Psychiatric disorders and long COVID

After an episode of COVID-19, more than half of patients present lingering symptoms of post-acute COVID syndrome [1], [2], [3]. Long COVID [3,4] is defined by the presence of those symptoms 12 weeks after the acute infection [5]. Dyspnea, cognitive impairment and asthenia are the most frequent long COVID manifestations [4].

Among those symptoms, psychiatric ones occur frequently [6]. Beyond psychiatric symptoms, major depressive episodes (MDE) and anxiety disorders like generalized anxiety disorder or panic disorder are common after COVID-19 [7,8]. In particular, in patients with long COVID respiratory complaints, anxiety disorders are frequent [9], [10], [11]. In the COMEBAC cohort [6] of 177 survivors assessed 4 month after a hospitalization for acute COVID-19, respiratory complaints were associated with a 7-fold higher risk of anxiety disorders and a 4-fold higher risk of MDE. Taquet et al. [10] report in a cohort of electronic health records a prevalence of 6.2 % of abnormal breathing associated with anxiety disorders or MDE during the 6 months following acute COVID-19, corresponding to a 2-fold higher co-occurrence of those lingering manifestations, compared to a matched cohort of patients recovering from influenza.

Although a major cause of long term disability, of suicide attempts [12,13], and of worsening of the prognosis of medical conditions [14], psychiatric disorders are underdiagnosed in non-psychiatric contexts [15]. Moreover, after assessing a cohort of COVID-19 survivors [6,8,9], we noticed that it is difficult for these patients to identify their own psychiatric symptoms and disorders and ask for appropriated care. Thus, pulmonologists and general practitioners are often the first line to detect post-COVID psychiatric symptoms and disorders. It is important to underline that the more quickly an appropriate treatment is engaged for psychiatric disorders, the best is the outcome, thus rapid diagnosis is crucial.

In long COVID patients, especially those with respiratory complaints, pulmonologists should pay attention to anxiety disorders and MDE.

Excessive worry, restlessness, a feeling of being “on edge,” recurrent thoughts about illness and disability, irritability, muscle tension, or insomnia are the core symptoms of anxiety disorders. Sadness, diminished interest or pleasure in activities, decrease in appetite and weight loss, psychomotor retardation, fatigue, loss of energy, feelings of worthlessness, diminished ability to think or concentrate, thoughts of death, suicidal ideation are symptoms of depression. MDE is diagnosed when the patient present five or more of those symptoms during at least 15 days, with a significant impact on daily life. Suicidal thoughts comprise patients’ willing to die, or more frequently not preventing themselves from dying (for example, by ceasing to eat, or stopping important medications). Self-questionnaires may be useful and easy to detect quickly psychiatric symptoms [16,17]. Ideally, a trained psychologist should screen systematically MDE and anxiety in long COVID patients with one of those symptoms. If suspected, MDE and anxiety disorders should benefit from a consultation with a psychiatrist to confirm the diagnosis. Selective serotonin recapture inhibitors (SSRI) are a safe and effective treatment of both MDE and anxiety disorders that can be prescribed by a general practitioner. In case of treatment-resistant depression (i.e. MDE that does not improve after an antidepressant treatment of adequate doses and duration [18]), patient should be referred to a psychiatrist. Suicide risk is an emergency that must be treated by a psychiatrist as quickly as possible.

A multidisciplinary approach of long COVID is be the best way to face this condition. Rapid detection, diagnosis and treatment of psychiatric disorders associated with long COVID could globally improve patient's outcome.

Declaration of Competing Interest

The authors declare that they have no competing interests.