Acute Psychosis and COVID-19 Infection: Psychiatric Symptoms in Hospitalized Patients

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in various medical and psychosocial consequences globally. Respiratory infections are common among patients infected with the SARS-CoV-2 virus, the causative virus of coronavirus disease 2019 (COVID-19). However, various psychiatric and neurocognitive symptoms and sequelae of COVID-19 have been reported as well.  This study aimed to describe two clinical case reports of patients with no prior history of psychiatric illnesses admitted to the psychiatric inpatient unit with acute onset of psychosis. A 49-year-old woman with no past medical history and no past psychiatric history was admitted to the inpatient psychiatric unit with suicidal ideation and was noted to have acute psychosis. A 56-year-old woman with a history of hypertension with no past psychiatric history was admitted to the hospital with acute hypoxic respiratory failure secondary to COVID-19 pneumonia and was noted to have acute psychosis.  Various psychiatric and neurocognitive symptoms and sequelae of COVID-19 have been reported. However, the pathophysiology, direct biological effects of the disease, treatment modalities, worsening of symptoms due to various medications, and other long-term sequelae are not fully understood. Therefore, clinicians should be mindful of neuropsychiatric symptoms and conduct a detailed history and physical examination on all patients presenting with psychiatric symptoms in the context of COVID-19. It is also essential to assess for signs and symptoms of delirium in patients presenting with neuropsychiatric symptoms. Further research is needed to identify the etiology, predisposing factors, exacerbating or precipitating factors contributing to neuropsychiatric symptoms associated with infection with the SARS-CoV-2 virus. In addition, the pathophysiology contributing to these symptoms and pharmacological interventions for managing these sequelae need to be evaluated.

New-Onset Catatonia and Delirium in a COVID-Positive Patient.

Coronavirus disease (COVID-19) is a strain of coronavirus family, which was initially found in China in late 2019 and subsequently spread to rest of the world. COVID-19 has led to physical and mental health complications since its onset. In addition to the pandemic-associated social stresses, biological complications include direct viral encephalitis, autoimmune-mediated responses, medication side effects, hypoxic brain injury, and delirium, which can collectively cause varied presentations of neuropsychiatric symptoms. Neuropsychiatric complications have been reported in the acute stages of COVID-19 and post-infection period. Here we report our experience treating a patient who initially presented with a severe depressive episode and subsequently developed catatonia and delirium following hospital-acquired COVID-19 infection.