RETRACTED: Remission of Subacute Psychosis in a COVID-19 Patient With an Antineuronal Autoantibody After Treatment With Intravenous Immunoglobulin

McAlpine, Lindsay; Lifland, Brooke; Check, Joseph R.; Angarita, Gustavo A.; Ngo, Thomas T.; Pleasure, Samuel J.; Wilson, Michael R.; Spudich, Serena; Farhadian, Shelli; Bartley, Christopher M.

doi:10.1016/j.biopsych.2021.03.033

Cited by 19 publications

(20 citation statements)

References 26 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“… Reported Dx: Acute psychosis DSM-5 Dx: Psychotic disorder due to COVID-19, with hallucinations Concurrent massive pulmonary embolism. McAlpine et al, 2021 [ 52 ] 30, M, US Developed erratic sleep, disorganized speech, and religious delusions, eventually presenting to emergency department on day 22 for aggression and discharged with haloperidol, only to represent on day 34 with anxiety and aggression. Fever and malaise None None +SARS-CoV-2 PCR.…”

Section: Resultsmentioning

confidence: 99%

“…In this review, there were a few examples of low bias cases that convincingly excluded delirium. There were also two cases of psychosis attributed autoimmune encephalitis which improved with steroids [ 28 , 52 ], one of which identified a novel autoantibody [ 52 ]. So, although COVID-19-associated psychosis could represent a distinct clinical entity, we suggest that non-delirious psychosis in COVID-19 is less common than has been reported in epidemiologic studies [ 1 ], consistent with previous commentary on the subject [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Based on the American Psychiatric Association practice guidelines for schizophrenia [ 77 ], neuroimaging and lumbar puncture should be considered in the presence of focal neurological deficits, new onset seizures, later age onset, or concern for autoimmune encephalitis (e.g., personality change, rapid onset of deficits over 3 months or less, lethargy or decreased level of consciousness). Given reported cases of autoimmune encephalitis in COVID-19-associated psychosis [ 28 , 52 ], the threshold for obtaining these studies in cases of psychosis associated with COVID-19 that have excluded delirium should be low.…”

Section: Discussionmentioning

confidence: 99%

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

Smith

Gilbert

Riordan

et al. 2021

General Hospital Psychiatry

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Objectives To describe the comorbidities, presentations, and outcomes of adults with incident psychosis and a history of COVID-19. Methods We completed a descriptive systematic review of case reports according to PRISMA guidelines, including cases of adult patients with incident psychosis and antecedent or concurrent COVID-19. We extracted patient demographics, comorbidities, clinical course, and outcomes, and assessed cases for quality using a standardized tool. Results Of 2396 articles, we included 40 reports from 17 countries, comprising 48 patients. The mean age of patients was 43.9 years and 29 (60%) were males. A total of 7 (15%) had a documented psychiatric history, 6 (13%) had a substance use history and 11 (23%) had a comorbid medical condition. Delusions were the most common (44 [92%]) psychiatric sign and psychosis lasted between 2 and 90 days. A total of 33 (69%) patients required hospitalization to a medical service and 16 (33%) required inpatient psychiatric admission. The majority (26 [54%]) of cases did not assess for delirium and 15 (31%) cases were judged to be of high risk of bias. Conclusions Despite the growing awareness of COVID-19's association with incident psychosis at a population level, cases of COVID-19-associated psychosis often lacked clinically relevant details and delirium was frequently not excluded. PROSPERO registration number: CRD42021256746.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Smith

Gilbert

Riordan

et al. 2021

General Hospital Psychiatry

View full text Add to dashboard Cite

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“…There have been reports that found the association of psychosis (new-onset) with elevated C-reactive protein, serum ferritin, lactate dehydrogenase (LDH), D-dimer, and derangements of white blood cells [21••, 23-25]. In addition, it has been reported that autoimmune changes in the brain due to the development of novel neuronal autoantibody are associated with psychosis which is refractory to antipsychotic treatment [26].…”

Section: Covid-19 and Psychosismentioning

confidence: 99%

COVID-19 and Psychotic Symptoms: the View from Psychiatric Immunology

Tripathy

Singh

et al. 2021

Curr Behav Neurosci Rep

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Purpose of Review To explore the immunological underpinnings of psychosis in the COVID-19 patients. Recent Findings COVID-19 pandemic led to a surge in psychiatric morbidities, including psychosis. Various putative biological and psychosocial changes have been implicated in COVID-19-related psychosis. COVID-19 is a proinflammatory state. Alterations in immunological processes both as a direct consequence of infection or secondary to the hyperimmune response heuristically explain the etiopathogenesis of psychosis in the affected individual. The uses of immunosuppressant and immunomodulatory drugs may be the other moderators of a psychotic presentation in COVID-19 patients. Evidence to substantiate this hypothesis is still lacking however, which further studies should address. Because of its management implications, a better understanding of the involved immunological mechanisms becomes extremely important. Summary Evidence suggests a putative role of immunological alterations in the pathogenesis of COVID-19-related psychosis. The immunological abnormalities are primarily attributed to the pathophysiology of COVID-19 infection, medications used, and stress.

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Immune-mediated neurological syndrome in SARS-CoV-2 infection: a review of literature on autoimmune encephalitis in COVID-19

et al. 2021

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Introduction The novel Coronavirus Disease 2019 (COVID-19) is an infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which has been spreading rapidly amongst humans and causing a global pandemic. The notorious infection has shown to cause a wide spectrum of neurological syndrome, including autoimmune encephalitis. Objective Here, we systematically review the literature on autoimmune encephalitis that developed in the background of SARS-CoV-2 infections and also the possible pathophysiological mechanisms of auto-immune mediated damage to the nervous system. Methodology An exhaustive search was made in Medline/PubMed, Embase, Scopus and other medical databases, and 28 relevant published articles were selected according to the strict inclusion criteria. Results Autoimmune encephalitis can occur via three possible proposed pathophysiological mechanism and can manifest during or after the acute infection period. It is more common in adult but can also occur in the paediatric patients. There were various spectra of autoantibody panels reported including antineuronal antibody, anti-gangliosides antibody and onconeural antibody. Majority of the patients responded well to the immunomodulating therapy and achieved good recovery. Conclusion In conclusion, SARSCoV-2 infection can induce various spectrum of autoimmune encephalitis. It is a major concern since there is very limited long-term study on the topic. Hence, this review aims to elucidate on the potential long-term complication of SARS-CoV-2 infection and hopefully to improve the management and prognosis of COVID-19.

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RETRACTED: Remission of Subacute Psychosis in a COVID-19 Patient With an Antineuronal Autoantibody After Treatment With Intravenous Immunoglobulin

Cited by 19 publications

References 26 publications

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

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

COVID-19 and Psychotic Symptoms: the View from Psychiatric Immunology

Immune-mediated neurological syndrome in SARS-CoV-2 infection: a review of literature on autoimmune encephalitis in COVID-19

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