Acute-Onset Psychosis Following Prolonged Hospitalization for COVID-19 Pneumonia

BACKGROUND SARS-CoV-2 infection presents with a variety of clinical manifestations, from asymptomatic courses to prolonged hospitalizations with severe systemic inflammatory responses and multiorgan failure. One particular sequela of the disease that has gained wider attention over the past year is the sudden onset of neuropsychiatric symptoms in the weeks following recovery from COVID-19 pneumonia. While the pathophysiology for the development of this condition is uncertain, symptoms ranging from mild confusion and anxiety to florid psychosis with manic delusions and auditory and visual hallucinations have been rarely, but increasingly, reported in the literature. The acute development of such symptoms in the post-recovery period can be devastating for patients, their caregivers, and clinicians who may be unaware of effective management options. CASE REPORT In this case report, we present a 23-year old man who developed psychotic symptoms, including acute mania, delusions of grandeur, and auditory and visual hallucinations, 1 week following an extended hospitalization for COVID-19 pneumonia. The patient was admitted to our psychiatric unit and treated with a combination of antipsychotic and mood stabilizer medications. After 2 weeks of treatment, the patient's psychotic and mood-related symptoms resolved, with normal mental status maintained at last follow-up 1 month following discharge from our unit. CONCLUSIONS The acute development of neuropsychiatric symptoms is a rare but increasingly recognized sequela of COVID-19. Despite the severity of initial presentation, patients can be successfully treated with short courses of typical antipsychotic medications with complete return to baseline, unimpaired functioning, and no lingering psychiatric sequela.