Psychiatric side effects of chloroquine in COVID-19 patients: two case reports

Benjelloun, Roukaya; Otheman, Yassine; Kettani, Chafik El

doi:10.11604/pamj.supp.2020.35.24064

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…39 Cases of CQ-induced mania may present as druginduced psychosis, or behave more like an affective disorder. 40 Although most psychiatric side effects of CQ and hydroxychloroquine have been described in the setting of rheumatologic disease treatment, 38 two case reports describe psychosis and anxiety in COVID-19 patients treated with CQ, 41 and a global pharmacovigilance study found the use of hydroxychloroquine was associated with an increased risk of psychiatric disorders. 42 Interestingly, in four of the five patients presented (#1, #3, #4, and #5), the rapid onset of symptoms after initiation of the drug and remission shortly after discontinuation, support CQ as a potential trigger for their neuropsychiatric symptoms; however, the direct impacts of direct CNS infection by SARS-CoV-2 or the indirect effects of neuroinflammation secondary to COVID-19 cannot be excluded.…”

Section: Chloroquine Neurotoxicitymentioning

confidence: 99%

Remitting neuropsychiatric symptoms in COVID‐19 patients: Viral cause or drug effect?

Forero‐Peña

Hernandez

Herrera

et al. 2021

Journal of Medical Virology

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Numerous reports of neuropsychiatric symptoms highlighted the pathologic potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relationship the onset and/or exacerbation of mental disease. However, coronavirus disease 2019 (COVID-19) treatments, themselves, must be considered as potential catalysts for new-onset neuropsychiatric symptoms in COVID-19 patients. To date, immediate and long-term neuropsychiatric complications following SARS-CoV-2 infection are currently unknown. Here we report on five patients with SARS-CoV-2 infection with possible associated neuropsychiatric involvement, following them clinically until resolution of their symptoms. We will also discuss the contributory roles of chloroquine and dexamethasone in these neuropsychiatric presentations.

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Section: Chloroquine Neurotoxicitymentioning

confidence: 99%

Remitting neuropsychiatric symptoms in COVID‐19 patients: Viral cause or drug effect?

Forero‐Peña

Hernandez

Herrera

et al. 2021

Journal of Medical Virology

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“…A total of 26 articles reporting cases related to the safety of HCQ or CQ during treatment for COVID-19 were found [ 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 ]. Table 6 synthesises the data from the cases reporting HCQ and CQ adverse drug reactions in COVID-19-affected patients and Table S21 of Supplementary Material part 2 provides full details.…”

Section: Resultsmentioning

confidence: 99%

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.

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“…Psychiatric side effects from hydroxychloroquine and chloroquine in the context of COVID-19 infection are also poorly understood. Antibiotic treatment was discontinued, and resolution of hallucinations was reported in 48 hours, and the patient remained asymptomatic after follow-up around two months later [ 14 ]. It is possible that antibiotic use, particularly quinolones, increased the risk of the emergence of psychotic symptoms in the setting of COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

New-Onset Mania and Psychosis in Adolescents in the Context of COVID-19 Infection

Meeder¹,

Adhikari²,

Sierra-Cintron³

et al. 2022

Cureus

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There is a growing body of evidence that coronavirus disease 2019 (COVID-19) is linked with neuropsychiatric complications such as psychosis and delirium in adults. Much less is known about the neuropsychiatric manifestations of this virus in the child and adolescent population. This case series discusses two unique adolescent patients who presented with new-onset mania and psychosis in the context of an otherwise asymptomatic COVID-19 infection, which raises several questions about whether and how the virus precipitates mania and psychosis, whether these symptoms are transient or predisposes patients to a chronic psychiatric disorder, and confounding variables that may have contributed to the symptoms. These questions can then be points for future research and longitudinal follow-up that can better improve our knowledge about the relationship between this complicated virus and how it affects children psychiatrically.

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Psychiatric side effects of chloroquine in COVID-19 patients: two case reports

Cited by 9 publications

References 16 publications

Remitting neuropsychiatric symptoms in COVID‐19 patients: Viral cause or drug effect?

Remitting neuropsychiatric symptoms in COVID‐19 patients: Viral cause or drug effect?

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

New-Onset Mania and Psychosis in Adolescents in the Context of COVID-19 Infection

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