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Neuropsychology

Long COVID symptoms ‘can last at least 12 months’

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People experiencing Long COVID may have symptoms for at least 12 months after the initial COVID-19 infection, a new study has revealed. 

As a result, those living with Long COVID are being significantly and negatively impacted in terms of their cognition, ability to work, participation in physical activity, interaction with others, and overall quality of life for a greater period than many initially anticipated. 

The Mount Sinai study is one of the first to measure the actual impairment and impact of Long COVID, or Post-Acute COVID Syndrome (PACS), on patients, and detail factors that may exacerbate their symptoms. 

This work will help guide lawmakers and national and international health agencies to develop strategies and policies to support these patients during their lengthy recovery.

Its results must help shape policy around dealing with the “longer-term public health emergency” of Long COVID, the research team said. 

“It is imperative to understand the burden of this novel condition and develop targeted interventions to help patients participate in daily activities, as well as policies that will assist them with their disability and employment status,” says senior author Dr David Putrino, director of rehabilitation innovation for the Mount Sinai Health System. 

“This study is a concerning reminder of how severely debilitating PACS symptoms are, the toll they take on health and wellness, and the fact that, without active treatment, these symptoms appear to persist indefinitely.”

A team of researchers did a retrospective, observational study of 156 patients treated at Mount Sinai’s Center for Post-COVID Care between March 2020 and March 2021. 

The patients had previously had COVID-19 and had not yet been vaccinated at the time of the study. 

Patients filled out surveys on persistent symptoms and triggers of symptom exacerbation a median of 351 days from their first day of infection – patients received surveys after scheduling their first appointment and timestamped once submitted. 

They were asked detailed questions about fatigue, breathlessness, ability to complete moderate and vigorous intensity physical activity, cognitive function, health-related quality of life, anxiety, depression, disability, and their pre- and post-COVID-19 employment status.

The most common reported symptoms were fatigue (82 per cent of patients), followed by brain fog (67 per cent), headache (60 per cent), sleep disturbance (59 per cent), and dizziness (54 per cent). 

Researchers performed a more detailed evaluation of the severity of self-reported cognitive impairment and discovered that more than 60 per cent of PACS patients had some level of cognitive impairment (either mild, moderate or severe), with symptoms including diminished short-term memory, difficulty remembering names, and issues with decision-making and daily planning.

In total, 135 patients answered questions about their employment pre- and post-COVID-19, and the number of patients in full-time work (102) went down to 55.

Going further, the study noted factors that the patients said made their PACS symptoms worse. 

The biggest trigger was physical exertion (reported by 86 per cent of patients), followed by stress (69 per cent), dehydration (49 per cent), and weather changes (37 per cent).

“Many of the symptoms reported in this study have been measured, but for many this is the first time they have been objectively documented using well-validated patient-reported outcomes, and linked to changes in activities of daily living and quality of life,” explains Dr Putrino. 

“The long duration of these symptoms remind us that this is a problem that is not going away, and that we need to aggressively pursue policies that will better support and protect these patients in the long-term. 

“Future research should focus on more detailed monitoring of PACS symptoms—better understanding how and why they are happening will be crucial in developing targeted treatments.”

Neuropsychology

Sport and exercise ‘have key role in mental health and wellbeing’

The Moving for Mental Health report highlights the role of physical activity in supporting mental resilience and recovery

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Physical activity and sport can play a key role in supporting mental health and wellbeing and helping people to recover from the ongoing impact of the COVID-19 pandemic, a new report has concluded. 

The Moving for Mental Health report includes better training for health professionals to prescribe movement as a means of effectively tackling the vast growth in people experiencing mental health issues. 

Produced following the onset of the pandemic, the report sets out evidence that developing a healthy relationship with physical activity and being involved in linked programmatic interventions and social networks is beneficial, can improve people’s mental health and wellbeing, and help tackle social isolation.

The project, by the Sport for Development Coalition and Mind, highlights how COVID-19 has exposed the weaknesses of single-sector responses to addressing complex mental health problems and tackling growing health inequalities. 

The report recommends physical activity and community sport be further embedded in health policy and integrated care systems while calling for an enhanced role for experts by experience and diverse communities leading in the design, implementation and evaluation of future strategy and programming.

Launched at an online meeting of the All-Party Parliamentary Group for Sport, it is also designed to support and inspire public bodies, funders, commissioners and policy-makers as well as community-based programme providers aiming to enhance the impact of movement for mental health.

Paul Farmer, chief executive of Mind, said: “While Mind’s research suggests that half of adults and young people have relied on physical activity to cope during the pandemic, we also know that physical activity levels for people with long-term health conditions, including mental health problems, have declined. 

“Considering how vital physical activity is for many people’s mental health, it is clear that we need a collective effort to reach those who need support the most.”

Andy Reed, chair of the Sport for Development Coalition, said: “This report is aimed at supporting and informing policy-makers about how we can maximise the contribution of targeted sport and physical activity-based interventions at this crucial time.”

The research was led by a team of academic researchers from Edge Hill University and Loughborough University, and draws on evidence and submissions from over 70 organisations including sport and mental health organisations, public bodies and Government departments.

Andy Smith, professor of sport and physical activity at Edge Hill University, said: “The impact of Covid-19 on people’s mental health and wellbeing cannot be overstated. 

“It has brought to light the significant mental health inequalities which existed prior to COVID-19, but which have since worsened further, especially among those living in under-served and low-income communities. 

“Our research is calling on the Government and other public bodies to invest in the provision of movement opportunities for mental health across multiple policy sectors, and to use the evidence presented as a basis for making more effective policy decisions which benefit everyone’s mental health and which tackle deep-seated inequalities.”

Moving for Mental Health is the first policy report in a series being published throughout 2022 by the Coalition and relevant partners. The reports are aimed at maximising the contribution of targeted sport-based interventions to helping ‘level up’ communities facing disadvantage and deprivation and tackling deep-seated health and societal inequalities which have been exacerbated by COVID-19.

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Neuropsychology

Fewer psychiatric beds linked to rise in prison numbers

While bed provision dropped by 93 per cent, the prison population grew by over 200 per cent, new research has found

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A 90 per cent decrease in the number of NHS psychiatric beds is linked to a trebling of the total prison population, new research has revealed.

The study found that between 1960 and 2019 the number of psychiatric beds reduced by 93 per cent. And over time, the prison population increased by 208 per cent, and the number of female prisoners more than quadrupled.

The research, from Newcastle University, is the first to analyse almost 60 years of annual data on NHS bed numbers and the prison population in England using time lag analysis.

Experts say the NHS needs to better integrate health services, social care, housing and employment support to break the link between community care and rising rates of imprisonment.

Dr Patrick Keown, honorary clinical senior lecturer at Newcastle University, said: “Our study shows that as the number of psychiatric NHS beds available was reduced, then in subsequent years we saw a growth in the size of the prison population.

“We show that cuts in the number of psychiatric beds is associated with more prisoners ten years later, and this was true for the whole period of 1960 to 2019. 

“For every 100 psychiatric beds that were closed, there were 36 more prisoners ten years later – three more female prisoners and 33 more male prisoners.

“These findings show that reductions in psychiatric beds may lead to more people being imprisoned. And this is particularly striking for the female prison population.”

The relationship between NHS psychiatric beds and prison numbers, known as the ‘Penrose hypothesis’, was first proposed in 1939 and subsequently reported in several countries.

This research found the hypothesis held true for the whole period available to study as the number of psychiatric beds fell from 201,275 to 19,389 between 1960 and 2019. Learning disability beds had the largest proportion (98 per cent) of bed closures with a reduction of 56,181. Mental illness beds reduced by 125,706 (87 per cent).

At the same time, the prison population more than trebled from 26,048 to 80,203 (208 per cent). The male prison population increased 204 per cent from 25,182 to 76,495; the female prison population increased 328 per cent from 866 to 3,708.

The research shows that the reasons behind the increase in prison numbers are complex and multi-factorial.

Dr Keown added: “It’s possible that people who would previously have been in hospital are coming into contact with the police and the criminal justice system more frequently when in the community.”

The researchers found that it was also notable that there was a very strong association between reductions in beds for people with intellectual disability and the increase in the prison population.

Dr Iain McKinnon, honorary clinical senior lecturer at Newcastle University, said: “We believe that further bed closures, especially secure beds for offenders including those with intellectual and developmental disabilities, and the proposed changes to mental health legislation should be very carefully considered. 

“This is particularly in the light of the potential criminalisation of those with mental health disorders, including mild learning disability or borderline intellectual functioning.”

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Neuropsychology

People with prior mental ill health hit harder by pandemic disruption

Research lays bare impact on jobs and healthcare during the COVID-19 pandemic

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People living with depression or anxiety pre-pandemic have been more severely affected by disruption to jobs and healthcare, a new study has revealed. 

The research found that those with higher levels of anxiety and depression symptoms experienced a much greater likelihood of disruptions to both their professional and personal lives.

The study, which looked at data from 59,482 people, found that this group of people were 24 per cent more likely to have had delays to medical procedures, 12 per cent more likely to lose their job, and 33 per cent more likely to have had disruption to prescriptions or medication during the first eight to 10 months of the pandemic than those with average levels of anxiety and depression symptoms.

Lead author Dr Michael Green, of the University of Glasgow, said: “During the pandemic, many people lost their jobs or lost their income and faced disruptions to healthcare. Our study shows that this disruption was particularly likely to affect people with prior mental ill health.

“We need to ensure that healthcare and support for economic hardship are not overly difficult to access for these vulnerable people, especially as existing pandemic economic supports like furlough are removed.”

Professor Nishi Chaturvedi, of the MRC Unit for Lifelong Health and Ageing at UCL, who co-leads the COVID-19 Longitudinal Health and Wellbeing National Core study, said: “The anxiety and depression experienced by the participants of the study go beyond the mental ill health reported to GPs and healthcare services. 

“This is a largely hidden group of people vulnerable to potentially long-lasting health and socioeconomic consequences of the pandemic.”

Lead author Dr Giorgio Di Gessa, of the UCL Institute of Epidemiology & Healthcare, said: “Policymakers should take these findings into account in the provision of future healthcare and economic support, as failing to address these disruptions risks widening health inequalities further. 

“Special care should be taken by pharmacists and primary care staff to ensure people with mental health difficulties do not miss appointments, procedures and prescriptions.

“It is also important to note that pre-pandemic psychological distress was generally more common among women, younger generations, ethnic minorities, and those with fewer qualifications, meaning the overall impact of disruption on these groups is larger.”

The work was conducted as part of the COVID-19 Longitudinal Health and Wellbeing National Core study, led by UCL researchers and funded by UKRI. The study involved researchers at UCL, King’s College London, the University of Glasgow, the University of Leicester, the University of Edinburgh, and the University of Bristol.

In each of the longitudinal studies, respondents answered questionnaires designed to assess mental health about three years before the pandemic on average. They later reported the disruptions they experienced between March and December last year.

The researchers compared disruptions faced by people whose responses showed “average” levels of anxiety and depression to disruptions affecting people with more anxiety and depression than average, regardless of whether they had a clinical diagnosis or were seeking treatment for a mental illness.

The research team looked at the disruptions of the pandemic in three areas: healthcare (medication access, procedures or surgeries, and appointments); economic activity (employment, income, or working hours); and housing (change of address or household composition). 

They found that people with prior mental ill health were more likely to face economic and healthcare disruption, but had no greater likelihood of housing disruption.

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