Post-COVID neuropsychiatric syndrome: clinical presentation and management

Together with the world's increasing exposure to and knowledge about the coronavirus disease 2019 (COVID-19), there has been a growing recognition of the neuropsychiatric (NP) impact of COVID-19 infections. Such complications have been described during the acute phase of the infection with emerging data showing that in some - in particular severe - cases of COVID-19 infection, the acute viral infection can be associated with delirium, confusion, and psychosis, possibly related to the cytokine storm. Importantly, a much larger proportion of COVID-19 cases experience neuropsychiatric complications at follow-up. Six months after clinical recovery, an estimated 34% of COVID-19 survivors are diagnosed with new-onset neuropsychiatric disorders, in particular anxiety disorders (17%), mood disorders (14%), substance use disorders (7%) and insomnia (5%) (Taquet et al., 2021). Besides these psychiatric symptoms, the post-COVID NP syndrome (also referred to as “long COVID”) is often accompanied by debilitating fatigue and deficits in several cognitive domains. Studies conducted in Italy, Germany, UK and the US found that post-COVID NP symptoms affect between 20 to 70% of patients infected with COVID-19 and can last for over one year after the acute infection, suggesting a separate and enduring mechanism. Most strikingly, post-COVID NP syndrome also occurs in younger and previously healthy adults with an initial mild COVID-19 presentation. It is clear that these symptoms threaten the quality of life and the societal functioning of a significant proportion of the active population and will severely impact mental health services in the next decade (Mazza et al., 2020; Gennaro et al, 2021). Given the scale of the problem, it is clear that these patients cannot be managed in expert centres alone and every clinician involved in the care of patients with neuropsychiatric symptoms needs to be informed about the clinical management of post-COVID NP symptoms. 
This educational session will provide an in-depth overview of the clinical presentation and management of post-COVID NP syndrome, including tools for screening, diagnostic work-up, counselling and treatment options. Both experts have been involved in clinical research on post-COVID neuropsychiatric consequences since the early stages of the pandemic, and have accumulated strong clinical experience managing these patients. Questions which will be addressed in the session include: (1) Whether post-COVID NP syndrome is a separate clinical syndrome, or a subtype of post-infectious neuropsychiatric presentations which have historically been observed with other types of infections; (2) How to differentiate post-COVID depression from regular major depressive episodes; (3) To what extent post-COVID neuropsychiatric syndrome overlaps with the clinical syndrome described as “long COVID”; and (4) Which pharmacological options are available for the prevention and treatment of post-COVID depression (Benedetti et al. 2020; De Picker et al. 2022).
This session was recorded on 8 October 2023 at the 36th ECNP Congress in Barcelona.