The effects of Covid-19 on brain function and mental health, as well as the reasons for flaws in diagnosis of psychiatric illness, are all discussed in this episode of the MQ Open Mind podcast. Professor Rory O’Connor and MQ’s 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 went on to gain a PhD in brain imaging. During this period, he spent a lot of time at the Boston Children's Hospital in the USA as part of Harvard Medical School developing techniques for brain imaging. Studying medicine brought him to the UK where he studied in Oxford.
Becoming increasingly interested in the brain, behaviour and how to measure both brain activity and individual experience, Max’s career turned to clinical Psychiatry. In the last decade, his work has helped to make huge leaps forward possible for both remote research, mental health and most recently, the effect Covid-19 can have on brain function in studies supported by MQ.
Diagnosis Flawed
Max began by chatting with Professor Rory about a far more established problem in psychiatry, an area Max is fascinated and motivated by, and that is flaws in diagnosis.
“Diagnosis in Psychiatry is not made based on tests, blood tests or even scans. They’re based on a collection of symptoms. Unfortunately, that means often the diagnoses we make are not necessarily reliable. By that, I don’t necessarily mean what we’re telling patients is wrong or not helpful. But the label we give might be different depending on which psychiatrist we are.”
As he explains in the episode to Professor Rory and Craig, diagnosis based on symptoms has major implications. Not just on patients, but also on research.
“Where some psychiatrists might give a patient a diagnosis of depression, another one might give them a diagnosis of anxiety and a third might give them a diagnosis of mixed anxiety and depression. That doesn't really matter in some ways since treatment is very much the same both psychologically and medically. But for research, that can cause problems when we try to find biomarkers of illnesses.”
Max applauds the wisdom of experience, saying that patients have known instinctively that a label can be given but individual experience is unique. He notes even though patients can identify with a label, they know their life their experience is much more complex than this simple diagnosis.
“With psychiatric illnesses {psychiatrists and researchers} tend to think the diagnostic label is the ground truth, so we need to find a biomarker that perfectly fits. But it's probably unlikely to ever be {possible} if we rely on diagnoses that are themselves not reliable.”
Effects of Covid-19
Dr Max’s main area of recent exploration, supported by MQ, has focused upon brain function and Covid-19. In the episode, the trio discuss the commonality for people who've been hospitalised with Covid-19 to carry on having symptoms and how some symptoms affect different parts of the body such as breathing, ability to exercise, fatigue, concentration, and mood.
Early in the pandemic, Max had been conducting studies looking at large scale electronic health data to see whether people with Covid-19 were at an increased risk of being diagnosed with brain disorders including cognitive problems, depression, anxiety, psychosis and also strokes, brain haemorrhage and more. He and his colleagues found, he says “quite clearly”, that having Covid-19 was associated with a much greater risk of brain disorders than having something like the flu.
This discovery led to greater interest in understanding why. Why could such effects be instigated by Covid-19, caused by a small virus? Why is it that this small virus can cause such huge impacts on the brain? This open question is one to which Max and his team are beginning to find answers.
Why Might Covid-19 Affect The Brain?
There are a few hypotheses, Max states in the podcast, held by people who have expertise in infectious diseases, neuroscience, neuro-inflammation, neurology and Psychiatry. Hypotheses he covers in the episode include:
- Inflammation: theory is there might be a degree of inflammation that might affect the brain due to Covid-19. We know that neuro-inflammation, inflammation in the brain, can cause a variety of problems including cognitive problems.
- Blood clots: people who have Covid-19 are at an increased risk of having blood clots in different parts of the body and that includes the lungs obviously but that also includes the brain and that reflected what we what we've seen in epidemiology of Strokes. After Covid-19 it might well be that clots in the brain might cause things like cognitive problems.
- Autoimmune response: the response of our immunity may mean the virus lies dormant in different parts of the body perhaps even the brain then the various activating or reactivating previous infections.
These hypotheses, which Max notes are valid, are now being explored further and thanks to his work now with evidence to back them up.
Max also states how important it is to note how much someone's surroundings play a part in the effects of having the virus. Where you start before the Covid-19 determines how your Covid-19 illness is going to influence how much you recover from it. Some people might start out with great reserves, either cognitive or physical reserves, but might still go on to have repeated experiences of Covid-19 and suffer the effects.
“Some patients I've seen, they used to run a business very successfully then have Covid-19 and find it very difficult to recover. Six months or 12 months down the line, they are still not able to do the simple tasks that are required of somebody who's running a business such as basic arithmetic or simple concentration. This is a very interesting, peculiar phenomenon and clearly has traumatic consequences.”
In Dr Max’s Bidirectional published paper, not only did he predict psychological outcome or psychiatric outcome of Covid-19 but also looked into why people with premorbid or mental health problems might be at increased risk of 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 notes some keys statistics of his studies into the effects of Covid-19 on mental health and the links between the two.
- People with a history of psychiatric problems or diagnosis are at an increased risk of having Covid-19 in the first place.
- Others have also found that these people have an increased risk of dying from Covid-19 or having severe consequences from Covid-19.
- In addition, Covid-19 itself can then lead to increased risks of those disorders.
Max offers plausible explanations for the above, including biological causes, such as inflammation or the impact of psychiatric disorders on the immune system, and also psychological and social.
“It might be sometimes more difficult for people with a psychiatric illness to self-isolate. They might have been more at risk of catching Covid-19 simply because the risk for them of being completely isolated was much greater than for most other people.”
Max’s understanding holds compassion for those for whom isolation can be psychologically dangerous if not life-threatening.
“Other people could probably safely self-isolate 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 benefit.”
Hope App-lied
Max’s work is also uncovering potential solutions. Rehabilitation for cognitive function appears to be proving useful for those experiencing loss of brain function post-Covid-19. Intense brain exercises might mean they recover a large portion of their cognitive potential, according to Max. If this is the case and indeed effective, as Professor Rory agrees in the podcast, that would be a fantastic news for those patients.
Hope also comes in the form of more app-based treatments available for mental wellness, including mood tracking apps of which, Max is a bit of a pioneer.
Not only has Max gained a claim for fame thanks to revolutionary work in brain fog studies but also through app development. As an engineer, he developed a mental health app backed in 2012, over a decade ago before app development and mental health were as widespread as they are now.
“We discussed the idea of developing an app that would allow us to measure people's mood and behaviour on a day-to-day basis. We were young and ambitious and thought ‘let's just 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 to collect 10 million data points among 60,000 people who reported their mood and behaviour several times daily. The app’s success has helped many people and researchers, although Max has one small confession.
“Although I developed the app with friends in Boston in the US, we're all Belgians so there was more beers involved in this app development than perhaps in those by developers like Zuckerberg!”
With all his awards and successes, MQ is proud to add to his list of achievements being one of our supported researchers.
We include Dr Maxime in our celebration for International Men’s Day (19 November 2023) as a part of our list of researchers who are MQ have supported and we look at his work in more detail in our 5 amazing men in mental health research article.
Watch or listen to the podcast episode by clicking the video below.
