Case Reports: Exposure to SARS-CoV-2, Acute Kidney Injury, and Lithium Toxicity.

PURPOSES: The aims of the study were to review 3 cases of lithium toxicity among individuals with bipolar disorder who were diagnosed with COVID-19 and to review the literature discussing the implications of COVID-19 and exposure to SARS-CoV-2 relative to medical use of lithium in management of bipolar disorder. METHODS: This is a case review of medical and psychiatric notes of 3 individuals with bipolar disorder, managed with lithium, who developed COVID-19. This study discussed these cases in context of previous case reports and relevant literature pertaining to lithium and exposure to SARS-CoV-2. FINDINGS: Infection with SARS-CoV-2 along with symptoms of COVID-19 and mental state changes in three individuals were temporally associated with lithium levels in the toxic range. IMPLICATIONS: Exposure to SARS-CoV-2 or symptoms suggestive of COVID-19 should result in increased clinical monitoring of individuals taking lithium. Those taking lithium and providers are advised to have a low clinical threshold for requesting lithium levels and kidney function estimates for the duration of the COVD-19 pandemic.

Covid-19 pandemic and lockdown impacts: A description in a longitudinal study of bipolar disorder.

OBJECTIVES: To investigate the impact of the SAR-Cov-2 pandemic and lockdown on individuals with bipolar disorder in comparison to healthy controls. METHODS: A longitudinal study of 560 participants including 147 healthy controls was conducted between April 30 and May 30, 2020 during a state-wide lockdown. Bi-weekly measures included the Coronavirus Impact Scale, the Pittsburg Sleep Quality Index, the Patient Health Questionnaire, 9-item, and the Generalized Anxiety Disorder scale, 7-item. Generalized estimating equations method was used to examine the longitudinal change of the measures within the lockdown and the change from pre-pandemic period to pandemic period. RESULTS: All participants reported an impact of lockdown. Individuals with bipolar disorder reported greater impact from the stay-at-home orders with disruptions in routines, income/employment, social support and pandemic related stress. While these measures improved over time, healthy controls recovered quicker and with greater magnitude than persons with bipolar disorder. Comparing mood symptom severity measures in mid-March through May 2020 to the same time window in 2015-2019 (pre- verses post-pandemic), there were no significant differences among individuals with bipolar disorder, whereas healthy controls showed a significant, albeit transient, increase in mood symptoms. CONCLUSION: Everyone was impacted by the SARs-CoV pandemic; however, those with bipolar disorder experienced more life impacting changes from the stay-at-home orders vs healthy controls. These disruptions improved over time but much more slowly than healthy controls. Pre- vs post-pandemic comparisons show a modest but significant increase in mood severity in the healthy controls which was not observed in those with bipolar disorder.