COVID-19 Infection Associated with Psychosis in Hemodialysis Patient

Abstract

Hemodialysis is a medical procedure to correct electrolyte imbalance and remove fluids and waste products from the blood of patients with end-stage renal disease. Dialysis patients are immunosuppressed and hence at risk of complications of coronavirus infection. In addition, dialysis for most patients is performed in-center, with therapy offered three times per week for 3.5 hours per session in sites highly exposed to virus contamination. A weak immune system and low cytokine storm explain why COVID-19 may be less severe in dialysis patients as death due to COVID-19 or effects on comorbidities in COVID-19 patients is due to overresponse against the virus by the immune system and cytokine storm. However, during the frequent trips between the dialysis center and home, the risk of coronavirus infection could be high. Moreover, hemodialysis patients constitute a distinct and high-risk group that is often associated with low immunity, decline or loss of the ability to work, substantial economic burden, the inability to fulfill family responsibilities and participate in an active social life, and suffer from various complications such as muscle weakness, pruritus, fatigue, diabetes, hypertension, and restless legs. These factors are associated with lower quality of life and poor clinical outcomes, leading to a higher risk of psychological problems than in the general population. We report a rare case of new-onset psychosis (mostly delirium) following COVID-19 infection in a middle-aged hemodialysis patient with rapid recovery.

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.…”