June 9, 2020 13h55
Updated at 14h03
The psychological sequelae of the COVID-19 (bis)
BLOG / In my chronicle of last Sunday, I submitted the case of a man very aged, who was awarded the COVID-19 after three weeks spent at the hospital, but that seemed to be of the psychological sequelae. He had apparently never returned to its “personality” and his usual mood, showing on the contrary a irritability and a lack of enthusiasm extended to his family does not know.
I mentioned in this column a study recently published in The Lancet concluding that most of the patients with the COVID-19 should get out of it without suffering from a mental disorder, but that the nursing staff would do better to keep an eye on symptoms of depression, anxiety, fatigue and post-traumatic stress disorder, because the authors of the article were observed not evil. I quoted also the professor of psychology at Université Laval Geneviève Belleville, who confirmed to me that it should not be assumed that a change of mood in an elder is simply due to the aging, “especially when it does not appear to be a physiological cause behind it, such as the onset of dementia”.
I received a very interesting comment of a doctor of Laval, who told me that yes, it is quite possible that the change of mood of this gentleman is entirely due to the hospitalization, but that in the case of a disease like the COVID-19, which affects more organs and various systems that the respiratory infections, the usual, it need to be very careful in the interpretation of symptoms.
However, the passage of my text, on the absence of a physiological to complete before concluding that the hospital stay is in question occurs at the very end, and it is very brief. The commentary of Dr. Bonnaud makes me realize that I probably would have had to make out a little more this possibility, so I reproduce here (with his permission) in order to get the grades needed :
I follow you on twitter and very much appreciate your professionalism and scientific rigor. I’ve never commented on one of your articles in the past, but I felt myself drawn by the article above cited.
I agree with you for the fact that a change of living environment, such as a hospitalization and/or without a stay in intensive care may permanently lead to a deterioration of the mood, especially in the elderly.
However, as with any change of mood in a patient, it is necessary to have a differential diagnosis that includes elimination of physiological pathologies. Even if our knowledge on infection with the SARS-COV2 are embryonic, it seems that this pathology presents more systemic symptoms than other viruses in original respiratory.
It is known that several viruses (West Nile Virus, Zika etc ) can cause damage to the nervous system and give symptoms of neurological peripheral and central (which includes changes of mood).
Before concluding with an injury to the psychological in the context of an infection with SARS-COV2 proven, it would first validate if the interference is rather organic. We see patients who develop neurologic complications of the infection to SARS-COV2 : neuritis, sensory (pain and numbness), neuritis of motor (muscle weakness localized), cognitive impairments or mood (irritability, reduced patience). These symptoms usually appear several days/weeks after the initial infection, either in phase or stroke.
At the level of the brain, “the psychological influence of the physical” and vice-versa. According to your article, the patient had to obtain physiotherapy services. If the onset of psychological symptoms is to coincide with a neurological device (complaint of pain and fatigue), this indicates that the problem could be in part of organic origin. In this case, it is reassuring to know that the tip of neuropathies of the original virus is usually very good.
In the Face of a virus with multiple facets and that we know little of, I think you have to be very careful in the interpretation of symptoms.
Dr. Jeanne Bonneau, Laval