Introduction
COVID-19 infection has been associated with several long-term negative physical and neuropsychiatric outcomes including fatigue, dyspnea, insomnia, pain, cognitive issues, anxiety, and depression in up to 75% patients with history of severe illness at 6-month follow-up.
The large number of COVID-19 cases at the University of Colorado hospital (UCH) and difficulty evaluating patients during hospitalization highlighted the need for ongoing psychiatric support. Since July 2020, the Psychiatric Consultation for the Medically Complex (PCMC) clinic has evaluated 13 patients with neuropsychiatric sequelae following hospitalization for severe COVID-19.
Methods
Patients were referred from the UCH Post-ICU clinic or identified via phone outreach program. Psychiatric evaluation was scheduled if patients endorsed significant impact of neuropsych symptoms related to recent COVID-19 infection. Evaluations consisted of traditional psychiatric interviews and structured screening tools including MoCA and HADS.
Results
The PCMC clinic evaluated 13 patients between July and January. 7/13 were female with median age of 47 (range 28-72). Most patients experienced a complicated hospital course with notable impact on occupational and social functioning following discharge. 0/13 had cognitive concerns prior to infection, though 9/13 patients noted subsequent cognitive symptoms including deficits in short-term memory, word finding, concentration, and complex problem-solving. Of those patients, the majority had MoCA scores >28 with cognitive issues resolving over time. 5/13 patients had no preexisting psychiatric history, while 8/13 had a history of anxiety and depression. Median HADS score was 16 (range 6-21). 3/13 patients reported depressive symptoms largely related to bereavement. 10/13 patients reported worsening anxiety, which in all cases was related to either illness anxiety or trauma of illness and ICU stay. Many patients reported ongoing physical symptoms including dyspnea, pain, fatigue, light-headedness, and headaches.
Discussion
Unfortunately, many infected with the novel coronavirus endorse ongoing physical and neuropsychiatric symptoms long after resolution of acute illness. These patients have become known as “Covid long-haulers” and the impact on their quality of life is substantial. While the above clinic sample size is small, themes arise of illness anxiety, trauma reactions, and subjective cognitive concerns that are not found on traditional cognitive screening tests. While there is hope that vaccinations will significantly reduce severe COVID-19 illness rates, the reality remains that millions across the world have been infected and will require ongoing psychological evaluation and support.
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