Acute Psychosis and COVID-19 Infection: Psychiatric Symptoms in Hospitalized Patients

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in various medical and psychosocial consequences globally. Respiratory infections are common among patients infected with the SARS-CoV-2 virus, the causative virus of coronavirus disease 2019 . However, various psychiatric and neurocognitive symptoms and sequelae of COVID-19 have been reported as well.This study aimed to describe two clinical case reports of patients with no prior history of psychiatric illnesses admitted to the psychiatric inpatient unit with acute onset of psychosis. A 49-year-old woman with no past medical history and no past psychiatric history was admitted to the inpatient psychiatric unit with suicidal ideation and was noted to have acute psychosis. A 56-year-old woman with a history of hypertension with no past psychiatric history was admitted to the hospital with acute hypoxic respiratory failure secondary to COVID-19 pneumonia and was noted to have acute psychosis.Various psychiatric and neurocognitive symptoms and sequelae of COVID-19 have been reported. However, the pathophysiology, direct biological effects of the disease, treatment modalities, worsening of symptoms due to various medications, and other long-term sequelae are not fully understood. Therefore, clinicians should be mindful of neuropsychiatric symptoms and conduct a detailed history and physical examination on all patients presenting with psychiatric symptoms in the context of COVID-19. It is also essential to assess for signs and symptoms of delirium in patients presenting with neuropsychiatric symptoms. Further research is needed to identify the etiology, predisposing factors, exacerbating or precipitating factors contributing to neuropsychiatric symptoms associated with infection with the SARS-CoV-2 virus. In addition, the pathophysiology contributing to these symptoms and pharmacological interventions for managing these sequelae need to be evaluated.

COVID-19-associated psychosis: A systematic review of case reports

“…Finally, 18 articles did not include individual level data and 7 articles were available as abstracts only. A total of 40 articles met inclusion criteria, comprising 48 individual patients from 17 countries ( Table 1 ) [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ]. All but a single study [ 54 ] were in English and 20 (42%) cases were reported in the United States, where the largest proportion of these cases were documented.…”

“… Limited case details. Kazi et al, 2021 [ 43 ] 49, F, US Admitted to psychiatry with 2 weeks of thoughts of jumping in front of a train, weight loss, agitation, guilt about her grandmother's death 40 years ago and “paranoid delusions.” 3-week history of intermittent cough and anorexia. None None “Tested positive for SARS-CoV-2.” CBC, glucose, BMP, LFTs, TFTs normal.…”

“… Reported Dx: Psychosis related to COVID-19 DSM-5 Dx: Psychotic disorder due to COVID-19, with delusions Recently stopped working and had a breakup with her partner 2 months before admission. Kazi et al, 2021 [ 43 ] 56, F, US Hallucinations and bizarre delusions “talking about numbers on the wall” prior to admission. While admitted, had AVH that God was speaking with her, and “inflated self-esteem.” Presented with 2 weeks of dyspnea, chills and cough in the setting of positive SARS-CoV-2 test, requiring admission for acute hypoxic respiratory failure.…”

Characteristics of patients in inpatient psychiatry during the COVID-19 pandemic

“…This timeline is particularly important, as evidence stretching back to influenza outbreaks of the 18th and 19th centuries has demonstrated the increased incidence of psychiatric disease following viral infection [ Emily et al, 2020 ]. Only now are we gaining insight into this association, with the pathophysiologic commonality of aberrant inflammation being posited as the mechanism underlying the increased incidence of psychiatric symptoms in those with and recovering from COVID-19 [ Bauer et al, 2019 ; Bryce et al, 2021 ; Emily et al, 2020 ; Jansen et al, 2021 ; Kazi et al, 2021 ; Khademi et al, 2021 ; Mazza et al, 2020 ; Senra H, 2021 ]. COVID-19 has been shown to precipitate neuroinflammation via the release of proinflammatory cytokines both acutely and after the initial infection, with these proinflammatory cytokines having the potential to reduce monoamine levels, blunt neuroplasticity, and promote excitotoxicity [ Bauer et al, 2019 ; Emily et al, 2020 ].…”

COVID-19 Infection and Risk for Neuropsychiatric Symptoms

“…Acute infection can also cause delirium and, in some older adults, can be the first sign of infection, even before fever or cough. Unrecognized hypoxia can result in mood dysregulation, confusion, and psychosis ( 3 ) in patients without prior psychiatric history. Anecdotal reports from major hospital systems have found the need for higher than average requirements for both benzodiazepines and opioids related to delirium and agitation in patients requiring mechanical ventilation due to COVID-19 acute respiratory distress syndrome compared with other causes of acute respiratory distress syndrome.…”