Nihilism, Neurocognition, and the Novel Coronavirus: A Case of Acute Onset Cotard's Syndrome

The novel coronavirus (COVID-19) is a respiratory illness that may cause neuropsychiatric sequelae, including persistent psychotic symptoms.

A 70-year-old White man with no prior psychiatric history presented with altered mental status, Cotard's syndrome, and rigid delusions of poverty and homelessness 6 weeks after recovering from a mild case of COVID-19. After extensive medical workup revealed no organic etiology, he was treated for psychotic symptoms with an atypical antipsychotic, an antidepressant, and electroconvulsive therapy, with improvement over time.

While COVID-19 is primarily a respiratory disease, some individuals may develop new-onset psychiatric or neuropsychiatric symptoms without prior psychiatric history.

To our knowledge, this is the only published case of post-COVID-19 psychotic symptoms treated with electroconvulsive therapy. As the pandemic continues, the total impact of COVID-19 on psychotic symptoms remains to be seen.