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Neuropsychology

Neurocognitive assessments to standardise global Long COVID approach

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Neurocognitive and mental health tests have been recommended by an international taskforce to harmonise the assessment of patients with Long COVID. 

The tests and questionnaires can be used internationally and will help to advance global understanding about the impact of the condition on the lives of millions of people worldwide. 

“Because COVID-19 is a new disease and the research deriving from it is new, we need to develop excellent research methods to address questions, such as: how many people have the problem, how long does it last, how many patients fully recover, do these neurocognitive difficulties precipitate dementia in some people?,” says lead author and research fellow in UNSW’s School of Psychology, Dr Lucette Cysique.

“Now we will be able to assess these problems in the best way possible using these expert recommendations.”

Dr Cysique – an expert in HIV neuropsychology and one of the first neuropsychologists to recognise that COVID-19 may lead to neurocognitive complications – last year set up a group made up of members of the NeuroCOVID International Neuropsychological Society special interest group, which is now a taskforce of more than 120 members.

She says the NeuroCOVID International Neuropsychology taskforce recommendations encompass brief, medium, and comprehensive evaluations.

The brief evaluation includes a short screening conducted at a patients’ bedside or by telehealth, and short questionnaire to assess olfaction, taste, and mental health.

At the more comprehensive level, there are options for cognitive computerised assessments, standard neuropsychological tests and objective testing of taste and smell.

There are also mental health recommendations that cover a wide range of pandemic stress impacts and pre-existing psycho-social vulnerabilities.

Dr Cysique and her colleagues trialled the recommended methods in the landmark ADAPT study led by Associate Professor Gail Matthews from the Kirby Institute, who is also Head of Infectious Diseases at St Vincent’s Hospital.

The ADAPT study is following over 150 individuals who have had COVID-19 for up to two years to understand how people recover following their infection.

“A significant proportion of individuals continue to have a variety of symptoms, or long COVID, several months after acute infection,” Professor Matthews says.

Researchers within the study are exploring whether abnormalities in the immune response to COVID-19 are driving this new syndrome.

“When studying a new phenomenon such as Long COVID it is critical that we use a set of well validated globally generalisable measures such as these developed by the NeuroCOVID International Neuropsychology taskforce,” Professor Matthews says.

Dr Cysique says the recommended methods showed up to 23 per cent of study participants had neurocognitive difficulties six months after infection.

She says accurately knowing who is experiencing difficulties is the first step for intervention with Long COVID.

“We know that some people develop a ‘brain fog’ such as difficulties in concentrating and paying attention and this can persist months after infection,” Dr Cysique says.

“In some patients, such difficulties are associated with a feeling of generalised fatigue which can be severe enough that people cannot work as efficiently as they used to.”

She says she hopes that the recommendations will lead to the creation of a large global research database that will produce robust research results to determine what is the frequency of neurocognitive problems in people with Long COVID.

“This will assist in developing an accurate picture of what is the burden of neurocognitive difficulties post COVID,” Dr Cysique says.

“This, in turn, will assist in patients’ management and inform health policies.”

Neuropsychology

Lockdown ‘changed thoughts about the future and other people’

Future planning and considering others both reduced during the first wave in the UK, research finds

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Prolonged social isolation and changes to work opportunities during the first UK lockdown were linked with changes in people’s thought patterns, a new study suggests. 

The first UK lockdown caused huge disruption to people’s social and work lives. As part of the study, researchers analysed people’s thought patterns to see what effect these changes had on their everyday thoughts.

Researchers in the study – the first to document systematic changes in thinking patterns during the COVID-19 pandemic – texted participants at random times during their day over one week, asking them what they had just been thinking about and what they were doing.

They then compared the thought patterns from this dataset to a comparable dataset gathered before the lockdown.

Lead author Brontë McKeown, from the University of York’s Department of Psychology, said: “Normally, people spend a lot of time thinking about other people and planning for the future in their daily lives. We found that both of these thought patterns were disrupted during lockdown.

“We found that future thinking was reduced overall during lockdown, and only seemed to occur at pre-lockdown levels when people were actively engaged in work.

“We know that future thinking is generally associated with positive mental health outcomes so the fact that this type of thinking was reduced in lockdown may help explain some of the negative emotional changes documented during this time.

“People were also alone a lot more during lockdown. And when they were alone, they tended to think about other people less than before lockdown. 

“But on the rare occasions when people were able to interact with others, they thought more about other people than before lockdown.

“These findings suggest that how much we think about other people depends on how much we interact with them: we are social thinkers because we live in a social world. 

“During prolonged periods of physical isolation, we reduce the amount of time we think about others and when we do get to engage in social interaction, that promotes a bigger increase in our social thoughts.”

Dr Giulia Poerio, co-author and lecturer in Psychology at the University of Essex, said: “Anecdotally, people have reported changes in aspects of their mental lives brought about by the pandemic, such as changes in what occupies their thoughts or dreams. 

“Our study is the first to actually document the systematic changes that have occurred in thinking patterns during this unprecedented time.

“Our findings are exciting because they show how important our external environment and social interactions are for shaping what is going on internally and suggest that changing our external world could be one way of changing the (mal)adaptive thought patterns that make up so much of our waking lives.”

As well as changes to social and future thinking, they also found that older adults – aged between 55 and 78 years – experienced more detailed thoughts during their virtual social interactions compared to in-person ones during the lockdown. 

This increase in detailed thoughts for older adults during virtual interactions may be linked to the phenomenon of ‘Zoom fatigue’.

Researchers said the findings highlighted the important role our social and working lives play in shaping what we think, and how we think, as we go about our everyday lives.

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Neuropsychology

Mental health impact of child abuse ‘can last 70 years’

Shocking new research reveals child maltreatment can impact into middle and older age

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The mental health impact of maltreatment of a child can last as long as 70 years, shocking new research has revealed. 

The study highlights the links between childhood trauma and ongoing mental health disorders, which can last into middle and older age adulthood. 

The research, led by the University of Glasgow, looked at data from more than 56,000 participants from the UK Biobank to investigate the link between child maltreatment – including physical, emotional and sexual abuse, as well as neglect – and mental health in later life.

“Our findings indicate that the potential mental health consequences of child maltreatment are apparent for as long as 20 to 70 years after the occurrence, even among individuals with no history of mental disorders in early adulthood,” says Dr Frederick Ho, lead author of the study. 

Researchers found that adults who had experienced three or more maltreatment types in childhood had the highest risk of all mental health conditions – almost twice the risk of the people without maltreatment experience.

The study also found that emotional abuse and neglect had stronger associations with all mental disorders, followed by sexual and physical abuse. 

The association between child maltreatment and all mental disorders was stronger among participants who binge drank or in those who had few social visits.

“Our study supports a range of existing findings that all demonstrate a clear association between child maltreatment and poor mental health outcomes in adulthood,” says Dr Ho. 

“We also show that those who reported binge drinking were more vulnerable to any mental disorders and behavioural syndrome following child maltreatment. 

“This suggests that child maltreatment victims who also have drinking problems represent a particularly vulnerable subgroup for mental illness and should be better supported.”

The study also explored a wide range of factors that might explain the link between child maltreatment and mental health conditions in later life, but could not identify any strong mechanisms.

Dr Ho adds: “As we did not identify strong mediators, prevention of child maltreatment should be prioritised to reduce maltreatment-related mental health burdens.”

The work was funded by Wellcome Trust.

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‘Better psychological support needed for frontline healthcare workers’

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Frontline healthcare workers need a range of ‘flexible’, ‘easily accessible’ and ‘consistent’ psychological support to overcome the significant mental health burden resulting from the COVID-19 pandemic. 

A team of psychiatrists and psychologists, who formed the Covid Trauma Response Working Group, say there needs to be an increase in mental health awareness training for all staff in health and social care settings, supported by more assertive outreach to identify those most in need.

In addition, more sustained funding is needed for psychological support services – not just during crises – and equity of access to support needs to be ensured between different teams, services and localities, across the entire health and social care sector.

Dr Jo Billings, associate professor at UCL Division of Psychiatry, who led the study, said: “In the UK, it has been estimated that 45 to 58 per cent of the frontline health and social care workforce met criteria for clinically significant levels of anxiety, depression and/or PTSD shortly following the first wave of the pandemic.

“This is amongst a workforce already under considerable strain pre-COVID-19, as evidenced by the growing incidence of stress, burnout, depression, drug and alcohol dependence and suicide across all groups of health professionals, worldwide.

“The need to support the mental health of frontline staff during Covid-19 has been recognised, however this pandemic has also highlighted a paucity of research on the mental health needs of frontline health and social care workers, and a lack of evidence-based guidance about what psychosocial support might be most effective in helping them.”

For the in-depth qualitative interview study, 25 frontline staff (17 female, eight male) from a range of professions, services and localities – but who all worked directly with Covid-19 patients – were interviewed between June 1st and July 23rd, 2020.

Health and social care workers were asked to describe their experiences and views about psychosocial support during the pandemic.

Support from psychological services, when available, was largely valued, and those who had accessed them, or knew others who had, spoke positively about them. However, there appeared to be large disparities in what was available and significant barriers to access.

Many described service provision as confusing and poorly communicated, leading to a lack of awareness about services available. It was also described as inflexible with some services only available Monday to Friday in working hours, which did not correspond to the shift patterns that most staff worked during the pandemic. 

Further, many said they were too busy to access support services during the available times.

The interviews revealed there were ‘striking inconsistencies’ in the provision of mental health support across healthcare services, noted by those who moved between locations and specialties. 

There were particular barriers to access for staff who were not employed by the NHS, restricting access to many NHS based services for social care staff and agency staff not on NHS contracts.

Participants also referenced an ongoing reluctance and stigma, summed up by Nathan, a junior doctor: “The problem with healthcare is that mental health is slightly stigmatised in healthcare workers and people don’t want to admit that there is a problem…they stress a culture of resilience and I don’t think anyone wants to be seen as being unable to cope with anything.”

Dr Billings, who is also a consultant clinical psychologist, said: “Significant steps need to be urgently taken to improve the psychological wellbeing and morale of the UK health and social care workforce and to ensure that the services they deliver to the UK population are sustainable, during the COVID-19 pandemic and beyond.

“Resources for support need to be made consistently available, and easily accessible to all staff. 

“However, systemic and cultural barriers to access need to be addressed to ensure that accessing such resources is not inadvertently stigmatising. 

“Access to resources also needs to be equitable, within different teams and localities and across the health and social care workforce.”

Other recommendations put forward by the group included staff having ‘protected time’ during work to access wellbeing and psychological services; staff who are redeployed between teams need additional support; role modelling by senior staff and culture change are needed to increase willingness to talk; and a flexible combination of peer, organisational and professional support, is most likely to be acceptable and effective.

Co-author, Dr Michael Bloomfield, UCL Division of Psychiatry and consultant NHS psychiatrist, added: “The results of this study show that a ‘one-size fits all’ approach to providing support is unlikely to be helpful. Nevertheless, these systems of support need to be coherent, consistently communicated and easily accessible.”

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