Commentary on 2 Cases of Neuropsychiatric Symptoms Occurring in Association With COVID-19

Abstract

Two cases are presented involving neuropsychiatric symptoms occurring in the context of coronavirus disease 2019 (COVID-19) infections. The first case involved a middle-age man with no known psychiatric history who presented with acute psychotic symptoms (delusions, hallucinations, disorganization) after recovery from a recent respiratory illness. This patient tested positive for COVID-19 on admission. The patient's symptoms were not consistent with delirium and testing did not suggest a neurological etiology. The patient's psychosis eventually resolved 6 weeks after its abrupt onset with treatment with antipsychotic medication. The second case involved a 44-year-old man with a history of depression and psychotic symptoms who presented after a serious suicide attempt and tested positive for COVID-19 on admission. The patient had subsequent negative tests while on the inpatient psychiatric unit before again testing positive later in his admission. The patient's positive COVID-19 tests appeared to coincide with exacerbations in his mood symptoms, which led to the suicide attempt and psychotic episode that initially caused his admission. This patient was successfully treated with clozapine. In both of these cases, the question arose as to whether there was a link between the COVID-19 infections and the neuropsychiatric symptoms. Growing evidence suggests that severe neuropsychiatric sequelae can develop after COVID-19 infection.