Dr Sanil Rege is a Consultant Psychiatrist at Vita Health Care and is founder of Psychscene and Psych Scene Hub. He has a special interest in neuropsychiatry and has published articles covering neuroimmunology and psychiatry.

In this video, Dr Sanil Rege covers the psychiatric and neuropsychiatric manifestations of COVID-19. There is increasing evidence of the neurotropic and neuroinvasive nature of SARS-CoV-2.

Taxonomically similar viruses like SARS and MERS were associated with neuropsychiatric symptoms. SARS-CoV-2 has 96% genomic sequence homology with a bat CoV found in a cave in Yunnan province, China (which does not infect humans) – raising the possibility that the virus originated in bats.

However, infectious nature indicates another intermediate host that has not been identified. SARS-CoV-2 uses the ACE2 receptor for entry.

The ACE2 receptor is found in many organs in the body (eyes, nose, kidneys, liver, brain, endothelium, lungs) and this likely contributes to the multiorgan involvement in COVID. Dysregulation of the ACE2 receptor leads to inflammation, fibrosis, and vasoconstriction.

Another core feature of the illness is hypercoagulability.

The virus entry in the brain is through a number of direct and indirect mechanisms

Direct mechanisms: 

1. Olfactory network
2. Medullary respiratory network
3. Enteric nervous system

Indirect mechanisms: 

1. Myeloid cell trafficking (Trojan horse mechanisms)
2. Cytokine storm
3. Neuroinflammation
4. Gut-brain translocation

CNS manifestations: 

1. Encephalopathies
2. Meningoencephalitis
3. Psychiatric disorders – host immune response and psycho-social factors
4. Peripheral NS disorders – e.g GBS, neuropathy
5. Myopathies
6. Anosmia and Ageusia

Role of the Psychiatrist: 

The video discusses the role of the psychiatrist in more detail, taking a bio-psychosocial perspective.

We cover management principles for psychiatrists based on currently available treatments.

Drug interactions with antiretrovirals, steroids, and N-P side effects of Interferon, Steroids, Chloroquine, and Hydroxychloroquine are discussed.

COVID-19 challenges the mind-body dichotomy.

Psychiatrists will play an important role in bridging the gap by addressing the short and long term biological, psychological, and social consequences of the condition.

A truly multidisciplinary effort is required.

Read the detailed article on COVID-19 and the Brain – the neuropsychiatric manifestations of SARS-CoV-2 CNS infection

Other articles on COVID-19: 

1. Psychological consequences of quarantine
2. Mental health challenges for health care workers during COVID-19.