A case of Kretschmer's sensitive delusion related to COVID-19 pandemic

Presents a case report of a 45-year-old woman with a brief psychotic disorder, in which pathogeny was an effect of the pandemic, modulating a classic syndrome described more than one century ago by Ernst Kretschmer. During the mandatory screening before hospital admission, the patient tested positive for SARS-CoV-2. Basic tests were performed, including blood alcohol concentration, urinary drug screening, and brain computerized tomography - all normal. Regarding her premorbid personality, she had cluster C personality traits. The discharge diagnosis was a Brief psychotic disorder. Other differential diagnoses were considered such as schizophreniform disorder, psychotic depression, bipolar disorder, late-onset schizophrenia, but the rapid onset of the picture, the brief resolution, the absence of dominant affective symptomatology, and the absence of negative symptomatology led to assume that it was more likely a brief reactive psychosis. antipsychotic medication was suspended gradually and she didn't present any recurrence of symptoms. In this case report, the author reviews a classic nosological entity, commonly forgotten, revived by a very current and particular social situation (the COVID-19 pandemic), whose social conditionings can affect mental health. The author emphasizes the importance of a thorough anamnesis with a complete evaluation of the premorbid character, which allowed an early intervention and subsequent better prognosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Internet Gaming Disorders and Early Onset Psychosis in Young People: A Case Study and Clinical Observations.

BACKGROUND: Over the last ten years, the video game industry has grown exponentially, involving about 2.5 billion young adults in the world. The estimated global prevalence of gaming addiction has been reported to be 3.5% ranging from 0.21% to 57.5% in the general population. Moreover, during the recent COVID-19 pandemic period, school closures and stay-at-home measures have also further increased the opportunities for prolonged and intensified playing of video games. Little is known about the relationship between IGD and psychosis, and the literature is still scarce. Some characteristics of patients with psychosis, particularly those with a first-episode psychosis (FEP), may suggest that these individuals would be particularly liable to develop IGD. CASE PRESENTATION: We report two cases of young patients with to Internet gaming disorder, experiencing early onset psychosis treated with antipsychotic therapy. CONCLUSION: Although it is difficult to show the specific mechanisms underlying the psychopathological alterations in IGD, it is clear that excessive exposure to video games could be a risk factor for precipitating psychosis especially in a vulnerable age group such as adolescence. Clinicians should be aware of the possibility of a higher risk of psychotic onset associated specifically with gaming disorders in very young people.

COVID-19-Associated Acute Psychotic Disorder-Longitudinal Case Report and Brief Review of Literature.

Even though since the beginning of the COVID-19 pandemic, the literature became more and more abundant on data and hypotheses about the various consequences on people's lives, more clarity needs to be added to the existing information. Besides the stressful experiences related to the COVID-19 pandemic, SARS-CoV-2 infection has been proven to impact brain functioning through direct and indirect pathogenic mechanisms. In this context, we report a case of a patient presenting with a first episode of psychosis following COVID-19. In our case, a 28-year-old male patient with no personal or family psychiatric history developed psychotic symptoms (delusions, hallucinations, and disorganized behaviour) that required antipsychotic treatment and inpatient hospitalization one week after he was discharged from the hospital after COVID-19. At the six-month and one-year follow-up, the patient was in remission without any psychotic signs or symptoms. A brief review of the literature is also provided. The case presented in this article outlines the possibility that the post-COVD-19 recovery period might be a crucial time for the onset of acute psychotic disorder, and therefore, routine psychiatric assessments should be carried out during all phases of the disease. A clearer picture of the impact of the COVID-19 pandemic on mental health will most likely be revealed in the future as many consequences need long-term evaluation.

Serious mental illness and in-hospital mortality among hospitalized patients with acute COVID-19: A large-database analysis in Japan.

OBJECTIVE: The association of serious mental illness (affective or non-affective psychotic disorders) with higher mortality in patients infected with acute coronavirus disease 2019 (COVID-19) has been suggested. Although this association remains significant after adjusting for medical comorbidities in previous studies, admission clinical status and treatment modalities should be considered as important confounding factors. METHODS: We aimed to assess whether serious mental illness is associated with in-hospital mortality, in patients with COVID-19 by adjusting for comorbidities, admission clinical status, and treatment modalities. Our nationwide cohort in Japan included consecutive patients admitted to 438 acute care hospitals for laboratory-confirmed acute COVID-19 from January 1, 2020 to November 30, 2021. RESULTS: Of 67,348 hospitalized patients (mean [standard deviation] age, 54 [18.6] years; 3891 [53.0%] female), 2524 patients (3.75%) had serious mental illness. In-hospital mortality was 282/2524 (11.17%) among patients with serious mental illness, while it was 2118/64,824 (3.27%) in other patients. In the fully adjusted model, serious mental illness was significantly associated with in-hospital mortality (odds ratio, 1.49; 95% CI, 1.27-1.72). E-value analysis confirmed the robustness of the results. CONCLUSION: Serious mental illness remains a risk for mortality in acute COVID-19 after adjusting for comorbidities, admission clinical status, and treatment modalities. Vaccination, diagnosis, early assessment and treatment should be prioritized for this vulnerable group.

Covid -19 pandemic's impact on the clinical presentation of brief psychotic disorders

Introduction: A major increase in mental health issues was noted since the outbreak of the covid-19 pandemic even in patients with no history of mental health illness, specifically brief psychotic disorders. Objective(s): Establish the covid-19 pandemic circumstances as precipitating factors of psychosis independently from other stressors Methods: This is a cross-sectional and descriptive study carried out in the psychiatric department of the University Hospital of Mahdia including two groups of patients over a period of 15 months: From October 2018 to December 2019 are pre-covid cases, and the second group consists of the ones admitted between June 2020 and August 2021. We have collected the data of patients diagnosed with brief psychotic disorder according to DSM-5. We have focused on two clinical characteristics of the psychotic episodes (theme of delusions, stressors). Result(s): We have collected 19 patients, 12 among them during the pre-covid period. In our pre-covid period, brief psychotic disorder presented mostly with marked stressors (33.3%) whilst in the middle of the pandemic, marked stressors are present in only 14.3% of the cases. Which could suggest that this state of alarm can singlehandedly trigger psychosis. For the theme of delusions, in the pre-covid period, the religious theme appeared to be the most frequent (58.3%), whilst during the pandemic, persecution became the most prevalent (71.4%), showing how living in fear of contracting the virus could manifest itself in delusional content. Conclusion(s): Living in a prolonged state of alarm is, in itself, a marked stressor, theoretically capable of increasing the psychosis rate and altering its characteristics.

COVID- 19 Following Acute Psychosis: Case series report

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. Objective(s): 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. Method(s): 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 toDSM5 criteria for BPD. Result(s): 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. Conclusion(s): 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.

Psycho-Covid

Introduction: The COVID-19 pandemic generated a health emergency and led to the adoption of different measures, including home quarantine and social isolation, which, as we have seen, has had an impact on the mental health of the majority of citizens, with the possibility of psychiatric disorders appearing. in people without prior mental illness, such as acute decompensations in patients with known disorders, more vulnerable to environmental stressors. Objective(s): Learn and rethink alarm signals in extreme situations such as the one experienced in recent months, as well as observe the impact, negative in many cases, but positive in others, of the patients we treat daily. Method(s): Description through brief clinical cases of the impact of the COVID-19 pandemic on psychotic patients and the decompensation that it has entailed, including due to confinementmeasures and social isolation, associated with over-information through the media, chaos initial and the uncertainty that it caused and the associated fear. Result(s): Restrictions as a result of COVID-19 have played a very relevant role as an external stressor for the appearance of psychopathological alterations, including psychotic symptoms. In addition, people who suffer from psychosis or at risk of psychotic disorder can be especially affected and trigger acute psychopathology with social isolation, loss of daily routines, unemployment, homelessness. Conclusion(s): These cases are an example that shows the need for an early and effective approach to the rise in mental illnesses in circumstances of this caliber.

Distinctive features of First Episode of Psychosis during the Covid-19 pandemic

Introduction: COVID19 has brought several psychosocial stressors that are having an impact on global mental health. The impact of the pandemic on the incidence of First Episode of Psychosis (FEP) is not clear. Objective(s): To describe the clinical and sociodemographic characteristics of FEP patients diagnosed since the onset of theCOVID19 pandemic and compare them with the equivalent period of the previous year. Method(s): We included all FEP patients attended at Parc de Salut Mar (Barcelona, Spain) from March 14, 2020 (when the state of emergency in Spain began) to December 31, 2020 with the same period of 2019. We assessed sociodemographic variables, duration of untreated psychosis (DUP), cannabis and alcohol use, psychiatric diagnosis, and psychiatric symptom scales. We performed a univariate analysis between the groups using U-Mann Whitney for continuous variables and Chi-Square for qualitative variables. Result(s): A total of 20 FEP patients were diagnosed in each period. No differences were found in sociodemographic variables, scales scores or DUP. During COVID19 period there was a smaller proportion of cannabis users (60% vs 90%;p=0.028) and a tendency of lower weekly consumption (14.44 vs 16.42;p=0.096). There were more cases of BPD (25% vs 5%;p=0.077) and less of affective psychosis (0% vs 25%;0.017). Conclusion(s): During the COVID-19 pandemic we did not find an increase of FEP or more severe clinical presentations. However, we identified differences in the type of FEP that could be related to the psychosocial stressors of this time.

COVID-19 Psychiatric Inpatient Unit- experience and challenges

Introduction: On January 2021 the Department of Psychiatry became the only unit exclusively dedicated to COVID patients with severe mental illness in acute decompensation. Only patients in risk of rapid medical deterioration were excluded and forwarded to intensive care. Objective(s): Discussion of this unprecedented experience. Method(s): Analysis of 28 patients hospitalized during 3 months with both an acute psychiatric disorder and an SARS-CoV-2 infection;description of the multidisciplinary intervention made. Result(s): Our samplewas characterized by a majority of patients with an acute psychotic episode derived from a schizophrenia spectrum disorder (42%) or a bipolar affective disorder (21%). Only 3% of the patients had a diagnosis of severe major depressive disorder. And 10% of patients developed severe respiratory symptoms requiring oxygen or urgent transfer to COVID medical wards. Most patients presented periods of psychomotor agitation, lack of impulse control and self-aggression. Psychopharmacological and psychotherapeutic interventions had to be adapted to these unusual conditions. Most of them had already gone through a period of isolation in the buffer ward created to exclude false negatives, which promoted atypical deliriums and symptoms of post-traumatic stress. The psychiatric team was faced with the emergent need to adapt an intervention model based on trust to a model that had to prioritize physical safety. Conclusion(s): The pandemic experience was transformative forall who lived through it. From the challenge perspective, it may have been enriching. But the maintained confrontation with the antithesis of therapy, defined by "caring, supporting, communicating, approaching", was devastating in ways that we consider essential to be debated.

The double penalty of the coronavirus: Decidedly this virus has not yet revealed all its secrets!

Introduction: The direct and indirect effects of the COVID-19 pandemic on the mental health of the population have become a concern in the field of research in psychiatry. First psychotic episodes following infection with SARS cov2 have been reported. Objective(s): Through a clinical case, we will illustrate the association of psychiatric symptoms with SARS cov2 infection. Method(s): We discussed , through a clinical case, the association of psychiatric symptoms with infection by the coronavirus 19. Result(s): L.R, Tunisian 52-year-old, diabetic (type 2) women, with no personal or family psychiatric history and no toxic habits. she did not receive receive covid 19 vaccination. Twenty days before her admission to the psychiatry departement , she had fever, cough, myalgia, and anosmia .The diagnosis of a SARS COv2 infection was retained by her general practitioner. Two weeks later she suddenly presented a persecutory delirium, distressing auditory hallucinations, and attempted rat poison suicide. On admission, The patient had a delirium of persecution towards her entourage and an auditory hallucinatory syndrome with distressing content. She was put on 1 mg of Risperidone with restitution ad integrum after 7 days. COVID-19 serology test detected IgM antibodies which allowed us to conclude that the symptomatology was related to the infection by this virus. For the etiological research, we performed a serology that confirmed the recent exposure to SARS COV2 and. The diagnosis retained is a brief psychotic disorder post-Sars Cov2. Conclusion(s): The advanced hypothesis that infection with SARS CoV-2 could be the cause of the psychiatric manifestations remains unclear to this day.

Schizophrenia spectrum disorders following past exposure to ionizing radiation and SARS CoV-2 infection

Introduction: Whether exist a potential association between schizophrenia spectrum disorders following past exposure to ionizing radiation and SARS CoV-2 infection is unknown. Objective(s): To assess a possible role of double radiation-viral exposure in pre- and postnatal periods in schizophrenia spectrum disorders genesis. Method(s): Integration and analysis of information available with the results of own clinical and epidemiological studies. Result(s): The renaissance of interest to the viral hypothesis of schizophrenia is observing during the current COVID-19 pandemic. There is an increasing number of cases and case series reports on psychotic schizophreniform disorders following SARS CoV-2 infection diagnosed as COVID-19-asssociated brief psychotic disorder, first episode psychosis, acute and transient psychotic disorder. The prevalence rate of schizophrenia in A-bomb survivors in Nagasaki was very high - 6 % (Nakane and Ohta, 1986), and increased in those prenatally exposed to A-bombing (Imamura et al., 1995) and medical X-irradiation (Gross et al., 2018). We found a significant increase in the schizophrenia incidence in the Chornobyl exclusion zone personnel, as well as schizophreniform syndromes in Chornobyl clean-up workers (liquidators) irradiated by moderate to high doses (more than 0.30 Sv). The neural diathesis-stressor hypothesis of schizophrenia spectrum disorders was proposed (Loganovsky and Loganovskaja, 2000;Loganovsky et al., 2005). Recently we observed the clinical case of organic schizophrenia-like disorder in the liquidator who was ill with COVID-19. Conclusion(s): The linkage between schizophrenia spectrum disorders following past exposure to ionizing radiation and SARS CoV-2 infection can exist that should be studied on the irradiated cohorts with following COVID-19.

"I am the coronavirus": A case report and review

Introduction: As disorders of thought, delusions are modified by patients' background, and so their content varies widely according to location and throughout the ages. The COVID-19 pandemic has shown its global impact on society and mental health of the population, thus becoming a new delusional topic. Objective(s): We report a case where the COVID-19 pandemic has been integrated into a patient's delusion in an attempt to raise professional awareness for this new psychotic presentation. Method(s): Review of clinical notes and literature review. Result(s): A 38-year-old female patient with no prior psychiatric history presented with psychotic symptoms characterized by selfreferential ideas, feelings of guilt and delusions of ruin, with a sudden onset of less than 24 hours prior to observation. The patient claimed that she was the coronavirus and, as such, she was a common topic of conversation in both television and social media, and the reported deaths caused by COVID-19 were her own doing. As a result of this, the patient was asking doctors to kill her in order to save everyone else affected by the virus. After evaluation, a diagnosis of Acute and Transient Psychotic Disorder was considered. The patient was initially treated with paliperidone, but due to hyperprolactinemia and menstrual changes this was switched to aripiprazole. Symptoms remitted fully after 21 days of treatment, and six months later no recurrences have been described. Conclusion(s): This case illustrates the potential of the coronavirus pandemic outbreak as a new delusional topic. Possible side effects of treatment are also discussed.

When COVID-19 Is Not All: Femicide Conducted by a Murderer with a Narcissistic Personality "Masked" by a Brief Psychotic Disorder, with a Mini-Review.

Several cases of COVID-19-related mental disorders have emerged during the pandemic. In a case of femicide that occurred in Italy during the first phase of the pandemic, coinciding with a national lockdown, a discrepancy arose among forensic psychiatry experts, particularly toward the diagnosis of Brief Psychotic Disorder (BPD) related to COVID-19. We aimed to discuss the evaluation of the case through an integration of information and a literature review on comparable reported cases. An analysis of the diagnosis of brief acute psychosis was then performed, as well as a mini-review on cases of COVID-19-related psychosis. Results showed that psychotic symptomatology was characterized by polythematic delusions that always involved a SARS-CoV-2 infection. To a lesser extent, the delusions were accompanied by hallucinations, bizarre cognitive and associative alterations, insomnia, hyporexia, dysphoria, and suicidal behavior. No particularly violent acts with related injury or death of the victim were described. Finally, we could hypothesize that our case was better represented by a diagnosis of personality with predominantly narcissistic and partly psychopathic traits. The present case highlighted the importance, in the context of forensic psychiatry, of integrating assessments with the crime perpetrators, namely through accurate clinical interviews, neuropsychological tests, diachronic observations, and comparison with similar cases present in the literature. Such an integrated approach allows precise evaluation and reduces the odds of errors in a field, such as forensic psychiatry, where a diagnostic decision can be decisive in the judgment of criminal responsibility. Moreover, discerning forensics from health cases represents an important issue in risk management.

The Impact of the COVID-19 Pandemic on Inpatient Admissions for Psychotic and Affective Disorders: The Experience of a Large Psychiatric Teaching Hospital in Romania.

The COVID-19 pandemic resulted in a global sanitary crisis and, in addition, elicited serious mental health consequences. The utilization of psychiatric hospital-based services acts as an indicator of public mental health. Therefore, this research sought to investigate differences in the numbers and characteristics of inpatient admissions for psychotic and affective disorders at the largest Romanian psychiatric hospital between the period of lockdown (16 March-15 May 2020) and another three corresponding periods: the same year in the pre-lockdown period (16 January-15 March 2020), the immediate post-lockdown period (16 May-15 July 2020), and two years later (16 March-15 May 2022). A retrospective analysis was performed. The study included a total of 6604 patients. Inpatient admissions decreased during lockdown in comparison with the pre-lockdown period and immediate post-lockdown period for psychotic disorders (p < 0.001 and p < 0.001, respectively) and affective disorders (p < 0.001 and p < 0.001, respectively). For both psychotic and affective disorders, a decrease in the age of the patients admitted during lockdown, as compared with the pre-lockdown period (p < 0.05 and p < 0.001, respectively), was observed. The length of the hospital stay for affective disorders was higher immediately post-lockdown in comparison with the lockdown period (p < 0.001). Collectively, the present findings provide a glimpse of the immediate and long-term consequences of the COVID-19 pandemic and lockdown measures on patients' access to mental healthcare in the form of hospitalization, and these findings could provide the basis for the development of a different approach to times of crisis.

First Episode Psychosis Following COVID-19 Infection: Two Case Reports from Turkey

Coronoviruses can reach the brain by various mechanisms and cause neuropsychiatric symptoms. In addition to the direct effect of COVID-19, psychosocial stressors are thought to cause psychosis. We present two case reports of patients presenting with first episode psychosis after COVID-19 infection to a training and research hospital in Turkey. According to the Structured Clinical Interview-Clientian Version for DSM-5 Disorders (SCID-5/CV), both patients were diagnosed with first episode psychosis. The cases had psychosocial stressors and their complaints resolved with low-dose antipsychotic treatment. As a result, we think that psychosocial factors such as stressful events and environments created by the pandemic may trigger first-episode psychosis.

New-Onset Psychosis Associated with COVID-19: A Case Report

Coronavirus disease 2019 (COVID-19) has caused a huge burden across the world. COVID-19 affects not only physical health but also neuropsychiatric health. Reported neuropsychiatric presentations due to COVID-19 include encephalopathy, mood changes, and neuromuscular dysfunction, which may occur during the infection. There have been also reports showing that the COVID-19 could provoke psychosis during the infection. However, there is still no available evidence regarding this event. In this report, three uncommon cases of new-onset psychosis with mild symptoms of COVID-19 admitted to Bali Provincial Mental Hospital in Bangli, Indonesia are described. The patients had presented persecutory delusions and auditory hallucinations. None of the patients had suicidal ideation or behavior. Three of the cases met the criteria for brief psychosis according to Indonesia’s guidelines for mental health disorders and classification. This report showed brief psychosis without suicidal ideation. However, clinicians have to be more alert in treating this condition due to its potential emergency risk shown in previous reports.

COVID-19 Induced Psychosis in Patients with Underlying Mental Health Disorder: Case Report

The COVID-19 pandemic confronted the world with an unknown reality whose challenges extend beyond the immediate threat to human health posed by the virus itself. Numerous stressors such as fear of the disease gravity and absence of proper treatment protocols, prolonged social isolation, anxiety, and financial burden lead to increased risk of developing psychiatric disorders in patients with underlying mental health problems. We present a case of a 23-year-old female, with a history of anxiety and depression who presents with psychosis and mania after contracting 2019 novel coronavirus. The patient was asymptomatic for the infection. The purpose of this case report is to highlight the fact that COVID-19 can increase the risk of mania and newonset psychosis in patients with a previous psychiatric history.