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Coronavirus (COVID-19)

Targetable Biological Mechanisms Implicated in Emergent Psychiatric Conditions Associated With SARS-CoV-2 Infection

Educational Objective
To understand how biological and psychological mechanisms are implicated in emergent psychiatric conditions associated with COVID-19 infection

1 Credit CME

JAMA Psychiatry

Published Online: July 31, 2020

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Article Information and Disclosures

Teodor T. Postolache, MD^1,2;

Michael E. Benros, MD, PhD^3,4;

Lisa A. Brenner, PhD^2,5

Author Affiliations

¹Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore
²Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
³Biological and Precision Psychiatry, Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
⁴Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
⁵University of Colorado, Anschutz Medical Campus, Aurora

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in 2019 and then rapidly led to a pandemic with widespread cases of SARS and excess mortality. In response, mitigation efforts (including social distancing, quarantining, and closing of businesses and schools) have resulted in an unprecedented economic downfall. There is concern that these environmental stressors, augmented by psychological factors, such as loss of control, fear of death and dying, and isolation, are contributing to the emergence of psychiatric outcomes of the coronavirus disease 2019 (COVID-19) pandemic.¹ Furthermore, coronaviruses may induce cognitive, emotional, neurovegetative, and behavioral dysregulation through biological mechanisms, including direct neuroinvasion and triggering of immune activation. Increasing evidence has linked immune activation with depression and suicidal behavior, and according to several large meta-analyses, anti-inflammatory approaches have demonstrated efficacy in treating depression.²

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Article Information

Corresponding Author: Teodor T. Postolache, MD, Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, 685 W Baltimore St, MSTF Building, Room 930, Baltimore, MD 21201 (tpostola@som.umaryland.edu).

Published Online: July 31, 2020. doi:10.1001/jamapsychiatry.2020.2795

Conflict of Interest Disclosures: None reported.

Funding/Support: The writing of the manuscript was supported by the Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention and the Military and Veteran Microbiome Consortium for Research and Education and in part by merit award 1 I01 CX001310-01 from the Clinical Science Research and Development Service (Dr Postolache).

Role of the Funder/Sponsor: The funders had no role in the preparation, review, or approval of the manuscript or decision to submit the manuscript for publication.

Disclaimer: The views and opinions contained in this article are those of the authors and should not be construed as an official Department of Defense or Veterans Affairs position, policy, endorsement, or decision.

Additional Contributions: We thank Boris Tizenberg, MD (University of Maryland School of Medicine, Baltimore), for his excellent assistance with this project. He was not compensated for his contribution.

References

Rogers JP , Chesney E , Oliver D , et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611-627. doi:10.1016/S2215-0366(20)30203-0 PubMed Google Scholar Crossref

Köhler-Forsberg O , N Lydholm C , Hjorthøj C , Nordentoft M , Mors O , Benros ME . Efficacy of anti-inflammatory treatment on major depressive disorder or depressive symptoms: meta-analysis of clinical trials. Acta Psychiatr Scand. 2019;139(5):404-419. doi:10.1111/acps.13016 PubMed Google Scholar Crossref

Lund-Sørensen H , Benros ME , Madsen T , et al. A nationwide cohort study of the association between hospitalization with infection and risk of death by suicide. JAMA Psychiatry. 2016;73(9):912-919. doi:10.1001/jamapsychiatry.2016.1594 PubMed Google Scholar Crossref

Desforges M , Le Coupanec A , Dubeau P , et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 2019;12(1):E14. doi:10.3390/v12010014 PubMed Google Scholar

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Okusaga O , Yolken RH , Langenberg P , et al. Association of seropositivity for influenza and coronaviruses with history of mood disorders and suicide attempts. J Affect Disord. 2011;130(1-2):220-225. doi:10.1016/j.jad.2010.09.029 PubMed Google Scholar Crossref

Mao L , Jin H , Wang M , et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. doi:10.1001/jamaneurol.2020.1127 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.