University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Family Medicine/Neuropsychiatry


Martin Wu, MD; Brian Tessier, PA-C; Manuel Saint Martin, MD/JD


Purpose: The purpose of this article is to review the articles regarding neuropsychiatric symptoms, possible pathophysiology, and treatments for COVID-19 sequelae for primary care providers to effectively manage neuropsychiatric illness during and after the COVID-19 pandemic.

Method: A PubMed literature search and Onesearch were conducted with search terms of neuropsychiatric and COVID-19. Twenty pertinent articles were retrieved and served as the basis for this clinical review. Other studies cited by these articles were added with relevance to this review.

Results: More than one third of COVID-19 survivors developed neuropsychiatric symptoms, and about half of those who were admitted to ICU suffered from neuropsychiatric disorder less than six months post-infection. This was obtained from five systematic review articles, each including 13 to 66 studies, and five retrospective cohort studies, each including 179 to 236,379 patients, ranging from Asia, Europe, North America, and Oceania. The most common post-COVID-19 neuropsychiatric symptoms are headaches, muscle weakness, brain fog, dizziness, fatigue, disordered memory or cognition, and sleep disturbance, depression and anxiety, and potentially new-onset dementia. Many patients with long COVID syndrome were diagnosed with mast cell activation syndrome (MCAS) or chronic fatigue syndrome (CFS). Effective treatments include graded physical rehabilitation, psychological or behavioral counseling, analgesics, anti-inflammatory, antivirals, antidepressants, H1 or H2 antihistamines, mast cell stabilizer, and Leukotriene antagonists, CoQ10 and probiotics.

Conclusion: More than one third of patients who had COVID-19 infection were diagnosed with a neurological and/or psychiatric illness in the following 6 months after COVID-19 diagnosis. And, the COVID-19 has a bidirectional relationship with mental illness, including anxiety, depression, and post-traumatic stress disorder (PTSD).2 Thus, primary care clinicians need to know whether a patient has history of COVID-19 infection, and the patient’s history of neuropsychiatric conditions in order to make correct diagnoses and to offer effective treatments accordingly.

Keywords: COVID-19, neuropsychiatric sequela, bidirectional, long COVID, pathophysiology, gut-nervous axis, mast cell activation syndrome, chronic fatigue syndrome.


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