First episode psychosis following receipt of first dose of COVID-19 vaccine: A case report

Grover, Sandeep; Rani, Seema; Kohat, Komal; Kathiravan, Sanjana; Patel, Garima; Mehra, Aseem; Singh, Shubhmohan; Bhadada, Sanjay Kumar

doi:10.1016/j.schres.2022.01.025

Cited by 23 publications

(31 citation statements)

References 11 publications

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“…The occurrence of psychosis following vaccination may be mediated by immune response of the body against the SARS-CoV-2. Specifically, the administration of vaccine elicits a cellular immune reaction which leads to T-helper cell mediated outpouring of pro-inflammatory cytokines ( Grover et al, 2022a ). In some individuals, this may lead to cytokine storm and NMDA receptor hypofunction with a resultant increase in dopamine; this may trigger a psychotic state ( Grover et al, 2022a ).…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, the administration of vaccine elicits a cellular immune reaction which leads to T-helper cell mediated outpouring of pro-inflammatory cytokines ( Grover et al, 2022a ). In some individuals, this may lead to cytokine storm and NMDA receptor hypofunction with a resultant increase in dopamine; this may trigger a psychotic state ( Grover et al, 2022a ). Other hypothesized causes for psychosis post-vaccination include anti-NMDA encephalitis ( Flannery et al, 2021 , Hilaire et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“… Roberts et al, 2021 51/M First dose of AstraZeneca vaccine (Viral vector Vaccine) Altered Mental status 10 days Disoriented to time and place, disordered thought, labile mood, auditory hallucinations 4. Grover et al, 2022a 18/F First dose of AstraZeneca's Vaxzevria (Viral vector vaccine) Psychosis Same day Irritability, irrelevant speech, decreased sleep, delusions of persecution and reference, visual hallucinations. 5.…”

Section: Search Strategy and Study Selectionmentioning

confidence: 99%

“…Symptoms started few hours after the vaccination with irrelevant talk and over the next three days, it progressed to irritability, delusions of persecution and reference, and visual hallucinations. Because of the temporal correlation and because other causes, including delirium were excluded, a diagnosis of vaccine associated psychosis was considered ( Grover et al, 2022b ). Similarly, Giné-Servén et al described two cases of acute psychosis within a week following receipt of AstraZeneca vaccine ( Giné-Servén et al, 2021 ).…”

Section: Psychosismentioning

confidence: 99%

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Psychiatric adverse reactions to COVID-19 vaccines: A rapid review of published case reports

Balasubramanian

Faheem

Padhy

et al. 2022

Asian Journal of Psychiatry

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Search Strategy and Study Selectionmentioning

confidence: 99%

Section: Psychosismentioning

confidence: 99%

See 2 more Smart Citations

Psychiatric adverse reactions to COVID-19 vaccines: A rapid review of published case reports

Balasubramanian

Faheem

Padhy

et al. 2022

Asian Journal of Psychiatry

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“…There have been multiple reports on the rare occurrence of central nervous system (CNS) complications related to different types of COVID-19 vaccination, including ChAdOx1 nCoV-19, mRNA-1273 and BNT162b2. These included acute encephalopathy ( Roberts et al, 2021 , Grover et al, 2022 , Al-Mashdali et al, 2021 , Baldelli et al, 2021 ) or encephalitis, ( Zuhorn et al, 2021 , Torrealba-Acosta et al, 2021 , Fan et al, 2022 , Kobayashi et al, 2022 , Zlotnik et al, 2021 , Takata et al, 2021 ) which in some cases were associated with seizures including two cases of new-onset refractory status epilepticus (NORSE), ( Fan et al, 2022 , Aladdin and Shirah, 2021 ). There are also several reports of acute disseminated encephalomyelitis (ADEM) or ADEM-like presentations ( Vogrig et al, 2021 , Cao and Ren, 2021, Ozgen Kenangil et al, 2021 , Rinaldi et al, 2021, Kania et al, 2021 ) and acute necrotizing encephalopathy ( Bensaidane et al, 2022 , Siriratnam et al, 2022 ).…”

Section: Electroencephalography (Eeg)mentioning

confidence: 99%

The clinical neurophysiology of COVID-19-direct infection, long-term sequelae and para-immunization responses: A literature review

Haykal

Menkes

2023

Clinical Neurophysiology Practice

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Azd-1222

2022

Reactions Weekly

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Acute gastroenteritis with pancytopenia, transaminitis and psychosis: case reportAn 18-year-old woman developed acute gastroenteritis with pancytopenia, transaminitis and psychosis following vaccination with AZD-1222 [dosage and route not stated; not all durations of treatment to reaction onsets stated].The woman with no psychotic history was brought to the emergency department by family members for irrelevant talk and bizarre behavior. There was no history of substance use. After explosring her history, it was revealed that, she was well before receiving her first dose of AZD-1222 [Vaxzevria] vaccine. Within two to three hours of receiving vaccine, she developed high grade fever with chills, and multiple episodes of loose stools.The woman received unspecified antipyretics, which did not improve her symptoms. She then had dizziness and one episode of fall, after which she visited a local hospital, where she received treatment with unspecified IV fluids. Next day, her fever subsided, however, she started to remain anxious. She could not sleep at night, used to woke-up frequently, appeared fearful and would appear to be staring in between. She kept on pacing around and used to appear distressed. During the next 3 to 4 days, she started to remain irritable, talked irrelevantly, tried to run away from home, voiced delusions of persecution and reference, and had visual hallucinations of seeing Gods and demons. Because of these uncontrollable symptoms, she was brought to the emergency department. She was found to be negative for COVID-19 infection. However, she had pancytopenia and transaminitis, according to the investigational results. A diagnosis of AZD-1222 induced acute gastroenteritis with pancytopenia and transaminitis was considered. A consultation with psychiatrist was suggested for her psychotic symptoms. After psychiatric evaluation, differential diagnoses of organic psychosis versus acute and transient psychosis vs delirium were considered. She was started with olanzapine. Blood culture, urine examination including culture, cerebrospinal fluid examination, Wilson disease work-up, evaluation for systemic lupus erythematosus and workup for autoimmune encephalitis were all normal. EEG also showed normal results. However, brain MRI showed discrete tiny T2/FLAIR hyperintensities in deep white matter in bilateral fronto-parietal lobes. Due to absence of relevant symptoms, delirium was ruled out. After ruling out other causes, and relating a temporal association of symptoms with vaccine administration, a diagnosis of vaccine associated psychosis was considered. Because of continued symptoms and catatonia in the form of mutism, staring, rigidity and negativism, she was also started with lorazepam. The dose of olanzapine was also increased slowly. She showed significant improvement within 2 weeks, after which lorazepam was tapered off. She maintained well for three months with good adherence and regular follow-up. The dose of olanzapine was reduced further. She refused to take the next dose of the vaccine.

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First episode psychosis following receipt of first dose of COVID-19 vaccine: A case report

Cited by 23 publications

References 11 publications

Psychiatric adverse reactions to COVID-19 vaccines: A rapid review of published case reports

Psychiatric adverse reactions to COVID-19 vaccines: A rapid review of published case reports

The clinical neurophysiology of COVID-19-direct infection, long-term sequelae and para-immunization responses: A literature review

Azd-1222

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