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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 113-115

Psychosis following COVID-19 vaccination


Department of Psychiatry, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India

Date of Submission19-Jul-2022
Date of Decision20-Aug-2022
Date of Acceptance20-Sep-2022
Date of Web Publication16-Dec-2022

Correspondence Address:
Dr. Javangula Swetha Krishna
Department of Psychiatry, Narayana Medical College and Hospital, Nellore - 524 002, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_28_22

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  Abstract 


COVID-19 infection has caused a lot of pain and suffering to date, but it is still showing catastrophic effects on humanity even after developing and effectively using the COVID vaccines for the containment of the virus. With the prevailing pandemic, there are new problems arising postvaccination in people, especially the neuropsychiatric manifestations. The present case report is of a 46-year-old single mother who completed graduation and working as a primary school teacher brought to our outpatient department with complaints of muttering to herself, decreased sleep and appetite, hearing the voice of her husband who died 15 years back, and being fearful after 3 days of receiving the second dose of Covishield vaccine. She got prescribed tablet risperidone 2 mg (bd) and tablet clonazepam 0.5 mg at night. In the absence of any other causative explanations, a temporal association is that the presentation could have been triggered as a result of complications relating to COVID-19 vaccination.

Keywords: Corona virus, COVID-19 vaccines, psychosis, SARS-CoV-2, vaccination


How to cite this article:
Krishna JS, Harshitha V, Endreddy AR, Seshamma V V. Psychosis following COVID-19 vaccination. Telangana J Psychiatry 2022;8:113-5

How to cite this URL:
Krishna JS, Harshitha V, Endreddy AR, Seshamma V V. Psychosis following COVID-19 vaccination. Telangana J Psychiatry [serial online] 2022 [cited 2023 Feb 4];8:113-5. Available from: https://tjpipstsb.org/text.asp?2022/8/2/113/363973




  Introduction Top


COVID-19 infection is a contagious disease caused by a virus that leads to severe acute respiratory syndrome. It was declared a global pandemic on March 11, 2020, by the World Health Organization as more than 1 lakh infected cases were reported worldwide. The most common symptoms of SARS-COV infection include fever, lethargy, loss of smell and taste, and serious symptoms such as dyspnea, hypoxia, and respiratory failure and finally, leading to death due to multiorgan failure. It is clear that many infected individuals are developing certain neuropsychiatry symptoms as coronavirus has the ability to invade the nervous system through the olfactory epithelium.

During the initial stages of the pandemic, people were made aware of the preventive strategies that were found to be useful later, quarantine, hospitalization, and complete lockdown became the main strategies. Finally, developing vaccine against SARS-CoV-2 became the major goal, and within a few months, few vaccines were successfully developed and proved to be effective.

However, still COVID-19 is showing its catastrophic effects on humanity even after developing and effectively using the COVID vaccines for containment of the virus. Along with the prevailing pandemic, there are new problems arising postvaccination in people, especially the neuropsychiatric manifestations.[1]

To date, it is known that only a handful of vaccines reported developing psychosis after administration, such as typhus and pertussis,[2] yellow fever,[3] influenza due to N-Methyl D-Aspartate receptor hypofunctioning, or autoimmune encephalitis;[4] however, currently, COVID-19 vaccines are linked to developing substance/medication-induced psychotic disorder according to DSM 5 in people without any prior mental illness, and many case reports have been published from different countries.[5]

Over a period of a few weeks, all the possible reported side effects of COVID-19 vaccines, especially AstraZeneca/Covishield, Pfizer/BioNTech, and Moderna are analyzed by a UK-based website and listed to identify a large range of neuropsychiatric complications such as epilepsy, familial hemiplegic migraine, anxiety and depression, insomnia, dyssomnia, confusion and disorientation, and psychotic disorder.[6]

Covishield is an adenovirus vector vaccine that carries the spike protein of coronavirus, and other constituents of the vaccine include L-histidine ethanol, sodium chloride, sucrose, and disodium edetate dihydrate water for injection.


  Case Report Top


The present case report is of a 46-year-old single mother who completed graduation and working as a primary school teacher, belonging to a Hindu nuclear family of middle socioeconomic status of the urban background of Nellore region of Andhra Pradesh, was brought to our outpatient department by her daughter with complaints of muttering to herself, decreased sleep and appetite, hearing the voice of her husband who died 15 years back, and was fearful that something may happen to her and to her daughter just like the accident that her younger brother had 4 months back. On repeated asking why this may happen, she explained that her husband's voice is telling her that they would die of an accident and this would happen in the near future. Her family members noticed that she started to mutter to herself, her personal care was reduced, she stopped going to her work, and mostly preferred to stay at home for the past 20 days. These symptoms started after 3 days of receiving the second dose of the Covishield vaccine. On examination, the patient was conscious, coherent, oriented to place and person, had stable vitals, and was afebrile.

Patient's attender reported a history of fever after 2 days of the first shot of the Covishield vaccine which proceeded by symptoms of body aches, feeling restless, sleep deprivation, palpitation, and fear about events that could take place in the future; for confirmation, she had reverse transcription-polymerase chain reaction test done, which was negative. Her symptoms lasted most of the days for a week, despite her taking a psychiatrist consultation and prescribed T. escitalopram 10 mg night with T. clonazepam 0.5 mg night which she used for 1 month. She received her second dose of the Covishield vaccine after 2 months of the first dose, and within 3 days, her presenting complaints started with a decline in the severity of the previous complaints.

There was no past or family history of psychiatric illness or other serious comorbidities with well-adjusted premorbid personality and insight of Grade 2/5 as she attributed her condition is due to her husband. It was difficult to do her mental status examination and higher mental functions; however, the range of her affect was restricted to dull, and her psychomotor activity was slightly slow and she frequently got distracted, muttering to herself as she could hear her husband's voice talking to her during the interview and also could not pay attention to the questions asked. Her routine blood investigations were within the normal limits except for mild leukocytosis, an MRI brain was done, which was normal. We advised admitting the patient for further evaluation, but they denied admission and accepted for oral medications; hence, she got prescribed T. risperidone 2 mg (bd) and T. clonazepam 0.5 mg night.

Within 20 days of treatment, patient reported >70% improvement in her target symptoms without any extrapyramidal side effect. She has come for regular follow-up for continuous 3 months and is currently only on T. risperidone 2 mg night; she reports a complete improvement and is currently back on her regular routine.


  Discussion Top


SARS-CoV-2 is known to trigger a strong immune response, which includes the release of large amounts of inflammatory mediators. There is the possibility that the host reaction to the COVID-19 vaccines can recreate a mild version of the infection state,[1] as previous studies linked schizophrenia, bipolar disorder, and depression to the proinflammatory status of an individual as they found raised levels of interleukin-1, 6 and tumor necrosis factor-α among these individuals.[7]

In the absence of any other causative explanations, a temporal association is that the presentation could have been triggered as a result of complications relating to COVID-19 vaccination, and a strong reason is a short duration between vaccine administration and the onset of psychopathology.


  Conclusion Top


Psychosis after COVID-19 infection is known as many of the infected patients are developing neuropsychiatry manifestations due to the underlying inflammatory mechanisms; however, developing psychosis after the COVID vaccination is very rare. This report raises the possibility of COVID vaccines in triggering an immune response that could lead to immune dysregulation and developing psychosis following immunization of an individual.

This report highlights the inclusion of recent vaccination in history and that medical professionals need to be sensitized about this for early recognition and effectively managing the patients.

We still need to focus on the possibilities of mental health issues arising postvaccination, and the goal is to control or prevent these in the early stages. This information provided should not stop the use of COVID vaccines as the pandemic is still prevailing.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Grover S, Rani S, Kohat K, Kathiravan S, Patel G, Sahoo S, et al. First episode psychosis following receipt of first dose of COVID-19 vaccine: A case report. Schizophr Res 2022;241:70-1.  Back to cited text no. 1
    
2.
Hofmann C, Baur MO, Schroten H. Anti-NMDA receptor encephalitis after TdaP-IPV booster vaccination: Cause or coincidence? J Neurol 2011;258:500-1.  Back to cited text no. 2
    
3.
Romeo B, Rari E, Mazari A, Toullec A, Martelli C, Benyamina A. First-episode psychosis following vaccination against yellow fever: A case report. Encephale 2021;47:630-1.  Back to cited text no. 3
    
4.
Flannery P, Yang I, Keyvani M, Sakoulas G. Acute psychosis due to anti-N-Methyl D-aspartate receptor encephalitis following COVID-19 vaccination: A case report. Front Neurol 2021;12:764197.  Back to cited text no. 4
    
5.
Balasubramanian I, Faheem A, Padhy SK, Menon V. Psychiatric adverse reactions to COVID-19 vaccines: A rapid review of published case reports. Asian J Psychiatr 2022;71:103129.  Back to cited text no. 5
    
6.
GOV.UK. COVID-19 Vaccine AstraZeneca Analysis Print. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1101771/Vaccine_Analysis_Print_AstraZeneca_COVID-19_vaccine_pdf. [Last accessed on 2022 Aug 24].  Back to cited text no. 6
    
7.
Goldsmith DR, Rapaport MH, Miller BJ. A meta-analysis of blood cytokine network alterations in psychiatric patients: Comparisons between schizophrenia, bipolar disorder and depression. Mol Psychiatry 2016;21:1696-709.  Back to cited text no. 7
    




 

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