Meeting Poster Explores New Onset Psychosis in COVID-19

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CONFERENCE REPORTER

Increasingly, research has found a link between COVID-19 infection and neuropsychiatric abnormalities, including psychosis. With that in mind, a poster presented at the 2023 American Psychiatric Association Annual Meeting examined the differences between new onset psychosis following COVID-19 infection as compared with patients without concurrent infection.¹

The study included a systemic review of 57 case reports of new-onset psychosis in patients with COVID-19 infection; a first-episode psychosis study with 462 patients was used as comparison. The investigator also leveraged a study of 104 participants to ascertain effects of age of onset, and 8 unique case reports were examined for potential conclusions. All studies were identified as a result of searches via PubMed, British Journal of Psychiatry, BMJ Case Reports, Journal of the American Medical Association, and Psychiatric Times.

The investigation found symptoms differed between the groups, with paranoia, acute mania, and auditory hallucinations more common among the patients with infection. For those without COVID-19 infection, the symptoms trended differently between early- versus late-onset psychosis. Patients without infection and with early-onset psychosis displayed both positive and negative symptoms and greater levels of cognitive impairment. Meanwhile, less severe negative symptoms and less severe deficits in learning were found among the non-COVID infected individuals who had late-onset psychosis.

Antipsychotics were employed to manage acute symptoms across the patient populations. On the whole, treatment was required in the non-infected participants after stabilization, as symptoms tended to persist. In those with infection, long-term managed was determined based on need.

Importantly, the investigation found that psychosis did not necessarily resolve after recovery from COVID-19. “The psychotic symptoms tend to persist post-COVID–19 infection, highlighting the need for long-term psychiatric follow-up in these patients,” the poster concluded.

The interplay between infectious disease and psychosis is not new, with links found in patients with influenza, H1N1, and other coronaviruses like SARS and MERS.² Yet, researchers have noted that associations are not causality.³ Nevertheless, this poster further emphasizes the need for vigilance in detecting psychosis in patients with COVID-19 infection as well as continued research in this area.

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References

1. Anthony J. Investigation into differences of clinical presentation of new onset psychotic symptoms in patients infected With COVID-19. Presented at the 2023 American Psychiatric Association Annual Meeting. San Francisco, California. May 20, 2022.

2. St. Victor G, Azubuogu C, Liss MM, Manickam S, Thakurathi N. Psychosis in the patient with COVID-19: an emerging psychopathology? Psychiatric Times. 2022;39(6).

3. Moccia L, Kotzalidis GD, Bartolucci G, et al. COVID-19 and new-onset psychosis: a comprehensive review. J Pers Med. 2023;13(1):104.