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新冠病毒感染后新发精神病性障碍

New-Onset Psychosis Following COVID-19 Infection.

作者信息

Desai Saral, Sheikh Batool, Belzie Louis

机构信息

Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, USA.

出版信息

Cureus. 2021 Sep 12;13(9):e17904. doi: 10.7759/cureus.17904. eCollection 2021 Sep.

Abstract

Previous studies have suggested that some individuals experience neuropsychiatric symptoms following coronavirus disease 2019 (COVID-19) infection. We describe a case of new-onset psychosis following COVID-19 infection in a 55-year-old female with no prior psychiatric history. The patient started exhibiting symptoms of COVID-19 infection three weeks prior and was treated in the hospital with 4 L oxygen, dexamethasone 6 mg, and remdesivir therapy for seven days. Throughout her hospital stay, the patient had no neuropsychiatric symptoms. During her last week of stay, she was solely getting oxygen at home before presenting to the emergency department (ED) with severe psychosis. Her COVID-19 test in ED presentation was negative, and all potential etiologies for psychosis were ruled out. She was effectively treated for two weeks with 10 mg haloperidol and 1000 mg sodium valproate daily, followed by outpatient care. While variables such as a family history of bipolar disorder, psychosocial stressors, and steroid medication may have contributed to the patient's presentation, these circumstances alone did not result in neuropsychiatric symptoms in the past. COVID-19 infection may enhance the likelihood of developing neuropsychiatric problems on its own or amplify the effects of risk factors associated with an increased risk of psychosis. Neuropsychiatric consequences of COVID-19 infection may be under- or over-reported in individuals treated with steroids. Further research is necessary to identify individuals at risk of experiencing neuropsychiatric issues owing to COVID-19 infection and the prognosis.

摘要

先前的研究表明,一些人在感染2019冠状病毒病(COVID-19)后会出现神经精神症状。我们描述了一例55岁无精神病史的女性在感染COVID-19后新发精神病的病例。患者三周前开始出现COVID-19感染症状,在医院接受了4升氧气、6毫克地塞米松和瑞德西韦治疗七天。在她住院期间,患者没有神经精神症状。在她住院的最后一周,她在家中仅接受吸氧治疗,之后因严重精神病症状被送往急诊科(ED)。她在急诊科就诊时的COVID-19检测呈阴性,所有可能导致精神病的病因均被排除。她每天接受10毫克氟哌啶醇和1000毫克丙戊酸钠有效治疗两周,随后接受门诊治疗。虽然双相情感障碍家族史、社会心理压力源和类固醇药物等变量可能促成了患者的症状表现,但仅这些情况过去并未导致神经精神症状。COVID-19感染可能自身增加发生神经精神问题的可能性,或放大与精神病风险增加相关的危险因素的影响。在接受类固醇治疗的个体中,COVID-19感染的神经精神后果可能被低估或高估。有必要进行进一步研究,以确定因COVID-19感染而有神经精神问题风险的个体及其预后。

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