dcyphr | Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic


Using psychiatric signs or symptoms, symptom severity, diagnoses based on ICD-10, DSM-IV, or the Chinese Classification of Mental Disorders (third edition), quality of life, and employment as outcome variables in this systematic review and meta-analysis, the researchers examined the psychiatric and neuropsychiatric (i.e., delirium) displays of SARS, MERS, and COVID-19.

If SARS-CoV-2 follows a similar course to SARS-CoV or MERS, most patients will likely recover without experiencing a mental illness. A significant proportion of patients may suffer from delirium in the acute stage of SARS-CoV-2. Clinicians should be attentive of depression, anxiety, fatigue, PTSD, and certain neuropsychiatric syndromes in the longer term following COVID-19 infection.


There is a widespread understanding of the psychiatric implications of COVID-19 that may affect infected and non-infected populations for reasons including widespread anxiety, illness-related stigma, and governmental response.

Neuropsychiatric consequences (mental disorders attributable to nervous system disorders) can emerge directly or indirectly from infection (i.e., via medical therapy). Severe neuropsychiatric consequences may be proportionally rare, but given the reach of the pandemic, a significant population would be affected. The previous coronavirus epidemics were assessed to ascertain the possible psychiatric and neuropsychiatric consequences of COVID-19.


The authors searched MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases for relevant studies or abstracts.


In the acute illness stage, common symptoms among hospitalized SARS or MERS patients were confusion, depressed mood, anxiety, impaired memory, and insomnia. Along with the aforementioned symptoms, irritability, fatigue, and in one study traumatic memories and sleep disorders were among patients in the post-illness stage. In this stage, the point prevalence of PTSD was 32.2%, depression 14.9%, and anxiety disorders 14.8%. There was evidence for delirium in COVID-19 patients. There was much variability in the quality of the studies.


Relevant data on COVID-19 and the higher mortality rate of SARS and MERS that may be correlated with poorer psychiatric consequences make establishing conclusions with caution important. Confusion is common in the acute stage of SARS and MERS so delirium may become a significant problem of COVID-19. Depression, anxiety, PTSD, and fatigue may have a high prevalence post-COVID-19, but this data is early or unpublished at the moment with regard to COVID-19. The seemingly high prevalence of common symptoms like depression may have been a consequence of selection bias. This review suggests that most people will not suffer from a mental illness after coronavirus infection and that there is little evidence to suggest neuropsychiatric consequences beyond short-term delirium following infection.