key: cord-1049015-f4tvq1kx authors: Liang, Xiao; Zhu, Yuncheng; Fang, Yiru title: COVID‐19 and post‐traumatic stress disorder: A vicious circle involving immunosuppression date: 2020-07-17 journal: CNS Neurosci Ther DOI: 10.1111/cns.13431 sha: 6d1d44e6bf20b6e0304f2724354915ee06340e2c doc_id: 1049015 cord_uid: f4tvq1kx nan PTSD is defined as a stress-related disorder with subsequent autoimmune disease that may arise after exposure to a serious traumatic event or injury. 3 It is suggested that PTSD conforms with a bi-phasic stress response model: Acute stress may reflect an enhancement of the immune response while chronic stress may reflect a suppression of the immune response with increased susceptibility to infections. Therefore, these correlations pose a complex question regarding the conversion from T-helper 1 cells (Th1) to T-helper 2 cells (Th2). A study showed that chronic stress elicits the simultaneous suppression and enhancement of the immune response via alteration of the cytokine expression pattern. 4 In the chronic stress model, CD4 + Th1 subsets release Th1 cytokines that activate the inflammatory cellular immune response. The response involves IL12 and IFN-G, which is strongly suppressed by IL10. This action helps to shift the cellular immune response from anti-inflammatory process of Th1 to Th2 via adrenergic agonists as a result of stress. Moreover, the immunosuppressive effect is specific to the inflammatory cellular immune system. A shift from Th1 to Th2 cellular is strongly enhanced through the suppression of IL12, which is a major Th1 agonist within humoral immunity. However, the shift occurs proportionately rather than quantitatively. These effects above are observed over both the short and long term in PTSD. This decreased reaction of the immune system is also observed due to senescence with the chronic down-regulation of cortisol receptors sites. The down-regulation of cortisol receptors may reduce the capacity of lymphocytes to respond to anti-inflammatory signals and allow other cytokine-mediated processes to dominate in patients with PTSD. Many clinical observations have shown that elderly patients, those The risk and prevention of novel coronavirus pneumonia infections among inpatients in psychiatric hospitals Stress and psychological distress among SARS survivors 1 year after the outbreak Association of stress-related disorders with subsequent autoimmune disease Neurobiological and systemic effects of chronic stress The deadly coronaviruses: the 2003 SARS pandemic and the 2020 novel coronavirus epidemic in China SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know Severe viral pneumonia in adults: what is important for the ICU physician? Viral pneumonia in patients with hematopoietic cell transplantation and hematologic malignancies Clinical characteristics associated with therapeutic nonadherence of the patients with major depressive disorder: a report on the National Survey on Symptomatology of Depression in China Resting state functional connectivity of the thalamus in north Korean refugees with and without posttraumatic stress disorder Aberrant intrinsic functional connectivity in thalamo-cortical networks in major depressive disorder Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai