Postinfectious COVID-19 Catatonia: A Report of Two Cases

Neuropsychiatric symptoms are a common complication of COVID-19, with symptoms documented both during acute COVID-19 infection (parainfectious) and persisting or developing after the resolution of respiratory symptoms (postinfectious). Patients have presented with a variety of symptoms such as anosmia, thrombotic events, seizures, cognitive and attention deficits, new-onset anxiety, depression, psychosis, and rarely catatonia. Etiology appears to be related to disruption of regular neurotransmission and hypoxic injury secondary to systemic inflammation and cytokine storm. Although rare, catatonia and each of its subtypes have now been reported as complications of COVID-19 and therefore should be considered known to occur in both the parainfectious and postinfectious states. Diagnosis of catatonia in the context of COVID-19 should be considered when work-up for more common medical causes of encephalopathy are negative, there is no identifiable psychiatric etiology for catatonia, and there is a positive response to benzodiazepines.

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Surveillance study of acute neurological manifestations among 439 Egyptian patients with COVID-19 in Assiut and Aswan university hospitals

10.1101/2020.10.28.20221879 ◽

2020 ◽

Author(s):

Eman M Khedr ◽

Noha Abo-Elfetoh ◽

Enas Daef ◽

Hebatallah M. Hassan ◽

Mariam T Amin ◽

...

Keyword(s):

Neurological Disease ◽

Respiratory Symptoms ◽

Neuropsychiatric Symptoms ◽

Laboratory Data ◽

Neurological Complications ◽

Neurological Manifestations ◽

Common Complication ◽

University Hospitals ◽

Egyptian Patients ◽

The University

AbstractBackgroundCOVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study we estimate the frequency of such complications among hospital in-patients with COVID-19 in Assiut and Aswan University Hospitals.Material and MethodsWe screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory data, CT/MRI of chest and brain, and neurophysiology were performed for each patient if indicated.Results439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these 117 had acute neurological disease; the remainder had non-specific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke; the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of RR-MS (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31); the others had GBS (4), peripheral neuropathy (3), myasthenia gravis (2), or myositis (2). Fever, respiratory symptoms and headache, were the most common general symptoms. Hypertensions, Diabetes Mellitus, ischemic heart disease were the most common comorbidities in patients with CNS affection.ConclusionIn COVID⍰19, both the CNS and PNS are affected. Stroke was the most common complication for CNS and anosmia and/or ageusia were common for PNS diseases. However there were 6 cases encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG and 2 cases of myositis.

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Preeclampsia Part 2: fisiopatologia e trattamento

Giornale di Clinica Nefrologica e Dialisi ◽

10.33393/gcnd.2019.521 ◽

2019 ◽

Vol 31 (2) ◽

pp. 79-88

Author(s):

Stefano Michelassi

Keyword(s):

High Risk ◽

Endothelial Dysfunction ◽

Preterm Delivery ◽

Systemic Inflammation ◽

Systemic Disease ◽

Clinical Manifestations ◽

Morbidity And Mortality ◽

Curative Treatment ◽

Maternal Risks ◽

New Onset

Preeclampsia is a pregnancy-specific disorder usually defined as new-onset hypertension and proteinuria after the 20th week of gestation. Preeclampsia is a systemic disease with multiorgan involvement, and it is associated with a high risk of maternal and fetal morbidity and mortality. To date its pathogenesis is not completely understood, but placental hypoxia or hypoxia/reoxigenation may be the basic condition leading to systemic inflammation and endothelial dysfunction that induce all the clinical manifestations of the disorder. Delivery is the only curative treatment. Indeed, for the management of preeclampsia one needs to consider both the maternal risks due to continued pregnancy and the fetal risks associated with induced preterm delivery.

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Persistence of neuropsychiatric symptoms associated with SARS-CoV-2 positivity among a cohort of children and adolescents

10.1101/2021.09.28.21264259 ◽

2021 ◽

Author(s):

Victor M Castro ◽

Faith M Gunning ◽

Roy H Perlis

Keyword(s):

New England ◽

Children And Adolescents ◽

Language Processing ◽

Neuropsychiatric Symptoms ◽

Private Insurance ◽

Neuropsychiatric Symptom ◽

Older Children ◽

Primary Analysis ◽

Icd 10 ◽

New Onset

Background: Post-acute sequelae of COVID-19 are common among adults. The prevalence of such syndromes among community samples of children and adolescents remains less well characterized. Method: We identified all individuals age 5-18 across 2 New England health systems who had a positive SARS-CoV-2 PCR test between 3/12/2020 and 4/18/2021 and at least 90 days of follow-up visits documented in electronic health records. We identified neuropsychiatric symptoms in intervals prior to, and following, this testing using a previously-derived set of ICD-10 codes and natural language processing terms. Primary analysis examined sociodemographic features associated with presence of at least one incident (i.e., new-onset) neuropsychiatric symptom between 90 and 150 days after an initial positive test for COVID-19. Results: Among 5058 children (50% female, 2.9% Asian, 6.3% Black, and 63% White; 30% Hispanic; mean age was 12.4 (IQR 8.9-15.6), 366 (7.2%) exhibited at least one new-onset neuropsychiatric symptom between 90 and 150 days following initial SARS-CoV-2 test positivity. The most common incident symptoms at 90-150 days were headache (2.4%), mood and anxiety symptoms (2.4%), cognitive symptoms (2.3%), and fatigue (1.1%). In regression models, older children, girls, those with Hispanic ethnicity, those with public versus private insurance, and those with greater overall burden of medical comorbidity were more likely to exhibit subsequent symptoms. Conclusion: The prevalence of neuropsychiatric symptoms between 3- and 5- months following SARS-CoV-2 test positivity is similar to that observed in the period prior to infection. Prospective controlled studies will be needed to further refine these estimates.

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Anxiety and depression in patients with obstructive ventilation disorders: the respect study. Part 2

Russian Family Doctor ◽

10.17816/rfd2017415-20 ◽

2017 ◽

Vol 21 (4) ◽

pp. 15-20

Author(s):

Elena A Andreeva ◽

Marina A Pokhaznikova ◽

Irina E Moiseeva ◽

Olga Yu Kuznetsova ◽

Jean-Marie Degryse

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Heart Failure ◽

Chronic Heart Failure ◽

Respiratory Symptoms ◽

Airflow Limitation ◽

Anxiety And Depression ◽

Diagnostic Study ◽

Somatic Diseases ◽

Anxiety Depression

The article presents an analysis of the risk factors for anxiety and depression in people with airflow limitation based on the results of the second (diagnostic) phase of the RESPECT (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology). The data indicates that participants with airflow limitation that had been revealed during the epidemiological study and with borderline or abnormal anxiety and/or depression showed in diagnostic study persistent airflow limitation (FEV1/FVC = 66.48 ± 10.22, p < 0.05) and more perceived respiratory symptoms (CAT = 11.1 ± 10.01, mMRC = 1.68 ± 1.02, p < 0.001) compared to those without mental disorders. Also, they tended to have concomitant cardiovascular diseases (coronary heart disease, chronic heart failure, p < 0.001) and diabetes mellitus (p < 0.01) more frequently. Although chronic heart failure is the most prominent risk factor for anxiety/depression, it becomes non-significant when corrected for other somatic diseases and respiratory symptoms.

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1239 Mind Blown: Exploding Head Syndrome as a Side Effect of Marijuana

SLEEP ◽

10.1093/sleep/zsaa056.1233 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A472-A473

Author(s):

Christopher Missak ◽

Jenie George ◽

Indira Gurubhagavatula

Keyword(s):

Case Reports ◽

Neuropsychiatric Symptoms ◽

Epileptiform Activity ◽

Temporal Correlation ◽

Marijuana Use ◽

The United States ◽

Apnea Hypopnea Index ◽

Previously Treated ◽

Work Up ◽

Smoking Marijuana

Abstract Introduction Marijuana use is increasing the United States and has been associated with increased sensory perception, euphoria, and altered cognition. Exploding head syndrome is a parasomnia characterized by loud explosion-like noises occurring prior to or during sleep. This the first report to link marijuana use with the occurrence of EHS. Report of Case A 45-year-old man with depression, anxiety and multisubstance abuse reported two years of neuropsychiatric symptoms including: “fireworks going off in my brain,” visual hallucinations, and sudden arousals characterized by panic and vertigo. He reported bouts of occupational stress and severe anxiety previously treated with clonazepam for six months, but discontinued it due to poor clinical response. Normal findings were reported on a previous work-up including: MRI, EEG, and head CT Scan. During his visit, he reported that he had been smoking marijuana three times a day for 24 years. One month prior to his visit he discontinued marijuana, stopped clonazepam, and started using mirtazapine with improvement in all aforementioned symptoms. During the same month, he relapsed and smoked marijuana once with a sudden return of all previously described symptoms on the night following its use. These symptoms then resolved and did not recur again until 9 months later, after another episode of weekend marijuana use. An in-lab polysomnogram revealed an apnea-hypopnea index 2.2 per hour, increased alpha intrusion throughout the study, and no epileptiform activity. No parasomnias were observed during rapid-eye-movement (REM) or non-REM sleep. Conclusion The etiology of EHS remains elusive. A review of the research has proposed five major theories and case reports suggest a complex etiology. Given the temporal correlation with marijuana use and symptom resolution with its cessation, we presume that EHS resulted from a complex interplay between neurons susceptible to cannabinoids and their derivatives.

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Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Presenting as Recurrent and Migrating Focal Cortical Encephalitis

Child Neurology Open ◽

10.1177/2329048x20966172 ◽

2020 ◽

Vol 7 ◽

pp. 2329048X2096617

Author(s):

Xinran Maria Xiang ◽

Rachel Evans ◽

Jesus Lovera ◽

Rashmi Rao

Keyword(s):

Brain Mri ◽

Occipital Cortex ◽

Myelin Oligodendrocyte Glycoprotein ◽

New Right ◽

High Dose ◽

Antibody Testing ◽

Leptomeningeal Enhancement ◽

The Right ◽

Work Up ◽

New Onset

Although pediatric myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease is increasingly well-recognized, its full clinical spectrum is still being defined. Cortical encephalitis is emerging as a distinct clinico-radiologic syndrome of adult MOG antibody-associated disease. We describe a 12-year-old girl who presented with new onset seizures and left-sided hemiparesis. Brain MRI showed edema of the right temporal-parietal-occipital cortex with associated focal leptomeningeal enhancement. Patient received high-dose corticosteroids and 21 days of acyclovir despite negative infectious work-up due to the focal nature of encephalitis. Patient remained seizure-free for 20 months before presenting with new right hemiclonic seizures with right-sided hemiparesis and edema of the left temporal-parietal cortex with associated leptomeningeal enhancement. Patient’s MOG antibody titer was 1:40. She completed high-dose corticosteroids and intravenous immunoglobulin. Our patient highlights the importance of MOG antibody testing in pediatric focal cortical encephalitis to avoid unnecessary anti-viral agents and provide more appropriate immunotherapy and a more informed prognosis.

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Predictor Factors of Perceived Health in Family Caregivers of People Diagnosed with Mild or Moderate Alzheimer’s Disease

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193762 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3762 ◽

Cited By ~ 3

Author(s):

María Dolores Ruiz-Fernández ◽

José Manuel Hernández-Padilla ◽

Rocío Ortiz-Amo ◽

Cayetano Fernández-Sola ◽

Isabel María Fernández-Medina ◽

...

Keyword(s):

Mental Health ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Family Caregivers ◽

Mental Health Problems ◽

Neuropsychiatric Symptoms ◽

Perceived Health ◽

Health Problems ◽

Intervention Programs ◽

New Onset

Caring for a person diagnosed with Alzheimer’s disease has a negative impact on family caregivers’ psychological health. This study examined the factors related to ‘perceived health’ and ‘presence of new-onset mental health problems’ in family caregivers of people diagnosed with mild and moderate Alzheimer’s disease. A cross-sectional observational study carried out in Almeria’s Healthcare District (Spain). A total of 255 family caregivers (42.4% cared for people with mild Alzheimer’s disease and 57.6% cared for people with moderate Alzheimer’s disease) participated in the study from January to December 2015. Mainly, caregivers were women (81.5% in the mild Alzheimer’s disease group and 88.4% in the moderate Alzheimer’s disease group), and their average age was 56.54 years (standard deviation (SD) = 13.13) and 54.47 years (SD = 11.71), respectively. Around 47% of the caregivers had been caring for the person with Alzheimer’s between two and five years. The Goldberg General Health Questionnaire was used to measure perceived health and the presence of new-onset mental health problems. An exploratory descriptive analysis and a multivariate logistic regression analysis were conducted. For caregivers of people with mild Alzheimer’s disease, ‘perceived health’ was related to ‘perceived social support’ (r = −0.21; p = 0.028), ‘person’s level of dependency’ (r = −0.24, p = 0.05), ‘severity of the person’s neuropsychiatric symptoms’ (r = 0.22; p = 0.05), and ‘caregiver’s emotional distress in response to the person’s neuropsychiatric symptoms’ (r = 0.22; p = 0.05). For caregivers of people with moderate Alzheimer’s disease, ‘perceived health’ was related to ‘perceived social support’ (r = −0.31; p ˂ 0.01), ‘presence of neuropsychiatric symptoms’ (r = 0.27, p = 0.01), ‘severity of the person’s neuropsychiatric symptoms’ (r = 0.32, p = 0.01) and ‘caregiver’s emotional distress in response to the person’s neuropsychiatric symptoms’ (r = 0.029; p = 0.01). The presence of new-onset mental health problems was detected in 46.3% (n = 50) of caregivers of people with mild Alzheimer’s and 61.9% (n = 91) of caregivers of people with moderate Alzheimer’s. When people are diagnosed with mild Alzheimer’s disease, intervention programs for caregivers should aim to regulate emotions and promote positive coping strategies. When people are diagnosed with moderate Alzheimer’s disease, intervention programs for caregivers must allow them to adapt to caregiving demands that arise with the progression of Alzheimer’s disease.

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Immunomodulation and Regeneration Properties of Dental Pulp Stem Cells: A Potential Therapy to Treat Coronavirus Disease 2019

Cell Transplantation ◽

10.1177/0963689720952089 ◽

2020 ◽

Vol 29 ◽

pp. 096368972095208

Author(s):

Mohammed Zayed ◽

Koichiro Iohara

Keyword(s):

Stem Cells ◽

Tissue Regeneration ◽

Dental Pulp ◽

Respiratory Symptoms ◽

Distress Syndrome ◽

Treatment Approach ◽

Dental Pulp Stem Cells ◽

Cytokine Storm ◽

Potential Source ◽

Potential Use

The coronavirus disease 2019 (COVID-19) pandemic, originating from Wuhan, China, is known to cause severe acute respiratory symptoms. The occurrence of a cytokine storm in the lungs is a critical step in the disease pathogenesis, as it causes pathological lesions, pulmonary edema, and acute respiratory distress syndrome, potentially resulting in death. Currently, there is no effective treatment that targets the cytokine storm and helps regenerate the damaged tissue. Mesenchymal stem cells (MSCs) are known to act as anti-inflammatory/immunomodulatory candidates and activate endogenous regeneration. As a result, MSC therapy is a potential treatment approach for COVID-19. Intravenous injection of clinical-grade MSCs into COVID-19 patients can induce an immunomodulatory response along with improved lung function. Dental pulp stem cells (DPSCs) are considered a potential source of MSCs for immunomodulation, tissue regeneration, and clinical application. Although some current clinical trials have treated COVID-19 patients with DPSCs, this therapy has not been approved. Here, we review the potential use of DPSCs and their significance in the development of a therapy for COVID-19.

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Neuropharmacology of the Neuropsychiatric Symptoms of Dementia and Role of Pain: Essential Oil of Bergamot as a Novel Therapeutic Approach

International Journal of Molecular Sciences ◽

10.3390/ijms20133327 ◽

2019 ◽

Vol 20 (13) ◽

pp. 3327 ◽

Cited By ~ 6

Author(s):

Damiana Scuteri ◽

Laura Rombolà ◽

Luigi Antonio Morrone ◽

Giacinto Bagetta ◽

Shinobu Sakurada ◽

...

Keyword(s):

Essential Oil ◽

Psychological Symptoms ◽

Neuropsychiatric Symptoms ◽

Term Treatment ◽

Long Term Treatment ◽

Anxiety Depression ◽

Cognitive Disturbance

Aging of the population makes of dementia a challenge for health systems worldwide. The cognitive disturbance is a serious but not the only issue in dementia; behavioral and psychological syndromes known as neuropsychiatric symptoms of dementia remarkably reduce the quality of life. The cluster of symptoms includes anxiety, depression, wandering, delusions, hallucinations, misidentifications, agitation and aggression. The pathophysiology of these symptoms implicates all the neurotransmitter systems, with a pivotal role for the glutamatergic neurotransmission. Imbalanced glutamatergic and GABAergic neurotransmissions, over-activation of the extrasynaptic N-methyl-D-aspartate (NMDA) receptors and alterations of the latter have been linked to the development of neuropsychiatric symptoms experienced by almost the entire demented population. Drugs with efficacy and safety for prevention or long term treatment of these disorders are not available yet. Aromatherapy provides the best evidence for positive outcomes in the control of agitation, the most resistant symptom. Demented patients often cannot verbalize pain, resulting in unrelieved symptoms and contributing to agitation. Bergamot essential oil provides extensive preclinical evidence of analgesic properties. Incidentally, the essential oil of bergamot induces anxyolitic-like effects devoid of sedation, typical of benzodiazepines, with a noteworthy advantage for demented patients. These data, together with the reported safety profile, form the rational basis for bergamot as a neurotherapeutic to be trialed for the control of behavioral and psychological symptoms of dementia.

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COVID-19-associated brief psychotic disorder

BMJ Case Reports ◽

10.1136/bcr-2020-236940 ◽

2020 ◽

Vol 13 (8) ◽

pp. e236940 ◽

Cited By ~ 7

Author(s):

Colin M Smith ◽

Jonathan R Komisar ◽

Ahmad Mourad ◽

Brian R Kincaid

Keyword(s):

Mental Illness ◽

Family History ◽

Psychotic Disorder ◽

Neuropsychiatric Symptoms ◽

Healthy Woman ◽

Psychotic Symptoms ◽

First Case ◽

Brief Psychotic Disorder ◽

History Of ◽

New Onset

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.

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