First report of manic-like symptoms in a COVID-19 patient with no previous history of a psychiatric disorder

Lu, Shengyong; Wei, Ning; Jiang, Jiajun; Wu, Lingling; Sheng, Jifang; Zhou, Jianying; Fang, Qiang; Chen, Yu; Zheng, Shufa; Chen, Feng; Liang, Tingbo; Hu, Shaohua

doi:10.1016/j.jad.2020.08.031

Cited by 63 publications

(69 citation statements)

References 13 publications

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“…Similarly, Lu et al 31 reported a case of SARS‐CoV‐2 infection with manic‐like symptoms. After a manic‐like attack, IgG antibody specific to SARS‐CoV‐2 was detected in the CSF, but RT‐PCR in CSF for SARS‐CoV‐2 was negative.…”

Section: Resultsmentioning

confidence: 86%

“…In a preprint recently deposited in bioRxiv, Song et al 32 reported the detection of IgG antibodies specific to the spike protein of SARS‐CoV‐2 in CSF from a COVID‐19 patient with acute encephalopathy. The antibodies were able to block SARS‐CoV‐2 infection in brain organoids, which highlights the potential of SARS‐CoV‐2 neuroinvasion and subsequent immune response in the CNS.…”

Section: Resultsmentioning

confidence: 99%

“…SARS‐CoV‐2 viral antigen has been demonstrated in the olfactory bulb and tracts, 51 and the damage in the olfactory pathway was progressively less severe from peripherally to centrally 44 . Moreover, MRI examinations of COVID‐19 patients revealed obvious structural changes in the olfactory pathway, including olfactory nerve, olfactory bulb, and olfactory cortex, indicating that SARS‐CoV‐2 might enter the CNS via an olfactory bulb‐mediated trans‐neuronal route 31,71,72 …”

Section: Discussionmentioning

confidence: 99%

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Evidence of central nervous system infection and neuroinvasive routes, as well as neurological involvement, in the lethality of SARS‐CoV‐2 infection

liu

Tan

et al. 2020

Journal of Medical Virology

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The outbreak of coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), has become a significant and urgent threat to the global health. This review provided strong support for CNS infection with SARS‐CoV‐2 and shed light on neurological mechanism underlying the lethality of SARS‐CoV‐2 infection. Among the published data, only 1.28% COVID‐19 patients who underwent cerebrospinal fluid (CSF) tests were positive to SARS‐CoV‐2 in CSF. However, this does not mean the absence of CNS infection in most COVID‐19 patients, because postmortem studies revealed that some patients with CNS infection showed negative results in CSF tests for SARS‐CoV‐2. Among 20 neuropathological studies reported so far, SARS‐CoV‐2 was detected in the brain of 58 cases in 9 studies, and three studies have provided sufficient details on the CNS infection in COVID‐19 patients. Almost all in vitro and in vivo experiments support the neuroinvasive potential of SARS‐CoV‐2. In infected animals, SARS‐CoV‐2 was found within neurons in different brain areas with a wide spectrum of neuropathology, consistent with the reported clinical symptoms in COVID‐19 patients. Several lines of evidence indicate that SARS‐CoV‐2 used hematopoietic route to enter the CNS. But more evidence supports the trans‐neuronal hypothesis. SARS‐CoV‐2 has been found to invade the brain via the olfactory, gustatory and trigeminal pathways, especially at the early stage of infection. Severe COVID‐19 patients with neurological deficits are at a higher risk of mortality, and only the infected animals showing neurological symptoms became dead, suggesting that neurological involvement may be one cause of death. This article is protected by copyright. All rights reserved.

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Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evidence of central nervous system infection and neuroinvasive routes, as well as neurological involvement, in the lethality of SARS‐CoV‐2 infection

liu

Tan

et al. 2020

Journal of Medical Virology

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“…6 patients had positive SARS-CoV-2 antibodies but no evaluation to distinguish intrathecal synthesis from transudation [ 31 , 197 , 224 , 237 ]…”

Section: Resultsmentioning

confidence: 99%

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

141

143

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We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.

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“…What has become increasingly apparent is that patients with SARS-CoV-2 show higher manifestations of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms when compared with non-COVID controls [ 22 ]. Recently, a case report showed that manic-like symptoms might be a delayed response to CNS infection by SARS-CoV-2 in patients with no history of psychiatric illness [ 23 ]. While this could be mediated by the significant psychological stress experienced by these patients [ 22 ], there may also be neuropathological underpinnings to this phenomenon.…”

Section: Overview Of Sars-cov-2 With Emphasis On Neuropsychiatric Comentioning

confidence: 99%

The neuropsychiatric manifestations of COVID-19: Interactions with psychiatric illness and pharmacological treatment

Vuren

Steyn

Brink

et al. 2021

Biomedicine & Pharmacotherapy

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First report of manic-like symptoms in a COVID-19 patient with no previous history of a psychiatric disorder

Abstract: Highlights It was the first time that SARS-CoV-2 was tried to be identified from a CSF specimen in a COVID-19 patient with manic-like symptoms. The detection of SARS-CoV-2 specific IgG antibody in CSF was positive.

Cited by 63 publications

References 13 publications

Evidence of central nervous system infection and neuroinvasive routes, as well as neurological involvement, in the lethality of SARS‐CoV‐2 infection

Evidence of central nervous system infection and neuroinvasive routes, as well as neurological involvement, in the lethality of SARS‐CoV‐2 infection

Cerebrospinal fluid in COVID-19: A systematic review of the literature

The neuropsychiatric manifestations of COVID-19: Interactions with psychiatric illness and pharmacological treatment

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