COVID- 19 Following Acute Psychosis: Case series report

Abstract

Introduction Coronavirus disease (COVID-19) could result in various medical consequences. Clinical manifestations are diverse and range from asymptomatic or mild, fever-like symptoms, to more severe and life-threatening complications. Although the clinical presentation was initially dominated by respiratory symptoms, psychiatric symptoms and sequelae have been reported in COVID- 19 patients and convalescents. Objectives To describe four clinical case reports of patients admitted to the inpatient unit of Psychiatric Hospital Sarajevo (PHS) with acute onset of psychosis in the recovery stage of COVID-19. Methods In this case series we report cases of 4 patients, all female, mean age 53.25 years, hospitalized in PHS during the third wave of the COVID-19 pandemic. All developed psychotic symptoms in the recovery phase of COVID-19. None had a previous history of psychiatric disturbances of any kind. All patients were diagnosed with brief psychotic disorder (BPD), according to DSM 5 criteria for BPD. Results COVID-19 affects various organ systems, including the brain, with variable symptoms based on disease severity. Psychotic features have been observed as well. The pathophysiology and direct biological effects of the disease are not fully understood. COVID-19 patients and convalescents can develop psychotic symptoms as a consequence of multiple concurrent factors. Several proposed mechanisms include direct central nervous system infiltration, cytokine network dysregulation, peripheral immune cell transmigration, and post-infectious autoimmunity [1], treatments used to manage the infection, and psychosocial stress. Conclusions Clinicians need to be aware of possible psychotic manifestations in COVID-19 patients and survivors. Long-term follow-up is warranted to provide efficient patient care. Disclosure No significant relationships.

Keywords

• brief psychotic disorder
• Covid-19
• acute psychosis