Catatonia in a hospitalized patient with COVID-19 and proposed immune-mediated mechanism

Gouse, Brittany M; Spears, William; Archibald, Ashley Nieves; Montalvo, Cristina

doi:10.1016/j.bbi.2020.08.007

Cited by 25 publications

(31 citation statements)

References 8 publications

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“…However, the above reports also suggest an inflammatory basis for COVID-19-associated catatonia. We highlight the work of Gouse et al 13 in the current pandemic, who first demonstrated a correlation between the development of catatonic symptoms in COVID-19 patients and the concordant rise in serum pro-inflammatory markers. In general, there is also a co-occurrence of catatonic symptoms with non-viral inflammatory or autoimmune conditions, and with biochemical inflammatory markers in the neuroleptic malignant syndrome (NMS).…”

Section: Discussionmentioning

confidence: 72%

“…This was followed by a case report of an 80-year-old male presenting with moderately severe COVID-19 pneumonia who later developed akinetic catatonia. 13 Importantly, the authors demonstrated a rise in pro-inflammatory markers typically seen in COVID-19 disease (lymphocyte count, CRP, D-dimer, Ferritin, lactate dehydrogenase, and procalcitonin) concurrent with the onset of catatonia, that suggested an immune-mediated or inflammatory mechanism.…”

Section: Discussionmentioning

confidence: 96%

“… Ascertainment – No CSF studies Causality – Underlying SMI. – Other medical illness Zandifar and Badrfam, 2020 13 61, Male, Iran Auditory hallucinations, Capgras delusion, paranoia progressing to mutism, stupor, posturing, negativism, rigidity BFCRS score not reported Lethargy, nausea, seizure. Hyponatremia (Na 120 mg/L) Schizophrenia SARS-CoV-2 infection WBC count 15.7 x 10 9 cells/L Prior to catatonic symptoms: haloperidol 10 PO daily, biperiden 3mg PO daily; medications held at time of catatonia diagnosis Lorazepam 2mg PO TID Authors do not report whether lorazepam was continued on discharge; restarted on haloperidol 10mg PO daily, biperiden 3mg PO daily; resolution of catatonia after 24 hours.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 and Catatonia: A Case Series and Systematic Review of Existing Literature

Scheiner

Smith

Wohlleber

et al. 2021

Journal of the Academy of Consultation-Liaison Psychiatry

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Background Current observational literature on the mental health impact of the COVID-19 pandemic has focused on anxiety, depression, and sleep-disturbance among the public, healthcare workers, and COVID-19 patients. Case reports suggest catatonia and psychosis may be presenting symptoms of COVID-19 disease with a mechanism postulated to involve central nervous system changes in response to inflammation. There is a lack of robust evidence examining catatonia in this context. We sought to systematically review available case data and contextualize our findings. Case Presentations We present three cases of patients with catatonia seen at a large metropolitan tertiary care hospital in which their catatonia was likely attributable to SARS-CoV-2 infection. Ms. A is a female in her 50s with no psychiatric history who presented with self-inflicted stab wounds following her COVID-19 diagnosis. Ms. B is a female in her 50s with a history of schizophrenia, but no history of catatonia, who presented with akinetic catatonia, SARS-CoV-2 infection, and Clostridium difficile infection, without respiratory manifestations of COVID-19. Ms. C is a female in her 20s with a history of bipolar disorder (type 1) without catatonic features who presented with akinetic catatonia without the physical symptoms of SARS-CoV-2 infection. Discussion We present a brief review of six case reports detailing co-occurring catatonia and SARS-CoV-2 infection and one case report of catatonia attributed to the psychological stress of the COVID-19 pandemic in a patient without SARS-CoV-2 infection. We note one additional case of co-occurring catatonia and SARS-CoV-2 infection for which details are not available. COVID-19-associated catatonia may develop secondary to psychological and physical factors. Cases often report anxiety preceding catatonic symptoms. Developing evidence also suggests SARS-CoV-2 may act directly on the central nervous system or via a systemic inflammatory response. One of our cases featured significant anxiety preceding symptoms, and two had co-occurring elevated serum inflammatory markers. We suggest that clinicians should keep a high index of suspicion for both clinically significant anxiety disorders and catatonia.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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COVID-19 and Catatonia: A Case Series and Systematic Review of Existing Literature

Scheiner

Smith

Wohlleber

et al. 2021

Journal of the Academy of Consultation-Liaison Psychiatry

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“…There have been a number of cases documented in the literature of catatonia occurring in association with COVID-19 infection [7][8][9][10][11][12]. One case documented retarded catatonia with concurrent COVID-19 infection in a patient with no prior significant history; the authors attributed the presentation to possible brief psychotic disorder in the setting of increased anxiety secondary to the pandemic, involvement of medications associated with catatonia, as well as the direct neurologic impact of infection [7].…”

Section: Discussionmentioning

confidence: 99%

“…COVID-19 has also been found to exacerbate psychosis and potentially cause catatonia in patients with a prior psychiatric history. In one case, a patient with schizophrenia had an increase in pro-inflammatory markers leading the authors to note that an inflammatory state could be associated with altered GABAergic transmission and a hypodopaminergic state in the basal ganglia [ 9 ]. Another patient with a history of schizophrenia presented with a sudden exacerbation of psychotic symptoms and onset of catatonia in the setting of COVID-19 infection; since the patient was also hyponatremic, the authors postulated that COVID-19 induced syndrome of inappropriate antidiuretic hormone (SIADH) could contribute to the exacerbation of psychiatric symptoms [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Excited Catatonia — A Delayed Neuropsychiatric Complication of COVID-19 Infection

Zain¹,

Muthukanagaraj²,

Rahman³

2021

Cureus

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An increasing number of patients have been presenting with neuropsychiatric signs and symptoms associated with coronavirus disease (COVID-19). We present a case of a 69-year-old female with no prior psychiatric history who was brought to the emergency department due to bizarre behavior and paranoid thoughts for four to six weeks, worsening over the last two weeks. Psychiatric evaluation found that the patient had extreme restlessness and agitation, poor eye contact, paranoid delusions, visual hallucinations, and a flat affect with stereotypic repetition of speech and loose associations. The patient's family noted that two months prior she had symptoms of common cold associated with a severe cough and 20 pounds of weight loss. Suspicion for prior COVID-19 infection prompted an IgG antibody test, which was positive. Our patient displayed at least three of the signs needed to diagnose catatonia-agitation, rigidity, and echolaliaand had a therapeutic response to lorazepam, confirming suspicions of excited catatonia. Her seropositivity for IgG against COVID-19 suggested a COVID-induced brief psychotic disorder with catatonia, which makes this the first known case, to our knowledge, of a patient with delayed onset catatonia after COVID-19 infection. This suggests that clinicians should, after ruling out more plausible stressors, suspect possible coronavirus involvement in sudden onset psychotic disorders, especially in patients who do not fit the demographic of new-onset schizophrenia-spectrum diagnoses. Further research is needed on the pathophysiology behind COVID-19 altering neuronal function and neurotransmitter pathways.

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Clinical practice guideline for clozapine use in patients with COVID‐19

Ansari

Kelbrick

Paduret

et al. 2023

Prog Neurol Psychiatry

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Catatonia in a hospitalized patient with COVID-19 and proposed immune-mediated mechanism

Cited by 25 publications

References 8 publications

COVID-19 and Catatonia: A Case Series and Systematic Review of Existing Literature

COVID-19 and Catatonia: A Case Series and Systematic Review of Existing Literature

Excited Catatonia — A Delayed Neuropsychiatric Complication of COVID-19 Infection

Clinical practice guideline for clozapine use in patients with COVID‐19

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