Neuropsychiatric Symptomatology of SARS-CoV-2 Infection: What We Have Learned About Clinical Presentation and Persistence of Symptoms

For over a year now, the novel coronavirus has had a sweeping impact on the practice of all specialties of medicine. Knowledge of covid-19 illness has grown remarkably during this time. Yet, much is still unknown about the pathophysiology, onset and persistence of symptoms, and long-term prognosis regarding neuropsychiatric symptomatology. In this symposium, we present a series of cases to demonstrate both the diverse neuropsychiatric presentations that may be seen on C-L services in patients with current or prior SARS-CoV-2 infection and the challenges that arise in treatment. The session will include opportunities for audience participation via Poll Everywhere.

Speaker one will describe a case of mild cognitive impairment with subacute onset of new psychotic and mood symptoms in a SARS-CoV-2-positive patient without prior psychiatric diagnoses. The patient presented with minimal respiratory symptoms and, after a thorough workup, no other causes were identified for their change in behavior and thought process. Despite the initiation of psychotropic medications on the inpatient psychiatric unit, the patient was discharged with a noticeable decline in cognitive function compared to baseline. Little is known about the long-term effects of the virus on cognitive function, though more investigations into ‘long haulers’ are being conducted.

Speaker two will review two cases of patients without prior psychiatric diagnoses who developed catatonia in the setting of recent SARS-CoV-2 infection:
1) An elderly man with a remote history of cerebellar, basal ganglia, and brain stem strokes presented with altered mental status with CSF studies suggesting possible SARS-CoV-2-induced Miller Fischer Syndrome. He became catatonic and did not respond to standard treatment.
2) A middle-aged man presented with mild to moderate respiratory symptoms of pneumonia. He tested positive for SARS-CoV-2 and returned 12 days later with symptoms consistent with catatonia, which responded well to lorazepam.


Speaker three will interview a middle-aged gentleman with no psychiatric history who presented with new-onset grandiose and somatic delusions regarding 5G towers within two weeks of SARS-CoV-2 infection. He has provided informed consent for us to hear his first-hand experience of what it was like to have COVID with new-onset psychosis.


Speaker four will explore the available literature on lingering symptoms of SARS-CoV-2 infection1, and their importance in psychiatric practice. She will discuss the medications used to address neuropsychiatric symptoms of SARS-CoV-2 positive patients and their effectiveness. She will also explore the potentially confounding nature of virus-specific treatments that may themselves induce neuropsychiatric symptoms, thus muddying the waters of diagnostic clarity. We will also discuss hypotheses into why some neuropsychiatric symptoms resolve with these treatments while others seem to persist.

Aucott JN et al.Long-haul COVID: heed the lessons from other infection-triggered illnesses. Lancet. 2021;397(10278):967-968.