Year: 2026
Type: editorial
Abstract: Several contributions examine the clinical and biological links between infection and neuropsychiatric symptoms. In a small cohort of patients with post-acute COVID-19 syndrome, Watson et al. found that subjective cognitive complaints were more closely related to objective neuropsychological performance than to fatigue, depression, or measured inflammatory cytokines. The study suggests that reported 'brain fog' should not automatically be attributed to affective symptoms, although psychiatric comorbidity may still contribute. A prospective study by Zhang et al. examined the issue from another angle. Pre-pandemic bilateral insular gray-matter volume was associated with fear during the outbreak, and fear in turn mediated later posttraumatic stress symptoms and general distress. These findings suggest that biological vulnerability, emotional responses to an outbreak, and persistent cognitive symptoms are not necessarily competing explanations. In some patients, they may be different parts of the same clinical picture.At the same time, these associations need to be interpreted carefully. In a retrospective comparison of catatonia presentations before and after the pandemic, Göverti et al. found no clear increase or distinctive symptom pattern; only two post-pandemic cases had recent COVID-19. Rare cases of post-infectious catatonia may occur, but the available data do not support a broad causal syndrome. Looking beyond SARS-CoV-2, the meta-analysis by Luan et al. found headache, myalgia, and fatigue or asthenia in about one quarter of people with mpox without HIV coinfection. This is a useful reminder that mpox is not only a dermatological or sexualhealth condition. Lucchese and Stufano similarly draw attention to cognitive and depressive symptoms reported after dengue and chikungunya. Their message is particularly relevant for European mental-health services as the geographical distribution of arboviral infections changes.Two articles discuss associations that remain less firmly established. The mini-review by Andrade et al. reviews possible links between Toxoplasma gondii, dopaminergic signaling, neuroinflammation, and tryptophan-kynurenine metabolism. The authors also note that reported associations with psychosis, depression, and anxiety are generally small to moderate, and that cat ownership is an inconsistent marker of exposure. In an opinion article, Rajkumar considers whether childhood infections could contribute to disruptive behavior disorders through immune, basal-ganglia, and gut-brain pathways. Both contributions are best viewed as frameworks for research rather than evidence of established causation. Progress in these areas will require longitudinal studies, pathogen-specific exposure measures, repeated biological sampling, and careful control of familial and social confounding.Mental-health effects may also arise from recurrence, chronic symptoms, and the circumstances in which illness is experienced. The review by Qian et al. describes the association between recurrent urinary tract infections and anxiety or depression. It considers possible immune, endocrine, microbiome, and neuroendocrine pathways, but also the cumulative burden of repeated episodes. In a large longitudinal Dutch cohort, Chen et al. compared mental health and social functioning across successive COVID-19 waves in adults with and without moderateto-severe atopic dermatitis. Their findings show that the psychological effects of a pandemic are shaped by pre-existing illness. Disrupted care, ongoing symptoms, perceived vulnerability, and social restrictions may matter even when the infection itself is not the main driver.This was particularly evident among young adults. Weekly assessments by Noble and Raison showed a marked deterioration in university students' wellbeing during the pandemic, followed by gradual improvement after in-person learning resumed. Anhedonia tracked restrictions on social gatherings, pointing to the cost of prolonged disruption of social contact. At a population level, Liu et al. used a structural-equation model to examine public panic during pandemics. Event perception, information dissemination, opinions about preventive measures, collective behavior, and personal characteristics were closely connected. These findings have a practical implication: clear, consistent communication and active management of misinformation should be considered part of the mental-health response to an outbreak.The interaction between infection and mental health is especially clear in HIV, where chronic disease, stigma, disclosure, social support, and access to care are closely linked. The updated meta-analysis by Xue et al. confirms that psychological distress is common among people living with HIV. However, the marked heterogeneity between studies and the low or very low certainty of evidence for several correlates make a single global estimate or universal risk profile difficult to justify. In a cross-sectional study, Zhou et al. found that both offline and online social support were independently associated with better quality of life. Online support added value, but it did not make up for limited face-to-face support. This favors blended models of support rather than digital-only solutions.Stigma remains one of the main ways in which an infection can damage mental and social wellbeing. In a scoping review of randomized trials, Zhang et al. found that cognitive-behavioral and other multicomponent interventions often reduced HIV-related stigma. The interventions nevertheless differed substantially in content, intensity, populations, outcomes, and follow-up, which limits direct comparison. The qualitative study by Pan et al. adds detail that summary measures cannot capture. Decisions about disclosure to sexual partners involved concerns about discrimination, loss of a relationship, economic security, and personal safety. Disclosure support therefore needs to be individualized and should include practical safety planning, rather than simply encouraging people to disclose.Integration is also needed outside specialist HIV services. Among people attending sexually transmitted disease clinics in Shanghai, Wang et al. reported anxiety and depressive symptoms in 10.8% and 13.9%, respectively. Demographic, residency, marital, educational, and knowledge-related factors helped identify groups who might benefit from further assessment. The reverse approach is equally important: mental-health services should provide access to infectious-disease prevention, testing, and treatment. In almost 13,000 psychiatric inpatients in Poland, Tomasiewicz et al. found active HCV infection in 1.3%, with strong associations with injecting drug use and other markers of vulnerability. Routine opt-out testing linked to antiviral treatment could make psychiatric admission an opportunity to address an infection that may otherwise remain undiagnosed.Three practical priorities emerge from the collection. First, screening should work in both directions. Infectious-disease care should include attention to cognition, mood, anxiety, trauma, and social needs, while mental-health services should offer accessible testing and treatment for relevant infections. Second, future research needs to establish temporality more clearly. Prospective cohorts, shared outcome definitions, and a clear distinction between symptoms and diagnosed disorders would improve comparability. Studies should also combine neuropsychological assessment and biological measures with information on treatment and social context. Third, interventions need to address more than one level of the problem. Depending on the setting, this may include neurorehabilitation, psychological care, stigma reduction, social support, safer disclosure, and reliable risk communication.The breadth of this Research Topic reflects the complexity of the field. The included studies cover acute outbreaks, chronic infections, recurrent conditions, and psychiatric populations, but much of the evidence is observational and comes from a limited number of settings. Definitions and measurement tools vary, and several biological mechanisms remain plausible rather than proven. The collection therefore does not support one explanation for the relationship between infectious diseases and mental health. It does, however, support a clear clinical conclusion. Mental health should be considered throughout the course of an infectious disease, not only after the acute phase has resolved. Likewise, prevention, testing, and treatment of infections should be part of the care offered to vulnerable psychiatric populations. Closer collaboration between infectious disease, psychiatry, neurology, psychology, and public health is needed to improve both clinical outcomes and quality of life.
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7225801928
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