Does Social Stigma and Neglect Post-COVID-19 Matter? A Case Report on Brief Psychotic Disorder Post-COVID-19 and Self-Quarantine

Abstract

Social stigma and neglect post-coronavirus disease 2019 (COVID-19) and self-quarantine can be associated with a brief psychotic disorder (BPD). A 53-year-old African-American man with no significant past medical and psychiatric history was brought to the emergency department (ED) with symptoms of persecutory delusions post COVID-19 and self-quarantine. His symptoms included false beliefs that people were plotting to kill him which made him combative at work and home. As his symptoms worsened, his wife brought him to the hospital. He was given intramuscular haloperidol 5 mg one dose in the ED. The Clinical Health Psychology and Psychiatry team diagnosed the patient with BPD as per the Diagnostic and Statistical Method of Mental Disorder Fifth Edition (DSM-5). Over the next few days, his symptoms slowly improved. At follow-up visit in the outpatient clinic in a week, we found him back to his baseline without any delusional thoughts. Increased stressors post COVID-19, neglect at home, and social stigmata at work associated with COVID-19 along with his individual vulnerability appeared to be the cause of his delusions but various other mechanisms may exist. Our case raises the question: does social stigma and neglect post-COVID-19 and self-quarantine matter?

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.…”

“… Reported Dx: psychosis and depression; catatonia DSM-5 Dx: Psychotic disorder due to COVID-19, with delusions; catatonia due to COVID-19 Recent treatment with steroids preceding psychosis. Baral et al, 2021 [ 30 ] 53, M, US After 5 weeks of COVID-19, he experienced delusional thoughts that people, including his wife, were plotting to kill him. Fever, cough and weakness for 2 days None None + SARS-Cov-2 PCR.…”

A qualitative analysis of literature reporting and linking psychosis to COVID-19 infection. Findings from a postgraduate journal club

“…Eight ( Hansen et al 2020 , Alba et al 2021 , Noone et al 2020 (a), Kozato et al 2021 , Smith et al 2020 , Lim et al 2020 , Majadas et al 2020 , Baral et al 2021 ) have reported COVID-19 like illness prior to onset of psychotic symptoms. Eight have not shared the details regarding duration passed between a positive RT PCR swab and onset of psychosis (Sanchez et al 2020, Parker et al 2021 , Kozato et al 2021 , Lannier et al 2020, Majadas et al 2020 , Correa- et al 2020, Ferrando et al 2020 , Saje et al 2021 ).…”

Impact of COVID-19 symptoms on social aspects of life among female long haulers: A qualitative study

“…Likewise, other studies have shown that people feel a deep sense of exclusion due to stigma (69), which causes mental disorders (70). Furthermore, social stigma affects women's health by being a prominent barrier to diagnostic and treatment procedures for improving mental health problems such as anxiety and depression (71).…”