1887
Volume 2021, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: A range of neuropsychiatric diagnoses have been reported in association with coronavirus disease 2019 (COVID-19). However, only sporadic cases of mania or hypomania have been reported in patients with COVID-19. This study aimed to report clinical characteristics of 15 consecutive cases of COVID-19-associated mania or hypomania seen in three general hospitals in Qatar in the early months of the pandemic in 2020.

Methods: This study is a retrospective case-note review of 15 cases of COVID-19-associated mania or hypomania (confirmed by polymerase chain reaction test), seen as inpatient consultations out of the first 100 consecutive patients managed by consultation-liaison psychiatric teams in Qatar between 2 March 2020 and 7 July 2020.

Results: The mean age of the 15 patients was 40 years. Twelve patients had mania, and three had hypomania. Regarding the physical severity of COVID-19, 10 patients were asymptomatic, two had upper respiratory tract symptoms alone and three had pneumonia. None of the patients were intubated. Potential risk factors for mania/hypomania included pandemic-related psychosocial stress before admission (n = 9), past history of mania/bipolar disorder (n = 6) or psychosis (n = 2), raised inflammatory markers (n = 7) and steroid use (n = 3). None had a history of recent substance misuse. Other than one patient with advanced cancer, none had comorbidity regarded as likely to have caused mania or hypomania. Three patients had mild white matter ischaemic changes on brain imaging. Standard pharmacological treatment for mania (i.e. antipsychotic medication supplemented by prn benzodiazepines) was effective. Ten patients were discharged home from the COVID-19 facility where they presented, but five required transfer to Qatar's psychiatric hospital for further treatment of mania.

Conclusion: The association of mania or hypomania with COVID-19 may be spurious (e.g. representing an initial presentation of bipolar disorder) or causal. The reported cases illustrate a range of potential aetiological mechanisms by which COVID-19 could cause mania or hypomania. Cohort studies are necessary to determine the incidence, aetiology and prognosis of COVID-19-associated mania/hypomania.

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2021-11-30
2022-11-27
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References

  1. Machhi J, Herskovitz J, Senan AM, et al. (2020). The natural history, pathobiology, and clinical manifestations of SARS-CoV-2 infections. J Neuroimmune Pharmacol, 15:(3), 359–386. doi: 10.1007/s11481-020-09944-5. PMID: 32696264; PMCID: PMC7373339.
    [Google Scholar]
  2. Taquet M, Geddes JR, Husain M, et al. (2021). 6-month neurological and psychiatric outcomes in 236?379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry, S2215-0366:(21)00084-5. doi: 10.1016/S2215-0366(21)00084-5. Epub ahead of print. PMID: 33836148; PMCID: PMC8023694.
    [Google Scholar]
  3. Correa-Palacio AF, Hernandez-Huerta D, Gómez-Arnau J, et al. (2020). Affective psychosis after COVID-19 infection in a previously healthy patient: a case report. Psychiatry Res, 290, 113115. PMID: 32512352; PMCID: PMC7240262.
    [Google Scholar]
  4. Noone R, Cabassa JA, Gardner L,et al. (2020). Letter to the editor: new onset psychosis and mania following COVID-19 infection. J Psychiatr Res, 130:, 177–179. doi: 10.1016/j.jpsychires.2020.07.042. Epub 2020 Aug 8. PMID: 32823051; PMCID: PMC7414775.
    [Google Scholar]
  5. Iqbal Y, Al Abdulla MA, Albrahim S, Latoo J, Kumar R, Haddad PM. (2020). Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team. BJ Psych Open, 6:(5), e109. doi: 10.1192/bjo.2020.85. PMID: 32907692; PMCID: PMC7484218.
    [Google Scholar]
  6. Mawhinney JA, Wilcock C, Haboubi H, Roshanzamir S. (2020). Neurotropism of SARS-CoV-2: COVID-19 presenting with an acute manic episode. BMJ Case Rep, 13:(6), e236123. doi: 10.1136/bcr-2020-236123. PMID: 32540882; PMCID: PMC7298665.
    [Google Scholar]
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition (DSM-5). Arlington, VA.
    [Google Scholar]
  8. World Health Organisation. (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.
    [Google Scholar]
  9. Khan S, Haddad P, Montague L, Summerton C. (2020). Systemic lupus erythematosus presenting as mania. Acta Psychiatr Scand, 101:(5), 406–408. doi: 10.1034/j.1600-0447.2000.101005406.x. PMID: 10823302.
    [Google Scholar]
  10. Larson EW, Richelson E. (1998). Organic causes of mania. Mayo Clin Proc, 63:(9), 906–912. doi: 10.1016/s0025-6196(12)62694-9 . PMID: 3137394.
    [Google Scholar]
  11. Krauthammer C, Klerman GL. (1978). Secondary mania: manic syndromes associated with antecedent physical illness or drugs. Arch Gen Psychiatry, 35:(11), 1333–1339. doi: 10.1001/archpsyc.1978.01770350059005 . PMID: 757997.
    [Google Scholar]
  12. World Population Review. https://worldpopulationreview.com/countries/qatar-population Accessed: 22/07/2021.
  13. The World Bank. Available from: https://data.worldbank.org/indicator/SP.POP.TOTL?locations = QA (Accessed 22.07.21).
  14. Koenders MA, Giltay EJ, Spijker AT, Hoencamp E, Spinhoven P, Elzinga BM. (2014). Stressful life events in bipolar I and II disorder: cause or consequence of mood symptoms? J Affect Disord, 161:, 55–64. doi: 10.1016/j.jad.2014.02.036 . Epub 2014 Mar 18. PMID: 24751308.
    [Google Scholar]
  15. Sayana P, Colpo GD, Simões LR, et al. (2017). A systematic review of evidence for the role of inflammatory biomarkers in bipolar patients. J Psychiatr Res, 92:, 160–182. doi: 10.1016/j.jpsychires.2017.03.018 . Epub 2017 Mar 29. PMID: 28458141.
    [Google Scholar]
  16. Rodríguez Y, Novelli L, Rojas M, et al. (2020). Autoinflammatory and autoimmune conditions at the crossroad of COVID-19. J Autoimmun, 114:, 102506. doi: 10.1016/j.jaut.2020.102506 . PMID: 32563547; PMCID: PMC7296326.
    [Google Scholar]
  17. Muneer A. (2016). Bipolar disorder: role of inflammation and the development of disease biomarkers. Psychiatry investigation, 13:(1), 18–33. doi: 10.4306/pi.2016.13.1.18 . PMID: 26766943; PMCID: PMC4701682.
    [Google Scholar]
  18. Rogers JP, Chesney E, Oliver D, Pollak TA, et al. (2020). Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry, 7:(7), 611–627. doi: 10.1016/S2215-0366(20)30203-0. Epub 2020 May 18. PMID: 32437679; PMCID: PMC7234781.
    [Google Scholar]
  19. Sharma R, Sekhon S, Cascella M. (2021). White matter lesions. [Updated 2021 Feb 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562167/ .
    [Google Scholar]
  20. Pan S, Chen WC, Baal JD, Sugrue LP. (2020). Neuroradiological features of mild and severe SARS-CoV-2 infection. Acad Radiol, 27:(11), 1507–1514. doi: 10.1016/j.acra.2020.08.026. Epub 2020 Aug 29. PMID: 32912668; PMCID: PMC7456302.
    [Google Scholar]
  21. Moriguchi T, Harii N, Goto J, et al. (2020). A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis, 94:, 55–58. DOI: 10.1016/j.ijid.2020.03.062 . PMID: 32251791; PMCID: PMC7195378.
    [Google Scholar]
  22. Lewis KS, Gordon-Smith K, Forty L, Di Florio A, Craddock N, Jones L, et al. (2017). Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender. Br J Psychiatry, 211:(3), 169–174. doi: 10.1192/bjp.bp.117.202259 . PMID: 28684405; PMCID: PMC5579327.
    [Google Scholar]
  23. Bipeta R, Khan MA. (2012). Delirious mania: can we get away with this concept? A case report and review of the literature. Case Rep Psychiatry, 2012:, 720354. doi: 10.1155/2012/720354. Epub 2012 Nov 12. PMID: 23198239; PMCID: PMC3502817.
    [Google Scholar]
  24. Goodwin GM, Haddad PM, Ferrier IN, et al. (2016). Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol, 30:(6), 495–553. doi: 10.1177/0269881116636545. Epub 2016 Mar 15. PMID: 26979387; PMCID: PMC4922419.
    [Google Scholar]
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