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Interaktion von körperlichen Veränderungen und psychischen Störungen bei COVID-19. Ein Scoping Review

Interaction of somatic findings and psychiatric symptoms in COVID-19. A scoping review

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Zusammenfassung

Eine Infektion mit SARS-CoV‑2 kann zu einer Beteiligung des Nervensystems mit neurologischer oder psychiatrischer Symptomatik führen. Entzündungsvorgängen scheint dabei eine wesentlich größere Bedeutung zuzukommen als dem Virus selbst. Der Beitrag versucht aus der vorliegenden Literatur biologische Veränderungen im Kontext einer SARS-CoV‑2 Infektion zu identifizieren, die mit psychiatrischen Symptomen einhergehen können und beschäftigt sich schwerpunktmäßig mit Delir, kognitiven Störungen, Depression, Angst, postraumatischer Belastungsstörung und Psychosen. Neuroinflammation mit Schädigung der kapillaren Endothelzellen des Gehirns und Aktivierung von Mikroglia und Astrozyten und damit Freisetzung von Zytokinen spielen dabei in allen Bereichen eine zentrale Rolle und können zu Schädigungen der grauen und der weißen Substanz und zu Störungen des Hirnmetabolismus und der Konnektivität führen. Derartige neuroimmunologische Vorgänge sind als biologisches Korrelat bei vielen psychischen Erkrankungen, wie affektiven Störungen, Psychosen und dementiellen Erkrankungen, beschrieben. Die Aktivierung der Gliazellen kann lange über die auslösende Noxe hinaus andauern und damit auch zu Spätfolgen der Infektion beitragen.

Summary

An infection with SARS-CoV‑2 can affect the central nervous system, leading to neurological as well as psychiatric symptoms. In this respect, mechanisms of inflammation seem to be of much greater importance than the virus itself. This paper deals with the possible contributions of organic changes to psychiatric symptomatology and deals especially with delirium, cognitive symptoms, depression, anxiety, posttraumatic stress disorder and psychosis. Processes of neuroinflammation with infection of capillary endothelial cells and activation of microglia and astrocytes releasing high amounts of cytokines seem to be of key importance in all kinds of disturbances. They can lead to damage in grey and white matter, impairment of cerebral metabolism and loss of connectivity. Such neuroimmunological processes have been described as a organic basis for many psychiatric disorders, as affective disorders, psychoses and dementia. As the activation of the glia cells can persist for a long time after the offending agent has been cleared, this can contribute to long term sequalae of the infection.

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  1. Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich

    Hans Rittmannsberger, Martin Barth & Peter Malik

  2. Med Campus III, Universitätsklinik für Innere Medizin mit Schwerpunkt Pneumologie, Kepler Universitätsklinikum GmbH, Linz, Österreich

    Bernd Lamprecht

  3. Neuromed Campus, Klinik für Psychiatrie mit Schwerpunkt Suchtmedizin, Kepler Universitätsklinikum GmbH, Linz, Österreich

    Kurosch Yazdi-Zorn

  4. Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich

    Bernd Lamprecht & Kurosch Yazdi-Zorn

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Rittmannsberger, H., Barth, M., Lamprecht, B. et al. Interaktion von körperlichen Veränderungen und psychischen Störungen bei COVID-19. Ein Scoping Review. Neuropsychiatr 38, 1–23 (2024). https://doi.org/10.1007/s40211-023-00487-8

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