Are the Post-COVID-19 Posttraumatic Stress Disorder (PTSD) Symptoms Justified by the Effects of COVID-19 on Brain Structure? A Systematic Review

Author:

Kotzalidis Georgios D.123ORCID,Ferrara Ottavia Marianna2ORCID,Margoni Stella2ORCID,Ieritano Valentina2ORCID,Restaino Antonio2ORCID,Bernardi Evelina2ORCID,Fischetti Alessia2ORCID,Catinari Antonello2ORCID,Monti Laura4ORCID,Chieffo Daniela Pia Rosaria45ORCID,Simonetti Alessio2367ORCID,Sani Gabriele27ORCID

Affiliation:

1. NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza–Università di Roma, 00189 Rome, Italy

2. Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy

3. Centro Lucio Bini, 00193 Rome, Italy

4. UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy

5. Women, Children and Public Health Department, Catholic University of the Sacred Heart, 00168 Rome, Italy

6. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA

7. Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart, 00168 Rome, Italy

Abstract

COVID-19 affects brain function, as deduced by the “brain fog” that is often encountered in COVID-19 patients and some cognitive impairment that is observed in many a patient in the post-COVID-19 period. Approximately one-third of patients, even when they have recovered from the acute somatic disease, continue to show posttraumatic stress disorder (PTSD) symptoms. We hypothesized that the persistent changes induced by COVID-19 on brain structure would overlap with those associated with PTSD. We performed a thorough PubMed search on 25 April 2023 using the following strategy: ((posttraumatic OR PTSD) AND COVID-19 AND (neuroimaging OR voxel OR VBM OR freesurfer OR structural OR ROI OR whole-brain OR hippocamp* OR amygd* OR “deep gray matter” OR “cortical thickness” OR caudate OR striatum OR accumbens OR putamen OR “regions of interest” OR subcortical)) OR (COVID-19 AND brain AND (voxel[ti] OR VBM[ti] OR magnetic[ti] OR resonance[ti] OR imaging[ti] OR neuroimaging[ti] OR neuroimage[ti] OR positron[ti] OR photon*[ti] OR PET[ti] OR SPET[ti] OR SPECT[ti] OR spectroscop*[ti] OR MRS[ti])), which produced 486 records and two additional records from other sources, of which 36 were found to be eligible. Alterations were identified and described and plotted against the ordinary PTSD imaging findings. Common elements were hypometabolism in the insula and caudate nucleus, reduced hippocampal volumes, and subarachnoid hemorrhages, while white matter hyperintensities were widespread in both PTSD and post-COVID-19 brain infection. The comparison partly supported our initial hypothesis. These data may contribute to further investigation of the effects of long COVID on brain structure and function.

Publisher

MDPI AG

Subject

Medicine (miscellaneous)

Reference89 articles.

1. World Health Organization (2023, April 29). WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19—11 March 2020. Available online: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.

2. Worldometer (2023, April 29). COVID-19 Coronavirus Pandemic. Available online: https://www.worldometers.info/coronavirus/.

3. Global Burden of Disease Long COVID Collaborators, Wulf Hanson, S., Abbafati, C., Aerts, J.G., Al-Aly, Z., Ashbaugh, C., Ballouz, T., Blyuss, O., Bobkova, P., and Bonsel, G. (2022). Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA, 328, 1604–1615.

4. The prevalence and long-term health effects of Long COVID among hospitalised and non-hospitalised populations: A systematic review and meta-analysis;Routen;EClinicalMedicine,2022

5. Posttraumatic stress disorder in patients after severe COVID-19 infection;Janiri;JAMA Psychiatry,2021

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