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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

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
1.
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2.
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.13016PubMedGoogle ScholarCrossref
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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.2016.1594PubMedGoogle ScholarCrossref
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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.2010.09.029PubMedGoogle ScholarCrossref
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