Abstract
COVID19 infection was associated with possible psychiatric manifestations, including psychosis and mania. In addition, psychiatric disorders might be triggered by severe psychological reactions to the pandemic or the measures taken to contain it. This study aimed to assess the trends of new-onset psychosis/mania during the pandemic timeline. Psychiatric emergency department records during January-July 2019 and 2020 of two regional mental health centers were manually examined. Cases of new-onset psychosis or mania were found in 326 out of 5161 records examined. The ratio of these cases increased by 45.5% in 2020 compared to 2019 (189 out of 2367, 137 out of 2479, respectively, p = 0.001). The peak increase was in April 2020 (9.4% vs. 4.7%, p = 0.015). There was no association between the rise of new-onset psychotic or manic episodes and national incidence of COVID19 cases, as observed during Israel 2nd wave. PCR tests were negative, except a single case. In this study, an increase in new-onset psychosis/mania was identified during the initial phase of the pandemic. Though causality could not be directly inferred, lack of infection symptoms, negative PCR testing and temporal distribution incongruent with COVID19 caseload did not support a direct effect of SARS-CoV-2. Alternative explanations are discussed, such as psychological reaction to stress and preventive measures, as well as case-shifting between different mental health settings.
Highlights
COVID19 infection was associated with possible psychiatric manifestations, including psychosis and mania
The aim of this study is to examine whether the COVID19 pandemic has led to an increase in the number of new-onset severe psychiatric manifestations, psychoses and manic episodes
Due to lack of information regarding past psychiatric history or current clinical presentation, 5.3% of cases in 2019 and 7% of cases in 2020 could not be classified, 2479 and 2367 cases, respectively, were included in the final analysis
Summary
COVID19 infection was associated with possible psychiatric manifestations, including psychosis and mania. One case study presented an hyper-intense signal of the olfactory bulb and right gyrus rectus followed by thinning of the olfactory bulb in an MRI scan of a patient with positive PCR result for SARS-CoV-28 In addition to those notions, others suggested that the overall sensation of panic and stress due to the pandemic, in combination with the social and economic consequences of quarantine might give rise to negative psychiatric outcomes[9,10,11]. Post-traumatic stress disorder and other mental health consequences has been documented, with excess risk at certain groups (lower economic status, female sex, lower social support and more)[9] These trends were observed in previous e pidemics[9]. Report similar or slight decrease in psychotic cases[16,19].While studies acknowledged the different pathways in which the pandemic can affect these trends (biological vs psychological and sociological), results were conflicting, whether COVID19 positive patients were more likely to be psychotic[19], or no difference was observed between COVID19 positive and negative p atients[15]
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