Neuropsychiatric manifestations of COVID-19 can be clustered in three distinct symptom categories

Several studies have reported clinical manifestations of the new coronavirus disease, but few have systematically evaluated the neuropsychiatric complications of COVID-19. We reviewed medical records of 201 patients with confirmed COVID-19 (52 outpatients and 149 inpatients) treated at a large referral center in Tehran, Iran from March 2019 to May 2020. Using a clustering approach to categorize clinical symptoms, we found that 151 patients showed at least one neuropsychiatric symptom. Limb force reductions, headache, anosmia, and hypogeusia were among the most common neuropsychiatric symptoms. Hierarchical clustering showed three distinct neuropsychiatric groups: (1) anosmia and hypogeusia; (2) dizziness, headache, and limb force reduction; (3) photophobia, mental state change, hallucination, vision and speech problems, seizure, stroke, and balance disturbance. Three non-neuropsychiatric clusters included diarrhea and nausea; cough and dyspnea; and fever and weakness. Neuropsychiatric presentations are prevalent and heterogeneous and may originate from different mechanisms. Anosmia and hypogeusia appear distinct from more general constitutional-like and more specific neuropsychiatric symptoms. Skeletal muscular manifestations might be constitutional or neuropsychiatric.