Department of Psychiatry, Tristar Centennial Medical Center, HCA Healthcare, 2300 Patterson St, 37203, Nashville, TN, USA.
BMC Psychiatry. 2022 Jul 20;22(1):486. doi: 10.1186/s12888-022-04110-y.
The COVID-19 pandemic that began in late 2019 is caused by infection with the severe acute respiratory syndrome coronavirus-2. Since that time, many neuropsychiatric sequelae including psychosis, neurocognitive disorders, and mood disorders have been observed. The mechanism underlying these effects are currently unknown, however several mechanisms have been proposed.
A 47-year-old woman with past medical history including hypertension and premenstrual syndrome but no psychiatric history presented to the psychiatric hospital with new onset mania. She had developed symptoms of COVID-19 and was later diagnosed with COVID pneumonia. During quarantine, she reported high levels of stress, grief, and anxiety. Seventeen days into her illness, she developed altered mental status, sleeplessness, elevated mood, talkativeness, and preoccupations. Her spouse was concerned for her safety and contacted emergency medical services who brought her to the psychiatric hospital. She had not slept for five days prior to her arrival and exhibited flight of ideas, talkativeness, and grandiose ideas. She reported a family history of bipolar disorder but no past manic or depressive episodes. She was diagnosed with acute mania and stabilized using antipsychotics, a mood stabilizer, and a short course of a benzodiazepine. Many of her symptoms improved, including her elevated mood, increased activity level, and flight of ideas though she continued to have decreased need for sleep as her benzodiazepine was tapered. She and her partner were agreeable to transitioning to outpatient care after her mood stabilized.
This report emphasizes the link between COVID-19 and neuropsychiatric symptoms. Acute mania has no recognized association with COVID-19, but similar presentations have been reported. The patient's age and time to onset of psychiatric symptoms is consistent with previous reports. Given the growing body of evidence, this association warrants further investigation. Severe acute respiratory syndrome coronavirus-2 causes systemic inflammation and has been shown to be neurotropic. In addition, patients undergoing quarantine experience anxiety related to the disease in addition to social isolation. Psychiatric practitioners should be aware of these effects and advocate for psychiatric evaluation following COVID-19 infection. Understanding the sequelae of infectious disease is crucial for responding to future pandemics.
始于 2019 年末的 COVID-19 大流行是由严重急性呼吸系统综合征冠状病毒-2 感染引起的。自那时以来，已经观察到许多神经精神后遗症，包括精神病、神经认知障碍和情绪障碍。这些影响的机制目前尚不清楚，但已经提出了几种机制。
一位 47 岁的女性，既往有高血压和经前期综合征病史，但无精神病史，因新发躁狂症就诊于精神病院。她出现了 COVID-19 症状，后来被诊断为 COVID 肺炎。在隔离期间，她报告说压力、悲伤和焦虑水平很高。在她生病的第 17 天，她出现了精神状态改变、失眠、情绪升高、多话和注意力不集中。她的配偶担心她的安全，并联系了紧急医疗服务人员，将她带到了精神病院。在她到达之前的五天没有睡觉，表现出思维奔逸、多话和夸大观念。她报告有双相情感障碍家族史，但没有过去的躁狂或抑郁发作。她被诊断为急性躁狂症，并使用抗精神病药、情绪稳定剂和短期苯二氮䓬类药物稳定病情。她的许多症状得到改善，包括情绪升高、活动水平增加和思维奔逸，尽管她在减少苯二氮䓬类药物剂量时仍继续睡眠减少。她和她的伴侣同意在她的情绪稳定后过渡到门诊治疗。
本报告强调了 COVID-19 与神经精神症状之间的联系。急性躁狂症与 COVID-19 没有公认的关联，但类似的表现已有报道。患者的年龄和精神病症状发作时间与之前的报告一致。鉴于越来越多的证据，这种关联值得进一步研究。严重急性呼吸系统综合征冠状病毒-2 引起全身炎症，并已被证明具有神经毒性。此外，接受隔离的患者除了社会隔离外，还会因疾病而感到焦虑。精神科医生应该意识到这些影响，并在 COVID-19 感染后倡导进行精神科评估。了解传染病的后遗症对于应对未来的大流行至关重要。
