Brief Psychotic Disorder During the National Lockdown in Italy: An Emerging Clinical Phenomenon of the COVID-19 Pandemic

Abstract

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.

Deterioration of mental health despite successful control of the COVID-19 pandemic in South Korea.

“…( Adery, 2019 , AL‐Rousan and AL‐Najjar, 2020 , Kim et al, 2018 , Liu et al, 2020 , Lloyd-Sherlock et al, 2020 , Rajkumar, 2020 , Tsai and Wilson, 2020 , Yao et al, 2020 , Cohen et al, 1997 , D'Agostino et al, 2020 )…”

Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, italy.

“… Fiorillo and Gorwood, 2020 , Galea et al, 2020 , Libertini et al, 2019 , Nikolai and Weibell, 2019 , Sher, 2020 , D'Agostino et al, 2020 …”

The impact of the COVID-19 pandemic on negative symptoms in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia

“…Clinical case reports and commentaries have posited that the COVID-19 pandemic will lead to widespread reductions in service utilization and subsequent increases in acute symptom exacerbations in those who had already been diagnosed with a psychotic disorder prior to the pandemic [35,40,44]. There is also fear that reduced access to healthcare, social isolation, and reduced physical activity may lead those at clinical high risk (CHR) for developing psychosis to transition to illness onset [6,14,17]. Although clinical reports are alarming, empirical evidence for the detrimental effects of the COVID-19 pandemic on schizophrenia-spectrum symptoms in SZ and CHR populations has yet to be demonstrated relative to prepandemic data.…”