(PO-060) A Curious Case of Collegiate COVID Psychosis
A Curious Case of Collegiate COVID Psychosis
Neuropsychiatric manifestations of viruses have been documented for many years. The COVID-19 pandemic has led to concern for associated increases in neuropsychiatric symptoms in infected patients. There have been several case reports, case series, and literature reviews which have established this link. Typical features as described in the literature include a short course of illness involving largely positive symptoms, often with associated delirium or elevated inflammatory markers, which responds to low doses of antipsychotics (Watson et al., 2021; Parra et al., 2020). We present a case divergent from these typical findings.
Ms. X is a 19-year-old female college student with no personal or family psychiatric illness who had acute onset of psychotic symptoms about four days into a mild COVID-19 illness. She was admitted to our psychiatric unit for these psychotic symptoms, which included auditory and visual hallucinations, delusions, paranoia, disorganized speech and behavior, and withdrawal. Of note, there was no associated delirium or elevation in C-reactive protein or ferritin. Other etiologies of psychosis were considered and felt to be less likely by the treatment team. The patient started to improve once risperidone had been titrated to 5 mg nightly, and she was discharged at her psychiatric baseline on hospital day 10.
Most reported cases have described delirium associated with the COVID-19 infection, which raises concern for mislabeling of the cases as psychosis. Contrary to our case, typical cases are in older patients without negative symptoms who had short durations of illness and response to low doses of antipsychotics. These features are more consistent with a delirium diagnosis than a true psychotic episode. Additionally, unlike ours, most cases have reported associated increases in inflammatory markers, which raises concern for these psychoses being secondary to an inflammatory process induced by the virus, rather than being caused directly by the virus. Given the timing of symptoms and lack of evidence of inflammatory response in our patient, we believe this may be one of the first cases in which the virus itself induced a true psychotic episode.
As COVID-19 illness becomes more and more prevalent in hospitalized patients, psychiatrists, particularly consultation-liaison psychiatrists, must be aware of the course of illness, clinical features, objective findings, and prognostic indicators seen in COVID-19 associated psychosis. Further research is needed to more fully characterize the illness.
Watson, C. J., Thomas, R. H., Solomon, T., Michael, B. D., Nicholson, T. R., & Pollak, T. A. (2021). COVID-19 and psychosis risk: Real or delusional concern?Neuroscience Letters,741. doi:https://doi.org/10.1016/j.neulet.2020.135491
Parra, A., Juanes, A., Losada, C., Álvarez-Sesmero, S., Santana, V., Marti, I., . . . Rentero, D. (2020). Psychotic symptoms in COVID-19 patients. A retrospective descriptive study.Psychiatry Research,291. doi:https://doi.org/10.1016/j.neulet.2020.135491
To describe typical features of COVID-induced psychosis, discuss potential for misdiagnosis as delirium, and help clinicians diagnose and treat the illness
To present the specific features of our case and compare them to what has previously been reported in the literature
To highlight the need for further research into COVID-induced psychosis in order to assist in diagnosis and treatment