Chesney, E

David, AS

Fusar-Poli, P

Lewis, G

McGuire, P

Oliver, D

Pollak, TA

Rogers, JP

Zandi, MS

English

UCL Discovery

  Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website.  Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.  Correspondence664 www.thelancet.com/psychiatry   Vol 7   August 2020                                                                                                                                                Authors’ replyWe are grateful for the letters received regarding our Article,1 which high-light the interest in this field and raise relevant clinical hypotheses. These letters illustrate a funda-mental question: does infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lead to psychiatric and neuropsychiatric morbidity merely because COVID-19 is a severe illness or because of specific factors related to this infection?There are numerous—but still comparatively rare—examples of specific neuropsychiatric presen-tations of COVID-19 being collated in an online blog for the Journal of Neurology, Neurosurgery & Psychiatry.2 Yi-Min Wan and colleagues are correct that anosmia requires more Correspondencewww.thelancet.com/psychiatry   Vol 7   August 2020 665                                                   Michael S Zandi, Glyn Lewis, Anthony S Davidjonathan.rogers@ucl.ac.ukDivision of Psychiatry, University College London, London W1T 7NF, UK (JPR, GL); South London and Maudsley NHS Foundation Trust, London, UK (JPR, EC, TAP); Department of Psychosis Studies, King’s College London, London, UK (EC, DO, TAP, PM, PF-P); Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy (PF-P); UCL Queen Square Institute of Neurology, University College London, London, UK (MSZ); University College London Hospitals NHS Foundation Trust, London, UK (MSZ); and UCL Institute of Mental Health, University College London, London, UK (ASD)1 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. Lancet Psychiatry 2020; 7: 611–27.2 Butler M, Watson C, Rooney A, et al. BMJ blog: the neurology and neuropsychiatry of COVID-19. 2020. https://blogs.bmj.com/jnnp/2020/05/01/the-neurology-and-neuropsychiatry-of-covid-19/ (accessed July 2, 2020).3 Salazar de Pablo G, Serrano JV, Catalan A, et al. Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis. J Affect Disord 2020; published online June 25. DOI:10.1016/j.jad.2020.06.022.4 Solomon IH, Normandin E, Bhattacharyya S, et al. Neuropathological features of Covid-19. N Engl J Med 2020; published online June 12. DOI:10.1056/NEJMc2019373.5 Wessely S. The role of screening in the prevention of psychological disorders arising after major trauma: pros and cons. In: Ursano RJ, Fullerton CS, Norwood AE, eds. Terrorism and disaster: individual and community mental health interventions. Cambridge: Cambridge University Press, 2003: 121–45.6 Rose S, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2002; 2: CD000560.attention, as do stroke and other neurological conditions. Current literature has not often systematically assessed anosmia,3 and pathological studies have been unable to elucidate whether this symptom is due to direct infection or secondary to mucosal involvement.4Vijay Pattni and colleagues correctly observe that the frequency of post-traumatic stress disorder (PTSD) following admission to an intensive treatment unit is high, regardless of the illness. However, it is also probable that factors specific to the current pandemic are relevant, such as extreme social isolation, staff wearing full personal protective equipment, health-care professionals working outside their primary area of expertise, treatment with corticosteroids, and use of second-line agents for sedation. Current naturalistic studies struggle to disentangle these issues.Any recommendations should be proportionate and evidence-based. Pattni and colleagues suggest screening to identify patients at risk of developing PTSD, but we should exercise caution,5 since outcomes could be variable and targeting individuals who have yet to develop a psychiatric disorder could have unintended consequences.6Before implementing novel interventions, further research is required to identify an evidence base and subsequently establish clinical guidelines for minimising psychological harm after infection with SARS-CoV-2. Equally important, as suggested by Latha Velayudhan and colleagues, is implementation of existing evidence, such as appropriate management of delirium, which is likely to be seen frequently.JPR and EC contributed equally to this work. MSZ reports receiving personal fees from UCB Pharma for lecturing, outside the submitted work. PF-P reports personal fees from Lundbeck, outside the submitted work. All other authors declare no competing interests.*Jonathan P Rogers, Edward Chesney, Dominic Oliver, Thomas A Pollak, Philip McGuire, Paolo Fusar-Poli, 

Psychiatric and neuropsychiatric syndromes and COVID-19 - Authors' reply

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Psychiatric and neuropsychiatric syndromes and COVID-19 - Authors' reply

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