Sugawara Tomoko, Ichiki Rie
Department of Psychiatry Komagino Hospital Hachioji Tokyo Japan.
PCN Rep. 2025 Jul 11;4(3):e70148. doi: 10.1002/pcn5.70148. eCollection 2025 Sep.
The coronavirus disease 2019 (SARS-COV-2) pandemic has been associated with an increased risk of developing or exacerbating obsessive-compulsive disorder (OCD). This report presents a case of OCD onset in a 50-year-old male following recovery from acute SARS-COV-2 infection, highlighting the potential neuroinflammatory and neuroimmune mechanisms involved.
Mr. A, a 50-year-old cook with no prior psychiatric history, developed a loss of smell and taste by SARS-COV-2. This sensory impairment triggered severe anxiety, leading to compulsive checking behaviors and reassurance-seeking after recovering from SARS-COV-2. Initial treatment with fluvoxamine at 50 mg/day was insufficient, and his symptoms necessitated inpatient care. His compulsive behaviors continued during hospitalization, and escalation of fluvoxamine to 150 mg/day, alongside adjunctive risperidone at 3 mg/day was needed. Along with cognitive-behavioral therapy (CBT) advises, this resulted in symptom stabilization and eventual discharge. Postdischarge, Mr. A's OCD symptoms remained stable with ongoing medication, despite continued sensory disturbances.
This case illustrates the atypical onset of OCD in an older adult following SARS-COV-2 infection, potentially driven by neuroinflammation and altered neural pathways. The partial response to fluvoxamine and the need for risperidone suggest that SARS-COV-2-related OCD may involve complex neuroimmune changes beyond serotonin dysregulation. This case emphasizes the importance of recognizing neuropsychiatric complications in SARS-COV-2 survivors and underscores the need for further research into the mechanisms and management of SARS-COV-2-related neuropsychiatric symptoms, including OCD.
2019年冠状病毒病（SARS-CoV-2）大流行与患强迫症（OCD）或使强迫症加重的风险增加有关。本报告介绍了一名50岁男性在急性SARS-CoV-2感染康复后出现强迫症的病例，突出了其中潜在的神经炎症和神经免疫机制。
A先生是一名50岁的厨师，既往无精神病史，感染SARS-CoV-2后出现嗅觉和味觉丧失。这种感觉障碍引发了严重焦虑，导致在从SARS-CoV-2康复后出现强迫检查行为和寻求安慰行为。最初每天服用50毫克氟伏沙明治疗效果不佳，其症状需要住院治疗。住院期间他的强迫行为持续存在，需要将氟伏沙明剂量增至每天150毫克，并加用每天3毫克的利培酮。结合认知行为疗法（CBT）建议，这使症状得到稳定并最终出院。出院后，尽管感觉障碍仍持续存在，但A先生在持续用药情况下强迫症症状保持稳定。
本病例说明了SARS-CoV-2感染后一名老年人出现非典型强迫症发作，可能由神经炎症和神经通路改变所致。对氟伏沙明的部分反应以及对利培酮的需求表明，与SARS-CoV-2相关的强迫症可能涉及除血清素失调之外的复杂神经免疫变化。本病例强调了认识SARS-CoV-2幸存者神经精神并发症的重要性，并强调需要进一步研究与SARS-CoV-2相关的神经精神症状（包括强迫症）的机制和管理。
