COVID-19 related lockdown: a trigger from the pre-melancholic phase to catatonia and depression, a case report of a 59 year-old man

First-episode psychotic disorders in the wake of the COVID-19 pandemic: a descriptive review of casereports

OBJECTIVE

Since the onset of COVID-19 pandemic, many case reports and case series dealt with new-onset psychotic disorders in patients either infected with SARS-CoV-2 or thematically linked to the pandemic, but without an infection. Our aim was to provide a comprehensive collection of these reports to illustrate the nature of these psychoses.

METHODS

We conducted a literature search in MEDLINE, Embase, PsycINFO, using search terms regarding first-episode psychotic disorders in the context of corona.

RESULTS

96 case reports or case series covering 146 patients (62 without and 84 with SARS-CoV-2 infection) were found. Compared to patients without infection, patients with infection showed significantly more often visual hallucinations (28.6% vs 8.1%), confusion (36.9% vs 11.3%), an acute onset of illness (88.5% vs 59.6%) and less often depression (13.1% vs 35.5%) and a delusional content related to the pandemic (29.5% vs 78.3%). Both groups had an equally favourable outcome with a duration of psychosis ≤2 weeks in half and full remission in two-thirds of patients. In patients with infection, signs of inflammation were reported in 78.3% and increased CRP in 58.6%. While reports on patients with infection are continuously published, no report about patients without infection was found after July 2020.

CONCLUSION

Cases without infection were considered reactive and originated all from the first wave of the corona pandemic. In cases with infection, inflammation was considered as the main pathogenetic factor but was not found in all patients. Diagnosis was impeded by the overlap of psychosis with delirium.

Association of insomnia symptoms and non-restorative sleep with Typus melancholicus: a Japanese general population survey

This study aimed to investigate the association between insomnia symptoms and non-restorative sleep (NRS) in individuals with Typus melancholicus, a personality trait linked to depression, in the general population. We analyzed data from a Japanese cross-sectional survey of 2519 randomly sampled adults. Typus melancholicus was evaluated using a modified version of Kasahara's Typus melancholicus inventory (modified-KTM). Logistic regression analysis was used to examine the associations of insomnia symptoms and NRS with modified-KTM scores. We demonstrated that insomnia symptoms and NRS were both positively associated with modified-KTM scores. Our results provide evidence for an association between Typus melancholicus and insomnia.

Post-COVID-19 Suicide Note: A Case Report of Late Onset Catatonia

Coronavirus disease 2019 (COVID-19) creates acute and long-lasting infection which results in respiratory, cardiovascular, and neuropsychiatric problems. Etiology of neuropsychiatric manifestations can be associated with immune system response, inflammatory cytokines, and also the stressors which are experienced by patients as feeling the risk of being infected by the virus, economic problems, and social distancing. We aimed to present a case of a 53-year-old patient whose suicide note was found and was admitted with depressive and catatonic symptoms 8 weeks after the recovery from COVID-19. Catatonia was suspected, and he was given lorazepam 1 mg. Shortly thereafter, he was entirely alert, cooperative, and oriented. As an advantage of this case, the patient in our report had not used medications for COVID-19 and so we could exclude the effect of medications to the pathophysiology of post- coronavirus disease symptoms. A wide spectrum of neuropsychiatric manifestations was observed in terms of diagnosis after COVID-19. Catatonia can break out in the post-infectious period as well as in the para-infectious period. There are limitations to figure out the direct invasion of coronavirus and the effect of the systemic inflammation to the central nervous system. Nevertheless, it should be considered that catatonia may be one of the clinical results of COVID-19.

A case of catatonia in the aftermath of the COVID-19 pandemic: does autism spectrum matter?

BACKGROUND

There is growing concern about the psychopathological consequences of the COVID-19 pandemic. The prolonged stress due to the spreading fear of the contagion and to the enforced containment measures are deemed to trigger recurrences of preexisting mental disorders as well as the onset of new ones. From such perspective, clinical cases may be of primary ground to identify individual features and pandemic-related factors predisposing to the development of serious psychiatric symptoms.

CASE PRESENTATION

Mr. R. is a 64-year-old, married, unemployed man, whose premorbid personality was characterized by relevant autistic traits. The patient developed catatonia in the context of the COVID-19 pandemic. We aimed at discussing the role of both preexisting and precipitating factors.

CONCLUSIONS

Autism spectrum could represent a predisposing factor for severe psychopathological outcome and catatonia. Furthermore, the present clinical case highlights the role of COVID-19 pandemic in influencing physical and mental health.

Clinical Features of First-episode Psychoses During the COVID-19 Pandemic

INTRODUCTION

The pandemic of the new coronavirus infection has become one of the most significant global social shocks in the past decade. It influenced the lifestyle of many people, including those with mental disorders.

AIM

To compare the psychopathological structure of psychotic states in young patients (up to 40 years old) with first-episode psychosis before the COVID-19 pandemic and during the COVID-19 pandemic.

METHODS

The research was conducted at the First psychotic episode clinic of the Mental-health clinic No. 1 n.a. N.A. Alexeev, Moscow, Russia. In total, 66 patients were enrolled, who met the inclusion criteria: first-in-life admission to a mental healthcare unit that occurred during the spring of 2019 (control group) or spring 2020 (experimental group), diagnosis on admission that belonged to the group "Acute and transient psychotic disorders" (F23.XX) of ICD-10. Patients with a disability or concurrent somatic or neurologic conditions were excluded from the study. Assessment of clinical and psychopathological characteristics with the allocation of the leading syndrome within the psychotic state, psychometric assessment according to the PANSS scale was carried out, the above indicators were compared between the experimental and control group.

RESULTS

We observed statistically insignificant increase in the rates of affective and catatonic subtypes of psychoses, a decrease in the rate of the delusional subtype of paranoid syndrome. PANSS scores differed significantly for different clinical subtypes of psychoses, although the differences between the experimental and control groups showed no statistical significance. Additionally, in spring 2020, a considerable decrease in the total number of hospitalizations was revealed.

CONCLUSIONS

The differences in the clinical and psychopathological structure of psychotic states revealed during the COVID-19 pandemic were statistically insignificant. Additional results of the study may indicate a decrease in the availability of mental healthcare for patients with psychoses, which requires further investigation.

Depression Relapse during Long-Term Remission due to Media-Amplified Fear during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has reoriented societies across the world and placed a significant burden on caring for mental health among its population. In this study, we reported two cases where patients experiencing severe depression with delusions of having COVID-19 required inpatient treatment after long-term remission owing to the negative impact of media reports related to the pandemic. Despite the aggravation of their anxiety, the patients were unable to distance themselves from negative information in attempts to remain informed through media to prevent their families and themselves from being infected. Self-protection through improved media literacy is imperative for people to protect themselves from the fearmongering of the media and infodemic in the present-day scenario.

Excited Catatonia - A Delayed Neuropsychiatric Complication of COVID-19 Infection

An increasing number of patients have been presenting with neuropsychiatric signs and symptoms associated with coronavirus disease (COVID-19). We present a case of a 69-year-old female with no prior psychiatric history who was brought to the emergency department due to bizarre behavior and paranoid thoughts for four to six weeks, worsening over the last two weeks. Psychiatric evaluation found that the patient had extreme restlessness and agitation, poor eye contact, paranoid delusions, visual hallucinations, and a flat affect with stereotypic repetition of speech and loose associations. The patient's family noted that two months prior she had symptoms of common cold associated with a severe cough and 20 pounds of weight loss. Suspicion for prior COVID-19 infection prompted an IgG antibody test, which was positive. Our patient displayed at least three of the signs needed to diagnose catatonia - agitation, rigidity, and echolalia - and had a therapeutic response to lorazepam, confirming suspicions of excited catatonia. Her seropositivity for IgG against COVID-19 suggested a COVID-induced brief psychotic disorder with catatonia, which makes this the first known case, to our knowledge, of a patient with delayed onset catatonia after COVID-19 infection. This suggests that clinicians should, after ruling out more plausible stressors, suspect possible coronavirus involvement in sudden onset psychotic disorders, especially in patients who do not fit the demographic of new-onset schizophrenia-spectrum diagnoses. Further research is needed on the pathophysiology behind COVID-19 altering neuronal function and neurotransmitter pathways.