First manic episode following COVID-19 infection

A 56-year-old Caucasian male with no past psychiatric history presented to the Emergency Department (ED) for evaluation of new onset (24 hours) odd and erratic behavior preceded by a 4-week period of decreased need for sleep, averaging two hours per night. The sleep pattern change began within one week of an untreated symptomatic upper respiratory infection suspected to be due to COVID-19. On presentation to the ED, he endorsed fluctuating mood, increased energy, distractibility, and overvalued religious ideation that he was a prophet, although this was not a fixed belief. He was conceptually disorganized, responded to religiously themed command auditory hallucinations, but demonstrated fair insight into his unusual behavior. Family and personal past psychiatric history both were unremarkable. Medical workup in the ED included head computerized tomography (CT), general laboratory studies, and SARS-Coronavirus-2 RNS testing; other than mild neutrophilia and thrombocytosis, all studies were negative. He was admitted to the medical service for further evaluation. Risperidone 1 mg daily for psychotic symptoms and lorazepam 1 mg at bedtime for sleep were initiated.