Neuropsychiatric Presentation of COVID-19: A Case Report of Disinhibition in an Acute SARS-CoV-2 Infection

Overview

Journal HCA Healthc J Med

Specialty Health Services

Date 2023 Jul 10

PMID 37426858

Authors

I Jack Abramson

Kristy A Fisher

Clara V Alvarez

Jaqueline Horan Fisher

Affiliations

Soon will be listed here.

Abstract

Description Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral infection is notable for a high degree of symptom diversity. Emerging evidence suggests viral invasion of the central nervous system. Therefore, serious neurological and psychiatric manifestations are anticipated. We present the case of a 67-year-old male physician who has a history of stable bipolar disorder for decades and was recently hospitalized for persistent COVID-19 symptoms with documented positive serology. He presented with new and acute onset neuropsychiatric symptoms of disinhibition proximate to the viral infection. We postulate neuroinvasion as the putative origin of the patient's psychiatric instability. Furthermore, an investigation is needed to expand upon our understanding of the potential for neuropsychiatric morbidity related to SARS-CoV-2 for prompt diagnosis and appropriate management. There are also no current studies addressing the risks for neurological and psychiatric symptomatology in SARS-CoV-2 infected patients with persistent chronic mental illness.

References

Li Y, Bai W, Hashikawa T . The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020; 92(6):552-555. PMC: 7228394. DOI: 10.1002/jmv.25728. View

Netland J, Meyerholz D, Moore S, Cassell M, Perlman S . Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol. 2008; 82(15):7264-75. PMC: 2493326. DOI: 10.1128/JVI.00737-08. View

Baig A, Khaleeq A, Ali U, Syeda H . Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem Neurosci. 2020; 11(7):995-998. DOI: 10.1021/acschemneuro.0c00122. View

Li Y, Bai W, Hirano N, Hayashida T, Hashikawa T . Coronavirus infection of rat dorsal root ganglia: ultrastructural characterization of viral replication, transfer, and the early response of satellite cells. Virus Res. 2012; 163(2):628-35. PMC: 7114492. DOI: 10.1016/j.virusres.2011.12.021. View

Hamming I, Timens W, Bulthuis M, Lely A, Navis G, van Goor H . Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004; 203(2):631-7. PMC: 7167720. DOI: 10.1002/path.1570. View

Severance E, Dickerson F, Viscidi R, Bossis I, Stallings C, Origoni A . Coronavirus immunoreactivity in individuals with a recent onset of psychotic symptoms. Schizophr Bull. 2009; 37(1):101-7. PMC: 3004184. DOI: 10.1093/schbul/sbp052. View

Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L . Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020; 87:18-22. PMC: 7146689. DOI: 10.1016/j.bbi.2020.03.031. View

Ignatovich I, Hobbs J . Human parvovirus B19 infection leads to downregulation of thyroid, estrogen, and retinoid hormone receptor expression. Virology. 2013; 446(1-2):173-9. DOI: 10.1016/j.virol.2013.06.022. View

Yi Y, Lagniton P, Ye S, Li E, Xu R . COVID-19: what has been learned and to be learned about the novel coronavirus disease. Int J Biol Sci. 2020; 16(10):1753-1766. PMC: 7098028. DOI: 10.7150/ijbs.45134. View

10.

Carod-Artal F . Neurological complications of coronavirus and COVID-19. Rev Neurol. 2020; 70(9):311-322. DOI: 10.33588/rn.7009.2020179. View

11.

Kepinska A, Iyegbe C, Vernon A, Yolken R, Murray R, Pollak T . Schizophrenia and Influenza at the Centenary of the 1918-1919 Spanish Influenza Pandemic: Mechanisms of Psychosis Risk. Front Psychiatry. 2020; 11:72. PMC: 7054463. DOI: 10.3389/fpsyt.2020.00072. View

12.

Mortensen P, Pedersen C, Westergaard T, Wohlfahrt J, Ewald H, Mors O . Effects of family history and place and season of birth on the risk of schizophrenia. N Engl J Med. 1999; 340(8):603-8. DOI: 10.1056/NEJM199902253400803. View

13.

Ge H, Wang X, Yuan X, Xiao G, Wang C, Deng T . The epidemiology and clinical information about COVID-19. Eur J Clin Microbiol Infect Dis. 2020; 39(6):1011-1019. PMC: 7154215. DOI: 10.1007/s10096-020-03874-z. View

14.

Yolken R, Torrey E . Viruses, schizophrenia, and bipolar disorder. Clin Microbiol Rev. 1995; 8(1):131-45. PMC: 172852. DOI: 10.1128/CMR.8.1.131. View

15.

Kim J, Heo J, Kim H, Song S, Park S, Park T . Neurological Complications during Treatment of Middle East Respiratory Syndrome. J Clin Neurol. 2017; 13(3):227-233. PMC: 5532318. DOI: 10.3988/jcn.2017.13.3.227. View

16.

Mizuguchi M . Influenza encephalopathy and related neuropsychiatric syndromes. Influenza Other Respir Viruses. 2013; 7 Suppl 3:67-71. PMC: 6492655. DOI: 10.1111/irv.12177. View