Bio-psycho-social Approach to a Case of Mania-like Symptoms Associated with COVID-19 Infection

Abstract

Introduction: The corona virus or SARS-CoV 2 is known to also cause neuropsychiatric complications. Not only the infection itself but steroid use, fear of death and disruption of routine can act as stressors for precipitation of psychiatric illness in predisposed individuals. 

Case summary: A 65 years old male presented with hyperactivity, verbal aggression and increased sexual interests. The patient encountered COVID 19 infection a few weeks back, on oral Dexamethasone treatment along with conservative management at home. With tapering of steroids within a week, family members noticed that the manic symptoms increased. Past history was negative for significant medical, psychiatric or substance use. On examination there was remarkable psychomotor agitation, loud pressured speech, irritable mood, flight of ideas, grandiose ideas and impaired attention and concentration. A clinical diagnosis of F06.8 (other specified mental disorder due to known physiological condition) was made. He was started on Tab Risperidone 2mg, leading to rapid reduction in symptoms within a week (YMRS score was reduced from 31 to 2). Psychosocial interventions focusing on activity scheduling and psycho-education were also initiated. 

Discussion: This case illustrates an association between neuropsychiatric symptoms in SARS-CoV 2 patient and the complex interplay of three major domains (biological, psychological and social) in genesis of psychiatric illness.

Conclusion: Thus, we aim to establish role of COVID 19 infection as well as associated biopsychosocial changes that predispose an individual towards development of major psychiatric illnesses. Multimodal interventions keeping into account these factors are likely to result in rapid recovery.