Clinical and Psychological Aspects of Asthenia and Anxiety in COVID-19 Patients

Relevance. Among individuals who have recovered from COVID-19, anxiety, depression, sleep disturbances, and asthenia are highly prevalent; these symptoms are observed both during the acute phase of the disease and after recovery. Asthenia is characterized by exacerbation of emotional and motivational dysfunction, impaired cognitive performance, pain symptoms, and autonomic dysregulation.
Intention: to investigate the prevalence of the asthenic component of anxiety and its associations 2 years after recovery from COVID-19.
Methodology. 70 people (51.4 % women) aged 56 ± 9 years in 3 and 12 months after recovery from lung damage COVID-19 were examined. Data included structured interview, scores on the GAD-7, PHQ-9 and personality anxiety subtest of the IAT scale, results of examinations by a psychiatrist and a cardiologist.
Results and discussion. The asthenic component of anxiety exceeded the norm in 32.9 % of the examined patients, asthenia symptoms were detected in 71.4 %, affective symptoms - in more than 40 %. There were intensive manifestations of anxiety, depression and subjective disturbances of cognitive processes in patients with the asthenic anxiety above the norm. The prevalence of asthenia (p = 0.002, 87.0 % and 47.8 %) and the severity of depression manifestations (p = 0.030, 6.60 [4.00; 9.00] and 5.00 [3.00; 8.00]) decreased by a year in this group. Attention deficits correlated with heart rate 3 months after recovery (r = 0.532, p = 0.034) and depression severity with heart rate 9 months later (r = 0.474, p = 0.022). In the subjects with normatively expressed asthenic anxiety the severity of manifestations of affective disorders, asthenia (p = 0.006, 63.8 % and 34, 0 %) and adaptation disorders (p = 0.012, 21.3 % and 4.3 %). In addition, there were the inverse correlation between anxiety and diastolic arterial pressure (r= −0.353, p = 0.015), emotional lability and heart rate (r = −0.318, p = 0.029), impaired attention and diastolic arterial pressure (r = −0.308, p = 0.035) remained during the observation period. First, clinically expressed symptoms of asthenia are used to form in individuals with asthenic anxiety, who are constitutionally more sensitive to stressful events. In both groups of subjects, somatisation is a compensatory mechanism based on regression and reactive formations. In patients with normative asthenic anxiety, somatisation is based on the suppression of over-expressed experiences, on denial and compensation. There is a representation of a special personality predisposition in patients with excessive asthenic anxiety.
Conclusion. Assessing the severity of asthenic personal anxiety is crucial in patients with somatic disorders. Regardless of its intensity, when working with individuals prone to elevated blood pressure, clinicians should attend to personality characteristics and the specific interplay between emotional and somatic domains.

1. Androsova L.V., Vetlugina T.P., Nikitina V.B. [et al.]. Vospalitel’nye markery pri organicheskikh nepsikhoticheskikh rasstroistvakh [Inflammatory markers in organic nonpsychotic disorders]. Zhurnal nevrologii i psikhiatrii im. C.C. Korsakova [S.S. Korsakov Journal of Neurology and Psychiatry]. 2023; 123(3): 88–93. DOI: 10.17116/jnevro202312303188 (In Russ.)

2. Aftanas L.I., Gilinskaya O.M., Korenyok V.V. [et al.]. Psihofiziologicheskij analiz balansa aktivnosti oboronitel’noj i podkrepljajushhej motivacionnyh sistem u bol’nyh s gipertoniej [Psychophysiological analysis of defensive vs. Appetitive motivational systems activity balance in treatment naive hypertensives]. Sibirskij nauchnyj medicinskij zhurnal [Siberian Scientific Medical Journal]. 2011; 31(6): 122–134. (In Russ.)

3. Bizuk A.P., Vasserman L.I., Iovleva B.V. Primenenie integrativnogo testa trevozhnosti (ITT): metod. rekomendatsii [Application of the Integrative Anxiety Test (IAT): Methodological Recommendations.]. St. Petersburg: NIPNI named after V.M. Bekhterev, 2005. 23 p. (In Russ.)

4. Valiullina E.V. Psikhologicheskii mekhanizm vytesneniya pri situativnoi i lichnostnoi trevozhnosti [Psychological repression mechanism in situational and personal anxiety]. Vestnik of North-Eastern Federal University. Pedagogics. Psychology. Philosophy [Vestnik of North-Eastern Federal University. Pedagogics. Psychology. Philosophy]. 2020; (2): 25‑29. (In Russ.)

5. Vasenina E.E., Gankina O.A. Hronicheskij stress i astenija [Chronic Stress and Fatigue]. Lechebnoe delo [Medical Business]. 2023; (1): 29‑38. DOI: 10.24412/2071-5315-2023-12950. (In Russ.)

6. Vasenina E.E., Gankina O.A., Levin O.S. Stress, astenija i kognitivnye rasstrojstva [Stress, asthenia and cognitive disorders]. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova [S.S. Korsakov Journal of Neurology and Psychiatry]. 2022; 122(5): 23–29. DOI: 10.17116/jnevro202212205123. (In Russ.)

7. Volodina O.V. Psihosomaticheskie vzaimosvjazi trevozhnyh nevroticheskih rasstrojstv i gipertonicheskoj bolezni (analiticheskij obzor) [Psychosomatic interactions between anxiety neurotic disorders and hypertensive disease (analytical review)]. Rossijskij psihiatricheskij zhurnal [Russian journal of psychiatry]. 2009; (5): 43‑50. (In Russ.)

8. Gus’kova O.A., Jaroslavskaja E.I., Prilenskij B.Ju., Petelina T.I. Harakteristika psihologicheskogo sostojanija pacientov, perenesshih pnevmoniju, associirovannuju s COVID-19, cherez tri mesjaca posle vypiski iz stacionara [Psychological state characteristics of patients with COVID-19-associated pneumonia in three months after hospital discharge]. Profilakticheskaja medicina [Russian Journal of Preventive Medicine]. 2021; 24(9): 59‑65. DOI: 10.17116/profmed20212409159. (In Russ.)

9. Dzyak L.A., Tsurkalenko E.S. Trevozhnye rasstrojstva v obshhevrachebnoj praktike [Anxiety disorders in general practice]. Semejnaja medicina [Family Medicine]. 2018; (78(4)): 50‑55. DOI: 10.30841/2307-5112.4.2018.160701. (In Russ.)

10. Dyukova G.M. Astenicheskii sindrom: problemy diagnostiki i terapii [Asthenic syndrome: problems of diagnostics and treatment]. Effektivnaya farmakologiya [Effective pharmacotherapy]. 2012; (1): 40‑45. (In Russ.)

11. Eshimbetova S.Z., Raspopova N.I., Dujsenova A.K. [et al.]. Trevozhno-depressivnye rasstrojstva u pacientov s COVID-19 [Anxiety-depressive disorders in patients with COVID-19]. Vestnik Kazahskogo Nacional’nogo medicinskogo universiteta [Vestnik KazNMU]. 2021; (4). (In Russ.)

12. Korenyok V.V., Aftanas L.I., Pavlov S.V. [et al.]. Osobennosti dinamiki aktivatsii serdechnososudistoi sistemy v usloviyakh polozhitel’noi i otritsatel’noi emotsional’noi aktivatsii u cheloveka v norme i pri narushenii regulyatsii arterial’nogo davleniya [Individual time-course of cardiovascular activity during positive and negative emotional arousal in normal and hypertensive men]. Byulleten’ Sibirskogo otdeleniya Rossiiskoi akademii meditsinskikh nauk [Bulletin of Siberian Branch of Russian Academy of Medical Sciences]. 2007; (125(3)): 53‑63. (In Russ.)

13. Petrova L.V., Kostenko E.V., Eneeva M.A. Asteniya v strukture postkovidnogo sindroma: patogenez, klinika, diagnostika i meditsinskaya reabilitatsiya [Asthenia and post-COVID syndrome: pathogenesis, clinical presentations, diagnosis, and medical rehabilitation]. Doktor. Ru [Doctor. Ru]. 2021; (20(9)): 36–42. DOI: 10.31550/1727-2378-2021-20-9-36-42 (in Russ.)

14. Toropova A.S., Subbotina L.U. Issledovanie roli i mesta somatizatsii v strukture psikhologicheskoi zashchity lichnosti [Investigation of Somatization as Mechanism of Psychological Defense of Person]. Vestnik Yaroslavskogo gosu‑darstvennogo universiteta im. P. G. Demidova. Seriya gumanitarnye nauki [Bulletin of the P. G. Demidov Yaroslavl State University. Series On Humanities]. 2013; (24(2)): 78‑81. (In Russ.)

15. Kholmogorova A.B., Garanyan N.G. Somatizacija: istorija ponja-tija, kul’tural’nye i semejnye aspekty, ob#jasnitel’nye i psihoterapevticheskie modeli [Somatization: the history of the ponja-tiya, cultural and seminal aspects, explanatory and psychotherapeutic models.]. Konsul’tativnaja psihologija i psihoterapija [Counseling Psychology and Psychotherapy]. 2000; (25(2)): 5‑48. (In Russ.)

16. Shakirova I.N., Dyukova G.M. Asteniya – mezhdistsiplinarnaya problema [Asthenia – an interdisciplinary problem]. Trudnyi patsient [A difficult patient]. 2012; 10(5): 14‑16. (in Russ.)

17. Yarochkina M.V. Psikhologicheskie i psikhicheskie rasstroistva, svyazannye s pandemiei COVID-19 [Psychological and psychiatric disorders associated with the COVID-19 pandemic]. Nauchnye vyskazyvaniya [Scientific statements]. 2023; (33(9)): 57‑63. (In Russ.)

18. Andrews G., Kiloh L.G., Kehoe L. Asthenic personality, myth or reality. Aust N Z J Psychiatry. 1978; 12(2): 95–98. DOI: 10.3109/00048677809159599.

19. Bin Adnan M.A.A., Bin Kassim M.S.A., Bt Sahril N., Bin Abd Razak M.A. Prevalence and Predictors of Anxiety among Stable Hospitalized COVID-19 Patients in Malaysia. Int J Environ Res Public Health. 2022; 20(1): 586. DOI: 10.3390/ijerph20010586.

20. Cathébras P., Kohout É., Savall A., Goutte J. L’anxiété centrée sur la santé: une autre épidémie à laquelle il faut se préparer [Health anxiety: Another epidemic to prepare for]. Rev Med Interne. 2024; 45(10): 641–648. DOI: 10.1016/j.revmed.2024.03.002. (In French)

21. Crocq M.A. A history of anxiety: from Hippocrates to DSM. Dialogues Clin Neurosci. 2015; 17(3): 319–325. DOI: 10.31887/DCNS.2015.17.3/macrocq.

22. Demiryürek E., Çekiç D., Işsever K. [et al]. Depression and anxiety disorders in COVID-19 survivors: role of inflammatory predictors. Noro Psikiyatr Ars. 2022; 59(2): 105–109. DOI: 10.29399/npa.27698.

23. Gramaglia C., Gattoni E., Gambaro E. [et al.]. Anxiety, stress and depression in COVID-19 survivors from an Italian cohort of hospitalized patients: results from a 1-year follow-up. Front Psychiatry. 2022; 13: 862651. DOI: 10.3389/fpsyt.2022.862651.

24. Grogans S.E., Bliss-Moreau E., Buss K.A. [et al.]. The nature and neurobiology of fear and anxiety: State of the science and opportunities for accelerating discovery. Neurosci Biobehav Rev. 2023; 151: 105237. DOI: 10.1016/j.neubiorev.2023.105237.

25. Huang L., Yao Q., Gu X. [et al.]. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021; 398(10302): 747–758. DOI: 10.1016/S0140-6736(21)01755-4.

26. Instructions for patient health questionnaire (PHQ) and GAD-7 measures. 2010. [Internet] URL: PHQandGAD7_InstructionManual.pdf

27. Kaya U., Güvenir M., Aykac A. Post-quarantine anxiety and depression levels of COVID-19 positive patients, Northern Cyprus. Afr Health Sci. 2023; 23(4): 143–154. DOI: 10.4314/ahs.v23i4.17.

28. Keough M.E., Riccardi C.J., Timpano K.R. [et al.]. Anxiety symptomatology: the association with distress tolerance and anxiety sensitivity. Behav Ther. 2010; 41(4): 567–574. DOI: 10.1016/j.beth.2010.04.002.

29. Rose M., Devine J. Assessment of patient-reported symptoms of anxiety. Dialogues Clin Neurosci. 2014; 16(2): 197–211. DOI: 10.31887/DCNS.2014.16.2/mrose.

30. Sohrabivafa M., Sadeghi R., Riahi F. [et al.]. Predictive factors of anxiety and depression in COVID-19 survivors: a cross-sectional study. Health Sci Rep. 2023; 6(11): e1712. DOI: 10.1002/hsr2.1712.

31. Yıldırım N., Dayılar Candan H., İnan A.H. Psychological distress in patients with COVID-19 during hospitalization. Clin Nurs Res. 2022; 31(3): 376–384. DOI: 10.1177/10547738211040322.

32. Zhu C., Zhang T., Li Q. [et al.]. Depression and anxiety during the COVID-19 pandemic: epidemiology, mechanism, and treatment. Neurosci Bull. 2023; 39(4): 675–684. DOI: 10.1007/s12264-022-00970-2.