Post-COVID Chronic Fatigue Syndrome: New Challenge Ahead

Coronavirus disease 2019 (COVID-19) is a viral infection that causes various respiratory, gastrointestinal, and vascular symptoms. The acute illness phase lasts for about 2-3 weeks. However, there is increasing evidence that a percentage of COVID-19 patients continue to experience long-lasting symptoms characterized by fatigue, dyspnea, myalgia, exercise intolerance, and sleep disturbances, difficulty concentrating, anxiety, fever, headache, malaise, and vertigo. Similar symptoms are reported by patients who having myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). ME/CFS pathology is not known: it is thought to be multifactorial, resulting from the dysregulation of multiple systems in response to a particular trigger. There is a resemblance between post-acute COVID-19 symptoms and ME/CFS. However, at present, there is inadequate evidence to establish COVID-19 as an infectious trigger for ME/CFS. Further research is required to determine the natural history of this condition, as well as to define risk factors, prevalence, and possible interventional strategies. Keywords: chronic fatigue syndrome, COVID-19, human coronavirus, myalgic encephalomyelitis, post-infectious fatigue, review.

Brain correlates of impaired goal management in bipolar mania

Background Although executive impairment has been reported in mania, its brain functional correlates have been relatively little studied. This study examined goal management, believed to be more closely related to executive impairment in daily life than other executive tasks, using a novel functional magnetic resonance imaging (fMRI) paradigm in patients in this illness phase. Methods Twenty-one currently manic patients with bipolar disorder and 30 matched healthy controls were scanned while performing the Computerized Multiple Elements Test (CMET). This requires participants to sequentially play four simple games, with transition between games being made either voluntarily (executive condition) or automatically (control condition). Results CMET performance was impaired in the manic patients compared to the healthy controls. Manic patients failed to increase activation in the lateral frontal, cingulate and inferior parietal cortex when the executive demands of the task increased, while this increase was observed in the healthy controls. Activity in these regions was associated with task performance. Conclusions Manic patients show evidence of impaired goal management, which is associated with a pattern of reduced medial and lateral frontal and parietal activity.

Post-viral mental health sequelae: Systematic review and meta-analysis of prevalence proportions

Background: Mental health problems (MHP) in COVID-19 patients and survivors were anticipated already during early stages of this pandemic. We aimed to synthesize the prevalence of anxiety, depression, post-traumatic and general distress of major virus epidemics since 2002. Methods: In this systematic review and meta-analysis, we searched PubMed, PsycINFO, and Embase from 2002 until April 14, 2021 for peer-reviewed studies reporting prevalence of MHP in adults with laboratory-confirmed or suspected SARS-CoV-1, H1N1, MERS-CoV, H7N9, Ebolavirus, or SARS-CoV-2 infection. We included studies that assessed MHP with well-validated and frequently used scales. A three-level random-effects meta-analysis for dependent sizes was conducted to account for multiple outcome reporting. We pooled MHP jointly and separately for mild or moderate-to-severe severity by acute (one month), ongoing (one to three month), and post-illness phase (longer than three months). A meta-regression was conducted to test for moderating effects. PROSPERO registration: CRD42020194535. Findings: We identified 59 studies providing a total of 187 effect sizes. Range for sample size (n=14-n=1002), females (22-79%), and mean age (32-72 years). MHP prevalence was higher for mild (35.5-46.3%) compared to moderate-to-severe MPH (17.3-22.3). MHP, in general, decreased from acute to post-illness from 46.3% to 38.8% and for mild and moderate-to-severe from 22.3% to 18.8%, respectively. We found no evidence of moderating effects except for non-random sampling and H1N1 showing higher proportions. Interpretation: MHP decreased over time but were still on a substantial level at post-illness. This highlights a need for rapid access to mental health care and rehabilitation planning in affected individuals.

Reward processing electrophysiology in schizophrenia: Effects of age and illness phase

BackgroundReward processing abnormalities may underlie characteristic pleasure and motivational impairments in schizophrenia. Some neural measures of reward processing show strong age-related modulation, highlighting the importance of considering age effects on reward sensitivity. We compared event-related potentials (ERPs) reflecting reward anticipation (stimulus-preceding negativity, SPN) and evaluation (reward positivity, RewP; late-positive potential, LPP) across individuals with schizophrenia (SZ) and healthy controls (HC), with an emphasis on examining effects of chronological age, brain age (i.e., predicted age based on neurobiological measures), and illness phase.MethodsSubjects underwent EEG while completing a slot-machine task for which rewards were not dependent on performance accuracy, speed, or other preparatory demands. Slot-machine task EEG responses were compared between 54 SZ and 54 HC individuals, ages 19 to 65. Reward-related ERPs were analyzed with respect to chronological age, categorically-defined illness phase (early; ESZ versus chronic schizophrenia; CSZ), and were used to model brain age relative to chronological age.ResultsIllness phase-focused analyses indicated there were no group differences in average SPN or RewP amplitudes. However, a group x reward outcome interaction revealed that ESZ differed from HC in later outcome processing, reflected by greater LPP responses following loss versus reward (a reversal of the HC pattern). While brain age estimates did not differ among groups, depressive symptoms in SZ were associated with older brain age estimates while controlling for negative symptoms.ConclusionsESZ and CSZ did not differ from HC in reward anticipation or early outcome processing during a cognitively undemanding reward task, highlighting areas of preserved functioning. However, ESZ showed altered later reward outcome evaluation, pointing to selective reward deficits during the early illness phase of schizophrenia. Further, an association between ERP-derived brain age and depressive symptoms in SZ extends prior findings linking depression with reward-related ERP blunting. Taken together, both illness phase and age may impact reward processing in SZ, and brain aging may offer a promising, novel marker of reward dysfunction that warrants further study.