Abstract:
Background:
The COVID-19 pandemic has been an inciting factor for a wide variety of neuropsychiatric symptoms, including first-episode psychosis. Objective: The aim of this systematic review was to summarize the current literature on COVID-19 associated post-viral first-episode psychosis (FEP). Methods: A systematic review was completed using PRISMA guidelines and identified 81 articles that met inclusion criteria. Results: Articles included case reports, case series, and cohort studies with post-viral FEP occurring outside the setting of delirium, demonstrating a broad range of symptoms. Conclusion: This systematic review shows that post-viral FEP associated with COVID-19 follows a pattern similar to psychosis associated with other viral infections, and is an important consideration when building a differential for first-episode psychosis when delirium has been ruled out. Better understanding post-viral FEP associated with COVID-19 and other viral illnesses may help clarify aspects of underlying pathophysiology of psychotic symptoms broadly.
INTRODUCTION:
The COVID-19 pandemic has been well-established as an inciting factor of neuropsychiatric symptoms, both in the acute and subacute phases of illness. The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can impact all organ systems, including the brain, in patients with and without pre-existing psychiatric illness(1). In patients infected with COVID-19, neuropsychiatric symptoms include cognitive deficits, disturbances in consciousness, encephalitis, convulsions, ataxia,
METHODS:
This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review was initially approached as a scoping review and subsequently converted to a systematic review. Study was not eligible for PROSPERO registration given the timeline of data extraction. Informaionists JN and KL assisted in the development of search terms. The search strategy was run on June 25, 2021, in the electronic databases MEDLINE (PubMed), Embase (Embase.com), The
RESULTS:
We retrieved 6,086 articles from our initial database search. An additional 17 articles were identified outside this database search after hand searching citations of these key studies; thus a total of 6,103 articles. Of those, 2,721 duplicates were removed. The number of articles screened was 3,382 and 3,180 were excluded. Full-text articles assessed for eligibility were 202. Of those, 81 met inclusion criteria. Of those, the types of papers included for data synthesis were: 37 case reports,
DISCUSSION:
This systematic review of the literature identified 37 case reports, five case series, and eight cohort studies focused on post-viral FEP associated with COVID-19, in adult patients infected with COVID-19, with no pre-existing psychiatric history nor evidence of dementia, who developed FEP outside the setting of delirium. Prior reviews have been done to evaluate the relationship between psychosis and COVID-19. Generally, the most speculated theory has been psychosis manifesting as part of an
CONCLUSIONS:
Psychosis is a complex phenomenon with multifactorial etiology that is highly disruptive and poses safety risks. It has been associated with viral infections, including COVID-19. As newer variants emerge and our understanding of the pathogenesis and neuropsychiatric consequences of COVID-19 continues to evolve, it may be helpful to perform longitudinal studies of individuals who experienced post-viral FEP in the context of COVID-19 infection, including the measurement of immunological and