ABSTRACT
We present a case of a 14-year-old, previously healthy female, admitted with acute coronavirus disease 2019 infection and new-onset seizures secondary to virus-associated necrotizing disseminated acute leukoencephalopathy. Her symptoms resolved completely with intravenous immunoglobulin and steroids. Pathophysiology and prognosis of neurologic manifestations of coronavirus disease 2019 remain unclear.
Subject(s)
COVID-19/complications , Intracranial Hemorrhages/etiology , Leukoencephalopathies/etiology , Leukoencephalopathies/virology , SARS-CoV-2 , Adolescent , Anticonvulsants/administration & dosage , Anticonvulsants/therapeutic use , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Intracranial Hemorrhages/pathology , Leukoencephalopathies/pathology , Levetiracetam/administration & dosage , Levetiracetam/therapeutic use , Lorazepam/administration & dosage , Lorazepam/therapeutic use , Seizures/drug therapy , COVID-19 Drug TreatmentABSTRACT
A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.
Subject(s)
Anxiety Disorders/psychology , COVID-19/psychology , Psychotic Disorders/psychology , Adult , Anti-Anxiety Agents/administration & dosage , Antipsychotic Agents/administration & dosage , Anxiety Disorders/drug therapy , Humans , Lorazepam/administration & dosage , Male , Mirtazapine/administration & dosage , Pandemics , Psychotic Disorders/drug therapy , Qatar , Quarantine/psychology , Risperidone/administration & dosage , SARS-CoV-2Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Haloperidol/administration & dosage , Lorazepam/administration & dosage , Olanzapine/administration & dosage , Pandemics , Pneumonia, Viral , Psychotic Disorders , Adult , Antipsychotic Agents/administration & dosage , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Delusions/diagnosis , Humans , Involuntary Treatment , Male , Pandemics/prevention & control , Paranoid Behavior/diagnosis , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Psychotic Disorders/diagnosis , Psychotic Disorders/drug therapy , Psychotic Disorders/etiology , SARS-CoV-2 , Social Isolation/psychology , Treatment OutcomeSubject(s)
Antidepressive Agents/administration & dosage , Diphenhydramine/administration & dosage , Hypnotics and Sedatives/administration & dosage , Psychiatric Department, Hospital , Psychotic Disorders , Sertraline/administration & dosage , Adolescent , Adolescent Psychiatry , Antipsychotic Agents/administration & dosage , Female , Haloperidol/administration & dosage , Humans , Lorazepam/administration & dosage , Psychotic Disorders/complications , Psychotic Disorders/drug therapy , Risperidone/administration & dosageABSTRACT
BACKGROUND: Anticipatory prescribing (AP) of injectable medications in advance of clinical need is established practice in community end-of-life care. Changes to prescribing guidelines and practice have been reported during the COVID-19 pandemic. AIMS AND OBJECTIVES: To investigate UK and Ireland clinicians' experiences concerning changes in AP during the COVID-19 pandemic and their recommendations for change. METHODS: Online survey of participants at previous AP national workshops, members of the Association for Palliative Medicine of Great Britain and Ireland and other professional organisations, with snowball sampling. RESULTS: Two hundred and sixty-one replies were received between 9 and 19 April 2020 from clinicians in community, hospice and hospital settings across all areas of the UK and Ireland. Changes to AP local guidance and practice were reported: route of administration (47%), drugs prescribed (38%), total quantities prescribed (35%), doses and ranges (29%). Concerns over shortages of nurses and doctors to administer subcutaneous injections led 37% to consider drug administration by family or social caregivers, often by buccal, sublingual and transdermal routes. Clinical contact and patient assessment were more often remote via telephone or video (63%). Recommendations for regulatory changes to permit drug repurposing and easier community access were made. CONCLUSIONS: The challenges of the COVID-19 pandemic for UK community palliative care has stimulated rapid innovation in AP. The extent to which these are implemented and their clinical efficacy need further examination.