This episode of the MQ Open Mind podcast discusses the effects of Covid-19 on brain function and mental health, as well as the reasons for errors in the diagnosis of psychiatric illnesses. MQ’s Professor Rory O’Connor and Craig Perryman spoke to MQ researcher and academic clinical fellow at the Department of Psychiatry at the University of Oxford, Dr Maxime Taquet.
Originally an engineer, Dr. Maxime earned a PhD in brain imaging. During this period he spent a lot of time at Boston Children’s Hospital in the US as part of Harvard Medical School developing brain imaging techniques. Studying medicine took him to the United Kingdom, where he studied at Oxford.
Becoming increasingly interested in the brain, behavior, and how to measure both brain activity and individual experience, Max’s career focused on clinical psychiatry. Over the last decade, his work has helped make possible major advances for both remote research, mental health and, most recently, the effect Covid-19 may have on brain function in studies supported by MQ.
Faulty diagnosis
Max began by chatting with Professor Rory about a much more established problem in psychiatry, an area that fascinates and motivates Max: diagnostic failures.
“The diagnosis in Psychiatry is not made based on tests, blood tests or even examinations. They are based on a collection of symptoms. Unfortunately, that means that often the diagnoses we make are not necessarily reliable. By this I don’t necessarily mean that what we tell patients is wrong or unhelpful. But the label we give it can be different depending on the psychiatrist we are.”
As Professor Rory and Craig explain in the episode, diagnosis based on symptoms has important implications. Not only in patients, but also in research.
“Where some psychiatrists may give a patient a diagnosis of depression, another may give a diagnosis of anxiety and a third may give a diagnosis of mixed anxiety and depression. In some ways, that doesn’t really matter, since the treatment is practically the same both psychologically and medically. But for research, that can cause problems when we try to find biomarkers for disease.”
Max applauds the wisdom of experience, saying that patients instinctively know that a label can be attached, but that the individual experience is unique. He points out that although patients can identify themselves with a label, they know that their life is much more complex than this simple diagnosis.
“With psychiatric illnesses {psychiatrists and researchers} tend to think that the diagnostic label is the fundamental truth, so we need to find a biomarker that fits perfectly. “But it’s probably unlikely that it will ever be {possible} if we rely on diagnoses that themselves are unreliable.”
Effects of Covid-19
Dr Max’s recent main area of exploration, with support from MQ, has focused on brain function and Covid-19. In the episode, the trio discusses the commonalities of people who have been hospitalized with Covid-19 still having symptoms and how some symptoms affect different parts of the body, such as breathing, the ability to exercise, fatigue, concentration and mood.
Early in the pandemic, Max had been conducting studies analyzing large-scale electronic health data to see if people with Covid-19 were at increased risk of being diagnosed with brain disorders, including cognitive problems, depression, anxiety, psychosis and also cerebrovascular accidents. hemorrhage and more. He and his colleagues discovered, he says “quite clearly,” that having Covid-19 was associated with a much higher risk of brain disorders than having something like the flu.
This discovery sparked increased interest in understanding why. Why would Covid-19, caused by a small virus, cause such effects? Why can this small virus cause such big impacts on the brain? This open question is one that Max and his team are beginning to find answers to.
Why could Covid-19 affect the brain?
There are some hypotheses, Max says in the podcast, held by people with expertise in infectious diseases, neuroscience, neuroinflammation, neurology and psychiatry. The hypotheses he covers in the episode include:
- Inflammation: The theory is that there could be a degree of inflammation that could affect the brain due to Covid-19. We know that neuroinflammation, inflammation of the brain, can cause a variety of problems, including cognitive problems.
- Blood clots: People who have Covid-19 are at increased risk of having blood clots in different parts of the body and that includes the lungs obviously, but it also includes the brain and that reflects what we have seen in the epidemiology of stroke. After Covid-19, it is very possible that clots in the brain cause things like cognitive problems.
- Autoimmune response: Our immune response can mean that the virus remains latent in different parts of the body, perhaps even the brain, and then various previous infections become activated or reactivated.
These hypotheses, which Max says are valid, are now being explored further and, thanks to his work, there is now evidence to support them.
Max also states how important it is to consider the extent to which a person’s environment influences the effects of having the virus. Your pre-Covid-19 starting point determines how your Covid-19 illness will influence how much you recover from it. Some people may start out with great reservations, whether cognitive or physical, but may still have repeated experiences of Covid-19 and suffer the effects.
“Some patients I have seen used to run a very successful business and then they get Covid-19 and find it very difficult to recover. Six or 12 months later, they are still not able to perform the simple tasks required of someone running a business, such as basic arithmetic or simple concentration. “This is a very interesting and peculiar phenomenon and clearly has traumatic consequences.”
In the article published in Dr. Max’s Bidirectional, he not only predicted the psychological or psychiatric outcome of Covid-19, but also investigated why people with mental health or premorbid problems might be at higher risk of contracting Covid-19.
In 2022, Max won an award for this work, winning the Core Psychiatric Trainee of the Year award from the Royal College of Psychiatrists.
Mental health and Covid-19
In the episode, Max points out some key statistics from his studies on the effects of Covid-19 on mental health and the links between the two.
- People with a history of psychiatric problems or diagnoses are at higher risk of having Covid-19 in the first place.
- Others have also found that these people are at higher risk of dying from Covid-19 or having serious consequences from Covid-19.
- In addition, Covid-19 itself can increase the risk of suffering from these disorders.
Max offers plausible explanations for the above, including biological causes, such as inflammation or the impact of psychiatric disorders on the immune system, but also psychological and social causes.
“Sometimes it can be more difficult for people with a psychiatric illness to isolate themselves. “They might have been more at risk of contracting Covid-19 simply because the risk of being completely isolated was much higher than for most other people.”
Max’s understanding has compassion for those for whom isolation can be psychologically dangerous, if not life-threatening.
“Other people could probably safely isolate themselves for a few months without it having a detrimental impact on their health or mental health. “For people with severe or diagnosed psychiatric disorders, the risks did not outweigh the benefits.”
Esperanza lied on the app
Max’s work is also uncovering possible solutions. Rehabilitation of cognitive function appears to be proving useful for those experiencing loss of brain function after Covid-19. According to Max, intense brain exercises could allow them to regain a large part of their cognitive potential. If this is the case and it really is effective, as Professor Rory agrees in the podcast, it would be fantastic news for those patients.
Hope also comes in the form of more app-based treatments available for mental well-being, including mood-tracking apps of which Max is a bit of a pioneer.
Max has not only gained fame through groundbreaking work in brain fog studies, but also through app development. As an engineer, he developed a supported mental health app in 2012, more than a decade ago before app development and mental health were as widespread as they are now.
“We discussed the idea of developing an application that would allow us to measure people’s mood and behavior on a daily basis. We were young and ambitious and thought ‘let’s do it!’ The idea turned out to be more successful than we imagined.”
The app was used in a reality TV show in France and helped collect 10 million data points across 60,000 people who reported on their mood and behavior multiple times a day. The success of the app has helped many people and researchers, although Max has a small confession.
“Although I developed the app with friends in Boston, USA, we are all Belgian, so there were more beers involved in the development of this app than perhaps those of developers like Zuckerberg.”
With all his awards and successes, MQ is proud to add being one of our supported researchers to his list of achievements.
We included Dr. Maxime in our celebration of International Men’s Day (November 19, 2023) as part of our list of researchers MQ has supported and we discuss his work in more detail in our research article on 5 Incredible Men in Health mental.
Watch or listen to the podcast episode by clicking on the video below.
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