The brain does not recognize the coronavirus because of its similarity with the cells of the nervous system, and therefore does not fight it — and passes it as «its own.» This leads to acute psychosis and sometimes partial memory loss. How to deal with this?
At the very beginning of the pandemic, we naively believed that only our lungs were in immediate danger. The more time passed, the clearer it became that the virus is omnivorous: it acts swiftly and sophisticatedly, without knowing any obstacles.
Thousands of scientists around the world, bit by bit, collected knowledge about this infection, and now much is known, including the effect of this disease on the psyche. Scientists publish articles in scientific journals, and practitioners try to verify this data with their own clinical experience. And they come to personal, exclusive discoveries.
Renat Shaydullin, a psychiatrist, head of the department of psychiatry and psychotherapy at the Clinic of Doctor Isaev, director of the Double Diagnosis rehabilitation center.
Photo: EPA
— I noticed that among my patients who were forced to seek help from me for the first time as a psychiatrist, there are many people who have had a covid infection. The leading complex of complaints in these patients is the largest group — disorders of the affective sphere: people either stop sleeping altogether, or sleep little, or superficial sleep, with frequent awakenings.
— Is it the influence of covid or fears that arose during the period of illness?
Renat Shaydullin. Photo from personal archive
— Fears, even if they were so pronounced, should have had time to dissipate, because most often, mental problems in people arose at a time when the covid was already receding or they had already recovered, that is, they already had a test for the presence of the virus negative. But this manifestation was formed — persistent insomnia, sleep disturbances: they either had nightmares and woke up in a state of horror, or they slept in short intervals, jumping many times a night.
Based on my own practice, I can conclude that almost 40 or even 50 percent of patients who first see me as a psychiatrist have suffered a covid infection. They debut mental disorders that do not go away without the help of a specialist. They continue to suffer from this not only in the first months of the illness, but sometimes even six months after the transferred covid.
— Is sleep disturbance already a reason for visiting a psychiatrist?
— Of course, this is the first «red flag»: you urgently need to seek help, because the more time passes from the onset of the disease, the more difficult and longer is the treatment. With timely treatment, treatment may well manage on an outpatient basis, but if it is delayed, then, as a rule, a person cannot escape the hospital.
There is another group of postcoid disorders, and it, like insomnia, exists in the affective sphere. These are depression or prolonged asthenization — depletion of the nervous system:
a person becomes weak, lethargic, apathetic, passive, he ceases to be interested in anything, his mood is low, he is crying, thoughts slowly flow, in order to formulate them, he spends a lot of time and does everything through force. He becomes so maladjusted that there is a violation of social functions: it is difficult for him to go to work, he quits it. And if he studied, he cannot continue his studies. It lasts a month, or two, and sometimes even longer.
I have also come across such post-like manifestations as panic attacks: fear of death, hypochondriacal feelings. It is important to note here that this began in my patients for the first time in their lives and precisely after the infection. With a panic attack — and this is a pronounced state of fear — all organs suffer: the heart and lungs work worse, profuse sweating begins, tremors of the hands, there is a feeling of lack of air, and tachycardia sets in.
These are all the leading symptoms, complexes of the influence of covid on the mood sphere. But in our clinical practice, we often encounter the so-called postcoid psychoses. Fortunately, this group is less numerous. A person suffered from covid and after a couple of days, or maybe a week later, he has psychomotor agitation, paranoid delusions, and auditory pseudohallucinosis. The picture is very similar and almost identical in terms of the disorder to psychosis, which is suffered by patients with schizophrenia. But the way out is more favorable: as soon as we remove psychotic manifestations, the patient returns to a painful state.
We also often encounter such patients, although they mostly end up in the city psychiatric hospitals named after Gannushkin or Alekseev, in the clinics of the first episode.
— Why is this all happening?
— Remember what the primary complaint of a patient with covid is a loss of smell or taste, or a person experiences unpleasant odors that are not present in principle. This is a lesion in the frontal lobes of the brain, because the center responsible for breathing is located there. The fact is that the SARS-CoV-2 virus recognized as neurotoxic, this is confirmed in conversations by many of my colleagues and my teachers with professorships. He enters the brain, overcoming various levels of the blood-brain barrier of the central nervous system. That is, in other words, our brain is located in a certain capsule, which creates a barrier between the circulatory system and the central nervous system. The barrier, like a filter, does not allow microorganisms circulating in the blood to enter the nervous tissue, toxins — everything that can damage the brain. This, by the way, complicates the treatment of many diseases of the central nervous system, since it also blocks a number of drugs. But the SARS-CoV-2 virus, due to its similarity with the cells of the nervous system, overcomes the barrier. The body does not recognize it as something foreign.
Photo: RIA Novosti
— You said that 40 or even 50 percent of people are forced to visit a psychiatrist for the first time in their life precisely because of the condition associated with the transferred covid. The profile of the clinic in which you work is associated with the treatment of addictions — alcohol, drug and others. When you talked about mental disorders in the sphere of mood and postcoid psychosis, did you mean people who are addicted?
— No, I was talking about people who have no addictions. Everything was fine with them: they worked, studied, enjoyed life, had some hobbies. But they got infected with covid, and life, even after recovery, seemed to go downhill. Our clinic specializes in two areas: work with addictions and a separate psychiatric direction. I am a psychiatrist, not a narcologist, and I deal more with those people who suffer from mental disorders. At the same time, I take part in work with those patients who have two competing diagnoses: for example, there is depression and alcohol or drug abuse.
It often happens, relieving stress, we drink so much, then more, and then — habit and addiction. A large amount of cortisone is released in the body, which does not go anywhere, but leads a person to binge. Alcohol has a kind of anti-anxiety, soothing effect. But this condition quickly passes and you need to drink again, and again — this is addiction, mental illness.
And I note with concern one more, rather dangerous phenomenon associated with the postcoid state:
if a person who is addicted to alcohol or drugs becomes infected and has been ill, he often develops Korsakov's syndrome. This is severe amnesia
a person does not remember what happened today, yesterday or the day before yesterday, but he perfectly remembers what happened 20 years ago. He believes that now is not 2021, but 2001, for example. His son got married, works, and he claims that his son is only eight years old and he goes to school. There is a loss of orientation in time and space. Speech does not suffer yet, he can tell with whom he worked many years ago, but at the same time, where he is currently working, it is difficult to answer.
In the third stage of alcoholism, Korsakov's syndrome first occurred in people at a later age, with the appearance of covid, the age group becomes younger. A person, perhaps, at the time of illness and did not drink, the last time he drank a few days before, but if he has a predisposition to this disease, covid starts the process very quickly and irreversibly.
These are isolated cases, but they began to appear more often in men up to a maximum of 65 years. People who suffered from Korsakov's syndrome against the background of both covid and alcohol are brought to us from the «red» zone of specialized hospitals. Here is a history teacher, he is 54 years old, I greet him, talk, leave and come back in 10 minutes. He greets me as if he is seeing me for the first time, his memory is erased.
— And is this, in contrast to postform psychosis, really irreversible?
— To what extent it is reversible, I will not say yet, it is clear that a very long treatment is required and the prognosis is vague. But the cases are fresh, so we will treat and observe. If after postcoid psychosis our patients leave without losses, they do not develop emotional coldness, their memory and working capacity are fully restored, then in the case of Korsakov's syndrome everything is much more complicated and hopeless. As a rule, they receive a disability status — this is a disabling disease.
But there is also positive news in my clinical practice. Patients who took certain antidepressants for depression or in connection with panic attacks, if they fell ill with covid, they either had no symptoms or very easily: a couple of days broke down with a subfebrile temperature of 37.2 and no more. I'm talking about people who took antidepressants both in the dock and during the pandemic, and continue to do so.
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— That is, their disease goes away without complications? How do you explain this interesting fact?
— What is an antidepressant itself as such? This is a drug for increasing the body's resistance to stress. What is covid infection? This is stress for the body. An antidepressant helps to keep the levels of serotonin and dopamine in the body in a normal concentration. And when this is the case, the response of our immune system to the invasion of the virus is more powerful and adequate. Of course, these facts must be explained by the joint research work of psychiatrists and immunologists, now this is not a studied area at all. But I talked about these personal work observations with my colleagues and was extremely surprised when I learned from them that Israeli and Italian psychiatrists came to the same conclusions.
— Is there a connection between the severity of the transferred covid and psychiatric disorders? Are these consequences associated with age or gender, with some kind of chronic diseases?
— I'll start my answer with the story of one drug, cipralex. It is an antidepressant, but when he first arrived in Russia for testing, he did not go to psychiatrists, but to the Bakulev Institute of Cardiac Surgery. Why? Because patients who have undergone coronary artery bypass grafting, this drug was indicated on the third day after surgery. It blocks the action of cortisol, the stress hormone and fear. When there is a lot of cortisol, spasm of both coronary vessels and cerebral vessels is caused. Which can lead to either myocardial infarction or ischemic stroke. The medicine blocks cortisol. And also, according to my preliminary data, it blocks covid.
All this is due to hormones that have not yet been fully isolated. We know the main hormones: serotonin, dopamine, adrenaline and others. But there are many more that we still don't know anything about. This is now being done by the young science of neuroendocrinology — it studies our emotions, intellect, and nervous system. The school is new, there are few specialists in Russia, offhand — about ten people, no more. I am engaged in this science and studied in parallel with my main specialty — it was interesting and important for me, because the effect of hormones on the psyche is simply impossible to overestimate.