Clinical and pathogenetic heterogeneity of anxiety disorders in COVID-19 survivors

Objective. To analyze the clinical and pathogenetic heterogeneity of anxiety disorders in COVID-19 survivors to inform differentiated therapeutic approaches. Material and methods. A comparative, observational, prospective study included 90 patients, with the presence of anxiety symptoms after a SARS-CoV-2 infection. The sample was divided into two groups: Group 1 (n=63), treatment-naïve patients; and Group 2 (n=27), patients with a history of anxiety or affective disorders (F32.0—F42.0) before SARS-CoV-2 infection. Clinical-psychopathological and psychometric assessments included the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D), the Generalized Anxiety Disorder questionnaire (GAD-7), and the A.M. Vein autonomic disorder questionnaire. Results. Anxiety severity reached moderately severe levels (median scores on HAM-A: 24—25; GAD-7: 16). Asthenia was observed in 87.8% of patients, and cognitive impairment (‘brain fog’) occurred in 77.8%. Autonomic disorders (A.M. Vein average score 37.4—37.9) included cardiac (53.3%), gastrointestinal (17.8%), and pain syndromes. Three clinically relevant primary psychopathological syndromes were identified: anxiety-asthenic (61.2%), anxiety-hypochondriacal (31.1%), and anxiety-depressive (7.7%). The organic pathway (neuroinflammation) was predominant in the pathogenesis. The somatogenic pathway was associated with autonomic dysfunction and pain syndromes, while the psychogenic (nosogenic) pathway contributed to the development of anxiety-hypochondriacal and anxiety-depressive syndromes. Conclusions. Anxiety disorders in the post-COVID period are highly heterogeneous and require differentiated therapeutic approaches. Pharmacotherapy, including antidepressants and neurometabolic therapy, is indicated for the organic subtype, while psychotherapy should be prioritized for the psychogenic subtype.