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1.
Brain Behav Immun ; 87: 34-39, 2020 07.
Article in English | MEDLINE | ID: covidwho-1719335

ABSTRACT

The coronavirus disease 19 (COVID-19) pandemic is a significant psychological stressor in addition to its tremendous impact on every facet of individuals' lives and organizations in virtually all social and economic sectors worldwide. Fear of illness and uncertainty about the future precipitate anxiety- and stress-related disorders, and several groups have rightfully called for the creation and dissemination of robust mental health screening and treatment programs for the general public and front-line healthcare workers. However, in addition to pandemic-associated psychological distress, the direct effects of the virus itself (several acute respiratory syndrome coronavirus; SARS-CoV-2), and the subsequent host immunologic response, on the human central nervous system (CNS) and related outcomes are unknown. We discuss currently available evidence of COVID-19 related neuropsychiatric sequelae while drawing parallels to past viral pandemic-related outcomes. Past pandemics have demonstrated that diverse types of neuropsychiatric symptoms, such as encephalopathy, mood changes, psychosis, neuromuscular dysfunction, or demyelinating processes, may accompany acute viral infection, or may follow infection by weeks, months, or longer in recovered patients. The potential mechanisms are also discussed, including viral and immunological underpinnings. Therefore, prospective neuropsychiatric monitoring of individuals exposed to SARS-CoV-2 at various points in the life course, as well as their neuroimmune status, are needed to fully understand the long-term impact of COVID-19, and to establish a framework for integrating psychoneuroimmunology into epidemiologic studies of pandemics.


Subject(s)
Coronavirus Infections/psychology , Cytokine Release Syndrome/psychology , Mental Disorders/psychology , Nervous System Diseases/psychology , Pneumonia, Viral/psychology , Acute Disease , Anxiety/etiology , Anxiety/immunology , Anxiety/psychology , Bacterial Translocation , Betacoronavirus , COVID-19 , Chronic Disease , Coronavirus Infections/complications , Coronavirus Infections/immunology , Coronavirus Infections/therapy , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/therapy , Demyelinating Diseases/etiology , Demyelinating Diseases/immunology , Demyelinating Diseases/physiopathology , Demyelinating Diseases/psychology , Depression/etiology , Depression/immunology , Depression/psychology , Humans , Immunologic Factors/adverse effects , Mental Disorders/etiology , Mental Disorders/immunology , Mental Health , Nervous System Diseases/etiology , Nervous System Diseases/immunology , Nervous System Diseases/physiopathology , Neurodegenerative Diseases/etiology , Neurodegenerative Diseases/immunology , Neurodegenerative Diseases/physiopathology , Neurodegenerative Diseases/psychology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Pneumonia, Viral/therapy , Psychoneuroimmunology , Psychotic Disorders/etiology , Psychotic Disorders/immunology , Psychotic Disorders/psychology , Public Health , SARS-CoV-2 , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/immunology , Stress Disorders, Post-Traumatic/psychology
3.
Sci Rep ; 11(1): 21002, 2021 10 25.
Article in English | MEDLINE | ID: covidwho-1483148

ABSTRACT

COVID19 infection was associated with possible psychiatric manifestations, including psychosis and mania. In addition, psychiatric disorders might be triggered by severe psychological reactions to the pandemic or the measures taken to contain it. This study aimed to assess the trends of new-onset psychosis/mania during the pandemic timeline. Psychiatric emergency department records during January-July 2019 and 2020 of two regional mental health centers were manually examined. Cases of new-onset psychosis or mania were found in 326 out of 5161 records examined. The ratio of these cases increased by 45.5% in 2020 compared to 2019 (189 out of 2367, 137 out of 2479, respectively, p = 0.001). The peak increase was in April 2020 (9.4% vs. 4.7%, p = 0.015). There was no association between the rise of new-onset psychotic or manic episodes and national incidence of COVID19 cases, as observed during Israel 2nd wave. PCR tests were negative, except a single case. In this study, an increase in new-onset psychosis/mania was identified during the initial phase of the pandemic. Though causality could not be directly inferred, lack of infection symptoms, negative PCR testing and temporal distribution incongruent with COVID19 caseload did not support a direct effect of SARS-CoV-2. Alternative explanations are discussed, such as psychological reaction to stress and preventive measures, as well as case-shifting between different mental health settings.


Subject(s)
Bipolar Disorder/epidemiology , COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data , Psychotic Disorders/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Bipolar Disorder/psychology , COVID-19 Nucleic Acid Testing , Electronic Health Records , Emergency Service, Hospital/trends , Female , Hospitals, Psychiatric/trends , Humans , Israel/epidemiology , Longitudinal Studies , Male , Middle Aged , Pandemics , Psychotic Disorders/psychology , Stress, Psychological , Young Adult
4.
J Psychiatr Pract ; 27(2): 131-136, 2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1291391

ABSTRACT

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is a pandemic infection caused by the Severe Acute Respiratory Syndrome 2 Coronavirus (SARS-2-CoV). Although most prominently associated with pulmonary manifestations, COVID-19 is increasingly implicated in neuropsychiatric complications, including delirium and psychosis. There is a potential causal link between COVID-19 infection and psychotic symptoms; however, case reports to date have been incomplete, as the patients described had known psychiatric histories or other plausible medical causes for altered mental status. We present a longitudinal case of COVID-19 psychosis in a patient who underwent comprehensive diagnostic evaluation. This case is a contribution to the inchoate characterization of neuropsychiatric manifestations of COVID-19 infection. CASE REPORT: We present a case of late-onset psychosis in a middle-aged man with no psychiatric history who tested positive for COVID-19 on admission following a recently resolved upper respiratory illness. His acute presentation-characterized by delusions, hallucinations, and disorganized thought and behavior, for which he required inpatient medical admission and subsequent inpatient psychiatric hospitalization-was successfully treated. During his hospitalization, he underwent comprehensive medical and neurological workup (including neuroimaging; electroencephalography; and serum and cerebrospinal fluid testing) that was grossly unremarkable. DISCUSSION: Despite myriad potential causes of the patient's psychosis, this patient's diagnostic workup was largely unrevealing, apart from his nasopharyngeal SARS-2-CoV reverse transcriptase polymerase chain reaction assay. As such, psychosis secondary to COVID-19 infection emerged as the presumptive diagnosis.


Subject(s)
COVID-19/complications , COVID-19/psychology , Psychotic Disorders/complications , Psychotic Disorders/psychology , Acute Disease , Antipsychotic Agents/therapeutic use , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Humans , Longitudinal Studies , Male , Middle Aged , Psychotic Disorders/drug therapy , Risperidone/therapeutic use , SARS-CoV-2
9.
Sci Rep ; 11(1): 7169, 2021 03 30.
Article in English | MEDLINE | ID: covidwho-1160544

ABSTRACT

In current international classification systems (ICD-10, DSM5), the diagnostic criteria for psychotic disorders (e.g. schizophrenia and schizoaffective disorder) are based on symptomatic descriptions since no unambiguous biomarkers are known to date. However, when underlying causes of psychotic symptoms, like inflammation, ischemia, or tumor affecting the neural tissue can be identified, a different classification is used ("psychotic disorder with delusions due to known physiological condition" (ICD-10: F06.2) or psychosis caused by medical factors (DSM5)). While CSF analysis still is considered optional in current diagnostic guidelines for psychotic disorders, CSF biomarkers could help to identify known physiological conditions. In this retrospective, partly descriptive analysis of 144 patients with psychotic symptoms and available CSF data, we analyzed CSF examinations' significance to differentiate patients with specific etiological factors (F06.2) from patients with schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F2). In 40.3% of all patients, at least one CSF parameter was out of the reference range. Abnormal CSF-findings were found significantly more often in patients diagnosed with F06.2 (88.2%) as compared to patients diagnosed with F2 (23.8%, p < 0.00001). A total of 17 cases were identified as probably caused by specific etiological factors (F06.2), of which ten cases fulfilled the criteria for a probable autoimmune psychosis linked to the following autoantibodies: amphiphysin, CASPR2, CV2, LGl1, NMDA, zic4, and titin. Two cases presented with anti-thyroid tissue autoantibodies. In four cases, further probable causal factors were identified: COVID-19, a frontal intracranial tumor, multiple sclerosis (n = 2), and neurosyphilis. Twenty-one cases remained with "no reliable diagnostic classification". Age at onset of psychotic symptoms differed between patients diagnosed with F2 and F06.2 (p = 0.014), with the latter group being older (median: 44 vs. 28 years). Various CSF parameters were analyzed in an exploratory analysis, identifying pleocytosis and oligoclonal bands (OCBs) as discriminators (F06.2 vs. F2) with a high specificity of > 96% each. No group differences were found for gender, characteristics of psychotic symptoms, substance dependency, or family history. This study emphasizes the great importance of a detailed diagnostic workup in diagnosing psychotic disorders, including CSF analysis, to detect possible underlying pathologies and improve treatment decisions.


Subject(s)
Psychotic Disorders/cerebrospinal fluid , Adolescent , Adult , Age of Onset , Aged , Autoimmune Diseases of the Nervous System/cerebrospinal fluid , Autoimmune Diseases of the Nervous System/psychology , Biomarkers/cerebrospinal fluid , COVID-19/psychology , Cerebrospinal Fluid Proteins/analysis , Child , Child, Preschool , Humans , Middle Aged , Psychotic Disorders/etiology , Psychotic Disorders/psychology , Retrospective Studies , Schizophrenia/cerebrospinal fluid , Young Adult
10.
Psychiatriki ; 32(1): 79-82, 2021 Apr 19.
Article in English | MEDLINE | ID: covidwho-1148406

ABSTRACT

The COVID-19 outbreak has affected millions of people globally and it also has a huge psychological impact. The objective of this case report is to outline the possible effect of the COVID-19 pandemic to the content of delusions in patients with psychosis. Α 34-year-old male with no history of mental disorder, involuntarily hospitalized due to agitation and aggression towards others, experienced grandiose delusions, referential delusions and delusions of passivity. The content of all his delusions was related to the COVID-19 pandemic. His symptoms were not proven to be caused by any physical condition or substance use disorder. He was prescribed olanzapine 10mg bd and lorazepam 2,5mg td and demonstrated significant improvement with a complete subsidence of his symptoms within a week. He was discharged after a total of 13 days with an ICD-10 diagnosis of brief psychotic disorder. At his 6 months follow-up, he reported no psychiatric symptoms. Existing literature indicates a strong relationship between life experiences and the content of delusions. This case report highlights how the stressful life event of the COVID-19 outbreak affected the content of our patient's delusions.


Subject(s)
COVID-19/psychology , Delusions/psychology , Pandemics , Psychotic Disorders/psychology , Adult , Aggression , Anti-Anxiety Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Delusions/drug therapy , Humans , Involuntary Commitment , Life Change Events , Lorazepam/therapeutic use , Male , Olanzapine/therapeutic use , Psychomotor Agitation , Psychotic Disorders/drug therapy , Stress, Psychological/complications , Stress, Psychological/psychology
11.
J Clin Neurosci ; 87: 29-31, 2021 May.
Article in English | MEDLINE | ID: covidwho-1116965

ABSTRACT

Despite neuropsychiatric outcomes of SARS-CoV-2 infection are now under close scrutiny, psychoneuroimmunological characteristics of COVID-19 and precise pathophysiology of neuropsychiatric manifestations of the infection are still obscure. Moreover, there still exists a shortfall in demonstrating specific clinical manifestations of the brain involvement of the virus. Here, we presented a 33-year-old female patient with COVID-19, reporting acute-onset paranoid delusions symptoms, insomnia and irritability. Cranial MRI showed an hyperintense signal in the splenium of the corpus callosum with decreased apparent diffusion coefficient, which might possibly indicate the presence of cytotoxic edema related to the brain involvement of the infection. Following the completion of SARS-CoV-2 treatment, both cytotoxic edema and psychiatric symptoms resolved. In light of this report, we suggest that either heightened immune response and direct viral infection that SARS-CoV-2 may lead to such psychiatric manifestations and neuropsychiatric monitoring should be performed in patients with COVID-19. Prompt recognition of psychiatric consequences of COVID-19 may help clinicians provide guidance for differential diagnosis and manage them accordingly.


Subject(s)
COVID-19/diagnostic imaging , Mania/diagnostic imaging , Psychotic Disorders/diagnostic imaging , Acute Disease , Adult , Brain/diagnostic imaging , COVID-19/complications , COVID-19/psychology , Female , Humans , Magnetic Resonance Imaging , Mania/etiology , Mania/psychology , Psychotic Disorders/etiology , Psychotic Disorders/psychology
12.
Rev Psiquiatr Salud Ment (Engl Ed) ; 13(2): 90-94, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-125044

ABSTRACT

INTRODUCTION: The world is currently undergoing an extremely stressful scenario due to the COVID-19 pandemic. This unexpected and dramatic situation could increase the incidence of mental health problems, among them, psychotic disorders. The aim of this paper was to describe a case series of brief reactive psychosis due to the psychological distress from the current coronavirus pandemic. MATERIALS AND METHODS: We report on a case series including all the patients with reactive psychoses in the context of the COVID-19 crisis who were admitted to the Virgen del Rocío and Virgen Macarena University Hospitals (Seville, Spain) during the first two weeks of compulsory nationwide quarantine. RESULTS: In that short period, four patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a brief reactive psychotic disorder. All of the episodes were directly triggered by stress derived from the COVID-19 pandemic and half of the patients presented severe suicidal behavior at admission. CONCLUSIONS: We may now be witnessing an increasing number of brief reactive psychotic disorders as a result of the COVID-19 pandemic. This type of psychosis has a high risk of suicidal behavior and, although short-lived, has a high rate of psychotic recurrence and low diagnostic stability over time. Therefore, we advocate close monitoring in both the acute phase and long-term follow-up of these patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Pneumonia, Viral/psychology , Psychological Distress , Psychotic Disorders/etiology , Quarantine/psychology , Stress, Psychological/complications , Adult , COVID-19 , Coronavirus Infections/complications , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Psychiatric Status Rating Scales , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Risk Factors , SARS-CoV-2 , Spain , Suicide/psychology
13.
Neurosci Lett ; 741: 135491, 2021 01 10.
Article in English | MEDLINE | ID: covidwho-1071804

ABSTRACT

Historical epidemiological perspectives from past pandemics and recent neurobiological evidence link infections and psychoses, leading to concerns that COVID-19 will present a significant risk for the development of psychosis. But are these concerns justified, or mere sensationalism? In this article we review the historical associations between viral infection and the immune system more broadly in the development of psychosis, before critically evaluating the current evidence pertaining to SARS-CoV-2 and risk of psychosis as an acute or post-infectious manifestation of COVID-19. We review the 42 cases of psychosis reported in infected patients to date, and discuss the potential implications of in utero infection on subsequent neurodevelopment and psychiatric risk. Finally, in the context of the wider neurological and psychiatric manifestations of COVID-19 and our current understanding of the aetiology of psychotic disorders, we evaluate possible neurobiological and psychosocial mechanisms as well as the numerous challenges in ascribing a causal pathogenic role to the infection.


Subject(s)
COVID-19/complications , COVID-19/diagnosis , Delusions/diagnosis , Delusions/etiology , Psychotic Disorders/diagnosis , Psychotic Disorders/etiology , Adolescent , Adult , COVID-19/psychology , Delusions/psychology , Female , Humans , Male , Middle Aged , Psychotic Disorders/psychology , Risk Factors , Young Adult
14.
Community Ment Health J ; 57(1): 30-34, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064543

ABSTRACT

The COVID pandemic is now leading to the emergence of a secondary mental health pandemic. Clients with psychosis are at increased risk of poorer medium- and long-term psychosocial and clinical outcomes. In response to the pressing need to flexibly deliver high-quality care to individuals with psychosis, this brief report proposes high yield cognitive behavioral techniques for psychosis (HY-CBt-p) facilitated by task sharing and digital enhancements. HY-CBt-p is delivered over fewer sessions than formulation-based Cognitive Behavioral Therapy for psychosis (CBTp), can be learned by a range of providers, and includes techniques such as developing a normalizing explanation; techniques to reduce anxiety, depression, and insomnia, which perpetuate psychotic symptoms; self-monitoring; reality testing; and wellness planning. Previous research suggests that effect sizes will be lower than that of 16-session formulation-driven CBTp, but additional research is needed to test the feasibility, acceptability, efficacy, and comparative effectiveness of different forms of remote-delivered CBTp.


Subject(s)
Cognitive Behavioral Therapy/methods , Delivery of Health Care/methods , Psychotic Disorders/therapy , Quality of Health Care , Telemedicine , COVID-19 , Female , Humans , Male , Pandemics , Psychotic Disorders/psychology , SARS-CoV-2
15.
Res Dev Disabil ; 110: 103856, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1014787

ABSTRACT

During the COVID-19 pandemic, the Oasi Research Institute of Troina (Italy) became an important hotbed for infection; in fact, 109 patients with different levels of Intellectual Disability (ID) tested positive for COVID-19. The procedures and interventions put in place at the Oasi Research Institute due to the COVID-19 pandemic are exhaustively reported in this paper. The description of the clinical procedures as well as remote/in person psychological support services provided to people with ID and their families are here divided into three different sections: Phase I (or Acute phase), Phase II (or Activity planning), and Phase III (or Activity consolidation). In each section, the main psycho-pathological characteristics of patients, the reactions of family members and the multidisciplinary interventions put in place are also described.


Subject(s)
COVID-19/epidemiology , Developmental Disabilities/rehabilitation , Intellectual Disability/rehabilitation , Psychosocial Support Systems , Telemedicine , Academies and Institutes , Adolescent , Adult , Aged , Aged, 80 and over , Autism Spectrum Disorder/epidemiology , Autism Spectrum Disorder/psychology , Autism Spectrum Disorder/rehabilitation , COVID-19/mortality , COVID-19/physiopathology , COVID-19/psychology , Child , Child, Preschool , Comorbidity , Developmental Disabilities/epidemiology , Developmental Disabilities/psychology , Disease Hotspot , Disease Outbreaks , Epilepsy/epidemiology , Female , Hospitals, Special , Humans , Hypothyroidism/epidemiology , Infant , Intellectual Disability/epidemiology , Intellectual Disability/psychology , Italy , Male , Middle Aged , Mood Disorders/epidemiology , Mood Disorders/psychology , Mood Disorders/rehabilitation , Obesity/epidemiology , Overweight/epidemiology , Personality Disorders/epidemiology , Personality Disorders/psychology , Personality Disorders/rehabilitation , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Psychotic Disorders/rehabilitation , Respiratory Distress Syndrome/physiopathology , SARS-CoV-2 , Severity of Illness Index , Young Adult
16.
BMJ Case Rep ; 13(12)2020 Dec 16.
Article in English | MEDLINE | ID: covidwho-983650

ABSTRACT

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-2
19.
Psychiatry Res ; 294: 113493, 2020 12.
Article in English | MEDLINE | ID: covidwho-808327

ABSTRACT

OBJECTIVE: Individuals with severe mental illnesses (SMI), including schizophrenia spectrum illnesses and affective disorders, may be at increased risk for negative mental health outcomes related to the COVID-19 pandemic. This study compared the severity of pre-pandemic symptoms and affective experiences to current symptoms to evaluate this possibility. METHODS: 148 individuals with SMI (92 with schizophrenia spectrum illnesses and 56 with affective disorders) were recruited from ongoing ecological momentary assessment studies that sampled day-to-day experiences and symptom severity prior to the pandemic. Participants completed a one-time phone survey that queried these same experiences/symptoms between April and June of 2020. RESULTS: Severity of affective experiences and psychotic symptoms remained stable across time, as did sleep duration. Well-being and the number of substances used increased during the early months of the pandemic. Increases in well-being were associated with being female and spending less time alone pre-pandemic. Patterns of stability/change did not differ according to diagnostic category. CONCLUSIONS: At this relatively early stage, individuals with SMI are not reporting a worsening of symptoms or affective experiences and instead appear to be resilient in the face of the pandemic. Continued assessment is needed to determine whether this resilience will persist as the pandemic progresses.


Subject(s)
COVID-19/psychology , Mental Health , Mood Disorders/psychology , Psychotic Disorders/psychology , Schizophrenic Psychology , Adult , Ecological Momentary Assessment , Female , Humans , Male , Middle Aged , Pandemics , Risk Factors
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