New-onset psychosis due to COVID-19

New-onset psychosis due to COVID-19 | BMJ Case Reports

Article New-onset psychosis due to COVID-19

The psychoses that appear due to Covid-19 - which are not "Dementias" - are fortunately rare and of the "toxic" type (Psychosis of toxic and / or infectious etiology) and, therefore, their treatment is the same as in the rest: Combat and eradicate the somatic cause that originated them and, if necessary, the use of neuroleptics, controlling the possible extrapyramidal effects, and "ad hoc" psychotherapy.

COVID-19 may cause psychosis, at least in theory, through one or more of these mechanisms:

- COVID deliria- which can be either a garden variety delirium in a setting of systematic infection (cytokine storm) or neurocovid (related to viral neurotropism). Low potency antipsychotics are preferred (e.g. chlorpromazine) since catatenoid features are commonplace and these patients are commonly dehydrated where use of high potency APs (e.g. haloperidol) could prove problematic. Melatonin, dexmeditomidine, amantadine, valproate, and vit C/D can help with these deliria.

- A relapse in a known psychotic patient due to overwhelming stress (restrictions imposed, infodemics, ...) would be treated as usual by adjusting current dose of APs.

- de novo psychosis (affective/schizophreniform) as stress/diathesis in vulnerable population (genetically predisposed) or viral infection could be otherwise causative (as viral flu related to schizophrenia) and again APs, atypical, would be deployed as usual (besides other psychotropic agents depending on primary diagnosis eg psychotic depression would mandate an antidepressant+ an antipsychotic)

Two important clinical considerations here would be closely monitoring QTc, and possible DDIs with COVID protocols.

Trust this might help.

well done

Interesting question