2019年底开始的COVID-19大流行是由严重急性呼吸道综合症冠状病毒-2感染引起的。从那时起,许多神经精神后遗症,包括精神病,神经认知障碍,并观察到情绪障碍。这些影响的潜在机制目前尚不清楚,然而,已经提出了几种机制。
一名47岁女性,既往病史包括高血压和经前综合征,但无精神病史,因新发躁狂症到精神病医院就诊。她出现了COVID-19的症状,后来被诊断出患有COVID肺炎。在隔离期间,她报告说压力很大,悲伤,和焦虑。在她生病的十七天里,她的精神状态改变了,失眠,情绪升高,健谈,和关注。她的配偶担心她的安全,并联系了将她带到精神病医院的紧急医疗服务。在她到达之前,她已经五天没有睡觉了,并表现出了很多想法,健谈,和宏伟的想法。她报告有双相情感障碍的家族史,但没有过去的躁狂或抑郁发作。她被诊断出患有急性躁狂症,并使用抗精神病药物稳定下来,一种情绪稳定剂,和一个短期的苯二氮卓类药物。她的许多症状都有所改善,包括她情绪高涨,活动水平提高,尽管她的苯二氮卓类药物逐渐减少,但她的睡眠需求继续减少。她和她的伴侣在情绪稳定后同意过渡到门诊护理。
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没有公认的联系,但也有类似的报道。患者的年龄和出现精神症状的时间与以前的报告一致。鉴于越来越多的证据,该协会值得进一步调查。严重急性呼吸综合征冠状病毒-2引起全身性炎症,并已被证明是嗜神经的。此外,接受隔离的患者除了社会隔离外,还会经历与疾病有关的焦虑。精神科医生应该意识到这些影响,并倡导在COVID-19感染后进行精神病学评估。了解传染病的后遗症对于应对未来的大流行至关重要。
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.