Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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Over 100,000 cases of psychiatric disorders reported following COVID vaccination

12/2/21


https://www.dcclothesline.com/2021/12/0 ... ccination/


A newly released report suggests that 75,000 people could die from what is called “deaths of despair” – including suicide and substance abuse – due to the Wuhan coronavirus (COVID-19).

The COVID-19 vaccines seem to exacerbate the problem. More than 100,000 cases of hallucinations, anxiety, sleep disorders, psychosis and suicide following COVID-19 shots have been reported so far.

While the physical symptoms of the virus have been well-reported for months, the psychological and sociological factors associated with it are only starting to ring alarms.

The combination of physical distancing, economic stress, barriers to mental health treatment, pervasive anxiety and a spike in gun sales are creating a perfect storm for suicide mortality.

David Gunnell, professor of epidemiology at the University of Bristol and head of the Bristol Suicide and Self-harm Research Group, said: “Suicide is likely to become a more pressing concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups.”
COVID vaccine’s adverse effects on mental health

A shocking case of vaccine adverse event was documented in a healthy, 20-year-old woman who suffered acute psychosis one week after receiving her Pfizer vaccine.

She had a high blood pressure and a racing heart, so she was admitted to the hospital, where she had a psychotic episode a day later.

Another report in October described the “erratic and bizarre behavior” of a 31-year-old office manager, who was rushed by police to an emergency room.

The man was said to be anxious and claiming to be a clairvoyant, or can communicate with the dead. He also claimed to hear people “drumming outside his house” and a constant voice of a colleague he believed to be his lover, but had no romantic relationship with.

His symptoms began a month earlier as he received his first dose of an mRNA-based COVID-19 vaccine, according to reports. The symptoms gradually got worse until he was admitted to the neurology department of a hospital.

The next day, he was found walking around the unit talking to himself, saying that the EEG machine was communicating with him. He was given antipsychotic medications and his hallucinations subsided two days later.

Another case described a 57-year-old man who was admitted to the psychiatric emergency medical unit after he attempted suicide three days after taking the Pfizer vaccine. He was said to have symptoms of dementia, which began the evening he received the vaccine. He became irritable and began talking to himself as he developed nihilistic delusions.

This mental health phenomenon was also reported in children who have been inoculated with the vaccine. The Vaccine Adverse Event Reporting System (VAERS) showed that a 13-year-old girl developed “extremely elevated anxiety, irrational thoughts and OCD thoughts and behaviors” that started showing after her injection in June.

Another child had tingling sensations in his limbs and electric-like jolts of pain in his brain. He would lay under the blanket for hours, having difficulty sleeping. He was later diagnosed with “autoimmune encephalitis” and now needs a full-time caregiver. (Related: Documents and videos reveal life-threatening adverse effects of COVID-19 vaccines.)

Psychosis and suicide

Meanwhile, a 48-year-old woman took a Pfizer vaccine and experienced a psychotic episode that would have led to suicide on the same day.

“I literally thought I was going to drive myself and my nephew to Heaven. I left the house without a phone and drove all the way to where my vehicle ran out of gas. I was apprehended by the highway patrol and taken to the local hospital,” she shared.

The World Health Organization‘s global drug database of adverse drug events listed 121,559 cases of psychiatric disorders following COVID vaccine administration, including insomnia, anxiety, sleep disorders, hallucinations, depression and agitation. The list includes 213 reports of near-death experiences and 57 suicides.

In a case report, New York researchers noted that the virus that causes COVID-19 can trigger a powerful immune response, which includes large amounts of proinflammatory cytokines. It has been hypothesized that these COVID-triggered cytokine storms may increase the risk of psychosis.

Article by Mary Villareal
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Re: Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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In a case report, New York researchers noted that the virus that causes COVID-19 can trigger a powerful immune response, which includes large amounts of proinflammatory cytokines. It has been hypothesized that these COVID-triggered cytokine storms may increase the risk of psychosis.
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Re: Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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Can new onset psychosis occur after mRNA based COVID-19 vaccine administration? A case report

8/8/21

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349391/


The COVID-19 pandemic continues to have a deleterious impact on mental health at multiple levels. Fear of infection, stress related to social isolation, work, financial or family loss can lead to mood symptoms, anxiety or substance abuse. COVID-19 infection is associated with a host of neuropsychiatric symptoms, including psychosis, even in individuals without previous mental illness. Many of these symptoms have been associated with a COVID-19-induced hyperinflammatory state. The host reaction to COVID-19 vaccines may recreate a mild version of the actual infection. The development of COVID-19 vaccines is unarguably a great stride in the management of the pandemic. We report a case of a man with new onset psychosis after administration of an mRNA-based COVID-19 vaccine.

A 31-year-old, single Hispanic male without past medical or psychiatric history, was brought to the emergency room by police because of erratic and bizarre behavior. He was found to be anxious, guarded, superficial and grandiose. He reported becoming ‘clairvoyant’, being able to talk with dead people, hearing ‘people drumming outside his house’ and the constant voice of a co-worker whom he believed to be a paramour- it was later confirmed that there was no romantic relationship. All these symptoms began one month ago, after receiving the first dose of an mRNA-based COVID-19 vaccine, and markedly worsened three weeks later after receiving the second dose. Previously, he was asymptomatic, working full-time as an office manager. Although functional in adolescence and adulthood, he described himself as a loner, with an inclination to overly spiritual ideas, and able to communicate directly with God. He had a few close friends and romantic relationships.

His-vital signs, blood chemistry, urine toxicology, urinalysis and chest radiograph were within normal limits, except for moderate leukocytosis with left shift, and erythrocyte sedimentation rate of 48 mm/h. His-COVID-19 PCR was negative. Non-contrast head computerized tomography with- and without-contrast showed hyperintensities throughout the subcortical and periventricular white matter. Magnetic resonance imaging (MRI) also revealed focus of FLAIR hyperintensity in the left peritrigonal white matter, with multiple nonspecific punctate hyperintensities throughout the subcortical and periventricular white matter and focus of susceptibility in the right lateral thalamus. The patient was admitted to the neurology service, where a video electroencephalogram (EEG) was negative. He refused a lumbar puncture. The following day he was wandering the unit talking to himself, stating that the ‘EEG machine was communicating with him’. The patient demonstrated poor insight into his symptoms. He was started on risperidone 0.5 mg po qhs and placed on one-to-one observation. The next day, risperidone was increased to 0.5 mg qam and 1 mg qhs, and the patient was transferred to the psychiatric ward. He engaged in milieu treatment, and the hallucinations and delusions resolved after two days. He was discharged on the same medication regime five days later, with good insight about his symptoms. One week after discharge he was taking medication, asymptomatic and back to work.

This is the first report of psychotic symptoms after receiving a COVID-19 vaccine. SAR-CoV- 2 is known to trigger a powerful immune response, which includes the release of large amounts of proinflammatory cytokines. As of January 2021, 42 cases of psychosis associated with COVID-19 infection have been reported. It has been hypothesized that a COVID-19 triggered cytokine storm may increase the risk of psychosis. Coincidentally, schizophrenia has been linked to a pro-inflammatory status (Goldsmith et al., 2016).

We need to be mindful that this patient had some schizotypal personality traits, strongly associated with the development of schizophrenia, and we could be observing the onset of schizophrenia, with the vaccine being only an epiphenomenon. However, first psychotic breaks occur infrequently at this age and our patient did not exhibit thought disorganization. His-predominant symptoms were auditory hallucinations, grandiose delusions of becoming clairvoyant, and erotomaniac delusions to which he demonstrated poor insight on initial evaluation. His-psychotic symptoms persisted and worsened until one week after the second vaccine dose he required hospitalization and initiation of antipsychotic medication. Hence, the most parsimonious explanation is that the vaccine, innocuous to the millions of people who have already received it, may have triggered psychotic symptoms in an individual with an intrinsic vulnerability, likely via a hyperinflammatory state. Administration of the mRNA-1273 vaccine elicits a milder immune response compared with COVID-19 infection, including a cellular immune reaction, leading to T-helper cells production of proinflammatory cytokines.

The development of psychosis following vaccines administration is extremely rare. It has only been reported following a handful of vaccines: yellow fever (Romeo et al., 2021), rabies (Bhojani et al., 2014), smallpox, typhus and pertussis (Hofmann et al., 2011), with anti-NMDA receptor encephalitis as the likely mechanism (Hofmann et al., 2011). However, other vaccines, like influenza, have been shown to cause neuropsychiatric symptoms by the stimulation of these proinflammatory cytokines. Kuhlman and colleagues examined 41 college-aged individuals after receiving the influenza vaccine and found that those with higher levels of serum interleukin-6 show more severe depressive symptoms (Kuhlman et al., 2018).

We strongly believe that this report should not deter the use of this vaccine, but would provide an element of caution and of close monitoring of individuals at risk for psychosis receiving this or other vaccines.
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Re: Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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What is post-COVID-19 psychosis and who’s at risk?

April 22, 2021


https://www.eehealth.org/blog/2021/04/c ... psychosis/


Most of us can list the symptoms of COVID-19 without much thought now. Fever. Shortness of breath. Cough. Loss of taste or smell. Fatigue.

And many of us have heard about the potential long-term physical effects of COVID-19.

However, doctors now are researching new mental health side effects from the virus. Though reported in small numbers and considered rare, COVID-19 psychosis has affected patients around the world.

Psychosis is a mental disorder in which patients have an impaired sense of reality. Symptoms of psychosis can include hallucinations, delusions, talking incoherently and agitation.

A New York Times article outlines a handful of cases involving people in their 30s, 40s and 50s who had never been diagnosed with a mental health illness but developed psychosis within weeks after testing positive for COVID-19. Many of the patients had mild symptoms of COVID-19.

The cases highlighted a physical therapist who told her therapist she had repeated visions of her children being murdered and that she had come up with plans to kill her children, a woman who tried to pass her three children through a fast-food drive-thru window because she believed they would be kidnapped, and another man who had hallucinations of monkeys and lions and believed that a family member was an imposter.

In a March news conference, Illinois Rep. David Welter mentioned a case involving a 48-year-old man who took his own life. The man’s widow told WGN News that her husband had been hospitalized for COVID-19 and put on oxygen. When he returned home, she said he was a “different man” and that he worried about things that were not happening. He died by suicide 16 days after his COVID-19 diagnosis.

The cases have raised concern among clinicians. However, experts agree additional research is needed.

Some research has indicated that the body’s reaction to COVID-19 could lead to inflammation around the brain which in turn can affect a person’s mental health. Researchers believe that the inflammation of the brain could also be responsible for other COVID-19 symptoms such as loss of taste or smell.

Other studies suggest psychiatric effects may be linked to the body’s immune system response to the virus, in which the immune system might remain engaged after the patient recovers physically. This persistent immune activation is a leading explanation for brain fog and memory problems associated with COVID-19.

There are still many unanswered questions about whether genetic makeup or an undetected predisposition for psychiatric illness increases risk, and how long the psychosis lasts. Cases of post-infectious psychosis have occurred with other viruses, including the 1918 Spanish flu and coronaviruses SARS and MERS.

According to the Centers for Disease Control and Prevention, one study found that patients diagnosed with a psychiatric disorder within the past year had a higher incidence of COVID-19 diagnosis than patients without a psychiatric disorder.

Is COVID-19 the cause of psychosis or just a coincidence? We still don’t know the potential effects of COVID-19 on the brain. The study’s authors recommended clinicians be on the lookout for new onset of psychiatric disorders, even in patients with no history of mental illness.

While the risk of post-COVID psychosis is low, patients and their families should watch for new onset of paranoia, believing things are happening that cannot be true, talking or muttering to themselves, or responding to something that no one else can see or hear. More subtle symptoms can include increased irritation and aggression, a decrease in personal hygiene and withdrawal from family and friends.
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Re: Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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Psychiatric pathology potentially induced by COVID-19 vaccine

8 November 2021


https://wchh.onlinelibrary.wiley.com/do ... 02/pnp.723

Abstract

Vaccines are the predominant biological management measure for controlling the COVID-19 pandemic, and aim to break the chain between disease status and hospitalisation. Unseen or rare side-effects are being reported via the COVID-19-specific Yellow Card reporting site, including mania, psychosis and encephalitis of various subtypes. This article presents a patient displaying a range of psychiatric pathologies that occurred within 10 days of AstraZeneca COVID-19 vaccination and resolved spontaneously without antipsychotic medication. The possibility of a vaccine-related autoimmune encephalitis (AE) is tentatively raised.

The UK Medicines and Healthcare products Regulatory Agency (MHRA) gave authorisation for the first COVID-19 vaccines in December 2020 as part of their ‘rolling review’ process that assessed the safety and efficacy of the medicines.1 As of 12 August 2021, three vaccines have been approved for UK use: the BioNTech Pfizer vaccine; the Oxford University AstraZeneca vaccine, and, most recently, the Moderna vaccine.

Vaccination, in general, is a safe procedure designed to prevent the outbreak of communicable disease and to protect vulnerable groups; but, like all pharmaceutical agents, side-effects associated with vaccines are common. While the majority of side-effects are minor, significant complications are possible. Indeed, the AstraZeneca vaccine trials were halted in phase 3 by a case of transverse myelitis, and people under 40 years of age will no longer be offered this vaccine due to an association with blood clots.2-4 Furthermore, the neurological sequelae of COVID-19 infection itself are increasingly common and include cases of encephalitis.5, 6 A recent systematic review and meta-analysis of outcomes in 129 008 patients across 23 studies with radiologically- or biochemically-confirmed encephalitis as a complication of COVID-19 infection indicated an incidence of 0.215% and an average mortality rate of 13.4%.7

The COVID-19-specific Yellow Card reporting site records suspected side-effects of medications, vaccines or procedural adverse incidents to ensure continuing safe use.8 They produce an analysis print of the reported side-effects of all available COVID-19 vaccines, and up until the 28 July 2021, had identified a large range of neuropsychiatric complications.9 Of the approximate total of 23.4 million people who received a second dose of the AstraZeneca vaccine, this included 54 potential cases of encephalitis of varying subtypes; but there are also reports of new-onset bipolar disorder, psychosis and confusional states.

There have been further cases of encephalitis of varying forms reported in those who received the Pfizer/BioNTech vaccine, with a total of 23 cases identified from the approximate figure of 13.8 million people to have had both doses.10 There was, at the time of writing, a single association between administration of the Moderna vaccine and a case of Japanese B encephalitis, with the important caveat that considerably fewer people have had two doses of the Moderna vaccine than either of the other preparations, at approximately 400 000.11

As yet, there are no COVID-19 case reports on encephalitis as a result of vaccination. Herein, we present a patient displaying a range of psychiatric pathologies. Symptoms occurred within 10 days of AstraZeneca vaccination and resolved spontaneously without the need for antipsychotic medication. We tentatively raise the possibility of a vaccine-related autoimmune encephalitis (AE).

Presentation


The patient is a 51-year-old Caucasian male, who is married with no children. There is no family history of mental illness to suggest any genetic susceptibility to psychiatric morbidity. There were no perinatal complications or neurodevelopmental delays in his infancy. His early life experiences were very good; he lived in a caring and supportive family environment, with no significant traumatic experiences. This likely underpins his resourceful personality, with no significant maladaptive personality traits observed during his inpatient stay. This is demonstrated in good functioning in terms of both occupation (with a successful job) and relationships (with one serious long-term relationship). Prior to admission, he had had no previous contact with psychiatric services. He had only a single contact with his GP in January 2021 for anxiety symptoms following an episode of chest pain. He was prescribed sertraline, but he took one dose only because he felt sedated and unilaterally discontinued the medication.

The patient had his first dose of AstraZeneca COVID-19 vaccine in mid March 2021. No other precipitating factors were identified, such as illicit substance use or significant stressors. In the days after administration of this initial dose, he developed flu-like symptoms that included a severe ‘splitting’ headache. Ten days later, his wife observed that he was becoming confused, with a significant change in his behaviour. He was taken to the accident and emergency department of the local general hospital by ambulance after he stopped eating, drinking and communicating. Physical assessment, including a CT head scan and routine blood tests, found no abnormalities. Therefore, two days later he was referred to psychiatric services and was subsequently admitted to the adult mental health inpatient unit under Section 2 of the Mental Health Act 1983.

A number of clinical features were reported by the patient's wife and subsequently observed by the nursing staff during his psychiatric inpatient admission. He was confused and disoriented in time and place. His communication ranged from speaking in short sentences, sometimes whispering or mumbling to being completely mute. He was thought disordered. When he was given some paper to write down his thoughts, he was unable to write anything meaningful and was drawing lines only. He stated that he was hearing voices, both male and female, saying the word ‘Covid’ to him, but he could not elaborate any further. His mood was labile and informed his behaviour, which was bizarre and at times very disinhibited. On one occasion he was incontinent of urine. Physical examination was unremarkable; aside from the aforementioned confusion and disorientation, there were no abnormalities that suggested neurological symptomatology. Physical investigations, including routine bloods, were all normal.

Based on the absence of risk factors, the age of onset, the acute onset and the fluctuating clinical picture and predominating confusion, an organic cause was suspected by the clinical team. The onset of symptoms following the first dose of COVID-19 vaccine was thought to be significant. An MRI and a blood screen for autoimmune encephalitis (NMDA receptor antibodies, anti-Caspr2 antibody, anti-Lgi1 antibodies, anti-AMPA1 antibodies, anti-AMPA2 antibodies and anti-GABAb receptor antibodies) were requested. On a regular basis, he was prescribed only lorazepam 1mg, twice daily. Antipsychotic medication in the form of haloperidol 5mg twice daily, was prescribed on an unscheduled, pro re nata basis only. There were no doses administered during his stay on the ward.

He did not report any fever, or symptoms of autonomic dysfunction. He did not report vomiting or symptoms suggestive of focal seizures. He did not report any swallowing difficulties or abnormal eye movements. He was sleeping well during his stay on the ward.

The patient's mental state improved in the four days following admission leading to a complete resolution of all symptoms described. He was discharged on 7 April 2021. One month post-discharge, he reported feeling very well with no recurrence of symptoms.

At the time of writing this report, an MRI head was awaited. The results of the autoimmune encephalitis screen were all negative.

Discussion

Autoimmune encephalitis (AE) comprises a group of non-infectious, immune-mediated inflammatory disorders of the brain.12 It is a debilitating neurological disorder, characteristically developing as a rapidly progressive encephalopathy secondary to brain inflammation that creates a diffuse, poly-syndromic clinical picture with a complex differential diagnosis.13

Original cases were classically from paraneoplastic-derived antibodies against intracellular onco-neuronal antigens that were not directly pathogenic; their immune-mediated T-cell responses against the tumour invoked a secondary nervous system response.

More recently, pathogenic antibodies against neuronal surface or synaptic antigens have been identified that also provoke immune-mediated diseases, some of which have a characteristic clinical presentation.

There is also a subset of patients with a seronegative AE, likely to have been provoked by T-cell response or as yet unidentified antibodies. This highlights both the gap in progress between the research and clinical settings in recent years and the considerable diagnostic challenge posed by this disease and its diffuse range of presentations in the absence of a confirmatory test result.14 Supplementary tests, such as EEG and MRI, are rarely pathognomonic and not always abnormal.

The negative sequelae of the above within psychiatric settings is that diagnoses of AE are often delayed as the psychiatric symptoms of disease are assessed and treatments are attempted, potentially compromising outcomes for patients.15

When deliberating the patient described here, a seronegative AE is a tentative possibility despite considerable diagnostic ambiguity. Investigations are incomplete but negative results, as above, would not preclude a diagnosis of AE.

Consideration around the potential role of the COVID-19 vaccine in this case is necessary. Vaccines are the predominant biological management measure for controlling the pandemic, and aim to break the chain between disease status and hospitalisation. Vaccine rollout has been necessarily rapid. Unseen or rare side-effects, including AE, are being reported.

In the absence of other causative explanations and in the context of the short period between vaccine administration and onset of psychopathology, as well as the resolution of symptoms without psychotropic medication, a tentative hypothesis is that the presentation could have been provoked as a result of complications relating to COVID-19 vaccination.
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Re: Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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People are getting psychosis after COVID-19, prompting scientists to investigate whether the body is mistakenly attacking the brain after infection

October 28, 2021

https://news.yahoo.com/people-getting-p ... 29202.html

Some patients develop symptoms of psychosis after getting COVID-19.

It is possible that the stress of the pandemic is causing the psychiatric problems.

But some scientists think it may be the virus causing the body to attack the brain.

In 2020, a day after developing COVID-19 symptoms, a 30-year-old man started thinking he could speak to his dead relatives.

The man, who had no history of mental illness, became convinced that the rapture was imminent, according to a case report published in August.

This psychotic episode went on for more than a month, during which the man knocked a door down, shoved his mother, and thought that he was being experimented on with radiation, the report said.

He was given antipsychotic drugs, but they had little effect. It was only after he was given medication usually used to treat autoimmune conditions that he got better, the case study said.

"Psychosis is one of medicine's big enigmas. We have a fairly poor understanding of what causes it and how it develops," Jonathan Rogers, a clinician and psychiatry researcher from University College London, told Insider.

Research suggests that psychiatric symptoms are common among COVID-19 survivors.

One study on the health records of more than 200,000 US COVID-19 patients found that about 13% received some kind of psychiatric or neurological diagnosis for the first time within six months of infection.

Psychosis - a particularly severe psychiatric condition - affected only 0.42% of that group, according to the study.

But such frequency was about twice that of people in the control group (patients who had the flu), the study said.

This sort of increase could be for an indirect reason: the psychological stress that comes from having COVID-19, two scientists who spoke with Insider said.

But research suggests that something else may be going on: The virus could be causing the body to attack itself, making the brain malfunction.

The theory is that the virus causes so-called anti-NMDA-receptor encephalitis, an autoimmune reaction that causes brain inflammation. That, in turn, can cause psychosis.

Usually, the brain is protected from the immune system because of a structure called the blood-brain barrier.

But COVID-19 might make that barrier "leaky," Benedict Michael, a clinician from Liverpool University, said.

"That then exposes immune cells to brain proteins that they wouldn't otherwise see," Michael, who oversees a registry of neurological complications in patients after COVID-19, said.

Michael said the immune system could then start attacking the cells in the brain, specifically, the NMDA receptors that are carried by neurons.

That, in turn, would make the neurons less sensitive to stimulation, he added. "It's a similar effect to ketamine," he said, referring to the powerful sedative.

The scientists said another virus, HSV-1, could cause similar brain problems.

They also pointed to a handful of recorded cases of brain inflammation after COVID-19 and some showing anti-NMDA-receptor antibodies in patients' blood.

The good news is that this kind of problem ought to be treatable with anti-inflammatory drugs and antipsychotics.

"We are hopeful that the majority will make a reasonable recovery because there's not been much brain damage," Michael said.

But both Rogers and Michael said the theory should be taken with a grain of salt. There are only a small number of documented psychosis cases after COVID-19, and even fewer where antibody levels have been measured, they said.

The presence of the anti-NMDA-receptor antibodies could be unrelated to the psychosis, Michael said.

"It's possible that there's an immunological basis for these individual psych cases, but I don't think it's proven in terms of the treatment," he said.

"Psychiatry has a history of all kinds of treatments that are good if you give them to just one patient but don't look so good when you do a clinical trial," he said.
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Re: Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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Greater numbers are needed but this is likely happening... thanks for the articles
People are getting psychosis after COVID-19, prompting scientists to investigate whether the body is mistakenly attacking the brain after infection
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Re: Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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it's getting harder to say what the numbers are Tim.
most interested peeps are now watching the data coming in :

https://vaers.hhs.gov/data.html
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Re: Over 100,000 cases of psychiatric disorders reported following COVID vaccination

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its something we are of course interested in so appreciate all the updates here
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6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records

May 01, 2021


https://www.thelancet.com/journals/lanp ... 5/fulltext

Summary

Background


Neurological and psychiatric sequelae of COVID-19 have been reported, but more data are needed to adequately assess the effects of COVID-19 on brain health. We aimed to provide robust estimates of incidence rates and relative risks of neurological and psychiatric diagnoses in patients in the 6 months following a COVID-19 diagnosis.

Methods


For this retrospective cohort study and time-to-event analysis, we used data obtained from the TriNetX electronic health records network (with over 81 million patients). Our primary cohort comprised patients who had a COVID-19 diagnosis; one matched control cohort included patients diagnosed with influenza, and the other matched control cohort included patients diagnosed with any respiratory tract infection including influenza in the same period. Patients with a diagnosis of COVID-19 or a positive test for SARS-CoV-2 were excluded from the control cohorts. All cohorts included patients older than 10 years who had an index event on or after Jan 20, 2020, and who were still alive on Dec 13, 2020. We estimated the incidence of 14 neurological and psychiatric outcomes in the 6 months after a confirmed diagnosis of COVID-19: intracranial haemorrhage; ischaemic stroke; parkinsonism; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood, and anxiety disorders (grouped and separately); substance use disorder; and insomnia. Using a Cox model, we compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory tract infections. We investigated how these estimates were affected by COVID-19 severity, as proxied by hospitalisation, intensive therapy unit (ITU) admission, and encephalopathy (delirium and related disorders). We assessed the robustness of the differences in outcomes between cohorts by repeating the analysis in different scenarios. To provide benchmarking for the incidence and risk of neurological and psychiatric sequelae, we compared our primary cohort with four cohorts of patients diagnosed in the same period with additional index events: skin infection, urolithiasis, fracture of a large bone, and pulmonary embolism.

Findings


Among 236 379 patients diagnosed with COVID-19, the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33·62% (95% CI 33·17–34·07), with 12·84% (12·36–13·33) receiving their first such diagnosis. For patients who had been admitted to an ITU, the estimated incidence of a diagnosis was 46·42% (44·78–48·09) and for a first diagnosis was 25·79% (23·50–28·25). Regarding individual diagnoses of the study outcomes, the whole COVID-19 cohort had estimated incidences of 0·56% (0·50–0·63) for intracranial haemorrhage, 2·10% (1·97–2·23) for ischaemic stroke, 0·11% (0·08–0·14) for parkinsonism, 0·67% (0·59–0·75) for dementia, 17·39% (17·04–17·74) for anxiety disorder, and 1·40% (1·30–1·51) for psychotic disorder, among others. In the group with ITU admission, estimated incidences were 2·66% (2·24–3·16) for intracranial haemorrhage, 6·92% (6·17–7·76) for ischaemic stroke, 0·26% (0·15–0·45) for parkinsonism, 1·74% (1·31–2·30) for dementia, 19·15% (17·90–20·48) for anxiety disorder, and 2·77% (2·31–3·33) for psychotic disorder. Most diagnostic categories were more common in patients who had COVID-19 than in those who had influenza (hazard ratio [HR] 1·44, 95% CI 1·40–1·47, for any diagnosis; 1·78, 1·68–1·89, for any first diagnosis) and those who had other respiratory tract infections (1·16, 1·14–1·17, for any diagnosis; 1·32, 1·27–1·36, for any first diagnosis). As with incidences, HRs were higher in patients who had more severe COVID-19 (eg, those admitted to ITU compared with those who were not: 1·58, 1·50–1·67, for any diagnosis; 2·87, 2·45–3·35, for any first diagnosis). Results were robust to various sensitivity analyses and benchmarking against the four additional index health events.
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