Post-acute COVID-19 syndrome with severe sexually deviant behavior.

The neurological symptoms of the coronavirus disease 2019 (COVID-19) can be prolonged or intensified. Many patients experience "brain fog" after recovery, termed as post-acute COVID-19 syndrome (PACS) or long COVID. Here, we describe the case of a male patient with post-COVID-19 encephalopathy and psychotic symptoms. He developed delirium and behavioral abnormalities associated with PACS after the COVID-19 infection resolved. He was admitted for sexually inappropriate behavior and catatonia symptoms. His cerebrospinal fluid tested positive for severe acute respiratory syndrome coronavirus 2 on polymerase chain reaction testing. Brain magnetic resonance imaging showed no abnormalities; however, single-photon emission computed tomography showed increased uptake in the bilateral thalamus, septal regions, and posterior cingulate gyrus. In our patient's case, the course of events led to the diagnosis of PACS with psychosis related to post-acute COVID-19 encephalopathy. Surprisingly, COVID-19 encephalitis is not caused solely by direct brain injuries; autoimmune paraneoplastic or post-infectious encephalitis can occur after viral clearance. PACS is known to cause delirium, brain fog, and depression within 4-12 weeks of the onset of COVID-19. COVID-19 is frequently associated with delirium. However, encephalopathy is overlooked owing to the lack of testing. Missed encephalopathy may progress to PACS.

The sustained psychological impact of coronavirus disease 2019 pandemic on hospital workers 2 years after the outbreak: a repeated cross-sectional study in Kobe.

BACKGROUND: Healthcare workers who are exposed to coronavirus disease 2019 are psychologically distressed. This study aimed to evaluate the mental health outcomes of hospital workers 2 years after the outbreak of coronavirus disease 2019 and to identify changes in the stress of hospital workers and predicted risk factors. METHODS: This survey was conducted 2 years after the initial evaluation performed under the first emergency declaration of the coronavirus disease 2019 pandemic among hospital workers at the same hospital in an ordinance-designated city in Japan from June to July 2022. Sociodemographic data, 19 stress-related question responses, the Impact of Event Scale-Revised, and the Maslach burnout inventory-general survey were collected. Multiple regression models were used to identify factors associated with each of the mental health outcomes 2 years after the coronavirus disease 2019 outbreak. RESULTS: We received 719 valid responses. Between 2020 and 2022, hospital workers' anxiety about infection decreased, whereas their exhaustion and workload increased. Multiple regression analysis revealed that 2 years after the coronavirus disease 2019 outbreak, nurses and young people were at a higher risk of experiencing stress and burnout due to emotional exhaustion, respectively. CONCLUSIONS: This is the first study to examine the long-term stress of hospital workers measured in Japan. Exhaustion and workload were worsened 2 years into the pandemic. Therefore, health and medical institutions should continuously monitor the physical and psychological health of staff members.

Characteristics of suicidal emergency room patients before and during the COVID-19 pandemic in Japan.

AIM: Owing to the stress caused by the behavioral restrictions and lifestyle changes during the COVID-19 pandemic, suicide rates have increased in Japan, especially among young people. This study aimed to identify the differences in the characteristics of patients hospitalized for suicide attempts in the emergency room, requiring inpatient care before and during the pandemic over 2 years. METHODS: This study was a retrospective analysis. Data were collected from the electronic medical records. A descriptive survey was conducted to examine changes in the pattern of suicide attempts during the COVID-19 outbreak. Two-sample independent t-tests, Chi-square tests, and Fisher's exact test were used for data analysis. RESULTS: Two hundred one patients were included. No significant differences were found in the number of patients hospitalized for suicide attempts, average age, or sex ratio before and during the pandemic periods. Acute drug intoxication and overmedication in patients increased significantly during the pandemic. The self-inflicted means of injury with high fatality rates were similar during the two periods. The rate of physical complications significantly increased during the pandemic, while the proportion of unemployed individuals significantly decreased. CONCLUSIONS: Despite studies predicting an increase in suicides based on past statistics of young people and of women, no significant changes were observed in this survey of the Hanshin-Awaji region, including Kobe. This may have been owing to the effect of suicide prevention measures and mental health measures implemented by the Japanese government after an increase in suicides and after past natural disasters.

COVID-19 delirium and encephalopathy: Pathophysiology assumed in the first 3 years of the ongoing pandemic.

Background: The coronavirus disease (COVID-19) continues to spread worldwide. It has a high rate of delirium, even in young patients without comorbidities. Infected patients required isolation because of the high infectivity and virulence of COVID-19. The high prevalence of delirium in COVID-19 primarily results from encephalopathy and neuroinflammation caused by acute respiratory distress syndrome (ARDS)-associated cytokine storm. Acute respiratory distress syndrome has been linked to delirium and psychotic symptoms in the subacute phase (4 to 12 weeks), termed post-acute COVID-19 syndrome (PACS), and to brain fog, cognitive dysfunction, and fatigue, termed "long COVID," which persists beyond 12 weeks. However, no review article that mentions "COVID-19 delirium" have never been reported. Basic Procedures: This narrative review summarizes data on delirium associated with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and related neurological symptoms of persistent post-infection illness (PACS or long COVID) after persistence of cognitive dysfunction. Thus, we describe the pathophysiological hypothesis of COVID-19 delirium and its continuation as long COVID. This review also describes the treatment of delirium complicated by COVID-19 pneumonia. Main Findings: SARS-CoV-2 infection is associated with encephalopathy and delirium. An association between COVID-19 infection and Alzheimer's disease has been suggested, and studies are being conducted from multiple facets including genetics, cytology, and postmortem study. Principal Conclusions: This review suggests that COVID-19 has important short and long-term neuropsychiatric effects. Several hypotheses have been proposed that highlight potential neurobiological mechanisms as causal factors, including neuronal-inflammatory pathways by cytokine storm and cellular senescence, and chronic inflammation.

Psychological impact of the COVID-19 pandemic on hospital workers in Kobe: A cross-sectional survey

Aim Many health-care workers exposed to coronavirus disease 2019 (COVID-19) are psychologically distressed. This study aimed to investigate the psychological impact of the COVID-19 pandemic on hospital workers under the emergency declaration in Japan. Methods This cross-sectional, survey-based study collected sociodemographic data and responses to 19 stress-related questions and the Impact of Event Scale-Revised (IES-R), which measures post-traumatic stress disorder (PTSD) symptoms, from all 3217 staff members at Kobe City Medical Center General Hospital from April 16, 2020 to June 8, 2020. Exploratory factor analysis was applied to the 19 stress-related questions. Multiple regression models were used to evaluate the association of personal characteristics with each score of the four factors and the IES-R. Results We received 951 valid responses;640 of these were by females, and 311 were by respondents aged in their 20s. Nurses accounted for the largest percentage of the job category. Women, those aged in their 30s?50s, nurses, and frontline workers had a high risk of experiencing stress. The prevalence of stress (IES-R?≥?25) was 16.7%. The psychological impact was significantly greater for those aged in their 30s?50s and those who were not medical doctors. Conclusions This is the first study to examine the stress of hospital workers, as measured by the IES-R, under the emergency declaration in Japan. It showed that women, those aged in their 30s?50s, nurses, and frontline workers have a high risk of experiencing stress. Health and medical institutions should pay particular attention to the physical and psychological health of these staff members.