COVID-ASSOCIATED PSYCHOTIC DISORDERS WITH COGNITIVE IMPAIRMENT: A CASE SERIES

Yuryeva L.M., Shornikov A.V., Kokashynskyi V.O., Brydun O.Y., Rachynska T.V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The COVID-19 pandemic has significantly changed the health care system in the world, and also leads to a significant number of COVID‑associated mental disorders. Usually psychiatrists diagnose non-psychotic (neurotic) mental disorders associated with SARS-CoV-2 virus, including asthenic, anxiety, and depressive disorders, but COVID-19- associated psychotic disorders are considered to a much lesser extent. The main mechanisms of the covid-associated mental disorders are psychological influences (including social isolation, unemployment, relationship breakdown, domestic violence), «cytokine storm» (CNS damage due to exposure to ACE-2 receptors), medication (especially glucocorticoids), being on artificial lung ventilation. The aim of our work was to review of a series of four cases of COVID-associated psychotic disorders among men over the age of 50 without previous mental and drug addiction disorders and with anosmia in the clinical picture. All our patients during the psychosis showed mild/moderate cognitive impairment, that is not a common and frequent syndrome during COVID-19. Except this no one of our patients has severe asthenia, anxiety or depression. Thus, the appearance of psychotic disorders with additional cognitive impairment in patients after COVID-19 with a history of anosmia forms a new problem in the diagnostic process and treatment of patients with COVID-associated mental disorders. The considered series of cases testifies the need for an integrated approach to the management of patients with COVID-19 and the need for close cooperation with the psychiatric service during counseling, observation and management of this group of patients. In addition, patients with psychotic disorders have a high suicidal risk, which indicates the need for thorough care in the acute phase of the disease and follow-up.

psychosis, psychotic disorders, cognitive impairment, anxiety, depression, anosmia, COVID-19

1. Ferrando SJ, Klepacz L, Lynch S, Tavakkoli M, Dornbush R, Baharani R, et al. COVID‑19 Psychosis: A Potential New Neuropsychiatric Condition Triggered by Novel Coronavirus Infection and the Inflammatory Response? Psychosomatics. 2020 Oct;61(5):551–5. DOI: https://doi.org/10.1016/j.psym. 2020.05.012.
2. Brown E, Gray R, Lo Monaco S, O’Donoghue B, Nelson B, Thompson A, et al. The potential impact of COVID‑19 on psychosis: A rapid review of contemporary epidemic and pandemic research. Schizophr Res. 2020 Aug;222:79–87. DOI: https://doi. org/10.1016/j.schres.2020.05.005.
3. Yuryeva LM, Shornikov AV. Psykhotychni rozlady pry COVID‑19: mekhanizmy rozvytku, osoblyvosti kliniky ta terapiyi. Ukrains’kyi Visnyk Psykhonevrolohii. 2020 Jan 29;28(4):13–7. DOI: https://doi.org/10.36927/ 2079–0325-V28-is4–2020–2. [in Ukrainian].
4. Pape K, Tamouza R, Leboyer M, Zipp F. Immunoneuropsychiatry – novel perspectives on brain disorders. Nat Rev Neurol. 2019 Jun;15(6):317–28. DOI: https://doi.org/10.1038/s41582–019–0174–4.
5. Baig AM, 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 Apr 1;11(7):995–8. DOI: https://doi.org/10.1021/ acschemneuro.0c00122.
6. Wohleb ES, McKim DB, Sheridan JF, Godbout JP. Monocyte trafficking to the brain with stress and inflammation: a novel axis of immune-to-brain communication that influences mood and behavior. Frontiers in Neuroscience. 2015;8:447. DOI: https://doi. org/10.3389/fnins.2014.00447.
7. Cleret de Langavant L, Petit A, Nguyen QTR, Gendre T, Abdelhedi J, Djellaoui A, et al. Clinical description of the broad range of neurological presentations of COVID‑19: A retrospective case series. Revue Neurologique. 2021 Mar;177(3):275–82. DOI: https://doi.org/10.1016/j.neurol.2021.01.004.
8. Del Brutto OH, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: A longitudinal prospective study nested to a population cohort. Eur J Neurol. 2021;28:3245–3253. DOI: https://doi.org/10.1111/ene.14775.
9. Alemanno F, Houdayer E, Parma A, Spina A, Del Forno A, Scatolini A, et al. COVID‑19 cognitive deficits after respiratory assistance in the subacute phase: A COVID‑rehabilitation unit experience. Di Gennaro F, editor. PLoS ONE. 2021 Feb 8;16(2): e0246590. DOI: https://doi.org/10.1371/journal. pone.0246590.
10. Sasannejad C, Ely EW, Lahiri S. Long-term cognitive impairment after acute respiratory distress syndrome: a review of clinical impact and pathophysiological mechanisms. Crit Care. 2019 Dec;23(1):352. DOI: https://doi.org/10.1186/s13054–019–2626-z.
11. Lu S, Wei N, Jiang J, Wu L, Sheng J, Zhou J, et al. First report of manic-like symptoms in a COVID‑19 patient with no previous history of a psychiatric disorder. Journal of Affective Disorders. 2020 Dec;277:337–40. DOI: https://doi.org/10.1016/j.jad.2020.08.031.
12. Kamal YM, Abdelmajid Y, Al Madani AAR. Cerebrospinal fluid confirmed COVID‑19-associated encephalitis treated successfully. BMJ Case Rep. 2020 Sep;13(9): e237378. DOI: https://doi.org/10.1136/bcr‑2020–237378.
13. Joseph AB, O’Leary DH. Brain atrophy and interhemispheric fissure enlargement in Cotard’s syndrome. J Clin Psychiatry. 1986 Oct;47(10):518–20.
14. Zakharov VV. Neyropsikhologicheskiye testy. Neobkhodimost’ i vozmozhnosti primeneniya. Consilium Medicum. 2011;13(2):82–90. [in Russian].

«Bulletin of problems biology and medicine» Issue 2 Part 1 (164), 2022 year, 288-292 pages, index UDK 616.98:578.834COVID-19–06:616.89–008.45/.48–07–08

10.29254/2077-4214-2022-2-1-164-288-292