SARS-CoV-2-associated first episode of acute mania with psychotic features

Abstract

Despite neuropsychiatric outcomes of SARS-CoV-2 infection are now under close scrutiny, psychoneuroimmunological characteristics of COVID-19 and precise pathophysiology of neuropsychiatric manifestations of the infection are still obscure. Moreover, there still exists a shortfall in demonstrating specific clinical manifestations of the brain involvement of the virus. Here, we presented a 33-year-old female patient with COVID-19, reporting acute-onset paranoid delusions symptoms, insomnia and irritability. Cranial MRI showed an hyperintense signal in the splenium of the corpus callosum with decreased apparent diffusion coefficient, which might possibly indicate the presence of cytotoxic edema related to the brain involvement of the infection. Following the completion of SARS-CoV-2 treatment, both cytotoxic edema and psychiatric symptoms resolved. In light of this report, we suggest that either heightened immune response and direct viral infection that SARS-CoV-2 may lead to such psychiatric manifestations and neuropsychiatric monitoring should be performed in patients with COVID-19. Prompt recognition of psychiatric consequences of COVID-19 may help clinicians provide guidance for differential diagnosis and manage them accordingly.

COVID-19-associated psychosis: A systematic review of case reports

“…Finally, 18 articles did not include individual level data and 7 articles were available as abstracts only. A total of 40 articles met inclusion criteria, comprising 48 individual patients from 17 countries ( Table 1 ) [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ]. All but a single study [ 54 ] were in English and 20 (42%) cases were reported in the United States, where the largest proportion of these cases were documented.…”

“…No lumbar puncture. Sen et al, 2021 [ 59 ] 33, F, TR Paranoid delusions that children were under effects of bad spirts and that husband having an affair. Also with insomnia, irritability, anxiety, dysphoric and manic Not reported None None +SARS-CoV-2 IgM.…”

A novel adverse effect of the BNT162b2 mRNA vaccine: First episode of acute mania with psychotic features

“…mRNA vaccines contain nucleotides from the genetic code of the virus that encode a viral protein. This protein is a viral antigen that can cause neuropsychiatric symptoms such as autoimmune psychosis (anti- NMDAR, AMPAR, CAPR2 encephalitis) by rapidly increasing a pro-inflammatory response and activated autoimmune mechanism ( Pollak et al 2020 ; Sen, Yesilkaya, and Balcioglu 2021 ). Another hypothesis suggests that the inflammatory mechanisms caused by COVID-19 can trigger neuropsychiatric symptoms via thiamine deficiency.…”

New variants and new symptoms in COVID-19: First episode psychosis and Cotard's Syndrome two months after infection with the B.1.1.7 variant of coronavirus

“…During the course of coronavirus disease-2019 (COVID-19) pandemic, many neuropsychiatric manifestations of the disease have been observed while the precise pathophysiology remains unknown ( Sen et al, 2021 ; Yesilkaya et al, 2021 ). New variants of coronavirus such as the 501.V2 and B.1.1.7 have emerged and obscurities in pathogenesis have increased even further with these variants.…”