Even mild COVID-19 is causing new onset of psychiatric disorders in children!

Medical News: Researchers from Shandong University’s Qilu Hospital in China have discovered a potential link between COVID-19 and the onset of psychiatric disorders in children. The study, conducted by a team of pediatric neurologists, raises awareness about how the SARS-CoV-2 virus may trigger mental health issues in children who experience mild symptoms of the virus. This Medical News report focuses on new findings regarding how COVID-19 impacts the mental well-being of children and offers insights into treatment options and recovery outcomes.


Even mild COVID-19 is causing new onset of psychiatric disorders in children

The Study Overview
The study, conducted from December 2022 to February 2023, involved 11 pediatric patients between 2 and 15 years old who developed new psychiatric symptoms after contracting COVID-19. These children had no history of psychiatric disorders and did not experience severe respiratory or cardiovascular complications from the virus. The study explores the data collected from these cases and reviews similar studies to emphasize the significance of the findings.
 
Key Symptoms in Pediatric Patients
One of the key findings from this research was the variety of psychiatric symptoms that emerged among the children. The symptoms ranged from hallucinations and delusions to more subtle changes, such as anxiety, nervousness, or behavioral abnormalities. Several children exhibited psychotic features, including visual and auditory hallucinations, and some even experienced complete dissociation from their surroundings.
 
For instance, a 2-year-old girl began hearing strange sounds and seeing objects that were not present, which caused her significant fear. In another case, a 13-year-old boy with a mild intellectual disability suddenly lost the ability to take care of himself after just two days of fever. His behavior changed drastically, including becoming highly talkative and developing insomnia.
 
Diagnostic Challenges
The clinical diagnosis process was complex because the brain imaging tests, such as MRI and EEG, showed no remarkable abnormalities. This posed a challenge for researchers, who relied heavily on cerebrospinal fluid (CSF) analysis to explore the immune response in the brain. Out of 10 patients who underwent lumbar puncture, only two showed signs of inflammation in the CSF, indicating an immune response in the brain.
 
The CSF analysis found increased protein, immunoglobulin levels, and elevated interleukin-8 (IL-8) levels in a minority of patients, which suggested disruption of the blood-brain barrier. These findings could potentially explain the development of psychiatric symptoms. Still, most patients had normal CSF results, making it difficult to pinpoint a clear cause for the psychiatric conditions.
 
Treatment and Recovery
Treatment varied among the patients, with some receiving antipsychotic drugs, others immunosuppressive therapy, and a few children needing no treatment at all. Among the p atients, five were treated with a combination of corticosteroids and intravenous immunoglobulin (IVIG), while four others received antipsychotic medications like olanzapine. Despite the different treatments, most patients showed good progress during follow-ups.
 
After one year of follow-up, eight out of the eleven children experienced significant improvement or complete remission of their psychiatric symptoms. However, one child remained with persistent symptoms, and another saw only mild improvements. The variability in recovery underscores the complexity of these psychiatric conditions and how they are influenced by the virus.
 
Broader Context and Similar Studies
To strengthen their findings, the researchers conducted a literature review of 12 other pediatric cases from previous studies. These cases mirrored the experiences of the children in the current study, with patients developing psychiatric symptoms such as obsessive-compulsive disorder, delusions, and hallucinations within three weeks of contracting COVID-19. The reviewed articles also revealed similar diagnostic patterns, where MRI scans showed no abnormalities and immune responses in the CSF varied.
 
In some cases, immune system overactivation appeared to contribute to psychiatric symptoms, with patients testing positive for certain antibodies, such as anti-basal ganglia antibodies. These immune responses suggest that, in some children, the virus might trigger autoimmune reactions that affect the brain.

The Role of Inflammatory Responses
One of the hypotheses proposed by the researchers is that the psychiatric symptoms may result from inflammation in the brain caused by the virus. The increased IL-8 levels found in two patients’ CSF point toward a potential inflammatory response within the central nervous system. IL-8 is a cytokine known to be associated with various neurological and psychiatric conditions, such as bipolar disorder and schizophrenia.
 
However, not all patients exhibited elevated IL-8 levels, and many did not show signs of systemic inflammation, suggesting that other factors could also play a role. The researchers also highlighted that disruption of the blood-brain barrier might contribute to psychiatric symptoms, as seen in patients with increased protein levels and positive oligoclonal bands in their CSF.
 
Implications for the Future
The findings of this study raise important questions about how COVID-19 might be affecting children’s mental health, even in cases where the infection itself appears mild. Given that psychiatric symptoms emerged within two weeks of the infection in most patients, it is clear that parents and healthcare providers need to be vigilant about monitoring children’s mental health after they recover from COVID-19.
 
The results also suggest that more research is needed to explore the mechanisms behind COVID-19-induced psychiatric symptoms, especially in children. The fact that brain scans and other tests often do not reveal abnormalities complicates diagnosis, making it harder to predict which children might be at risk.
 
Conclusion
This research presents a compelling case for the potential link between COVID-19 and the onset of psychiatric disorders in children. While most of the patients involved in this study recovered with the help of treatments like corticosteroids, immunoglobulin, and antipsychotics, there remain many unanswered questions about how and why these psychiatric symptoms develop.
 
It is crucial to continue investigating the role of immune responses, such as elevated IL-8 levels, and how they may disrupt normal brain function in some children. Moreover, as more cases emerge, a clearer picture may develop, allowing healthcare professionals to better identify and treat these conditions early on.
 
The study findings were published in the peer-reviewed journal: Frontiers in Neurology.
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1445903/full
 
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