Acute and Chronic Neuropsychiatric Sequelae of COVID-19

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Since March 2020, consultation-liaison psychiatrists around the world have dedicated a large portion of their efforts towards caring for patients with COVID-19 and studying the neuropsychiatric effects of the illness. In the acute infection stage, rates of delirium approach 80% in some populations, and non-delirium psychosis is emerging as an important phenomenon as well. Novel presentations are also being described, including a cluster of symptoms that resembles akinetic mutism and other reports of catatonia successfully treated with benzodiazepines. As the pandemic has continued, survivors are being characterized as having high rates of depression, anxiety and PTSD. A phenomenon of Long COVID has also emerged, characterized by ongoing fatigue, subjective brain fog, and, recently, some objective deficits in executive function on neuropsychological testing. Many of these patients initially only experienced mild illness not requiring hospitalization, but their symptoms have persisted for weeks or months, refractory to medication interventions.

In this workshop, we will present an overview of acute and chronic neuropsychiatric complications of infection with SARS-CoV-2. All presenters are actively involved in research related to COVID and will present their own findings and observations in addition to reviewing the literature.

Scott Beach, MD, is the Program Director for the MGH/McLean Adult Psychiatry Residency and an attending psychiatrist on the MGH CL service. He has published several articles characterizing delirium in the COVID+ population. He will review acute neuropsychiatric complications of COVID, discuss imaging and laboratory findings in patients with “neuroCOVID” and highlight some unusual symptoms seen in COVID delirium, including akinetic mutism.

Erica Baller, MD, is an inpatient CL psychiatrist at the University of Pennsylvania and a post-doc in neuropsychiatry. She has published on the management of COVID delirium. Dr. Baller will review potential pathophysiological mechanisms for involvement of the central nervous system by the SARS-CoV-2 virus and will discuss an algorithmic approach to managing delirium in the setting of COVID-19, with particular attention paid to ways in which this might differ from standard delirium management.

Christian Hicks, MD, is a CL Fellow at Columbia University and is currently working with a behavioral neurologist to provide care with post-acute sequelae of COVID. Dr. Hicks will review clinical findings and phenomenology of Long-COVID, in addition to discussing potential treatment modalities.

Davin Quinn, MD, is Vice Chair for Adult Clinical Services and a CL psychiatrist at the University of New Mexico who is currently studying neurodiagnostics, including EEG, FNIRS and fMRI in patients with chronic cognitive symptoms after COVID. He will present some preliminary data as well as review possible pathophysiology and suggested workup for patients with Long COVID.