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Neuropsychiatry
Original research
Somatic symptom disorder in patients with post-COVID-19 neurological symptoms: a preliminary report from the somatic study (Somatic Symptom Disorder Triggered by COVID-19)
  1. Alexandra Kachaner1,
  2. Cédric Lemogne2,3,
  3. Julie Dave4,
  4. Brigitte Ranque5,6,
  5. Thomas de Broucker4,
  6. Elodie Meppiel4
  1. 1Internal Medicine, Université Paris Cité, Paris, France
  2. 2Psychiatry, Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, Paris, France
  3. 3, Service de Psychiatrie de l’adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France
  4. 4Neurology, Centre Hospitalier de Saint Denis, Saint Denis, France
  5. 5Internal Medicine, Internal Medicine Department, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
  6. 6Université Paris Cité, Inserm UMR S970, Paris, France
  1. Correspondence to Dr Alexandra Kachaner, Internal Medicine, University of Paris, Paris, France; alexandra.kachaner{at}aphp.fr

Abstract

Objectives To assess the diagnosis of somatic symptom disorder (SSD) in patients with unexplained neurological symptoms occurring after SARS-CoV-2 infection, also referred to as long COVID.

Design Single-centre observational study.

Participants Adult patients experiencing unexplained long-lasting neurological symptoms after mild COVID. Of the 58 consecutive patients referred in our centre, 50 were included.

Intervention Patients were contacted for a standardised psychometric evaluation by phone, followed by a self-survey.

Main outcome Positive diagnosis of SSD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).

Results Although the patients did not meet the DSM-5 criteria for a functional neurological symptom disorder specifically, SSD diagnosis based on DSM-5 criteria was positive in 32 (64%) patients. In the remaining 18 patients, SSD was considered possible given the high score on diagnostic scales. Physical examination were normal for all. Brain MRI showed unspecific minor white matter hyperintensities in 8/46 patients. Neuropsychological assessment showed exclusively mild impairment of attention in 14 out of 15 tested patients, in discrepancy with their major subjective complaint. Forty-five (90%) patients met criteria for Chronic Fatigue Syndrome. Seventeen (32%) patients were screened positive for mood-anxiety disorders, 19 (38%) had a history of prior SSD and 27 (54%) reported past trauma. Additional self-survey highlighted post-traumatic stress disorder in 12/43 (28%), high levels of alexithymia traits and perfectionism. Long-lasting symptoms had a major impact with a high rate of insomnia (29/43, 67%), psychiatric follow-up (28/50, 56%) and work or pay loss (25/50, 50%).

Conclusion A majority of patients with unexplained long-lasting neurological symptoms after mild COVID met diagnostic criteria for SSD and may require specific management.

Trial registration number NCT04889313.

  • COVID-19
  • chronic fatigue syndrome
  • functional neurological disorder
  • somatisation disorder

Data availability statement

Data are available on reasonable request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/jnnp-2021-327899

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors EM and AK formulated the idea, planned the overall structure, conducted the literature reviews, prepared the tables/figures and wrote the manuscript. AK interviewed all the patients. AK is the author responsile for the overall content of the study. JD did the neuropsychological assessment. All other authors contributed to meetings, reviewed the manuscript for intellectual content and/or suggested revisions.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests CL reports personal fees and non-financial support from Janssen-Cilag, Lundbeck, Otsuka Pharmaceutical and Boehringer Ingelheim, outside the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.