新冠后综合征中的焦虑——患病率、机制与治疗

Anxiety in post-covid-19 syndrome - prevalence, mechanisms and treatment.

作者信息

Burkauskas J, Branchi I, Pallanti S, Domschke K

机构信息

Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, 00135 Palanga, Lithuania.

Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Roma, Italy.

出版信息

Neurosci Appl. 2023 Dec 24;3:103932. doi: 10.1016/j.nsa.2023.103932. eCollection 2024.

Abstract

In addition to the general impact of the COVID-19 pandemic on anxiety-related mental state, anxiety and anxiety disorders have also been implicated within 'post-COVID-19 syndrome', i.e. following a SARS-CoV-2 infection. The present narrative review provides an update on the current state of knowledge on anxiety and anxiety disorders in the context of post-COVID-19 syndrome, on epidemiological, psychological, and biological factors that may contribute to anxiety following a SARS-CoV-2 infection, as well as on therapy options available for anxiety in the context of post-COVID-19 syndrome. A multi-step systematic literature search of PubMed and Web of Science databases was performed applying the following broad search terms: ("anxiety" OR "anxiety disorder") AND ("COVID" OR "COVID-19" OR "corona" OR "pandemic" OR "Post-COVID" OR "Long-COVID"). Eligible articles published until November 15, 2022 were included. Meta-analyses identified anxiety prevalence rates ranging from 16.6% to 29.6% after a SARS-CoV-2 infection. Premorbid anxiety has not reliably been shown to be associated with post-COVID-19 syndrome. Female sex, older age, severity of COVID-19 infection, hospitalization, reduced mobility, uncertainty, loneliness and low social support, anxiety sensitivity and cognitive inflexibility as well as biological factors such as immune dysregulation, alterations in the angiotensin system and hypothalamus-pituitary-adrenal axis activation have been identified as potential anxiety risk factors in the context of post-COVID-19 syndrome. Treatment options comprise pharmacotherapy with selective serotonin/noradrenaline reuptake inhibitors and (internet-/computer-based) cognitive behavioral psychotherapy, possibly augmented by mindfulness-based techniques, physical exercise and non-invasive brain stimulation. Provided corroboration of the currently suggested increased risk of anxiety in the context of post-COVID-19 syndrome by future large-scale, prospective studies, a standardized screening for anxiety in patients with a SARS-CoV-2 infection - particularly in individuals with risk factors - and a psychiatric consultation and liaison service should be established to provide preventive and therapeutic interventions as early as possible.

摘要

除了新冠疫情对焦虑相关精神状态的总体影响外,焦虑及焦虑症还与“新冠后综合征”有关,即在感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)之后出现的情况。本叙述性综述提供了关于新冠后综合征背景下焦虑及焦虑症的当前知识状态的最新信息,介绍了可能导致SARS-CoV-2感染后焦虑的流行病学、心理和生物学因素,以及新冠后综合征背景下可用于治疗焦虑的方法。我们在PubMed和科学网数据库中进行了多步骤系统文献检索,使用了以下宽泛的检索词:(“焦虑”或“焦虑症”)与(“新冠”或“COVID-19”或“冠状病毒”或“大流行”或“新冠后”或“长期新冠”)。纳入了截至2022年11月15日发表的符合条件的文章。荟萃分析确定,SARS-CoV-2感染后的焦虑患病率在16.6%至29.6%之间。尚未确凿证明病前焦虑与新冠后综合征有关。女性、老年、新冠感染的严重程度、住院治疗、活动能力下降、不确定性、孤独感和社会支持不足、焦虑敏感性和认知灵活性,以及免疫失调、血管紧张素系统改变和下丘脑-垂体-肾上腺轴激活等生物学因素,已被确定为新冠后综合征背景下潜在的焦虑风险因素。治疗方法包括使用选择性5-羟色胺/去甲肾上腺素再摄取抑制剂进行药物治疗,以及(基于互联网/计算机的)认知行为心理治疗,可能辅以正念技术、体育锻炼和非侵入性脑刺激。如果未来大规模前瞻性研究证实目前所提示的新冠后综合征背景下焦虑风险增加,应建立针对SARS-CoV-2感染患者(尤其是有风险因素的个体)的标准化焦虑筛查,以及精神科会诊联络服务,以便尽早提供预防和治疗干预措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8db6/12244082/2344db8bd094/gr1.jpg

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