COVID-19 Induced Brief Psychotic Disorder: A Case Report and Review of Literature

Abstract

The COVID-19 pandemic has significantly impacted people around the world, with asymptomatic infection to severe diseases and death. There is an increasing incidence of mental health problems in patients diagnosed with COVID-19. There are some studies that discuss possible mechanisms responsible for psychotic disorders due to coronavirus as well as risk factors for developing psychosis in patients infected with the virus. We report the case and a review of the literature in a 29-year-old female with no past psychiatric history who was diagnosed with a brief psychotic disorder following infection with COVID-19.

New-Onset Psychosis in the Context of COVID-19 Infection: An Illustrative Case and Literature Review

“…Discharged after 7 days with no psychiatric symptoms. Atris et al, 2021 ( 12 ) 46-year-old male Insomnia, auditory hallucinations, paranoid delusions Loss of smell and taste, productive cough, loss of appetite ------------- Elevated CRP of 13.3 mg/dL, normal ferritin, normal d-dimer Quetiapine 50 mg twice daily, sodium valproate 200 mg twice daily Very low dose Psychiatric symptoms improved Bakre et al, 2022 ( 13 ) 29-year-old female Disorganized thought process, depressed mood, auditory and visual hallucinations, poor sleep, hyper-religiosity Sore throat, fever, headache, loss of smell and taste None ---------------- Olanzapine transitioned to aripiprazole 10 mg daily Low dose More organized thought process and behaviorally appropriate on 4 th day of admission. Discharged in stable condition on 5 th day.…”

“…Smith et al present a patient who improved on a low dose of Risperidone and was able to self-discontinue the medication ( 21 ). Bakre et al and Losee et al also describe patients whose symptoms improved within less than 5 days of hospitalization ( 13 , 19 ). Contrasting these case reports, Kumar et al and Parker et al describe patients whose recovery took 3 months and 6 weeks after symptom onset, respectively ( 18 , 20 ).…”

New-Onset Hyperreligiosity, Demonic Hallucinations, and Apocalyptic Delusions following COVID-19 Infection

“…Potential mechanisms that have been suggested include viral infiltration of the central nervous system, disruption of the cytokine network, peripheral myeloid cell recruitment to the CNS, autoimmune response [ 8 ], effects of concomitant corticosteroid treatment [ 9 ], or changes to gut microbial composition [ 10 ]. The virus is postulated to enter the central nervous system either hematogenously or via retrograde axonal transport of peripheral neurons after binding to angiotensin-converting enzyme 2 [ 11 ].…”

Schizophrenia Secondary to COVID-19 and Tuberculosis: A Case Series of Post-Infection Schizophrenia

“…In Case A, there is no evidence of neurotuberculosis as well as he was not on any antitubercular drug at the time of diagnosis. COVID-19-associated psychosis is reported to be acute onset and brief in nature, 5 occurring weeks to months after the infection, 6 or drug-induced. 7 In Case B, psychosis was of gradual onset, persistent, and started concomitantly with COVID-19 in a drug-naive person.…”

“…Mycobacterium tuberculosis infection and SARS-Cov2 infection are both associated with a rise in proinflammatory cytokines. 5 , 8 The inflammatory condition may also result in white matter ischemic changes in the brain, mediated by microglial activation and beta-amyloid accumulation, 9 which may be the reason for MRI brain changes seen in Case A, or it may be an incidental finding. A high level of proinflammatory cytokines has been found in the body fluid of patients with SZ.…”