Mania: An Atypical Presentation of probable Streptococcus Agalactiae Meningoencephalitis

Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a common pathogen in the neonatal period, causing meningitis and sepsis. In non-pregnant adults it is an unusual cause of meningitis. We report about an elderly female with several risk factors for invasive GBS infection who developed GBS meningoencephalitis one month after treatment for COVID-19 upper respiratory tract infection. The patient presented with mania, and the classic triad of headache, neck stiffness, and fever was absent which contributed to the delay in diagnosis. Following initiation of treatment with intravenous ceftriaxone she attained full recovery, and her behavior returned to baseline. This case illustrates an unusual presentation of an emerging infection and should alert clinicians about this presentation. By reporting this case we want to raise awareness about mania as a presenting feature of meningoencephalitis. This should lead to more timely diagnosis and better outcomes for future patients.

Mania after COVID-19 pneumonia.

COVID-19 is a disease affecting mainly the respiratory system, but the manifestations of the infection can be multi-organs. The effect of this disease on the mental state of patients cannot be neglected. In this case report, we presents the case of a fifteen years old boy who developed manic symptoms after the acute phase of the disease.Copyright © 2023 SOLEN s.r.o.. All rights reserved.

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.

Neuropsychiatric Side Effects of Steroids during Treatment for Pediatric Acute Lymphoblastic Leukemia: A Comprehensive Narrative Review

Background/Purpose: Pediatric Acute Lymphoblastic Leukemia (ALL) affects ~4000 young Americans each year. Steroids are essential to curative ALL treatment yet have significant neuropsychiatric side effects that decrease quality of life for patients and families. However, incidence and predisposing risk factors are not well understood. This review aims to describe the current literature on neuropsychiatric side effects of steroids in Pediatric ALL. Method(s): A precise search in PubMed and Embase was cultivated using controlled vocabulary terms (MeSH, Emtree) and keywords for the following concepts: pediatrics, steroids, side effects, cancer, and neurobehavioral manifestations. Keywords and controlled vocabulary for each subject were arranged logically and combined with other concepts by Boolean Logic, using the Boolean operator AND, resulting in 642 precise results exploring neurobehavioral side effects of steroids in children with cancer. Results (2010 to date of search) were imported into Covidence systematic review software, and reviewed by SB and AM. Result(s): Twenty-three articles met inclusion criteria. There is marked variability in research methodology and no standard measurement of neuropsychiatric symptoms. Commonly reported symptoms include mood swings, irritability, depression, anxiety, aggression, insomnia, mania, and psychosis with prevalence between 5% and 75%. Heterogeneous research methodology and descriptions of psychiatric symptoms make it difficult to determine risk factors, though dexamethasone, family psychiatric history, and younger age are consistently associated with greater risk of behavioral dysregulation. Genetic predisposition (Bcl1 polymorphism, SNPs in GR gene) may increase susceptibility to developing depression during treatment. Data suggest variable efficacy of antipsychotics, benzodiazepines, hydrocortisone, and potassium-chloride. Conclusions and Implications: Existing data about neuropsychiatric side effects of steroids in pediatric ALL is extremely heterogeneous, creating challenges for standardized assessment and treatment. The burden of these symptoms necessitates further research to identify and treat vulnerable patients. Standard measurement of these symptoms could be a first step in eventually alleviating this source of distress.

Populism and Its Definitions: Interpretations and Perspectives of a Multifaceted Political Model

This chapter deals with some of the many definitions of populism, starting with the first event in which a community of researchers came together for this purpose: the 1967 London Conference ‘To Define Populism'. The text follows the evolution of the central themes to the present day and explores, in particular, the tools produced by populism studies that help to understand two contemporary challenges: first, the emergence of new forms of populism fragmented into antagonistic groups during the SarsCoV2 Pandemic, but linked to broader authoritarian visions, and second, the new reflection on the principle of nationality and international solidarity that arose after the invasion of Ukraine by the Russian Federation. Both are challenges to the principles, intelligence and strength of democracies. This text focuses on two aspects in particular: first, the logic with which to construct definitions, so as to avoid errors of setting (unclear and ill-defined choice of subject to be studied), elaboration (conceptual stretching) and evaluation (researcher bias), and second, the understanding of the different identities with which the ‘people' presents itself and acts historically: populace, mob, civil society and revolutionary people;they cannot be confused within the same ‘populism'. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

First-episode mania after COVID-19: A case series in Iran.

Background: Increasing reports of manic episodes in patients during acute infection with COVID-19 have been documented since the pandemic began, including individuals without a previous personal or family history of bipolar disorder. As infections and autoimmunity have putative roles in bipolar disorder, we aimed to document the clinical presentations, associated stressors, family aggregation patterns, and brain imaging and electroencephalographic correlates with a series of patients with episodes of mania that emerged shortly after COVID-19 infections. Methods: We obtained all relevant clinical information from 12 patients whose first manic episode started within a month of COVID-19 infection and were treated at Rasool-e-Akram hospital and Iran psychiatric hospital, two tertiary medical centers in Tehran, Iran, in 2021. Results: Patients had a mean age of 44. The interval between the onset of symptoms of COVID and mania ranged between 0 and 28 days (mean: 16.25, median: 14 days); it was observed to be shorter in patients with a family history of mood disorders but not in those receiving corticosteroids. Alongside a descriptive overview of our sample, we provide detailed narrative descriptions of two of the cases for illustrative purposes and discuss our observations in the context of other cases reported elsewhere and the state-of-the-art regarding infectious diseases, COVID-19, and bipolar disorder as reported in previous literature. Conclusion: Our case series documents observational and naturalistic evidence from a dozen of cases of mania in the context of acute COVID-19, which, while limited, calls for analytical research of the phenomenon, and points at a family history of bipolar disorder and the use of corticosteroids as factors for particular focus.

Bipolar I disorder exacerbation following COVID-19 vaccination

We present the cases of a 60-year-old female patient and 40-year-old male patient who experienced exacerbations of previously well-controlled symptoms of bipolar I disorder (BD1) after receiving COVID-19 vaccines, despite being stable for years on the same medications. The first patient experienced worsened depression, mania, and psychosis that improved with an increase in risperidone. The second patient experienced depression, mania, psychosis, and suicidal ideation that resulted in hospitalization. Prior to hospitalization, he took lamotrigine and bupropion, the latter of which was changed to aripiprazole in hospital. We reviewed current literature on inflammation in mental disorders, vaccination-related inflammatory changes, and the type of inflammation induced by COVID-19 vaccines. Inflammation is a component of psychiatric disorders, and the inflammatory response induced by vaccines might potentiate acute mental health exacerbations, necessitating treatment changes. However, this case series should not be used to justify recommendations against vaccination without larger, well-designed studies. At this time, the known benefits of vaccination outweigh these unknown risks, especially because individuals with serious mental illness are more likely to die from COVID-19 than the general population. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Sequential provocation of Ekbom's syndrome and acute mania following AstraZeneca COVID-19 vaccination.

ChAdOx1 nCoV-19 vaccine (so called AZ vaccine), is widely used to prevent the SARS-CoV-2 pandemic and shows powerful effectiveness to deter community transmission. There are common immunogenicity-related side effects such as fever, myalgia, lethargy, and headache; however, rare report on the neuropsychiatric problems (Ramasamy et al., 2021). In Taiwan, more than 15,200,000 doses of AZ vaccine were injected by the end of 2022. Here we presented a unique case with separated episode of Ekbom's syndrome, also called delusion of parasitosis, and mania following successive AZ vaccination in three-month interval.

First Manic Episode Following SARS-CoV-2 Infection.

Since the beginning of the COVID-19 pandemic, there have been reports of neuropsychiatric symptoms following infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most notably mania and psychosis. However, despite the widely reported incidence of psychosis and mania following infection with SARS-CoV-2, a causal link between the virus and these neuropsychiatric symptoms has not been established. A myriad of confounding factors such as underlying psychiatric disorders, personal and family psychiatric histories, substance use, and treatment with steroids all have the ability to obscure a correlation between SARS-CoV-2 and subsequent psychiatric symptoms. Here we present a case of a manic episode in a 40-year-old male following a COVID-19 infection. He had no past psychiatric history, no family psychiatric history, and no history of substance use. This case is unique in that the patient lacks all these typical confounding variables. It should serve as an example of a first-time manic episode following a recent infection with SARS-CoV-2. It may contribute data to future investigations seeking to better elucidate the correlation between SARS-CoV-2 and neuropsychiatric symptoms such as mania.

The Impact of the COVID-19 Pandemic on Postpartum Maternal Mental Health.

OBJECTIVES: There are reports of mental health worsening during the COVID-19 pandemic. We aimed to assess whether this occurred in women who were pregnant at baseline (late 2019) and unaware of the pandemic, and who delivered after the implementation of COVID-19 restrictions and threat (March-April 2020). To compare the pandemic period with the pre-pandemic, we capitalized on a retrospective 2014-2015 perinatal sample which had had affective symptoms assessed. METHODS: The COVID sample were administered the Postnatal Depression Scale (EPDS), Zung Self-Rating Anxiety Scale (SAS), Hypomania Checklist-32 (HCL-32), Pittsburgh Sleep Quality Index (PSQI), and Perceived Stress Scale (PSS) at T0 (pregnancy) and T1 (post-delivery). The Non-COVID sample had completed EPDS and HCL-32 at the same timepoints. RESULTS: The COVID sample included 72 women, aged 21-46 years (mean = 33.25 years ± 4.69), and the Non-COVID sample included 68 perinatal women, aged 21-46 years (mean = 34.01 years ± 4.68). Our study showed greater levels of mild depression in T1 among the COVID sample compared to the Non-COVID sample. No significant differences in terms of major depression and suicidal ideation were found. The levels of hypomania were significantly different between the two groups at T1, with the COVID sample scoring higher than the Non-COVID sample. This may be related to the high levels of perceived stress we found during the postpartum evaluation in the COVID sample. LIMITATIONS: There was a relatively small sample size. CONCLUSIONS: New mothers responded to the pandemic with less mental health impairment than expected, differently from the general population. Women delivering amidst the pandemic did not differ in depressive and anxiety symptoms from their pre-pandemic scores and from pre-pandemic women. Because stress responses have high energy costs, it is optimal for maternal animals to minimize such high metabolic costs during motherhood. Evidence suggests that reproductive experience alters the female brain in adaptive ways. This maternal brain plasticity facilitates a higher purpose, the continuation of the species. This may point to the recruitment of motherhood-related resources, for potentially overcoming the effects of the pandemic on mental health.

Irritability in Preschool Children: A Predictor of Adolescent Psychopathology

Objectives: Adolescents are vulnerable populations at risk for mental health disorders due to physical, social, and educational transitions and need to be assessed seriously, especially after the recent COVID-19 pandemic. We aim to understand and identify irritability at a preschool age as a predictor of developing psychopathology later in adolescence. Method(s): A literature search was conducted using relevant Medical Subject Headings (MeSH) keywords in PubMed, MEDLINE, and PubMed Central databases. We identified all relevant published articles from inception until March 31, 2021. Out of 99 studies applied, 19 studies were chosen for full-text review when inclusion and exclusion criteria were applied. After a full-text review, we included 6 relevant studies in our final qualitative synthesis review. Result(s): The results of the studies showed an association between preschool irritability and mental health outcomes later in life. A 2019 study showed that irritability in preschoolers predicted later diagnosis of mood and externalizing disorders when controlled for social adversity, maternal history of mood disorders, and externalizing diagnoses at baseline. Irritability early in childhood predicted mania later in life (OR = 1.99;95% CI, 1.19-3.37;p =.009), and the OR of later being diagnosed with depression was 3.11 (95% CI, 1.32-3.27;p =.002) for each point increase in irritability factor score. Results further indicated that high stable irritability in early childhood is a predictor of irritability at age 12 (r =.35;p <.001). A 2021 study reproduced the results showing that preschool irritability predicted internalizing and externalizing comorbidity (OR = 1.67;95% CI, 1.22-2.28;p =.001). Conclusion(s): The findings show that irritability in preschool children is a predictor of internalizing, externalizing, and other behaviors later in life. It indicates an association between preschool irritability and psychopathology later in adolescence. A large-scale well-structured randomized controlled trial is recommended to unearth the potential benefit of identifying irritability in early life. ADOL, IMD, PSC Copyright © 2022

COVID-19 and first manic episodes: a systematic review.

Sars-CoV-2 is a respiratory virus that can access the central nervous system, as indicated by the presence of the virus in patients' cerebrospinal fluid and the occurrence of several neurological syndromes during and after COVID-19. Growing evidence indicates that Sars-CoV-2 can also trigger the acute onset of mood disorders or psychotic symptoms. COVID-19-related first episodes of mania, in subjects with no known history of bipolar disorder, have never been systematically analyzed. Thus, the present study assesses a potential link between the two conditions. This systematic review analyzes cases of first appearance of manic episodes associated with COVID-19. Clinical features, pharmacological therapies, and relationships with pre-existing medical conditions are also appraised. Medical records of twenty-three patients fulfilling the current DSM-5 criteria for manic episode were included. Manic episodes started, on average, after 12.71±6.65 days from the infection onset. Psychotic symptoms were frequently reported. 82.61% of patients exhibited delusions, whereas 39.13% of patients presented hallucinations. A large discrepancy in the diagnostic workups was observed. Mania represents an underestimated clinical presentation of COVID-19. Further studies should focus on the pathophysiological substrates of COVID-19-related mania and pursue appropriate and specific diagnostic and therapeutic workups.

Covid-19, not your normal flu: A case report on Covid-19 psychosis and mania in a Malaysian hospital.

Evidence suggests that acute severe coronavirus disease 2019 (COVID-19) may be associated with neuropsychiatric symptoms. This is a case report of a patient who had recently been infected with COVID-19 and had no history of psychiatric disorders presenting a few days after inpatient discharge from COVID-19 treatment with acute onset of psychosis and manic symptoms. This case illustrates the psychiatric presentation, possible causes, and management of post-COVID-19 psychosis.

Prenatal Exposure to SARS-Cov-2 and Schizophrenia Development: What to Expect?

Introduction: Schizophrenia is a complex and multifactorial psychiatric condition characterized by thought, speech, perception and behaviour disorders, and social and occupational impairment. It has been related that viral prenatal infection may contribute to schizophrenia development. As such, there are some hypotheses regarding SARS-Cov-2 prenatal infection and its potential relation with "future" offspring schizophrenia. Objective(s): Literature review of schizophrenia development and relation with viral infections, and data research of COVID-19 neurotropic effects. Method(s): Non-systematic review through literature using databases as Pubmed and UpToDate. Keywords used: schizophrenia, prenatal, viral infection, COVID-19, SARS-Cov-2. Result(s): Several studies had shown a relationship between prenatal viral infections, such as Influenza, and development of schizophrenia in the offspring. It relates with viral neurotropism mechanisms and inflammatory processes in the fetal neurology system. Regarding SARS-Cov-2, it is early to assume a relation between prenatal COVID-19 and offspring schizophrenia development. However, literature describes psychiatric manifestations post COVID, such as psychotic and manic episodes. As such, a SARSCov- 2 neurotropic effect is demonstrated. Conclusion(s): Schizophrenia has a multifactorial etiology. Since prenatal viral infections may interfere and contribute to schizophrenia development, it is logical to assume prenatal SARS-Cov-2 infection may also contribute. It may be relevant to investigate whether these offspring will manifest schizophrenia symptoms.

COVID-19 treatment corticosteroids-induced mania

Introduction: Psychiatric disturbances induced by substances are registered in both CIE-10 and DSM-5. It is also well known, since many years, the association between mania and corticosteroids (more than 200 results in PubMed found), recently widely used during the last pandemic against COVID-19. Objective(s): To remember and to point out the association of substance-induced mental disorders, warning about the experimentation in new clinical settings and raising awareness to prevent or treat its possible consequences in mental health. Method(s): A two cases clinical series with COVID-19 pneumonia treated with high-doses intravenous corticosteroids during more than a week. Two women, after theirs 50s, with no personal or family psychiatric history, developing after finishing the hospital treatment, insomnia, motor and behavioral hyperactivity and dysphoric mood with irritability, but preserving clinical insight. Result(s): At first, these states were assessed by internists and psychologists as reactive stress anxiety and were treated with benzodiazepines and psychotherapy, without success, during more than two weeks. After a psychiatric evaluation, considering the medical history and recent use of corticosteroids, the hipomania diagnosis was pointed out. Antipsychotic treatment (low doses olanzapine chosen) was induced with total remission of symptoms in less than 15 days with restitutio ad integrum. Regarding these cases, an updated bibliographic review on corticosteroid-induced mania and its treatment was carried out. Conclusion(s): With this presentation, the authors would like to highlight, in these times of pandemic, the importance of remembering the influence and relationship of drugs use in major psychiatric syndromes, both in the causal origin and in the treatment.

Manic episode following SARS-COV-2 Infection

Introduction: In December 2019, infection with the novel coronavirus (SARS-CoV-2) was first reported in the city of Wuhan, China. Although generally recognized for its often fatal respiratory problems, other neuropsychiatric complications are receiving increasing attention. Objective(s): We will try through a clinical case to explain the psychiatric disorders in the context of this infection, and to highlight the two main explanatory theories of psychiatric disorders, in relation with the SARS-Cov-2 infection. Method(s): We report here a case of SARS-CoV-2 infection in a 54-year-old female patient with no specific pathological history, including psychiatric, who presented a fever, anosmia, and asthenia in the absence of any respiratory signs. Her PCR came back positive and her chest CT scan was normal. The patient was treated with paracetamol with vitamin C, with good clinical improvement. She came 15 days later to the psychiatric emergency room with psychomotor excitement. The patient was motorically unstable, could not hold still, her mimicry was hypermobile, contact with her was familiar, she was logorrheic with flight of ideas, she verbalized multiple projects, her mood was euphoric and her sleep was disturbed. Her blood tests were unremarkable. Result(s): The diagnosis of manic episode was retained, and the patient was put on Olanzapine 10 mg, sodium Valproate 1g and Lorazepam 2.5 mg in degression with good clinical improvement. Conclusion(s): Although the data in the literature remain scarce concerning the impact of this virus on mental health, we will try through this clinical case to explain the psychiatric disorders in the context of this viral epidemic, due to stress and inflammation.

The course of psychiatric symptoms in older age bipolar disorder during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic gives us the unique opportunity to study the course of psychiatric symptoms and resilience in older adults with bipolar disorder (OABD) whilst experiencing a collective long lasting stressor. The aim of this study was to investigate the course of depressive, manic and anxiety symptoms in OABD during the first six months of COVID-19 and how loneliness and mastery are associated with this course. Mastery is defined as the control one experiences over one's life and environment. Resilience is defined as adaptation to challenging life conditions encompassing several aspects of personal resources. METHODS: In April 2020 (n = 81), June 2020 (n = 66) and September 2020 (n = 51), participants were included from the Dutch Older Bipolars (DOBi) cohort study. RESULTS: Depressive, manic and anxiety symptoms increased over all timepoints. Participants with a higher sense of mastery experienced a greater increase in depressive and anxiety symptoms. Loneliness did not interact with the course of these symptoms. CONCLUSIONS: OABD were resilient in the first months of COVID-19 outbreak, however depressive, manic and anxiety symptoms increased as the pandemic continued. Treatment strategies in coping with long lasting stressful events should include the focus on sense of mastery.

Is SARS-CoV-2 a Risk Factor of Bipolar Disorder?-A Narrative Review.

For 2.5 years we have been facing the coronavirus disease (COVID-19) and its health, social and economic effects. One of its known consequences is the development of neuropsychiatric diseases such as anxiety and depression. However, reports of manic episodes related to COVID-19 have emerged. Mania is an integral part of the debilitating illness-bipolar disorder (BD). Due to its devastating effects, it is therefore important to establish whether SARS-CoV-2 infection is a causative agent of this severe mental disorder. In this narrative review, we discuss the similarities between the disorders caused by SARS-CoV-2 and those found in patients with BD, and we also try to answer the question of whether SARS-CoV-2 infection may be a risk factor for the development of this affective disorder. Our observation shows that disorders in COVID-19 showing the greatest similarity to those in BD are cytokine disorders, tryptophan metabolism, sleep disorders and structural changes in the central nervous system (CNS). These changes, especially intensified in severe infections, may be a trigger for the development of BD in particularly vulnerable people, e.g., with family history, or cause an acute episode in patients with a pre-existing BD.

Bipolar I Disorder Exacerbation Following COVID-19 Vaccination.

We present the cases of a 60-year-old female patient and 40-year-old male patient who experienced exacerbations of previously well-controlled symptoms of bipolar I disorder (BD1) after receiving COVID-19 vaccines, despite being stable for years on the same medications. The first patient experienced worsened depression, mania, and psychosis that improved with an increase in risperidone. The second patient experienced depression, mania, psychosis, and suicidal ideation that resulted in hospitalization. Prior to hospitalization, he took lamotrigine and bupropion, the latter of which was changed to aripiprazole in hospital. We reviewed current literature on inflammation in mental disorders, vaccination-related inflammatory changes, and the type of inflammation induced by COVID-19 vaccines. Inflammation is a component of psychiatric disorders, and the inflammatory response induced by vaccines might potentiate acute mental health exacerbations, necessitating treatment changes. However, this case series should not be used to justify recommendations against vaccination without larger, well-designed studies. At this time, the known benefits of vaccination outweigh these unknown risks, especially because individuals with serious mental illness are more likely to die from COVID-19 than the general population.