Bulgarian Journal of Psychiatry, 2023; 8(4):14-21

Onset of psychiatric disorders in the course of post-covid syndrome. Case series from the practice

Yoanna Marinova, Milena Dimitrova
Clinic “Psychiatry”. Military Medical Academy – Sofia

Abstract. Introduction: SARS-CoV2 is a virus with proven neurotropic properties. The neuropsychiatric manifestations associated with passing COVID-19 infection are result of the virus penetration into the central nervous system. Depending on the severity of the disease, a variety of psychiatric diseases can develop as a consequence in the course of the post-covid syndrome. Materials and methods: We present series of 14 patients (9 men and 5 women aged between 25 and 68 years) admitted for psychiatric treatment up to 4 months after experiencing acute COVID-19 for the period 2020-2022. None of them had history of mental disorder in the past, however 3 of them had evidence of mental illnesses in the family. All patients underwent neuroimaging and neuropsychological examination, 1 patient underwent EEG due to suspicion of an epileptiform process. Results: Among the 14 patients, 6 had an established organic finding – 5 of them had evidence of cortical atrophy from neuroimaging examinations and 1 had pathological changes in the EEG. Affective disorders are most prevalent in the group. 6 of the patients (42.8%) showed symptoms of all types of affective episodes (3 mixed, 2 severe depressive episodes (1 with psychotic symptoms) and 1 manic). Half of them have proven cortical atrophy. Acute psychotic disorders are in second place, affecting 5 patients (35.7%), with 2 of them having cortical atrophy and one having an abnormal EEG recording. The third most frequent are anxiety disorders – 3 of the patients, 2 of which presented mainly with somatization symptoms. In 7 (50%) of the patients mild to moderate cognitive deficit was found. Of the studied group of patients – 5 had moderately severe and severe COVID-19 infection, demanding hospital admission and oxygen treatment. Conclusion: Patients with post-covid syndrome may develop a variety of psychiatric disorders that impair their functioning, and this does not depend on the severity of the past covid infection, but on the duration and severity of the consequent neuroinflammatory processes. The timely recognition and treatment of these conditions is of particular importance, and the approach to them should be complex and multidisciplinary, since their course and prognosis are different from endogenous mental disorders.

Key words: COVID-19, post-covid syndrome, mental disorder, acute psychosis, depression, mania

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