Severe and long‐lasting neuropsychiatric symptoms after mild respiratory symptoms caused by COVID‐19: A case report

Jozuka, Ryosuke; Kimura, Hiroki; Uematsu, Takashi; Fujigaki, Hidetsugu; Yamamoto, Yorimasa; Kobayashi, Masato; Kawabata, Kazuya; Koike, Haruki; Inada, Toshiya; Katsuno, Masahisa; Ozaki, Norio

doi:10.1002/npr2.12222

Cited by 9 publications

(11 citation statements)

References 25 publications

(22 reference statements)

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“…Presence of delirium as a clinical sign of compromised brain function was a frequent issue, even when cases of mere delirium were excluded. Yet there were patients who showed transition from delirium to psychosis (Caan et al, 2020;Clouden, 2020;Lim et al, 2020;Majadas et al, 2020;Khatib et al, 2021) and vice versa (Elkhaled et al, 2020;Panariello et al, 2020a;Jozuka et al, 2021) or states alternating between delirium and psychosis (Bernard-Valnet et al, 2020). Sometimes, delirium was reported as concomitant disorder or as a differential diagnosis to psychosis (Bernard-Valnet et al, 2020;Gillett & Jordan, 2020;Losee & Hanson, 2020;Haddad et al, 2021;Parker et al, 2021;Reinfeld & Yacoub, 2021), and in more than a third of all patients, confusion was documented.…”

Section: Patients With Infectionmentioning

confidence: 99%

First-episode psychotic disorders in the wake of the COVID-19 pandemic: a descriptive review of casereports

Rittmannsberger¹,

Barth²,

Malík³

et al. 2022

Acta Neuropsychiatr.

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Objective: Since the onset of COVID-19 pandemic many case reports and case series dealt with new onset psychotic disorders in patients either infected with SARS-CoV-2 or thematically linked to the pandemic, but without an infection. Our aim was to provide a comprehensive collection of these reports to illustrate the nature of these psychoses. Methods: We conducted a literature search in Medline, EMBASE, PSYCHINFO, using search terms regarding first episode psychotic disorders in the context of corona. Results: 96 case reports or case series covering 146 patients (62 without and 84 with SARS-CoV-2 infection) were found. Compared to patients without infection, patients with infection showed significantly more often visual hallucinations (28.6% vs 8.1%), confusion (36.9% vs 11.3%), an acute onset of illness (88.5% vs 59.6%) and less often depression (13.1% vs 35.5%) and a delusional content related to the pandemic (29.5% vs 78.3%). Both groups had an equally favourable outcome with a duration of psychosis ≤2 weeks in half and full remission in two thirds of patients. In patients with infection signs of inflammation were reported in 78.3% and increased CRP in 58.6%. While reports on patients with infection are continuously published, no report about patients without infection was found after July 2020. Conclusion: Cases without infection were considered reactive and originated all from the first wave of the Corona pandemic. In cases with infection, inflammation was considered as the main pathogenetic factor but was not found in all patients. Diagnosis was impeded by the overlap of psychosis with delirium.

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Section: Patients With Infectionmentioning

confidence: 99%

First-episode psychotic disorders in the wake of the COVID-19 pandemic: a descriptive review of casereports

Rittmannsberger¹,

Barth²,

Malík³

et al. 2022

Acta Neuropsychiatr.

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“…The interviews and focus groups were conducted in November and December 2021. [12,17,25,35,[61][62][63]] and informal interviews with patients as the authors are developing other research studies with patients suffering from this condition. Table 2 shows the list of topics and questions.…”

Section: Methodsmentioning

confidence: 99%

“…Regarding the characteristic symptomatology of this new pathology, it is confusing and not very speci c [20], and may be persistent or uctuating over time [19]. Long COVID patients may present a combination of symptoms that affect respiratory, dermatological, cardiovascular, gastrointestinal and/or neuropsychiatric levels [21][22][23][24][25]. Among the most predominant symptoms are extreme fatigue, shortness of breath, low-grade fever, cough, headache, chest and/or throat pain, muscle and joint pain, palpitations, diarrhea, loss of smell and/or taste, skin rashes, cognitive de cits such as mental fog, myalgias and tingling in the upper and lower extremities [26][27][28][29][30].…”

Section: Long Covidmentioning

confidence: 99%

The emotional well-being of Long COVID patients, widening social support and stigmatization in health and social services: a qualitative study

Samper-Pardo

Oliván-Blázquez

Magallón-Botaya

et al. 2022

Preprint

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Introduction: Long COVID patients have experienced a decline in their quality of life caused, in part but not wholly, by its negative emotional impact. Some of the most prevalent mental symptoms presented by Long COVID patients are anxiety, depression, and sleep disorders. Therefore, the need has arisen to establish the personal experiences of these patients to understand how they are managing in their daily lives while dealing with the condition. Objective: To increase understanding of the emotional well-being of people diagnosed with Long COVID. Methodology: A qualitative design was created and carried out using 35 patients, with 17 subjects being interviewed individually and 18 of them taking part in two focus groups. The participating patients were recruited in November and December 2021 from Primary Health Care (PHC) centers in the city of Zaragoza (Northern Spain) and from the Association of Long COVID Patients in Aragon. The study themes were emotional well-being, social support networks and experience of discrimination. All analyzes were performed iteratively using NVivo software. Results: The Long COVID patients demonstrated a very low state of mind due to their symptoms and limitations that had been persistent for many months in their daily life. Suicidal thoughts were also mentioned by several patients. They referred to anguish and anxiety about the future as well as fear of reinfection or relapse and returning to work. Many of the participants reported that they have sought the help of a mental health professional. Most identified discriminatory situations in health care. Conclusion: It is necessary to continue delving into the impact that Long COVID has had on mental health, and to provide entities with the necessary resources to solve these problems.

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“…In summary, about 30% of hospitalised COVID-19 patients developed neurological symptoms, including ataxia, agitation, delirium, headache, cerebrovascular disease, epilepsy, loss of taste and smell and diffuse corticospinal tract signs (Mao et al, 2020;Helms et al, 2020). While the area of the brain first affected by the virus may depend on the distribution of the ACE2 receptors, the neuropsychiatric symptoms in long COVID (Jozuka et al, 2021) are likely secondary to neurological damages from neuroinflammation, stroke, hypoxia and other causes yet to be discovered.…”

Section: Neurological Complicationsmentioning

confidence: 99%

Long COVID, neuropsychiatric disorders, psychotropics, present and future

Tang

Leonard

Helmeste

2022

Acta Neuropsychiatr.

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Long-COVID refers to the lingering or protracted illness long after the acute illness. Depression, anxiety, fatigue, concentration and cognitive impairment appeared to be reported often in long COVID, psychosis seemed uncommon. Neuropsychiatric disorders in long COVID could be a consequence of direct viral insult on the central nervous system (CNS), continuous neuroinflammation, or neurodegeneration and metabolic impairment following the cerebral vascular accidents, or hypoxia from pulmonary damages and fibrotic changes. It is important to know how patients with various disorders, not only neuropsychiatric disorders, thrive under long COVID. How much the neuropsychiatric disorders reported in long COVID are stress related in nature, due to prolonged quarantine and social isolation, would also be important to study. Patients with diabetes are already known to have a higher risk of mortality and morbidity in COVID-19. How brain glucose metabolism may contribute to the neuropsychiatric symptoms in long COVID is an important area for COVID-19 research. Patients on psychotropics often asked their clinicians about potential conflicts of their medications with anti-COVID 19 vaccinations, or whether it would increase their vulnerability to COVID-19 viral infection. Thus, early reports of protective effects of psychotropics against COVID-19 need to be validated. Some antidepressant and antipsychotic agents indeed possess significant affinities for the sigma-1 and histamine receptors. This, with the earlier reports of reduced number of sigma-1 receptors in post- mortem schizophrenic brains and the reported roles of sigma and histamine receptors in neuroinflammation and viral infections, may point to an important and novel direction for drug discovery against COVID-19. Literature and data in all these areas are accumulating at a fast rate. We reviewed and discussed the relevant and important literature.

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Severe and long‐lasting neuropsychiatric symptoms after mild respiratory symptoms caused by COVID‐19: A case report

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 9 publications

References 25 publications

First-episode psychotic disorders in the wake of the COVID-19 pandemic: a descriptive review of casereports

First-episode psychotic disorders in the wake of the COVID-19 pandemic: a descriptive review of casereports

The emotional well-being of Long COVID patients, widening social support and stigmatization in health and social services: a qualitative study

Long COVID, neuropsychiatric disorders, psychotropics, present and future

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