PSYCHIATRIC SYMPTOMS IN COVID-19 PATIENTS AND FACTORS ASSOCIATED WITH THESE SYMPTOMS: COULD PERIPHERAL INFLAMMATION MARKERS BE ONE OF THEM ?

Year 2024, Volume: 25 Issue: 1 - OCAK 2024 SAYISI, 94 - 102, 17.01.2024

Onur Gökçen Merve Akkuş Selman Erturhan Erkal Erzincan Alperen Bardakçı

https://doi.org/10.18229/kocatepetip.1242016

Abstract

OBJECTIVE: In addition to respiratory symptoms, there have been reports of increased psychiatric symptoms in COVID-19 patients. In this study, it is aimed to reveal the psychiatric symptoms seen in COVID-19 patients. We also investigated the relationship between these psychiatric symptoms and peripheral inflammatory markers.
MATERIAL AND METHODS: The patients were evaluated with "Interview Forms" specially created by the researchers for the study. DSM-V Acute Stress Disorder Scale (ASDS); Perceived Stress Scale-10 (PSS-10); State-Trait Anxiety Inventory (STAI-T/S); and finally Hospital Anxiety and Depression Scale (HADS) were used to determine patients' acute and perceived stress levels, depression and anxiety symptoms, state and generalized anxiety levels, and how these psychiatric symptoms were affected by different social conditions. D-dimer, fibrinogen, lymphocytes, CRP (C-reactive protein) and ferritin levels were taken into account as inflammatory markers.
RESULTS: Our study included 108 inpatients and 31 outpatients with COVID-19. The ASDS, STAI State Scale, and HADS depression scale scores of inpatients patients were found to be higher compared to outpatient patients. Increased fibrinogen levels in blood tests were found to predict higher acute stress disorder scores. HAD-Depression subscale and fibrinogen levels were also found to be positively correlated with each other.
CONCLUSIONS: Stress, depression and anxiety symptoms accompany COVID-19. In addition, high fibrinogen levels may be associated with psychiatric symptoms. Psychiatric symptoms are indirectly affected by physical illnesses. We can say that a pandemic that causes fear and anxiety all over the world may suppress the immune system in individuals and the suppressed immune system may indirectly make the infection more complicated.

Keywords

COVID-19, Anxiety, Depression, Inflammation

Project Number

yok

COVID-19 HASTALARINDA PSİKİYATRİK BELİRTİLER VE BU BELİRTİLERLE İLİŞKİLİ FAKTÖRLER: PERİFERİK İNFLAMASYON BELİRTEÇLERİ BUNLARDAN BİRİ OLABİLİR Mİ ?

Abstract

AMAÇ: Solunum semptomlarına ek olarak, COVID-19 hastalarında psikiyatrik semptomların da arttığına dair veriler bildirilmiştir. Bu çalışmada COVID-19 hastalarında görülen psikiyatrik belirtilerin ortaya konması amaçlanmıştır. Ayrıca bu psikiyatrik semptomlar ile periferik inflamatuar belirteçler arasındaki ilişki araştırılmıştır.
GEREÇ VE YÖNTEM: Hastalar çalışma için araştırıcılar tarafından özel oluşturulmuş “Görüşme Formları” ile değerlendirildi. Hastaların akut ve algılanan stres düzeylerini, depresyon ve anksiyete belirtilerini, durumsal ve genelleştirilmiş kaygı düzeylerini ve bu psikiyatrik belirtilerin farklı sosyal koşullardan nasıl etkilendiğini belirlemek için DSM-V Akut Stres Bozukluğu Ölçeği (ASBÖ); Algılanan Stres Ölçeği-10 (PSS-10); Durumluk-Sürekli Kaygı Envanteri (STAI-T/S); ve son olarak Hastane Anksiyete ve Depresyon Ölçeği (HADÖ) kullanıldı. İnflamatuar belirteçlerden D-dimer, fibrinojen, lenfositler, CRP (C-reaktif protein) ve ferritin seviyeleri dikkate alındı.
BULGULAR: Araştırmamıza 108 yatan, 31 ayaktan izlemi devam eden COVİD 19 hastası dahil edilmiştir. Yatan hastaların ASBÖ, STAİ Süreklilik Ölçeği ve HADS (Hastane Anksiyete Depresyon Skalası) puanları, ayaktan hastalara göre daha yüksek tespit edilmiştir. Kan testlerinde artmış fibrinojen seviyelerinin daha yüksek akut stres bozukluğu skorlarını öngördüğü bulunmuştur. HADS-Depresyon alt ölçeği ve fibrinojen düzeyleri de birbiriyle pozitif korelasyon gösterdiği bulunmuştur.
SONUÇ: Stres, depresyon ve anksiyete belirtileri COVID-19'a eşlik etmektedir. Ayrıca yüksek fibrinojen düzeyleri psikiyatrik belirtilerle ilişkili olabilir. Psikiyatrik belirtiler fiziksel hastalıklardan dolaylı olarak etkilenir. Tüm dünyada korku ve endişeye neden olan bir salgının bireylerde bağışıklık sistemini baskılayabileceğini ve baskılanan bağışıklık sisteminin dolaylı olarak enfeksiyonu daha da karmaşık hale getirebileceğini söyleyebiliriz.

Keywords

COVID-19, Anksiyete, Depresyon İnflamasyon

Supporting Institution

yok

Project Number

yok

References

• 1. AlSamman M, Caggiula A, Ganguli S, Misak M, Pourmand AJTAjoem. Non-respiratory presentations of COVID-19, a clinical review. The American Journal of Emergency Medicine. 2020;38(11):2444-54.
• 2. Sinanović O, Muftić M, Sinanović SJPD. COVID-19 pandemia: neuropsychiatric comorbidity and consequences. Psychiatria Danubina. 2020;32(2):236-44.
• 3. Cheng SK, Wong C, Tsang J, Wong KJPm. Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS). Psychological Medicine.2004;34(7):1187-95.
• 4. Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, Behavior, and Immunity. 2020;87:34-9.
• 5. Mak IWC, Chu CM, Pan PC, et al. Long-term psychiatric morbidities among SARS survivors. General Hospital Psychiatry. 2009;31(4):318-26.
• 6. Bohmwald K, Galvez N, Ríos M, Kalergis AM. Neurologic alterations due to respiratory virus infections. Frontiers in Cellular Neuroscience. 2018;12:386.
• 7. Wu KK, Chan SK, Ma TM. Posttraumatic stress, anxiety, and depression in survivors of severe acute respiratory syndrome (SARS). J Trauma Stress. 2005;18(1):39-42.
• 8. Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behavior and Immunity. 2020;87:18-22.
• 9. Lam MH-B, Wing Y-K, Yu MW-M, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Archives of Internal Medicine. 2009;169(22):2142-7.
• 10. Qin X, Shu K, Wang M, et al. Mental health status of patients with coronavirus disease 2019 in Changsha. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020:657-64.
• 11. Guo Q, Zheng Y, Shi J, et al. Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: a mixed-method study. Brain Behavior and Immunity. 2020;88:17-27.
• 12. Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behavior and Immunity. 2020;89:594-600.
• 13. Kurhan F, Kamis GZ, Çim EFA, Atli A, Dinc D. Relationship between Obsessive-Compulsive Symptoms and Anxiety Levels during the COVID-19 Pandemic in Healthcare Professionals vs. Non-Healthcare Professionals. International Journal of Mental Health Promotion. 2022;24(3):399-413.
• 14. Bo H-X, Li W, Yang Y, et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychological Medicine. 2021;51(6):1052-3.
• 15. Van Vuren EJ, Steyn SF, Brink CB, et al. The neuropsychiatric manifestations of COVID-19: Interactions with psychiatric illness and pharmacological treatment. Biomedicine & Pharmacotherapy. 2021:111200.
• 16. Yuan N, Chen Y, Xia Y, Dai J, Liu C. Inflammation-related biomarkers in major psychiatric disorders: a cross-disorder assessment of reproducibility and specificity in 43 meta-analyses. Translational Psychiatry. 2019;9(1):1-13.
• 17. Hou R, Garner M, Holmes C, et al. Peripheral inflammatory cytokines and immune balance in Generalised Anxiety Disorder: Case-controlled study. Brain Behavior and Immunity. 2017;62:212-8.
• 18. Wang W, Wang L, Xu H, et al. Characteristics of pro-and anti-inflammatory cytokines alteration in PTSD patients exposed to a deadly earthquake. Journal of Affective Disorders. 2019;248:52-8.
• 19. Cheng SK-W, Tsang JS-K, Ku K-H, Wong C-W, Ng Y-K. Psychiatric complications in patients with severe acute respiratory syndrome (SARS) during the acute treatment phase: a series of 10 cases. The British Journal of Psychiatry. 2004;184(4):359-60.
• 20. Brietzke E, Magee T, Freire RC, Gomes FA, Milev R. Three insights on psychoneuroimmunology of mood disorders to be taken from the COVID-19 pandemic. Brain Behavior & Immunity-Health. 2020;5:100076.
• 21. Dantzer R. Neuroimmune interactions: from the brain to the immune system and vice versa. Physiological Reviews. 2018;98(1):477-504.
• 22. Kahve AC, Kaya H, Okuyucu M, et al. Do anxiety and depression levels affect the inflammation response in patients hospitalized for COVID-19. Psychiatry Investigation. 2021;18(6):505.
• 23. Asçibasi K, Çökmüs FP, Aydemir Ö. DSM-5 Akut Stres Belirti Siddeti Ölçegi Türkçe Formunun geçerliligi ve güvenilirligi. Anadolu Psikiyatri Dergisi. 2017;18:38-44.
• 24. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of Health and Social Behavior. 1983:385-96. 25. Eskin M, Harlak H, Demirkıran F, Dereboy Ç, editors. Algılanan stres ölçeğinin Türkçeye uyarlanması: güvenirlik ve geçerlik analizi. New/Yeni Symposium Journal. 2013;51(3):32-140.
• 26. Spielberger, CD, Gonzalez-Reigosa, F, Martinez-Urrutia, A et al.The state-trait anxiety inventory. Revista Interamericana de Psicologia/Interamerican journal of psychology. 1971;5:3-4.
• 27. Oner N, Lecompte A. Sureksiz durumluk/surekli kaygi envanteri el kitabi. Bogazici Universitesi, Istanbul. 1985.
• 28. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;67(6):361-70.
• 29. Gabbai‐Armelin PR, de Oliveira AB, Ferrisse TM, et al. COVID‐19 (SARS‐CoV‐2) infection and thrombotic conditions: A systematic review and meta‐analysis. Eur J Clin Invest. 2021;21(6):e13559.
• 30. Mazzeffi MA, Chow JH, Tanaka K. COVID-19 associated hypercoagulability: manifestations, mechanisms, and management. Shock. 2021;55(4):465.
• 31. Alkhatip AAAMM, Kamel MG, Hamza MK, et al. The diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in COVID-19: a systematic review and meta-analysis. Expert Review of Molecular Diagnostics. 2021:1-10.
• 32. Zhang L, Yan X, Fan Q, et al. D‐dimer levels on admission to predict in‐hospital mortality in patients with Covid‐19. Journal of Thrombosis and Haemostasis. 2020;18(6):1324-9.
• 33. Von Känel R, Dimsdale JE, Adler KA, et al. Effects of depressive symptoms and anxiety on hemostatic responses to acute mental stress and recovery in the elderly. Psychiatry Research. 2004;126(3):253-64.
• 34. Ji X, Lu Y, Tian H, et al. Chemoresistance mechanisms of breast cancer and their countermeasures. Biomedicine & Pharmacotherapy. 2019;114:108800.
• 35. Cameron MJ, Bermejo-Martin JF, Danesh A, Muller MP, Kelvin DJ. Human immunopathogenesis of severe acute respiratory syndrome (SARS). Virus Research. 2008;133(1):13-9.
• 36. Liu Y, Ho RC-M, Mak A. Interleukin (IL)-6, tumour necrosis factor alpha (TNF-α) and soluble interleukin-2 receptors (sIL-2R) are elevated in patients with major depressive disorder: a meta-analysis and meta- regression. Journal of Affective Disorders. 2012;139(3):230-9.
• 37. Ng A, Tam WW, Zhang MW, et al. IL-1β, IL-6, TNF-α and CRP in elderly patients with depression or Alzheimer’s disease: systematic review and meta-analysis. Scientific Reports. 2018;8(1):1-12.
• 38. Köhler CA, Freitas TH, Maes Md, et al. Peripheral cytokine and chemokine alterations in depression: a meta‐analysis of 82 studies. Acta Psychiatrica Scandinavica. 2017;135(5):373-87.
• 39. Renna ME, O'Toole MS, Spaeth PE, Lekander M, Mennin DS. The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: A systematic Review and Meta‐ analysis. Depression and Anxiety. 2018;35(11):1081-94.
• 40. Rogers JP, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry. 2020;7(7):611-27.
• 41. Holmes EA, O'Connor RC, Perry VH, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry. 2020;7(6):547-60.
• 42. Elovainio M, Hakulinen C, Pulkki-Råback L, et al. Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study. The Lancet Public Health. 2017;2(6):e260-e6.
• 43. Matthews T, Danese A, Caspi A, et al. Lonely young adults in modern Britain: findings from an epidemiological cohort study. Psychological Medicine. 2019;49(2):268-77.
• 44. Wand APF, Zhong B-L, Chiu HFK, et al. COVID-19: the implications for suicide in older adults. International Psychogeriatrics. 2020;32(10):1225-30.
• 45. Pappa S, Ntella V, Giannakas T, et al. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behavior and Immunity. 2020;88:901-7.
• 46. Özdin S, Bayrak Özdin Ş. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. International Journal of Social Psychiatry. 2020;66(5):504-11.
• 47. Qiu J, Shen B, Zhao M, et al. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry. 2020;33(2): e100213.
• 48. Wang C, Pan R, Wan X, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behavior and Immunity. 2020;87:40-8.