Psychological Symptoms in COVID-19 Patients: Insights into Pathophysiology and Risk Factors of Long COVID-19

SIMPLE SUMMARY: The coronavirus can elude the immune response, potentially spreading to cells other than the respiratory tract’s epithelial cells. The neuro-invasive potential of certain coronaviruses has been observed in the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Based on past outbreaks, including SARS, MERS, and current reports of neuropsychiatric complications following COVID-19, many survivors may be at risk of a number of neuropsychiatric sequelae. Mounting evidence has shown the presence of mental health implications in COVID-19 survivors. This review shows that psychological symptoms including anxiety, depression, and post-traumatic stress disorder (PTSD) have an association with post-COVID-19 infection. The exact cause of these psychiatric sequelae is yet to be determined, but it seems to involve environmental, psychological, and biological factors. Although there are variations in terms of risk factors and the prevalence rate of these psychological symptoms, risk factors including the female gender and having a history of psychiatric disorders appears to be consistent a across few studies, and there are studies showing a higher prevalence rate among post-COVID-19 survivors than among the general population. A therapeutic intervention commonly used to alleviate these psychological symptoms are psychotropic medications, but probiotics could be a safe adjunctive treatment to improve these symptoms. ABSTRACT: There is growing evidence of studies associating COVID-19 survivors with increased mental health consequences. Mental health implications related to a COVID-19 infection include both acute and long-term consequences. Here we discuss COVID-19-associated psychiatric sequelae, particularly anxiety, depression, and post-traumatic stress disorder (PTSD), drawing parallels to past coronavirus outbreaks. A literature search was completed across three databases, using keywords to search for relevant articles. The cause may directly correlate to the infection through both direct and indirect mechanisms, but the underlying etiology appears more complex and multifactorial, involving environmental, psychological, and biological factors. Although most risk factors and prevalence rates vary across various studies, being of the female gender and having a history of psychiatric disorders seem consistent. Several studies will be presented, demonstrating COVID-19 survivors presenting higher rates of mental health consequences than the general population. The possible mechanisms by which the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the brain, affecting the central nervous system (CNS) and causing these psychiatric sequelae, will be discussed, particularly concerning the SARS-CoV-2 entry via the angiotensin-converting enzyme 2 (ACE-2) receptors and the implications of the immune inflammatory signaling on neuropsychiatric disorders. Some possible therapeutic options will also be considered.