Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team

Abstract

Background Reports of psychiatric morbidity associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tend to be limited by geography and patients’ clinical status. Representative samples are needed to inform service planning and research. Aims To describe the psychiatric morbidity associated with SARS-CoV-2 infection (confirmed by real-time polymerase chain reaction) in referrals to a consultation-liaison psychiatry service in Qatar. Method Retrospective review of 50 consecutive referrals. Results Most patients were male. Median age was 39.5 years. Thirty-one patients were symptomatic (upper respiratory tract symptoms or pneumonia) for coronavirus disease 2019 (COVID-19) and 19 were asymptomatic (no characteristic physical symptoms of COVID-19 infection). Seventeen patients (34%) had a past psychiatric history including eight with bipolar I disorder or psychosis, all of whom relapsed. Thirty patients (60%) had physical comorbidity. The principal psychiatric diagnoses made by the consultation-liaison team were delirium (n = 13), psychosis (n = 9), acute stress reaction (n = 8), anxiety disorder (n = 8), depression (n = 8) and mania (n = 8). Delirium was confined to the COVID-19 symptomatic group (the exception being one asymptomatic patient with concurrent physical illness). The other psychiatric diagnoses spanned the symptomatic and asymptomatic patients with COVID. One patient with COVID-19 pneumonia experienced an ischaemic stroke. Approximately half the patients with mania and psychosis had no past psychiatric history. Three patients self-harmed. The commonest psychiatric symptoms were sleep disturbance (70%), anxiety (64%), agitation (50%), depressed mood (42%) and irritability (36%). Conclusions A wide range of psychiatric morbidity is associated with SARS-CoV-2 infection and is seen in symptomatic and asymptomatic individuals. Cases of psychosis and mania represented relapses in people with schizophrenia and bipolar disorder and also new onset cases.

Characteristics and outcomes of COVID-19 inpatients who underwent psychiatric consultations

“…In this context, it can be said that it is no surprise that COVID-19 causes delirium. To our knowledge, in the only study evaluating psychiatric consultations in COVID-19 wards, Iqbal et al (2020) reported that delirium was 26% in a sample of 98% males with a mean age of 43.9. In our study, the rate of delirium diagnosis was higher in patients who requested a consultation (38.2%).…”

“…In general, it can be said that the reasons for requesting consultations in the present study (although the frequency and order varied) did not differ from the results of previous studies of patients in general hospital wards ( Göktaş et al, 2006 ; Wilson et al, 2012 ; Eser et al, 2018 ). However, a small number of studies conducted with patients with COVID-19 found that these complaints were more common in patients after psychiatric evaluations ( Helms et al, 2020 ; Iqbal et al, 2020 ). In a recent study investigating psychiatric morbidity in patients with COVID-19 ( Iqbal et al, 2020 ) who were referred to the consultation-liaison psychiatry service, it was reported that the most common symptoms of patients were insomnia (70%), anxiety (64%), agitation (50%) and depressive mood (42%).…”

“…However, a small number of studies conducted with patients with COVID-19 found that these complaints were more common in patients after psychiatric evaluations ( Helms et al, 2020 ; Iqbal et al, 2020 ). In a recent study investigating psychiatric morbidity in patients with COVID-19 ( Iqbal et al, 2020 ) who were referred to the consultation-liaison psychiatry service, it was reported that the most common symptoms of patients were insomnia (70%), anxiety (64%), agitation (50%) and depressive mood (42%). Similarly, the study conducted by Xie et al (2020) looked at patients who were experiencing the first episode of their mental disorders and were hospitalized with or without a diagnosis of COVID-19.…”

The roles of a psychiatrist in the COVID-19 pandemic

“… 1 There is accumulating evidence of higher rates of symptoms of common mental health problems such as anxiety and insomnia 2 , 3 , 4 associated with the current pandemic, with some reports of severe psychiatric disorders including mania and psychosis. 5 , 6 , 7 These may arise directly from the effects of infection with enforced isolation and quarantine after viral exposure, or indirectly from additional stressors such as complicated bereavement, job losses, intra-familial tension and sudden impoverishment. So how may a psychiatrist make a useful contribution, both in the midst and aftermath of a viral pandemic?…”

Reviewing stress in COVID-19 times

“…Depression has led the number of publications related to these conditions but stress also is a matter of great concern. [4][5][6][7] According to Selye 8 stress is abstract; it does not exist in a pure state and, like life, is very difficult to define. Stress on a rat or a man does not exist as such; it appears to be combined with something, that is, it depends on a specific agent to be produced.…”