Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy.
Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131 Naples, Italy.
Medicina (Kaunas). 2021 Nov 14;57(11):1244. doi: 10.3390/medicina57111244.
SARS-CoV-2 neuroinvasive and neurotropic abilities may underlie delirium onset and neuropsychiatric outcomes. Only a limited number of studies have addressed the potential effect of SARS-CoV-2 infection on mental health so far. Most studies mainly reported the acute onset of mixed neuropsychiatric conditions in patients infected with SARS-CoV-2, characterized by agitated behavior, altered level of consciousness, and disorganized thinking, regardless of psychological or socioeconomic triggering factors. The present narrative review aims to analyze and discuss the mechanisms underlying the neuroinvasive/neurotropic properties of SARS-CoV-2 and the subsequent mental complications. Delirium appeared as a clinical manifestation of SARS-CoV-2 brain infection in some patients, without systemic or multiple organ failure symptoms. A small number of studies demonstrated that neuropsychiatric symptoms associated with COVID-19, initially presenting as a confused state, may subsequently evolve in a way that is consistent with the patients' neuropsychiatric history. A literature analysis on this topic prevalently showed case reports and case series of patients presenting delirium or delirium-like symptoms as the main outburst of COVID-19, plus a cognitive impairment, from mild to severe, which pre-existed or was demonstrated during the acute phase or after infection. Dementia appeared as one of the most frequent predisposing factors to SARS-CoV-2 infection complicated with delirium. Instead, contrasting data emerged on the potential link between COVID-19 and delirium in patients with cognitive impairment and without a neuropsychiatric history. Therefore, clinicians should contemplate the possibility that COVID-19 appears as delirium followed by a psychiatric exacerbation, even without other systemic symptoms. In addition, cognitive impairment might act as a predisposing factor for COVID-19 in patients with delirium.
SARS-CoV-2 的神经侵袭和神经嗜性能力可能是谵妄发病和神经精神结局的基础。迄今为止，只有少数研究探讨了 SARS-CoV-2 感染对心理健康的潜在影响。大多数研究主要报告了感染 SARS-CoV-2 的患者出现混合性神经精神疾病的急性发作，其特征为激越行为、意识水平改变和思维紊乱，而不论心理或社会经济触发因素如何。本叙事综述旨在分析和讨论 SARS-CoV-2 的神经侵袭/神经嗜性特性及其随后的精神并发症的潜在机制。谵妄是一些患者 SARS-CoV-2 脑感染的临床表现，无全身或多器官衰竭症状。少数研究表明，与 COVID-19 相关的神经精神症状最初表现为意识模糊状态，随后可能以符合患者神经精神病史的方式进展。对这一主题的文献分析主要显示了表现为谵妄或谵妄样症状的患者的病例报告和病例系列，作为 COVID-19 的主要发作，以及从轻到重的认知障碍，这些在急性或感染后预先存在或表现出来。痴呆是 SARS-CoV-2 感染并发谵妄的最常见易感因素之一。相反，在认知障碍和无神经精神病史的患者中，COVID-19 与谵妄之间潜在联系的数据则相互矛盾。因此，临床医生应考虑 COVID-19 可能表现为谵妄，随后出现精神恶化，即使没有其他全身症状。此外，认知障碍可能是谵妄患者感染 COVID-19 的易感因素。
