Loading

Annals of Psychiatry and Mental Health

Effect of SARS-COV2 Virus on Nervous System and Mental Health

Mini Review | Open Access | Volume 10 | Issue 2

  • 1. Department of Microbiology, Al-Sham private university (ASPU), Syria
+ Show More - Show Less
Corresponding Authors
Rim M. Harfouch, Department of Microbiology, Faculty of pharmacy, Al-Sham private university (ASPU), Latakia, Syria, Email: r.h.foph.lat@aspu.edu.sy
Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19. COVID-19 has shown syndromic complexity. COVID-19 effects on the respiratory system have been well described in the literature, but we now recognize that COVID-19 also affects several other organs, including the nervous system. The neurological manifestations of SARS-CoV-2 infection are growing rapidly, as evidenced by several reports. There are several mechanisms responsible for such manifestations in the nervous system. For instance, post-infectious immunemediated processes, direct virus infection of the central nervous system (CNS), and virus-induced hyper-inflammatory and hypercoagulable states are commonly involved. Due to multifactorial and complicated pathogenic mechanisms, COVID-19 poses a large-scale threat to the whole nervous system. A complete understanding of SARS-CoV-2 neurological impairments is still lacking, but our knowledge base is rapidly expanding. Therefore, we anticipate that this comprehensive review will provide valuable insights in unfolding different neurological dimensions of COVID-19 and other CoV associated abnormalities.

Keywords

• COVID-19

• Depression

• Anxiety

• Mental health

INTRODUCTION

The world is currently facing the COVID-19 pandemic with a novel corona virus, SARS-CoV-2, initially observed in Wuhan, Hubei, China in the end of 2019 [1,2]. COVID-19 have been shown to affect other organs, including the brain, and recently reports on neurological symptoms due to COVID-19 infection are emerging. There are indications of neurotropic properties of SARS-CoV-2; however, yet little appears to be known about the exact mechanisms on how it affects brain functioning [3]. Furthermore, the indirect effects of the pandemic on general mental health are of increasing concern, particularly since the SARS-CoV-1 epidemic (2002–2003) was associated with psychiatric complications [4,5].

Human coronaviruses were not considered harmful before the year 2002, and they were a common cause of influenza, and unlike animals, coronaviruses did not cause serious diseases to humans, but that has changed since2002, when three new dangerous human coronaviruses appeared: SARS-CoV, MERSCoV, and SARS-CoV-2 [6].

The COVID-19 pandemic has spread rapidly and infected about 509 million people with 6.22 million deaths all around the world. Given the lack of specific therapy for and the rapid spread of this virus, vaccination would be a significant way in the fight against the SARS-CoV-2 pandemic [7,8].

PREVALENCE OF DEPRESSION AND ANXIETY DURING COVID-19 PANDEMIC

The Global Burden of Disease 2020 estimated that the COVID-19 pandemic has led to a 27.6% increase in cases of major depressive disorder (MDD) and a 25.6% increase in cases of anxiety disorders (AD) worldwide in 2020. Overall, the pandemic was estimated to have caused 137.1 additional disability- adjusted life years (DALYs) per 100 000 population for MDD and 116.1 per 100 000 population for AD. The greatest increases in MDD and AD were found in places highly affected by COVID-19, as indicated by decreased human mobility and daily COVID-19 infection rates. Females were more affected than males, and younger people, especially those aged 20–24 years, were more affected than older adults. Many low- and middleincome countries were also majorly affected [9].

According to Zhang et al. psychiatric symptoms among patients with COVID-19 have occurred. The prevalence of depression (29.2%) was elevated among 57 patients newly recovered from COVID-19 compared to participants in quarantine (9.8%), while no difference in anxiety level was found [10].

A previous study evaluated symptoms of patients with eating disorders during the pandemic and found 37.5% to report worsening in their eating disorder symptomatology and 56.2% to report additional anxiety symptoms[11], while another study reported that 20.9% of patients with preexisting psychiatric disorders reported worsening of their symptoms, but did not report the preexisting diagnoses[12].

EFFECT OF COVID-19 PANDEMIC ON SUICIDE PREVALENCE

During this pandemic, self-harm is likely to increase due to limited social interaction and increased feeling of anxiety amongst communities. Self-harm has been shown to be a risk factor for suicide. Combined with the barriers to effective treatment due to several restrictions on face to face treatment, vulnerable individuals may experience an increase in suicidal ideation, self-harm or suicide during the COVID-19 pandemic. However, there is very little systematic evidence linking COVID-19 to an increased risk of self-harm and/or suicide [13].

creased risk of self-harm and/or suicide [13]. Even a small increase in suicide may affect a large number of people due to the scale of the current pandemic. Literature on suicide during this pandemic is sparse and is almost entirely limited to case reports. This literature can inform clinical practice and can help in identifying research questions for future epidemiological studies. It was clear that majority of cases COVID-19 (or fear of it) precipitated suicide in people who had pre-existing mental health conditions. The role played by media coverage of COVID-19 educational pressures on adolescents and economic factors are highlighted by these case reports and need to be investigated in future studies [14].

NEURODEGENERATIVE DISORDERS

NEURODEGENERATIVE DISORDERS Parkinsonism is a late feature of encephalitis lethargica, which was first described following the influenza pandemic of 1918. While features of Parkinsonism and Parkinson’s disease (PD) have not been described in association with CoV pandemics or outbreaks, anti-CoV antibodies have been identified in cerebrospinal fluid (CSF) of individuals with Parkinson’s disease. Given that neural and immune cells can serve as reservoirs of latent CoV, it is plausible that this could contribute to delayed neurodegenerative processes, but this also, remains to be seen in COVID-19 [15].

BIOLOGICAL MECHANISMS OF SARS-COV-2 ON PSYCHIATRIC SYMPTOMS

Evidence of a variety of neurological symptoms among COVID-19 patients is evolving, and delirium is a frequently reported symptom of SARS-CoV-2 and could be caused by a direct CNS invasion. Two case studies reports SARS-CoV-2 meningitis/ encephalitis; however, only one of them had a confirmed positive SARS-CoV-2 RT-PCR test on CSF. ACE2 is a functional receptor for SARS-CoV-2 and it is known that ACE2 is expressed in neurons, which is interesting in the light of the many reports of anosmia as an early symptom of COVID-19, since SARS-CoV-1 has been suggested to enter the brain trough the olfactory bulb. Taken together this indicates that SARS-CoV-2 could be neurotrophic entering the brain through the olfactory bulb, leading to an increase in neuropsychiatric symptoms among the patients surviving COVID-19 [16].

DIRECT NEURO-INVASIVE EFFECTS OF SARSCOV-2 ON THE NERVOUS SYSTEM

The CNS is a potential target for SARS-CoV-2, because the ACE2 receptors are highly expressed in the neurons and glial cells in the CNS and epithelial cells of the digestive and respiratory systems. ACE2 receptors are expressed in multiple regions of the human and mouse brain, including the posterior cingulate cortex, motor cortex, substantia nigra, olfactory bulb, middle temporal gyrus, nucleus of tractus solitarius, ventrolateral medulla, and dorsal motor nucleus of the vagus nerve, and on several key cell types that make up the CNS including neurons and astrocytes. The entry of SARS-CoV-2 into the CNS is also possible through the hematogenous route. With the presence of the virus in the general circulation and the slow blood flow, the ACE2 receptors expressed in the capillary endothelium may interact with SARSCoV-2. Endothelial damage and cerebral bleeding observed in patients suffering from COVID-19 may also be due to this mechanism. Moreover, preliminary evidence suggests that there might be prognostic implications in the acute phase for the neuroinvasive potential of SARS-CoV-2. It has been hypothesized that any death that is entirely due to severe respiratory involvement is mediated by central hypoventilation syndrome secondary to CNS invasion.

Researchers at the Beijing Ditan Hospital used genome sequencing to identify SARS-CoV-2 in the CSF of a patient affected with clinical encephalitis and COVID-19, but it has still not been determined whether SARS-CoV-2 remains in the CNS over the medium or long term. However, viral latency in the CNS has been described for other viruses as well, including some coronaviruses. For example, in the CNS, human coronavirus OC43 (HCoV-OC43) was detected after more an year post-inoculation in a murine model of coronavirus encephalitis. How the virus can persist in the CNS is a question that has been the subject of debate. There have been suggestions that inflammatory and cytolytic strategies that have shown potential in the control of viral infection cannot be used in the brain by the immune system, as they can have potentially devastating consequences [17].

CONCLUSION

That neurological manifestations are broad and heterogenous suggesting different underlying pathogenic processes and pathways. It is crucial to explore the causality of SARS-CoV-2 regarding neurological manifestations and to exclude likely alternative causes. Therefore, clearly defined, standardized, and universal case definitions should be used across countries. Even though neurologic manifestations might represent a relatively small part of COVID-19 phenomena, early recognition and treatment is key to prevent a more severe outcome associated with higher morbidity and mortality

REFERENCES
  1. Harfouch RM, Alshaikh S, Alshimaly M, Assaad A, Ahmad J, Zoughaibi H, et al. Therapeutic approaches for covid 19: Challenges and successes. Ann Clin Analytical Med. 2021; 228-233.
  2. Harfouch RM. Antiviral Effects of Propolis against SARS-COV 2. Int J Clin Med Imaging. 2022; 9: 809.
  3. Haldrup M, Johansen MI, Fjaeldstad AW. Lugte- og smagstab som primære symptom på COVID-19 Ugeskr. Laeger. 2020; 04200205.
  4. Jebur A , Harfouch T, Harfouch R. COVID-19 Pandemic in the Arab World: A Mini-Review Article. CPQ Med.. 2021; 11: 01-10.
  5. Harfouch RM. Cytokine Storm Syndrome in COVID-19 Patients: Characteristics and Diagnosis. Ann Clin Med Case Rep. 2021; 7: 1-3.
  6. Mansour, Basem Mohammad, Deaa Mohammad Alsoleman, and Suhail Haydar Alghanem. “An Overview of Biological Warfare and SARS- CoV-2 as a Potential Biological Agent.” Middle East J Family Med.2022.
  7. Alhouri A, Salloum A, Harfouch RM, Soumya G. Possible side effects of using detergents during the Covid19 pandemic in Syria. Ann Clin Cases. 2020; 1: 1023.
  8. Harfouch, Rim M, Lama Al Haushey, Yahya Elshimali. Vaccination against SARS-CoV-2: Efficacy and Side Effects. IJCMCR. 2022; 20: 3.
  9. Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021; 398: 1700-1712.
  10. Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang D, et al. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun. 2020.
  11. Fernandez-Aranda F, Casas M, Claes L, Bryan DC, Favaro A, Granero R, et al. COVID-19 and implications for eating disorders. Eur Eating Disorders Rev. 2020; 28: 239-245.
  12. Zhou J, Liu L, Xue P, Yang X, Tang X. Mental health response to the COVID-19 outbreak in China. Am J Psychiatry. 2020.
  13. Farooq S, Tunmore J, Wajid Ali M, Ayub M. Suicide, self-harm and suicidal ideation during COVID-19: A systematic review. Psychiatry Res. 2021; 306: 114228.
  14. Rana U. Elderly suicides in India: an emerging concern during COVID-19 pandemic. Int Psychogeriatr. 2020; 10: 1-7.
  15. Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 2019; 12: 1-28.
  16. Leven Y, Bösel J. Neurological manifestations of COVID-19 - an approach to categories of pathology. Neurol Res Pract. 2021; 3: 39.
  17. Jha NK, Ojha S, Jha SK, Dureja H, Singh SK, Shukla SD, et al. Evidence of Coronavirus (CoV) Pathogenesis and Emerging Pathogen SARS-CoV-2 in the Nervous System: A Review on Neurological Impairments and Manifestations. J Mol Neurosci. 2021; 71: 2192-2209.

Harfouch RM. Effect of SARS-COV2 Virus on Nervous System and Mental Health. Ann Psychiatry Ment Health 10(2): 1176.

Received : 04 Aug 2022
Accepted : 13 Sep 2022
Published : 15 Sep 2022
Journals
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X