New-onset psychosis following COVID-19 vaccination: a systematic review.

Background: The emergence of a new coronavirus strain caused the COVID-19 pandemic. While vaccines effectively control the infection, it's important to acknowledge the potential for side effects, including rare cases like psychosis, which may increase with the rising number of vaccinations. Objectives: Our systematic review aimed to examine cases of new-onset psychosis following COVID-19 vaccination. Methods: We conducted a systematic review of case reports and case series on new-onset psychosis following COVID-19 vaccination from December 1st, 2019, to November 21st, 2023, using PubMed, MEDLINE, ClinicalKey, and ScienceDirect. Data extraction covered study and participant characteristics, comorbidities, COVID-19 vaccine details, and clinical features. The Joanna Briggs Institute quality assessment tools were employed for included studies, revealing no significant publication bias. Results: A total of 21 articles described 24 cases of new-onset psychotic symptoms following COVID-19 vaccination. Of these cases, 54.2% were female, with a mean age of 33.71 ± 12.02 years. Psychiatric events were potentially induced by the mRNA BNT162b2 vaccine in 33.3% of cases, and psychotic symptoms appeared in 25% following the viral vector ChAdOx1 nCoV-19 vaccine. The mean onset time was 5.75 ± 8.14 days, mostly reported after the first or second dose. The duration of psychotic symptoms ranged between 1 and 2 months with a mean of 52.48 ± 60.07 days. Blood test abnormalities were noted in 50% of cases, mainly mild to moderate leukocytosis and elevated C-reactive protein. Magnetic resonance imaging results were abnormal in 20.8%, often showing fluid-attenuated inversion recovery hyperintensity in the white matter. Treatment included atypical antipsychotics in 83.3% of cases, typical antipsychotics in 37.5%, benzodiazepines in 50%, 20.8% received steroids, and 25% were prescribed antiepileptic medications. Overall, 50% of patients achieved full recovery. Conclusion: Studies on psychiatric side effects post-COVID-19 vaccination are limited, and making conclusions on vaccine advantages or disadvantages is challenging. Vaccination is generally safe, but data suggest a potential link between young age, mRNA, and viral vector vaccines with new-onset psychosis within 7 days post-vaccination. Collecting data on vaccine-related psychiatric effects is crucial for prevention, and an algorithm for monitoring and treating mental health reactions post-vaccination is necessary for comprehensive management. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023446270.

Case report: Treatment-resistant schizophrenia with auto-aggressive compulsive behavior-Successful management with cariprazine.

The present case report describes a patient with treatment-resistant schizophrenia and auto-aggressive compulsive behavior who was effectively treated with a third-generation antipsychotic medication, cariprazine. The diagnosis was made 12 years ago, and the patient has been hospitalized 14 times and undergone various antipsychotic treatments. Despite receiving both inpatient and outpatient care, the patient's response to treatment has been only partial, and he has been classified as a treatment-resistant case. Therefore, the patient was switched to cariprazine, which led to significant improvements in both positive and negative symptoms, as well as the complete reduction of auto-aggressive compulsive behavior. These improvements contributed to the patient's overall social functioning and the achievement of remission, while also avoiding polypharmacy and eliminating the metabolic side effects associated with previous treatments.

Sympathetic nerve blocks for posttraumatic stress disorder: an evidentiary review for future clinical trials.

Posttraumatic stress disorder (PTSD) is a chronic disorder resulting from exposure to traumatic events. In recent years, sympathetic nerve blocks have gained interest as an emerging treatment modality for PTSD. They have been shown to reduce autonomic dysfunction associated with PTSD symptoms, particularly in refractory and treatment-resistant patients. However, there is limited evidence regarding the technique's effectiveness in PTSD patients. Therefore, this scoping review was designed to update and summarize the current literature on this topic to inform the design of future clinical trials and studies. Our review of 22 studies (mostly case reports and series) included 1,293 PTSD patients who received sympathetic nerve blocks, primarily military service members and veterans, with a median age of 42.2 years. 0.5% Ropivacaine was the preferred anesthetic, and the right sided stellate ganglion block was the most commonly used technique. Relapse of symptoms was reported commonly, resulting in additional nerve block sessions. Most reported side effects were mild and transient. Despite the encouraging results, we remain cautious in interpreting the benefit of the technique due to the lack of sufficient standardized clinical trial data, heterogeneity in reported results, and the potential for bias in reporting. Future studies should focus on evaluating and addressing the technique's effectiveness, safety, tolerability, and indications.

Validation of the generalized anxiety disorder scales (GAD-7 and GAD-2) in primary care settings in Latvia.

Background: Anxiety disorders are the most prevalent mental disorders in the world and have an important impact on the global burden of disease. Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder encountered in primary care. There are no available validated anxiety screening tools in primary care in Latvia. We aimed to validate both a seven-item and a two-item generalized anxiety disorder scale (GAD-7 and GAD-2) in the Latvian and Russian languages, to detect generalized anxiety disorder (GAD) in primary care settings in Latvia. Methods: During a 1-week period, all patients aged 18 years or older visiting their GP (general practitioners) with any health concern at 24 primary care settings throughout Latvia were invited to complete the GAD-7 in their native language (Latvian or Russian). Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI). Results: The study sample included 1,459 participants who completed the GAD-7 and the MINI. The GAD-7 items showed good internal reliability [Cronbach's alpha 0.87 for Latvian version and 0.85 for Russian version (for Latvia) of the GAD-7]. A cut-off score for detecting GAD of 5 or above was estimated for Latvian version of the GAD-7 (sensitivity 75.4%, specificity 68.9%, respectively) and 7 or above for Russian version of the GAD-7 (sensitivity 73.3%, specificity 84.1%, respectively). The internal reliability of the GAD-2 was lower for both languages (Cronbach's alpha 0.75 for Latvian version and 0.68 for Russian version of the GAD-2). A cut-off score of 2 or above was established for both the Latvian, and Russian versions of the GAD-2 (sensitivity 78.9 and 83.3%; specificity 63.7 and 69.1% for the Latvian and Russian versions of the GAD-2, accordingly) for detecting GAD. Conclusions: This is the first study to report criterion validity of the Latvian and Russian (for Latvia) versions of the GAD-7 and GAD-2, assessed in a nationwide study conducted at the primary care level.

First Episode Psychosis Following COVID-19 Vaccination: a Case Report.

Vaccines are crucial to ending the COVID-19 pandemic. An mRNA-based COVID-19 vaccine can cause mild to moderate side effects. A number of cases of cardiac, gastrointestinal, and psychiatric side effects have been reported as rare side effects associated with the COVID-19 vaccine. This article presents a patient, who after the second injection of the mRNA-based COVID-19 vaccine, immediately developed anxiety, nonspecific fear, and insomnia as the prodromal phase of psychosis. Starting from the second week, the patient manifested delusions of persecution, delusions of influence, thoughts insertion, and delusional behaviour, culminating in the suicide attempt. The duration of psychosis was eight weeks, and symptom reduction was observed only after the gradual administration of antipsychotics over four weeks. The investigations of the patient did not support any structural changes of the brain, any severe medical conditions, a neurological abnormality, a confusion or a state of unconsciousness or alterations in laboratory tests. Psychosis due to the use of alcohol or psychoactive substances was excluded. The psychological assessment of the patient demonstrated the endogenous type of thinking, and the patient had schizoid and paranoid personality traits strongly associated with schizophrenia. This case indicates a strong causal relationship between the mRNA-based COVID-19 vaccine injection and the onset of psychosis. We intend to follow up this case for possible development of schizophrenia and understand that the COVID-19 vaccine could possible play a trigger role in the development of primary psychosis. Longer-term supporting evidence is needed to estimate the prevalence of psychosis following vaccination with the mRNA-based COVID-19 vaccine.

Suicidality and Its Relation with Physical and Mental Conditions: Results from a Cross-Sectional Study of the Nationwide Primary Care Population Sample in Latvia.

Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical conditions, and health-related factors in the nationwide primary care population in Latvia. Materials and Methods: A cross-sectional study was performed within the framework of the National Research Program BIOMEDICINE 2014-2017 at 24 primary care settings across Latvia in 2015. Adult patients were evaluated over one week at each facility. Socio-demographic variables, physical condition, and health-related factors were assessed on-site by trained psychiatrists. Mental disorders and suicidality were determined using the Mini International Neuropsychiatric Interview, and assessments were conducted over the telephone within two weeks after the visit to the general practitioner. Results: Of the 1485 cases, 18.6% reported suicidality. Only current depression, any anxiety disorder, any alcohol use disorder, and physical-mental multimorbidity were significantly associated with suicidality in the multivariate logistic regression analysis. Gastrointestinal diseases were associated with current depression alone (odds ratio (OR) 10.36; 95% confidence interval (CI) 2.34-45.76) and comorbid depression with any anxiety disorder (OR 7.55; 95% CI 2.15-26.49) among persons with current suicidality. Conclusions: Screening for depression, anxiety, and alcohol use disorders regularly among patients with physical illness may be important to help recognise suicidality in primary care that could improve the quality of life of patients and prevent suicides.

Prevalence and associated factors of mental disorders in the nationwide primary care population in Latvia: a cross-sectional study.

BACKGROUND: Mental disorders are common amongst patients in primary care. There are no published studies on the prevalence of mental disorders in primary care patients in Latvia. The purpose of the study was to evaluate the current prevalence of mental disorders in the nationwide Latvian primary care population and to study possible associated factors and comorbidity of mental disorders. METHODS: A cross-sectional study within the framework of the National Research Program BIOMEDICINE 2014-2017 was performed at 24 primary care settings across Latvia. Adult patients seen over a 1-week time period at each facility were invited to participate in the study. Sociodemographic variables (age, sex, education, employment and marital status, place of residence, and ethnicity) were assessed onsite. A Mini-International Neuropsychiatric Interview assessment was conducted over the telephone within 2 weeks after the visit to the general practitioner (GP). RESULTS: Overall, 1485 individuals completed the interview. The current prevalence of any mental disorder was 37.2% and was significantly greater in women. Mood disorders (18.4%), suicidality (18.6%) and anxiety disorders (15.8%) were the most frequent diagnostic categories. The current prevalence of any mood disorder was associated with being 50-64 years of age, female sex, economically inactive status, divorced or widowed marital status and urban place of residence, whilst any current anxiety disorder was associated with female sex, lower education, and single marital status; however, being of Russian ethnicity and residing in a small city were protective factors. Suicidality was associated with female sex, lower education, unemployment or economically inactive status, being divorced or widowed and residing in a small city. The comorbidity rates between mental disorders varied from 2.9 to 53.3%. CONCLUSIONS: High prevalence rates of mental disorders, comorbidity and certain associated socio-demographic factors were found in primary care settings in Latvia. This highlights the importance of screening for depression and anxiety disorders and suicidal risk assessment by GPs. The results are fundamentally important for integrative medicine, monitoring and promotion of mental healthcare at the primary care level, as well as for healthcare policy and development of strategic plans in Latvia.