Excited Catatonia - A Delayed Neuropsychiatric Complication of COVID-19 Infection

An increasing number of patients have been presenting with neuropsychiatric signs and symptoms associated with coronavirus disease (COVID-19). We present a case of a 69-year-old female with no prior psychiatric history who was brought to the emergency department due to bizarre behavior and paranoid thoughts for four to six weeks, worsening over the last two weeks. Psychiatric evaluation found that the patient had extreme restlessness and agitation, poor eye contact, paranoid delusions, visual hallucinations, and a flat affect with stereotypic repetition of speech and loose associations. The patient's family noted that two months prior she had symptoms of common cold associated with a severe cough and 20 pounds of weight loss. Suspicion for prior COVID-19 infection prompted an IgG antibody test, which was positive. Our patient displayed at least three of the signs needed to diagnose catatonia - agitation, rigidity, and echolalia - and had a therapeutic response to lorazepam, confirming suspicions of excited catatonia. Her seropositivity for IgG against COVID-19 suggested a COVID-induced brief psychotic disorder with catatonia, which makes this the first known case, to our knowledge, of a patient with delayed onset catatonia after COVID-19 infection. This suggests that clinicians should, after ruling out more plausible stressors, suspect possible coronavirus involvement in sudden onset psychotic disorders, especially in patients who do not fit the demographic of new-onset schizophrenia-spectrum diagnoses. Further research is needed on the pathophysiology behind COVID-19 altering neuronal function and neurotransmitter pathways.