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

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.

Keywords: ACE-2; COVID-19; SARS-CoV-2; anxiety; depression; immune inflammatory signaling; mental health; post-traumatic stress disorder (PTSD).

Figure 1

PRISMA flow diagram of the study search and selection process.

Figure 2

Proposed mechanisms of probiotics in the management of psychiatric symptoms in COVID-19 patients.

Figure 3

Illustration of long COVID-19-associated psychiatric disorders. It is known that COVID-19 psychologically affects patients, leading to psychiatric disorders such as anxiety, depression, and post-traumatic stress disorder. These symptoms can be potentially alleviated by probiotics, as they may be one of the safest adjunctive treatments for alleviating psychiatric sequelae in post COVID-19 survivors.