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The impact of the COVID–19 pandemic on psychosis remains to be established. Here, we report six cases (3 Male; 3 Female) of First Episode Psychosis (FEP) admitted to our hospital in the second month of national lockdown. All patients underwent routine laboratory tests and a standardized assessment of psychopathology. Hospitalization was required due to the severity of behavioral abnormalities in the context of a full–blown psychosis (BPRS = 53,3 ± 15,6). Blood tests, toxicological urine screening and brain imaging were unremarkable, with the exception of a mild cortical atrophy in the eldest patient (Male, 73 years). All patients were negative for SARS-CoV-2 throughout their stay but three presented the somatic delusion of being infected. Of note, all six cases had religious/spiritual delusions and hallucinatory contents. Despite a generally advanced age (53,3 ± 15,6), all patients had a negative psychiatric history. Rapid discharge (length of stay = 13,8 ± 6,9) with remission of symptoms (BPRS = 27,5 ± 3,1) and satisfactory insight were possible after relatively low–dose antipsychotic treatment (Olanzapine–equivalents = 10,6 ± 5,4 mg). Brief Psychotic Disorder (BPD) / Acute and Transient Psychotic Disorder (ATPD) diagnoses were confirmed during follow–up visits in all six cases. The youngest patient (Female, 23 years) also satisfied available criteria for Brief Limited Intermittent Psychotic Symptoms (BLIPS). Although research on larger populations is necessary, our preliminary observation suggests that intense psychosocial stress associated with a novel, potentially fatal disease and national lockdown restrictions might be a trigger for FEP.

The ongoing Corona Virus Disease 2019 (COVID–19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms. The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalized in the first four months since lockdown in Milan. We recruited sixty-two patients hospitalized between March 8 to July 8, 2020 versus those first  hospitalized in the same period in 2019. The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes. Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse. Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019. These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.

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Background: Depressive symptoms occur in several psychiatric disorders, often in the absence of a formal diagnosis of depression. We aimed to evaluate the efficacy and the tolerability of amisulpride, both alone and as augmentation therapy, in the treatment of depressive symptoms in individuals with any major psychiatric disorder. Methods:We searched PubMed, Embase, PsycINFO, GreyLit, OpenGrey and Pro-Quest up to March 2020 for randomised controlled trials focussing on the treatment of an acute depressive episode in any major psychiatric disorder. A randomeffect meta-analysis was performed to synthesize the findings on depressive symptoms (primary outcome), response rate and tolerability. Results:We retrieved 11 studies including 2065 patients with a diagnosis of dysthymia (eight studies), major depression (one study) or schizophrenia (two studies). Amisulpride 50 mg/day was associated with a larger reduction of depressive symptoms compared to placebo (standardised mean difference [SMD] = −0.70, CI 95% −0.92, −0.49; I 2 = 0.0%), and was found to be comparable to selective serotonin reuptake inhibitors (SSRIs; SMD = −0.08, CI 95% −0.23, 0.06, I 2 = 0.0%), amineptine, imipramine and amitriptyline in the treatment of dysthymia (three studies, not pooled). In individuals with schizophrenia, amisulpride administered at higher doses (>400 mg/day) was comparable to olanzapine and risperidone (two studies, not pooled). In terms of tolerability, amisulpride was superior to placebo for dysthymia (odds ratio [OR] = 3.94, CI 95% 1.07, 14.48; I 2 = 0.0) and comparable with SSRIs (OR = 0.94, CI 95% 0.55, 1.62; I 2 = 0.0%). Conclusion:Treatment with amisulpride could be a valid choice for selected individuals with dysthymia or depressive symptoms in the context of schizophrenia.More studies on the efficacy and tolerability of amisulpride are needed to draw firm conclusions on its potential benefits in other psychiatric disorders.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.