COVID-19 Could Cause Patients To Get Psychological Disorders

Speaker 1: 00:00 Many of us are already experiencing some anxiety from being stuck at home during the crew and a virus pandemic and no psychiatrists at UC San Diego say some code 19 patients may experience psychological conditions from having the virus psychiatrists Susie home. And Emma Troyer who published an article on the subject in a peer review journal this week spoke with KPBS science and technology reporter Srilina. Chet Lani. Here's that interview. Speaker 2: 00:25 So Susie, do you mind Speaker 3: 00:26 kind of giving me an overview of what is the connection between the brain and the body's immune system? Speaker 4: 00:33 Okay, well let's start with that. The evidence and literature now show that brain, um, constantly communicates with the immune system and immune system communicates back to the brain. And in the sort of cases of virus infections such as COBIT 19, what we think is that either the virus itself or virus infected cells may truck traffic traffic to the brain and brain is supposed to be really a closely guarded by a barrier called blood brain barrier. Um, so in the case of these types of illnesses or an acute illness or chronic conditions, those barriers can be um, compromise. So that what we call leakage, um, of either the cells inflamed or activated immune cells can crossover, or in the case of an infection virus can crossover. Speaker 3: 01:33 Emma, maybe you can go over what that looks like in a, in a patient that has experienced a viral infection, Speaker 2: 01:40 what Susie is describing is once immune cells or cytokines have entered into the central nervous system, they basically cause inflammation and inflammation in any part of the brain, um, can lead to different symptoms depending on the part of the brain that's affected. So patients who have acute inflammation, um, it can be really confusing oftentimes because they present a lot of highly, highly variable presentations. So you can see changes in sleep, changes in alertness, changes in mood. Um, some people might have depressed mood, some people might have euphoric mood. You can experience hallucinations where you start to see or hear things that weren't there before or that other people don't see or hear. You can have difficulty thinking. Um, you can have difficulty with sensation, like the lack of taste and smell that's been described with Cova at 19. You can have difficulty moving parts of your body right now. What's what seems to be just being described. Um, particularly in some studies coming out of Wu Han is that, um, people who are severely infected and hospitalized have what we call encephalopathy, which basically just means change mental status. So people are confused, people's sleep schedule is dysregulated, people might be hallucinating, people might have rapidly fluctuating moods. Speaker 3: 03:11 You've mentioned a number of symptoms that are related to viral infections that we've seen in the past and sort of anecdotally from emerging evidence and stories out of Wu Han China. But this article itself is air view of literature around viral infections and how they might have psychological impacts. Why do you think we can take evidence from past diseases even if they're respiratory in nature? Uh, and conclude similar psychiatric responses with COBIT 19. Speaker 4: 03:44 Um, there is a very good question. Um, generally there is an actively expanding and fairly large literature and how the immune system activation and in a way dysregulation and the effect of that on the brain and also a lot of the brain related outcomes and functions and mood. And I may be able to expend some more on that. Speaker 2: 04:09 Yeah. So, um, I think first of all, we do have to have, um, appropriate caution with, you know, extrapolating from past pandemics, um, particularly because the, Speaker 2: 04:23 the largest pandemic that we've experienced in the most recent history would have been around the early 20th century with the flu pandemic of 1918, which of course is an influenza virus and not a Corona virus. So we do have to be careful about extrapolating, um, data from that. But if you go back in history a little bit, um, you see neuropsychiatrist like Karl Menninger and Constantine Von Economo around the early 20th century, really noting that around the time of the influenza pandemic, they're also describing what they call epidemics of psychosis or epidemics of encephalitis, which basically means inflammation of the brain. And so for a period of about 10 years in the early 20th century, what they saw is, um, individuals with a host of neurologic and psychiatric symptoms at the same time, sometimes following an infection immediately or sometimes weeks or months, even years later. Now, because that's over a hundred years ago. Speaker 2: 05:27 We can't say for sure if that was related to influenza or if it was related to the inflammation that that infection could have caused. Um, but I think what it does is it gives us reason to pause and say, this is something that we should be looking for. Um, if we've, if we've seen sort of psychiatric epidemics coincide with a viral pandemic in the past, um, and this is sort of a new frontier for all of us and that none us have really ever experienced a viral pandemic of this magnitude. I think the medical community, um, we want to sort of just be alert to, to this. Speaker 3: 06:07 It does seem like this is sort of an unprecedented moment in our lives and a lot of people are experiencing or range of emotions right now. And so as you had mentioned, you know, do you think there's going to be a larger public health, uh, issue or there needs to be a response? Speaker 2: 06:29 Two psychiatric conditions post Cobin um, yes. Um, I'm a psychiatrist, so maybe biased. Um, I, I think that we are, um, going to need a lot of services for the general public, for frontline healthcare workers. Um, and I think it is one of the, the messages of the article that we wrote is that going forward it might be difficult to ascertain if someone is experiencing, um, emotional distress or changes in behavior, et cetera going forward. Is that a result of the psychological distress of having experienced a pandemic or is that related to the effects of the virus or inflammation in someone who is infected? And that's going to be really difficult to tease apart of this article is to really raise awareness and to draw the medical attain medical community's attention to the matter. And in order to do that, extrapolating again as said, carefree extrapolation from previous cases. Speaker 3: 07:37 And you had mentioned this before, but not everyone who experiences coronavirus will also experience a psychological condition. Right, Speaker 2: 07:49 right. And I would say, you know, not everyone will experience a neurologic conditions like iatric condition, psychological distress, any, any of those. Um, an article like ours can certainly be a little bit scary. Um, I think for the public when it says, you know, there might be neuropsychiatric sequella or other symptoms that could follow this and they could be delayed by, um, long periods of time and we're, there's a lot of uncertainty already. And so I, we don't want to add to anxiety or add to panic for the public. Um, but we do hope to, to shine light on this for the medical community. Um, and also for the public to know that if, if you're experiencing changes in mood thinking behavior, um, these are things that we want you to, to talk about and we want you to share with your doctors, um, because we're going to be learning about this together. Speaker 2: 08:49 Um, I think Chris Cuomo, um, UN news host younger brother of Andrew Cuomo is a good example of someone who's currently experiencing covert 19 himself and, um, on national television, has openly talked about his own hallucinations and his own depression, his own anxiety, his own cognitive fog, um, while experiencing COBIT. And I think those are the types of open conversations that we want to have as a society. So we can really face this head on together. Well, thank you both for chatting with me. Of course. Thank you for having us. Thank you. That was UC San Diego psychiatrist, Susie Haun and Emma Troyer speaking to KBB a science and technology reporter. Shelina Chet Lani.