Mohammad Salim HOSSAIN, Sworadip CHOWDHURY, Hoimonti DEBI, Mohammad Tohidul AMIN, Sujan BANIK, Fahad HUSSAIN

Association between COVID-19 and psychological disorders with possible mechanisms

The current coronavirus pandemic is one of the most wrecking occasions in ongoing history, and it has an impact on mental health, especially in sleep disorder and anxiety. This review aimed to find an association between COVID-19 and psychological disorders like sleep disorder and anxiety by exploring its influential factors. COVID-19 patient has greater susceptibility to having anxiety and sleep disorder-related complications including post-traumatic stress disorder, obsessive-compulsive disorder (OCD), obstructive sleep apnea by infecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the central nervous system through the olfactory lobe. Although the mechanism of COVID-19 induced sleep disorder and anxiety-related complications have not been reported yet, the investigated data suggested that sleep disorder and anxiety-related complications are arising due to increasing cortisol, norepinephrine levels in the blood and decreasing glucocorticoid receptor signaling. Further examination and clinical studies are critically required to investigate the influential factors of COVID-19 patients' susceptibility to sleep disorder, anxiety for affirming speculation, and better treatment.

PDF

___

[1] Thompson R. Pandemic potential of 2019-nCoV. Lancet Infect Dis. 2020; 20(3): 280.
[2] WHO Director-General’s opening remarks at the media briefing on COVID-19 – 8 January 2021. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-mediabriefing-on-covid-19-8-january-2021 (accessed January 8,2021)
[3] Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, Ng CH. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020; 7(3): 228–229.
[4] Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020; 368: m1211.
[5] Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China. Med Sci Monit. 2020; 26: e923921.
[6] Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw open. 2020; 3(3): e203976.
[7] Sher L. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med. 2020; 70: 124.
[8] Rajeswari S, Sanjeevareddy N. Efficacy of progressive muscle relaxation on pregnancy outcome among anxious indian primi mothers. Iran J Nurs Midwifery Res. 2020; 25(1): 23–30.
[9] Liu S, Yang L, Zhang C, Xiang YT, Liu Z, Hu S, Zhang B. Online mental health services in China during the COVID19 outbreak. Lancet Psychiatry. 2020; 7(4): e17–e18.
[10] Wang W, Song W, Xia Z, He Y, Tang L, Hou J, Lei S. Sleep Disturbance and Psychological Profiles of Medical Staff and Non-Medical Staff During the Early Outbreak of COVID-19 in Hubei Province, China. Front Psychiatry. 2020; 11: 733.
[11] Zheng R, Zhou Y, Qiu M, Yan Y, Yue J, Yu L, Lei X, Tu D, Hu Y. Prevalence and associated factors of depression, anxiety, and stress among Hubei pediatric nurses during COVID-19 pandemic. Compr Psychiatry. 2021; 104: 152217.
[12] Tan T, Khoo B, Mills EG, Phylactou M, Patel B, Eng PC, et al. Association between high serum total cortisol concentrations and mortality from COVID-19. Lancet Diabetes Endocrinol; 2020; 8(8): 659-660.
[13] Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med . 2020; 382(12): 1177–1179.
[14] Miller AJ, Arnold AC. The renin–angiotensin system in cardiovascular autonomic control: recent developments and clinical implications. Clin Auton Res. 2019; 29(2): 231-243.
[15] Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh C-L, Abiona O, et al. Cryo-EM Structure of the 2019-nCoV Spike in the Prefusion Conformation. Science. 2020; 367(6483): 1260–1263.
[16] Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, HostVirus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem Neurosci. 2020; 11(7): 995–998.
[17] Soria V, González-Rodríguez A, Huerta-Ramos E, Usall J, Cobo J, Bioque M, et al. Targeting hypothalamic-pituitaryadrenal axis hormones and sex steroids for improving cognition in major mood disorders and schizophrenia: a systematic review and narrative synthesis. Psychoneuroendocrinology. 2018; 93: 8–19.
[18] Téblick A, Peeters B, Langouche L, Van den Berghe G. Adrenal function and dysfunction in critically ill patients. Nat Rev Endocrinol. 2019; 15(7): 417–427.
[19] Khoo B, Boshier PR, Freethy A, Tharakan G, Saeed S, Hill N, et al. Redefining the stress cortisol response to surgery. Clin Endocrinol. 2017; 87(5): 451–458.
[20] Ng Kee Kwong KC, Mehta PR, Shukla G, Mehta AR. COVID-19, SARS and MERS: A neurological perspective. J Clin Neurosci. 2020; 77: 13–16.
[21] Fries GR, Gassen NC, Rein T. The FKBP51 glucocorticoid receptor co-chaperone: Regulation, function, and implications in health and disease. Int J Mol Sci. 2017; 18(12): 2614.
[22] Rein T. FK506 binding protein 51 integrates pathways of adaptation: FKBP51 shapes the reactivity to environmental change. Bioessays. 2018; 38(9): 894–902.
[23] Grad I, Picard D. The glucocorticoid responses are shaped by molecular chaperones. Mol Cell Endocrinol; 2007; 275(1- 2): 2–12.
[24] Nair SC, Rimerman RA, Toran EJ, Chen S, Prapapanich V, Butts RN, et al. Molecular cloning of human FKBP51 and comparisons of immunophilin interactions with Hsp90 and progesterone receptor. Mol Cell Biol. 1997; 17(2): 594– 603.
[25] Wochnik GM, Rüegg J, Abel GA, Schmidt U, Holsboer F, Rein T. FK506-binding proteins 51 and 52 differentially regulate dynein interaction and nuclear translocation of the glucocorticoid receptor in mammalian cells. J Biol Chem. 2005; 280(6): 4609–4616.
[26] Zhang X, Clark AF, Yorio T. FK506-binding protein 51 regulates nuclear transport of the glucocorticoid receptor β and glucocorticoid responsiveness. Investig Ophthalmol Vis Sci. 2008; 49(3): 1037–1047.
[27] Pariante CM, Miller AH. Glucocorticoid receptors in major depression: Relevance to pathophysiology and treatment. Biol Psychiatry. 2001; 49(5): 391–404.
[28] Isaksson J, Comasco E, Åslund C, Rehn M, Tuvblad C, Andershed H, et al. Associations between the FKBP5 haplotype, exposure to violence and anxiety in females. Psychoneuroendocrinology. 2016; 72: 196–204.
[29] Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77(6): 683–690.
[30] Asadi-Pooya AA, Simani L. Central nervous system manifestations of COVID-19: A systematic review. J Neurol Sci. 2020; 413: 116832.
[31] Moro E, Priori A, Beghi E, Helbok R, Campiglio L, Bassetti CL, et al. The international European Academy of Neurology survey on neurological symptoms in patients with COVID-19 infection. Eur J Neurol. 2020; 27(9): 1727– 1737.
[32] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229): 1054–1062.
[33] Pinto JA, Ribeiro DK, Da Silva Cavallini AF, Duarte C, Freitas GS. Comorbidities associated with obstructive sleep apnea: A retrospective study. Int Arch Otorhinolaryngol. 2016; 20(2): 145–150.
[34] Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223): 507–513.
[35] Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004; 203(2): 631–637.
[36] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497–506.
[37] Cowley TJ, Weiss SR. Murine coronavirus neuropathogenesis: Determinants of virulence. J Neurovirol. 2010; 16(6): 427–434.
[38] Futch HS, Croft CL, Truong VQ, Krause EG, Golde TE. Targeting psychologic stress signaling pathways in Alzheimer’s disease. Mol Neurodegener. 2017; 12(1): 49.
[39] Sanders J, Nemeroff C. The CRF System as a Therapeutic Target for Neuropsychiatric Disorders. Trends Pharmacl Sci. 2016; 37(12): 1045–1054.
[40] Gunnar M, Quevedo K. The neurobiology of stress and development. Annu Rev Psychol . 2007; 58: 145–173.
[41] Arborelius L, Owens MJ, Plotsky PM, Nemeroff CB. The role of corticotropin-releasing factor in depression and anxiety disorders.J Endocrinol; 1999; 160(1): 1–12.
[42] Radley JJ, Williams B, Sawchenko PE. Noradrenergic innervation of the dorsal medial prefrontal cortex modulates hypothalamo-pituitary-adrenal responses to acute emotional stress. J Neurosci. 2008; 28(22): 5806–5816.
[43] Buckley TM, Schatzberg AF. On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: Normal HPA axis activity and circadian rhythm, exemplary sleep disorders. J Clin Endocrinol Metab. 2005; 90(5): 3106–3114.
[44] Dhabhar FS. Effects of stress on immune function: The good, the bad, and the beautiful. Immunol Res. 2014; 58(2-3): 193–210.
[45] Bryant PA, Trinder J, Curtis N. Sick and tired: Does sleep have a vital role in the immune system?. Nat Rev Immunol. 2004; 4(6): 457–467.
[46] Shearer WT, Reuben JM, Mullington JM, Price NJ, Lee BN, O’brian Smith E, et al. Soluble TNF-α receptor 1 and IL-6 plasma levels in humans subjected to the sleep deprivation model of spaceflight. J Allergy Clin Immunol. 2001; 107(1): 165–170.
[47] Lange T, Dimitrov S, Born J. Effects of sleep and circadian rhythm on the human immune system. Ann N Y Acad Sci. 2010; 1193: 48–59.
[48] Tan H-L, Kheirandish-Gozal L, Gozal D. Sleep, Sleep Disorders, and Immune Function. In: Fishbein A, Sheldon S. (Eds). Allergy and Sleep. Springer, Cham. 2019, pp. 3–15.
[49] Palmblad J, Cantell K, Strander H, Fröberg J, Karlsson CG, Levi L, et al. Stressor exposure and immunological response in man: Interferon-producing capacity and phagocytosis. J Psychosom Res. 1976; 20(3): 193–199.
[50] Said EA, Al-Abri MA, Al-Saidi I, Al-Balushi MS, Al-Busaidi JZ, Al-Reesi I, et al. Sleep deprivation alters neutrophil functions and levels of Th1-related chemokines and CD4+ T cells in the blood. Sleep Breath. 2019; 23(4): 1331–1339.
[51] Spiegel K. Effect of Sleep Deprivation on Response to Immunizaton. J Am Med Assoc. 2002; 288(12): 1471-1472.
[52] Lange T, Perras B, Fehm HL, Born J. Sleep enhances the human antibody response to hepatitis A vaccination. Psychosom Med. 2003; 65(5): 831–835.
[53] Everson CA. Sustained sleep deprivation impairs host defense. Am J Physiol. 1993; 65(5 Pt 2): R1148-R1154.
[54] Ramanathan L, Gulyani S, Nienhuis R, Siegel JM. Sleep deprivation decreases superoxide dismutase activity in rat hippocampus and brainstem. Neuroreport. 2002; 13(11): 1387–1390.
[55] Teixeira KRC, dos Santos CP, de Medeiros LA, Mendes JA, Cunha TM, De Angelis K, et al. Night workers have lower levels of antioxidant defenses and higher levels of oxidative stress damage when compared to day workers. Sci Rep. 2019; 9(1): 4455.
[56] Hajak G, Rodenbeck A, Staedt J, Bandelow B, Huether G, Rüther E. Nocturnal plasma melatonin levels in patients suffering from chronic primary insomnia. J Pineal Res. 1995; 19(3): 116–122.
[57] McGiffin JN, Galatzer-Levy IR, Bonanno GA. Is the intensive care unit traumatic? What we know and don’t know about the intensive care unit and post-traumatic stress responses. Rehabil Psychol. 2016; 61(2): 120–131.
[58] Bo HX, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al. Post-traumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychol Med. 2021; 51(6): 1052-1053.
[59] Aardema F, Wong SF. Feared possible selves in cognitive-behavioral theory: An analysis of its historical and empirical context, and introduction of a working model. J Obsess-compuls Rel. 2020; 24: 100479.
[60] Di Fusco SA, Pignalberi C, Santini L, Colivicchi F, Santini M. Arrhythmias and sleep apnea: physiopathologic link and clinical implications. J Interv Card Electrophysiol. 2020; 57(3): 387–397.
[61] Wu CI, Postema PG, Arbelo E, Behr ER, Bezzina CR, Napolitano C, et al. SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes. Hear Rhythm. 2020; 17(9): 1456–1462.
[62] Khawam E, Khouli H, Pozuelo L. Treating acute anxiety in patients with COVID-19. Cleve Clin J Med. 2020.
[63] Duarte RLM, Magalhães-Da-silveira FJ, Oliveira-E-sá TS, Silva JA, Mello FCQ, Gozal D. Obstructive sleep apnea screening with a 4-item instrument, named GOAL questionnaire: Development, validation and comparative study with no-apnea, STOP-bang, and NoSAS. Nat Sci Sleep. 2020; 12: 57–67.