Article Review: Ferrando, S.J., et al. (2020). COVID-19 psychosis: A potential new neuropsychiatric condition triggered by novel coronavirus infection and the inflammatory response?

Rebecca Girlinghouse, MA

WKPIC Doctoral Intern

 

The authors of this study sought to bring awareness to cases in which COVID-19 positive patients developed new-onset symptoms of psychosis.  They explained some hospitals have been reporting cases in which COVID-19 positive patients developed new symptoms of psychosis several days prior to emergency department (ED) admission.  Further, the authors reported having multiple COVID-19 positive patients in their own ED who were asymptomatic for physical symptoms of the virus but developed new-onset symptoms of psychosis.

 

The authors presented three cases in which asymptomatic individuals who tested positive for COVID-19 developed new psychiatric symptoms.  The first was a 30-year-old male who had been exhibiting new and bizarre behaviors several days before admission.  These included extreme anxiety, suicidal ideation, agitation, suspiciousness, auditory hallucinations of others chasing him, decreased sleep, and drinking excessive amounts of water.  His lab work was normal aside from elevated C-reactive protein (CRP), which indicated inflammation in the central nervous system (CNS).

 

The second case was a 34-year-old female with a history of panic disorder.  She presented to the ED with novel symptoms such as inattention, pressured speech, agitation, disorganization, suspiciousness, and the sensation of being on fire.  Lab work was normal except for low white blood cell count and elevated CRP.

 

The third case was a 33-year-old male on methadone maintenance. However, he had never experienced symptoms of psychosis during his lifetime.  He presented to the ED with agitation, auditory hallucinations, persecutory delusions regarding his ex-wife, and the belief that others were following him in a van and attempting to kill him.  Lab work was normal except for elevated CRP.

 

Based on these cases, and similar reports from other hospitals, the authors speculated that a significant inflammatory response within the patients (called a cytokine storm) had occurred as a result of COVID-19 infection.  This inflammation in the CNS then triggered symptoms of psychosis. The authors explained such immune system responses have been linked to other psychiatric illnesses such as depression, psychosis, and neurological impairment.  Further, all three patients’ lab work was relatively normal except for elevated CRP, which indicated an inflammatory response.  The authors suggested that future studies utilize more sensitive functional imaging techniques to better capture changes in the CNS during COVID-19 infection, using neuropsychological screening tools when possible, and taking samples of cerebral spinal fluid (CFS) if the virus had entered the CNS.

 

References

Ferrando, S.J., Klepacz, L., Lynch, S., Tavakkoli, M., Dornbush, R., Baharani, R., Smolin, Y. & Bartell, A. (2020). COVID-19 psychosis: A potential new neuropsychiatric condition triggered by novel coronavirus infection and the inflammatory response? Psychosomatics. https://www.sciencedirect.com/science/article/pii/S0033318220301511

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