beekman A (2020) Diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) for cognitive screening in old age psychiatry: determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls. Int J Geriatr Psychiatry 35(3):261–269. (PMID: 3165062310.1002/gps.5227)
McCormack HM, Horne DJ, Sheather S (1988) Clinical applications of visual analogue scales: a critical review. Psychol Med 18(4):1007–1019. (PMID: 307804510.1017/S0033291700009934)
Taquet M et al (2021) 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry 8(5):416–427. (PMID: 33836148802369410.1016/S2215-0366(21)00084-5)
Carfì A et al (2020) Persistent symptoms in patients after acute COVID-19. JAMA 324(6):603–605. (PMID: 32644129734909610.1001/jama.2020.12603)
Arnold DT et al (2021) Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. Thorax 76(4):399. (PMID: 3327302610.1136/thoraxjnl-2020-216086)
Carod-Artal FJ, García-Moncó JC (2021) Epidemiology, pathophysiology, and classification of the neurological symptoms of post-COVID-19 syndrome. Neurol Perspect 1:S5–S15. (PMID: 36798683866969110.1016/j.neurop.2021.07.005)
Stefanou M-I et al (2022) Neurological manifestations of long-COVID syndrome: a narrative review. Ther Adv Chronic Dis 13:20406223221076890. (PMID: 35198136885968410.1177/20406223221076890)
Lopez-Leon S et al (2021) More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv.
Iqbal FM et al (2021) Characteristics and predictors of acute and chronic post-COVID syndrome: a systematic review and meta-analysis. EClinicalMedicine 36:100899. (PMID: 34036253814137110.1016/j.eclinm.2021.100899)
Long Q et al (2021) Follow-ups on persistent symptoms and pulmonary function among post-acute COVID-19 patients: a systematic review and meta-analysis. Front Med (Lausanne) 8:702635. (PMID: 3454086210.3389/fmed.2021.702635)
Michelen M et al (2021) Characterising long COVID: a living systematic review. BMJ Glob Health 6(9):e005427. (PMID: 3458006910.1136/bmjgh-2021-005427)
Sanchez-Ramirez DC et al (2021) Long-term impact of COVID-19: a systematic review of the literature and meta-analysis. Biomedicines 9(8):900. (PMID: 34440104838958510.3390/biomedicines9080900)
Yelin D et al (2022) ESCMID rapid guidelines for assessment and management of long COVID. Clin Microbiol Infect. S1198-743X(22)00092-1.
Buchwald DS et al (2000) Acute infectious mononucleosis: characteristics of patients who report failure to recover. Am J Med 109(7):531–537. (PMID: 1106395310.1016/S0002-9343(00)00560-X)
White PD et al (2001) Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. The Lancet 358(9297):1946–1954. (PMID: 10.1016/S0140-6736(01)06961-6)
Candy B et al (2003) Predictors of fatigue following the onset of infectious mononucleosis. Psychol Med 33(5):847–855. (PMID: 1287739910.1017/S0033291703007554)
Ayres JG et al (1998) Post-infection fatigue syndrome following Q fever. QJM 91(2):105–123. (PMID: 957889310.1093/qjmed/91.2.105)
Sigera PC et al (2021) Dengue and post-infection fatigue: findings from a prospective cohort-the Colombo Dengue Study. Trans R Soc Trop Med Hyg 115(6):669–676. (PMID: 3309965310.1093/trstmh/traa110)
Wostyn P (2021) COVID-19 and chronic fatigue syndrome: Is the worst yet to come? Med Hypotheses 146:110469. (PMID: 33401106783654410.1016/j.mehy.2020.110469)
Ferrandi PJ, Alway SE, Mohamed JS (2020) The interaction between SARS-CoV-2 and ACE2 may have consequences for skeletal muscle viral susceptibility and myopathies. J Appl Physiol 129(4):864–867. (PMID: 32673162783200410.1152/japplphysiol.00321.2020)
Morgul E et al (2021) COVID-19 pandemic and psychological fatigue in Turkey. Int J Soc Psychiatry 67(2):128–135. (PMID: 3265068110.1177/0020764020941889)
D’Ascanio L et al (2020) Olfactory dysfunction in COVID-19 patients: prevalence and prognosis for recovering sense of smell. Otolaryngol Head Neck Surg 164(1):82–86. (PMID: 3266274510.1177/0194599820943530)
Iannuzzi L et al (2020) Gaining back what is lost: recovering the sense of smell in mild to moderate patients after COVID-19. Chem Senses 45(9):875–881. (PMID: 3303382710.1093/chemse/bjaa066)
Niklassen AS et al (2021) COVID-19: recovery from chemosensory dysfunction. A multicentre study on smell and taste. Laryngoscope 131(5):1095–1100. (PMID: 3340407910.1002/lary.29383)
Biadsee A et al (2021) Eight-month follow-up of olfactory and gustatory dysfunctions in recovered COVID-19 patients. Am J Otolaryngol 42(4):103065. (PMID: 33894627805592410.1016/j.amjoto.2021.103065)
Hopkins C et al (2021) Six month follow-up of self-reported loss of smell during the COVID-19 pandemic. Rhinology 59(1):26–31. (PMID: 33320115)
Klein H et al (2021) Onset, duration and unresolved symptoms, including smell and taste changes, in mild COVID-19 infection: a cohort study in Israeli patients. Clin Microbiol Infect 27(5):769–774. (PMID: 33607252788491910.1016/j.cmi.2021.02.008)
Paderno A et al (2020) Olfactory and gustatory outcomes in COVID-19: a prospective evaluation in nonhospitalized subjects. Otolaryngol Head Neck Surg 163(6):1144–1149. (PMID: 32600175733110810.1177/0194599820939538)
Petrocelli M et al (2021) Six-month smell and taste recovery rates in coronavirus disease 2019 patients: a prospective psychophysical study. J Laryngol Otol 135(5):436–441. (PMID: 3388816610.1017/S002221512100116X)
Xu H et al (2020) High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 12(1):8. (PMID: 32094336703995610.1038/s41368-020-0074-x)
Chen M et al (2020) Elevated ACE-2 expression in the olfactory neuroepithelium: implications for anosmia and upper respiratory SARS-CoV-2 entry and replication. Eur Respir J 56(3):200. (PMID: 10.1183/13993003.01948-2020)
Vindegaard N, Benros ME (2020) COVID-19 pandemic and mental health consequences: systematic review of the current evidence. Brain Behav Immun 89:531–542. (PMID: 32485289726052210.1016/j.bbi.2020.05.048)
Taquet M et al (2021) Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry 8(2):130–140. (PMID: 3318109810.1016/S2215-0366(20)30462-4)
Klaser K et al (2021) Anxiety and depression symptoms after COVID-19 infection: results from the COVID Symptom Study app. J Neurol Neurosurg Psychiatry 92(12):1254–1258. (PMID: 3458394410.1136/jnnp-2021-327565)
Huang C et al (2021) 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet 397(10270):220–232. (PMID: 10.1016/S0140-6736(20)32656-8)
Bond NG et al (2021) Post-ebola syndrome presents with multiple overlapping symptom clusters: evidence from an ongoing cohort study in Eastern Sierra Leone. Clin Infect Dis 73(6):1046–1054. (PMID: 33822010844278010.1093/cid/ciab267)
Kragholm K et al (2021) Association between male sex and outcomes of coronavirus disease 2019 (COVID-19)-A Danish Nationwide, Register-based Study. Clin Infect Dis 73(11):e4025–e4030. (PMID: 3263482710.1093/cid/ciaa924)
Sigfrid L et al (2021) Long Covid in adults discharged from UK hospitals after Covid-19: a prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol. Lancet Reg Health Eur 8:100186. (PMID: 34386785834337710.1016/j.lanepe.2021.100186)
Ya’qoub L, Elgendy IY, Pepine CJ (2021) Sex and gender differences in COVID-19: more to be learned! Am Heart J Plus Cardiol Res Pract 3:100011. (PMID: 10.1016/j.ahjo.2021.100011)
Bai F et al (2022) Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect 28(4):611.e9-611.e16. (PMID: 3476305810.1016/j.cmi.2021.11.002)
Mahase E (2022) Covid-19: vaccinated people are less likely to get long covid, review finds. BMJ 376:o407. (PMID: 3517297010.1136/bmj.o407)
Orendáčová M, Kvašňák E (2022) Effects of vaccination, new SARS-CoV-2 variants and reinfections on post-COVID-19 complications. Front Public Health 10:903568. (PMID: 35968477937253810.3389/fpubh.2022.903568)

Keywords: Fatigue; Long COVID-19; Neuropsychiatric sequelae; SARS-CoV-2; Vaccines

0 (COVID-19 Vaccines)

Date Created: 20230127 Date Completed: 20230825 Latest Revision: 20230825

20231215

PMC9882743

10.1007/s00406-023-01557-2

36707454