This case presented as part of the Poster Presentations at the 2021 NEI Congress is a good reminder of the importance of taking a thorough history.
Parul Kumar, MD, and colleagues from Westchester Medical Center, New York Medical College, Department of Psychiatry, reported on an unusual encounter as part of the 2021 Neuroscience Education Institute Poster Presentation. The patient, aged 38, was a White female with a history of schizoaffective disorder. She presented to the emergency department with reports of racing thoughts, distractibility, increased energy, decreased need for sleep, and hyper-talkativeness.
The patient reported delusions of her father invisibly raping her. She also reported hypoguesia and anosmia 1-2 days prior to her visit to the emergency department, but now was hallucinating smells of blood and flesh. She denied head trauma, seizures, as well as previous emotional, physical, and sexual trauma. The patient noted a remote history of migraines.
Neurological examination was within normal limits, as were brain computed tomography, chest X-ray, and various laboratory studies. However, the patient tested positive for SARS-CoV-2.
Following admission and treatment for 2 days that included aripiprazole, haloperidol, topiramate, and fluoxetine, the patient reported resolution of the hallucinations and was discharged to follow-up outpatient care.
Research has indicated that patients with schizophrenia have an increased risk for acquiring COVID-19, with an adjusted odds ratio of 7.34,1 along with increased risk for hospitalization (27.4% vs 18.6%) and mortality (8.5% vs 4.7%) compared with individuals with no psychiatric disorders, respectively. Kumar et al noted the olfactory symptoms were the only presenting symptoms associated with COVID-19 in their patient. Thus, they recommended testing for SARS-CoV-2 in patients with psychosis or other psychiatric illness who present with olfactory symptoms as part of the differential diagnosis.
1. Wang Q, Xu R, Volkow ND. Increased risk of COVID -19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry. 2020; Epub ahead of print.