Examining the Mental Health Impact: Investigating the Association between Suicide and Long Covid Syndrome

Since its emergence in late 2019, Covid-19 has had many devastating economic, social, mental, and physical health consequences and caused millions of deaths worldwide over the course of the pandemic. While most cases are mild and symptoms resolve within a couple of weeks, some Covid patients\u27 symptoms can last for multiple weeks, months, or even years after contracting the virus, and these long-lasting symptoms have been identified as Long-Covid. Psychiatric symptoms have been associated with Long-Covid in addition to physical symptoms, and impaired cognitive functioning, sleep abnormalities, depression, anxiety, PTSD, and psychosis have been observed in Long-Covid patients. Given the ties between suicide and mental health, particularly during the Covid-19 pandemic, suicide should be a concern for patients with Long-Covid; however, there are limited studies focused on this issue. This review aims to elucidate the connection between Long-Covid and suicide risk and provide a helpful resource to providers treating Long-Covid patients

Mortality and Comorbidities Associated with COVID-19 Infection in Psychiatric Patients from a State Hospital

Introduction: Coronavirus (COVID-19) infection has spread globally and resulted in more than one million deaths in the US as of July 2023, where it has been more severe in psychiatric wards. State hospitals are a particularly transmissible location for COVID-19, and the medications that psychiatric patients typically utilize may contribute to the incidence of comorbidities including obesity, hypertension, and diabetes. Studies have found that patients with preexisting mental health disorders and comorbidities tend to have worse COVID-19 outcomes. Thus, we examine the mortality and comorbidity rate of patients, and discuss how psychiatric medications may contribute to the risk of COVID-19 outcomes for psychiatric patients in a state hospital. Methods: We performed a retrospective study on 24 patients in a psychiatric state hospital who are above 18 years old, tested positive for COVID-19, and experienced symptoms severe enough to be admitted to a community hospital between April 1, 2020, to June 30, 2022. Patients with multiple COVID-19 admissions to the hospital during this period were excluded if the period between admissions was less than two weeks. Results: The patients had an average (IQR) age of 57.75 (48-64) and 2.12 (2-3) comorbidities. The most common psychiatric disorders were schizoaffective disorder (70.8%), schizophrenia (29.2%), and delirium (29.2%). For comorbidities, patients most commonly presented with hypertension (54.2%), chronic kidney disease (41.2%), diabetes (33.3%), and obesity (33.3%) upon admission. The most common psychiatric medications during admission for COVID-19 were antipsychotics (83.3%), mood stabilizers (54.2%), and antidepressants (54.2%). Conclusion: Though our study is qualitative in nature, it is meant to shed light on conditions that may precipitate the worsening of COVID-19 infection in hospitalized psychiatric patients. We recommend additional studies in order to have a comprehensive understanding of the extent to which psychiatric medications result in worse COVID-19 outcomes due to comorbidities

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Neuropsychiatric Manifestations of Arteriovenous Malformation: A Case of Acute Mania.

Current literature shows very few case reports about manic symptoms arising in patients with arteriovenous malformations and no other predisposing factors, where these cases presented with mania before the initiation of treatment. We report a rare case of a 46-year-old male patient, with a history of a left arteriovenous malformation (AVM) status post radiation treatment with associated seizures, who presented to the emergency department of a local hospital with acute mania and other behavioral changes. The patient had manic symptoms, including mood lability, impulsivity, insomnia, decreased appetite, jealous delusions, pressured speech, and suicidal ideations. The patient\u27s escitalopram dose for depression was reduced from 20 mg to 10 mg, and valproate was started during admission. After a three-day hospital admission, his psychiatric symptoms gradually improved. He was subsequently discharged home with additional instructions to follow up with his neurologist. In this case report, we show that organic manic disorder should be considered in any manic patient who presents outside the usual age of onset for idiopathic manic-depressive disease, lacks a family or personal history of affective disturbance, or exhibits concomitant neurologic deficits. In addition, we emphasize that distinguishing between primary psychiatric conditions and those secondary to medical causes for patients who present with acute mania can significantly impact the care a patient receives and can make a difference in their psychiatric and medical prognosis

Understanding the Complexity of Early-Onset Dementia.

Dementia, particularly Alzheimer\u27s disease, affects millions globally, with its prevalence increasing notably with age. Early-onset Alzheimer\u27s disease, however, affects individuals under 65 years old. Unfortunately, diagnosing dementia in patients under 65 years old is quite challenging and is often delayed, missed, or wrong. Thus, we present the case of a 60-year-old female, with a medical history of hypothyroidism and presumed dementia on donepezil, who presented to the emergency department for agitation, dramatic change in personality and behavior, as well as cognitive decline that started in her late 50s. We discuss the importance of performing a thorough history and physical examination, as well as a comprehensive workup for patients who present with dramatic changes in behavior due to the wide range of potential diagnoses. While certain reversible causes, such as hypothyroidism, nutritional deficiencies, and polypharmacy, can be promptly identified and treated, chronic neurocognitive disorders such as Alzheimer\u27s disease demand a timely evaluation for early multidisciplinary treatment to enhance patient outcomes