Understanding the state of confusion in patients with psychosis during COVID-2019 pandemic: A report of two cases

Abstract

Introduction. There is a lot of evidence that coronavirus disease 2019 has various manifestations. This paper presents a report of two cases with the aim to indicate the multifactorial etiology of confusional states in patients with mental disorders at the time coronavirus disease 2019 pandemic. The severe acute respiratory syndrome coronavirus-2 affects not only the respiratory and cardiovascular systems, but also the brain, kidneys and other organ systems. One of the first manifestations of this infection can be mental confusion. Case Study. The first patient, a woman diagnosed with schizoaffective psychosis, suddenly presented with confusion, followed by hypersedation which was at first attributed to overmedication. In another patient, with the diagnosis of bipolar affective disorder, sudden confusion (delirium) was initially recognized as an element of mental disorder deterioration. A more detailed observation revealed that the confused state in both patients was caused by severe acute respiratory syndrome coronavirus-2 infection. Discussion. It is common for the manifestations of severe acute respiratory syndrome coronavirus-2 infection to include respiratory and cardiovascular syimptoms. However, symptoms related to other organs and organ systems, including changes in neurological and psychological status, should not be ignored. Conclusion. It was noticed that confusion and delirium-like states are quite common early symptoms of coronavirus disease 2019. In psychiatric patients, it is always necessary to rule out the organic etiology of the consciousness disorder and immediately proceed with the diagnostic procedures. One should certainly keep in mind that diagnostic errors are possible, not only due to various manifestations of the infection, but also due to the stigmatization of mental illness, which must be overcome in order to provide the best possible treatment effects.