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16 December 2020: Editorial  

Psychiatric Manifestations of COVID-19 and Their Social Significance

Radek Ptacek1ABCDEFG, Hana Ptackova2ABCDEFG, Anders Martin2ABCDEF, George B. Stefano3ABCDEF*

DOI: 10.12659/MSM.930340

Med Sci Monit 2020; 26:e930340



ABSTRACT: Alterations in complex behavioral patterns during the extended period of the COVID-19 pandemic are predicted to promote a variety of psychiatric disease symptoms due to enforced social isolation and self-quarantine. Accordingly, multifaceted mental health problems will continue to increase, thereby creating a challenge for society and the health care system in general. Recent studies show that COVID-19 can directly or indirectly influence the central nervous system, potentially causing neurological pathologies such as Alzheimer disease and Parkinson disease. Thus, chronic COVID-19-related disease processes have the potential to cause serious mental illnesses, including depression, anxiety, and sleep disorders. Importantly, mental health problems can foster systemic changes in functionally-linked neuroendocrine conditions that heighten a person’s susceptibility to COVID-19 infection. These altered defense mechanisms may include compromised “self-control” and “self-care”, as well as a “lack of insight” into the danger posed by the virus. These consequences may have serious social impacts on the future of COVID-19 survivors. Compounding the functionally related issues of altered mental health parameters and viral susceptibility are the potential effects of compromised immunity on the establishment of functional herd immunity. Within this context, mental health takes on added importance, particularly in terms of the need to increase support for mental health research and community-based initiatives. Thus, COVID-19 infections continue to reveal mental health targets, a process we must now be prepared to deal with.

Keywords: Anxiety, COVID-19, Depression, Psychiatry, Psychology, Social Responsibility, Alzheimer Disease, COVID-19, Disease Susceptibility, Humans, Mental Health, Pandemics, Parkinson Disease, Physical Distancing, SARS-CoV-2, Self Care, self-control, Social Isolation, Survivors

It is well established that SARS-CoV-2 can infect and pathologically affect the human central nervous system, making it a prime target tissue [1–3]. In a recent review, we noted the involvement of ACE2 and nicotinic receptors as targets of viral-induced interaction, which can include encephalitis [1]. The neurologic associations of COVID-19 also provide the potential basis for long-term neurological sequelae [1]. Predictably, the neurological component also occurs with SARS-CoV-1 [4,5]. Therefore, it is surmised that the virus may play a role in Alzheimer disease and Parkinson disease [6]. In this regard, and at this stage of our understanding of COVID-19, it is unknown whether SARS-CoV-2 causes neurodegenerative diseases or accelerates their premature occurrence [1].

Moreover, recent data demonstrate SARS-CoV-2 affects long-term cognitive function, which may be anticipated given its presence in the brain and subsequent neurological dysfunction. Reports indicate that the virus can induce psychosis [7,8], mania [9], delirium [10], depression and anxiety [11], as well as confusion [12,13]. These reports are sensitive to the fact that the emergence of these mental health disorders could be associated with COVID-19, suggesting a possible correlation between such disorders and SARS-CoV-2. In particular, investigators are asking if these individuals are more susceptible to infection by the virus [14–17]. In our opinion, and that of the investigators cited here, the answer would appear to indicate that there is, indeed, a correlation, discernable even at this early stage of COVID-19 research. In part, mental health problems may foster conditions that heighten a person’s susceptibility to the virus, such as compromised “self-control” and “self-care”, as well as a “lack of insight” into the danger posed by the virus; “they may be incapable of practicing infection control, therefore being vulnerable to the COVID-19 and its complications” [16,18] (and noted by [15]). Significantly, neurological disorders can be associated with proinflammatory phenomena as their underlying cause. As such, we surmise that this fact alone can increase an individuals’ susceptibility to viral infection, which now may be exacerbated by compromised mental health [19,20].


Compounding the relational issue of mental health and virus susceptibility is the unintentional exposure of others by a carrier who may be burdened with mental health disorders. In this context, mental health takes on added importance, particularly in terms of the need to increase support for mental health research and community-based initiatives. As it stands now, mental health issues are stigmatized and lack sufficient attention and investment. The fact that mental health is an area that largely exists ‘under the radar’ may only worsen virus transmission and spread [13,21–24]. Furthermore, increased mental health challenges have arisen due to the COVID-19 pandemic and mitigation activities such as physical distancing and stay-at-home orders. Therefore, there is an urgent need for increased support for mental health centers and community outreach, as well as enhanced awareness of these issues [25–27]. It goes without saying that now, more than ever, greater investment is needed to strengthen mental health services.


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10. Beach SR, Praschan NC, Hogan C, Delirium in COVID-19: A case series and exploration of potential mechanisms for central nervous system involvement: Gen Hosp Psychiatry, 2020; 65; 47-53

11. Epstein D, Andrawis W, Lipsky AM, Anxiety and suicidality in a hospitalized patient with COVID-19 infection: Eur J Case Rep Intern Med, 2020; 7(5); 001651

12. Chen N, Zhou M, Dong X, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study: Lancet, 2020; 395(10223); 507-13

13. Zhang Y, Ma ZF, Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning province, China: A cross-sectional study: Int J Environ Res Public Health, 2020; 17(7); 2381

14. Yao H, Chen JH, Xu YF, Patients with mental health disorders in the COVID-19 epidemic: Lancet Psychiatry, 2020; 7(4); e21

15. Kim SW, Su KP, Using psychoneuroimmunity against COVID-19: Brain Behav Immun, 2020; 87; 4-5

16. Szczesniak D, Gladka A, Misiak B, The SARS-CoV-2 and mental health: From biological mechanisms to social consequences: Prog Neuropsychopharmacol Biol Psychiatry, 2021; 104; 110046

17. Taquet M, Luciano S, Geddes JR, Harrison PJ, Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62 354 COVID-19 cases in the USA: Lancet Psychiatry, 2020 [Online ahead of print]

18. Druss BG, Addressing the COVID-19 pandemic in populations with serious mental illness: JAMA Psychiatry, 2020; 77(9); 891-92

19. Esch T, Stefano GB, Proinflammation: A common denominator or initiator of different pathophysiological disease processes: Med Sci Monit, 2002; 8(5); HY1-9

20. Esch T, Stefano GB, Fricchione GL, Benson H, The role of stress in neurodegenerative diseases and mental disorders: Neuro Endocrinol Lett, 2002; 23(3); 199-208

21. Torales J, O’Higgins M, Castaldelli-Maia JM, Ventriglio A, The outbreak of COVID-19 coronavirus and its impact on global mental health: Int J Soc Psychiatry, 2020; 66(4); 317-20

22. DeLuca JS, Clement TW, Yanos PT, Does individual stigma predict mental health funding attitudes? Toward an understanding of resource allocation and social climate: Isr J Psychiatry Relat Sci, 2017; 54(1); 6-16

23. Yanos PT, DeLuca JS, Salyers MP, Cross-sectional and prospective correlates of associative stigma among mental health service providers: Psychiatr Rehabil J, 2020; 43(2); 85-90

24. Shinn AK, Viron M, Perspectives on the COVID-19 pandemic and individuals with serious mental illness: J Clin Psychiatry, 2020; 81(3); 20c om13412

25. Holmes EA, O’Connor RC, Perry VH, Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science: Lancet Psychiatry, 2020; 7(6); 547-60

26. Knapp M, Wong G, Economics and mental health: The current scenario: World Psychiatry, 2020; 19(1); 3-14

27. Czeisler ME, Lane RI, Petrosky E, Mental health, substance use, and suicidal ideation during the COVID-19 pandemic – United States, June 24–30, 2020: MMWR Morb Mortal Wkly Rep, 2020; 69(32); 1049-57

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750