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

Abstract

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.

Spotlight on non-motor symptoms and Covid-19

“…In the Covid-19 context, incident psychosis has not been very common, although more findings have been based on case reports and case series. According to a recent review of December 2021 summarizing the known published cases, delusions were the most typical sign of new-onset Covid-19 psychosis, and most patients had a favorable outcome, although 69% required hospitalization and 33% had to be admitted in a psychiatric facility ( Smith et al, 2021 ). However, concurrent delirium was not excluded in the majority of cases and the possibility of bias was considered high in almost one out of three patients, either due to a history of substance abuse, psychiatric disorders or other medical conditions, which might be related to secondary psychosis ( Smith et al, 2021 ).…”

“…According to a recent review of December 2021 summarizing the known published cases, delusions were the most typical sign of new-onset Covid-19 psychosis, and most patients had a favorable outcome, although 69% required hospitalization and 33% had to be admitted in a psychiatric facility ( Smith et al, 2021 ). However, concurrent delirium was not excluded in the majority of cases and the possibility of bias was considered high in almost one out of three patients, either due to a history of substance abuse, psychiatric disorders or other medical conditions, which might be related to secondary psychosis ( Smith et al, 2021 ). In the case-series of 10 advanced PwP diagnosed with Covid-19, no new-onset cases of psychosis was described, but psychotic features, which had been present prior to Covid-19, were reported to worsen during the infection ( Antonini et al, 2020 ).…”

Psychosis After Infection With SARS-CoV-2 in an Adolescent: A Case Report

“…1 Several case reports have demonstrated the association between psychotic symptoms following infection with COVID-19 in adults. 1,2 In a first episode of psychosis, clinical findings on history, examination and diagnostic studies may suggest that the psychotic symptoms are due to medical illness, which may be reversible. The presentation can include acute onset, predominance of visual or tactile hallucinations and association with other neurological symptoms.…”

“…As many as one-third of COVID-19 patients develop long term neuropsychiatric symptoms such as anxiety, depression, brain fog, psychosis, seizures, and suicidal behavior.1 Several case reports have demonstrated the association between psychotic symptoms following infection with COVID-19 in adults. 1 , 2 …”

“…In adults, neuropsychiatric symptoms associated with COVID-19 such as psychosis typically occur within days to weeks after the infection. 2 Child and adolescents have similarly shown that most neuropsychiatric symptoms develop after the acute respiratory infection resolves. 4 Our case adds to the emerging body of data on neuropsychiatric symptoms in youth with COVID-19 infection.…”