Psychosis And Coma In Covid-19: A Case Report

Abstract Objective The objective of this case is to spotlight the potential neurological andneuropsychiatric symptoms associated with COVID-19. Method A 55-year-old African American male with a history of schizophrenia, bipolar disorder, obesity, tobacco use, and hypertension voluntarily presented to the local hospital with auditoryhallucinations and delusions. During an inpatient stay, the patient developed symptomsconsistent with COVID-19 and subsequently tested positive for the virus. Thirty-nine days after the initial positive COVID-19 test result, he remained in a coma with retained brainstem responses. An EEG demonstrated encephalopathy and MRI showed multiple, well-circumscribed white matter lesions consistent with acute demyelination (Figure 1). After three days of high-dose steroids and over a month in a coma, the patient began following simple commands. Unfortunately, on hospital day 66, the patient developed sudden hypotension and worsening respiratory status. Results While psychotic episodes in relation to COVID-19 are not widely reported, psychotic episodes are shown in three COVID-19 cases. Other reports have found significant changes in consciousness in COVID-19 patients with delayed awakening from a comatose state. Pre-existing inflammatory responses in those with psychiatric disease may be accelerated by the immune response due to COVID-19. Conclusion Mental status changes in those with psychiatric illness who have COVID-19 are worth exploring. It is unclear whether a history of COVID-19 may accelerate a neuropsychiatric process or other central nervous system diseases. Future research may want to examine the possible interrelationship between pre-existing neurological vulnerabilities and COVID-19. The possibility of high-dose steroid treatment for COVID-19 neuroinflammatory complications should be considered.