|Year : 2020 | Volume
| Issue : 2 | Page : 152-154
A case report on acute and transient psychotic disorder due to coronavirus disease 2019 quarantine
Parveen Kumar1, Deepak Sachinand Tiwari1, Vishal Kanyhialal Patel2, Disha Alkeshbhai Vasavada1
1 Department of Psychiatry, M.P. Shah Medical College, Jamnagar, Gujarat, India
2 Department of Psychiatry, Dr. M. K. Shah Medical College and Research Center, Ahmadabad, Gujarat, India
|Date of Submission||07-Sep-2020|
|Date of Decision||25-Sep-2020|
|Date of Acceptance||17-Oct-2020|
|Date of Web Publication||23-Feb-2021|
Department of Psychiatry, M. P. Shah Medical College, Jamnagar - 361 008, Gujarat
Source of Support: None, Conflict of Interest: None
Unexpected situation of coronavirus disease-2019 pandemic could increase the incidence of mental health problems such as psychotic disorders and other mental health problems. Psychotic disorders can occur as a result of quarantine social isolation. Herewith, we present a case of 30-year-old male with onset of brief psychotic disorder after quarantine. The patient was treated with risperidone and had rapid improvement. Quarantine leads to stress and social isolation in individuals, which can result in psychosis. There is a need of early detection and intervention services to improve the outcome of psychosis due to quarantine.
Keywords: Acute and transient psychotic disorder, coronavirus disease-2019, quarantine
|How to cite this article:|
Kumar P, Tiwari DS, Patel VK, Vasavada DA. A case report on acute and transient psychotic disorder due to coronavirus disease 2019 quarantine. J Mental Health Hum Behav 2020;25:152-4
|How to cite this URL:|
Kumar P, Tiwari DS, Patel VK, Vasavada DA. A case report on acute and transient psychotic disorder due to coronavirus disease 2019 quarantine. J Mental Health Hum Behav [serial online] 2020 [cited 2022 May 25];25:152-4. Available from: https://www.jmhhb.org/text.asp?2020/25/2/152/309964
| Introduction|| |
As the pandemic outbreak in India is on-going, the Government of India has taken many measures such as initiating a major lockdown pan-India and special quarantine facilities for a minimum of 14 days to limit number of cases, which results in social isolation. Social isolation is defined as a lack of social connections or interaction with family members, friends, or community. It was observed that social isolation contributes to the development of depression, increased risk of suicide, and psychotic symptoms by reducing the possibility of reality testing through social interactions. The experience of delusions or hallucinations creates a feeling of being inimitable and untreatable and further leads to isolation from others, leading to worse mental health outcomes and overall quality of life. Presence of a stressor, perception of stressor, hopelessness, and feelings of no rescue from others lead to more stress in the individuals who are socially isolated than those who are not isolated. Here, we discuss a patient who developed psychotic symptoms in a quarantine center.
| Case Report|| |
A 30-year-old married male, working in a government setup, belonging to middle socioeconomic status and living with his family was brought by his wife to the hospital with complaints of fearful behavior that his colleagues were against him and his family members; wanted to take away his post; and wanted to harm him and kill him by mixing poison in his food. He refused to eat and drink any fluids based on the firm belief that colleagues were attempting to poison him. The patient also reported dysphoric mood and insomnia. The patient had traveled from another state and hence was placed in the quarantine center for 14 days. The patient was quarantined in the last week of April 2020 and admitted to our center in the 1st week of May 2020. After 10 days of quarantine, the patient developed these symptoms. The patient did not develop any symptoms related to coronavirus disease-2019 (COVID)-19 during the entire stay and also tested negative for COVID-19.
Physical examination was normal. On mental status examination, the patient was alert, conscious, well-groomed, mood was reported as being worried, objectively sad, and had persecutory delusions. There was no perceptual abnormality, insight was Grade I. The patient had normal premorbid psychosocial adjustment, no past history, and family history of psychiatric illness. There were no shared risk factors other than pandemic-related stress. Routine hematological test, biochemical test, computed tomography of the brain, and electroencephalogram were normal.
The patient described above was diagnosed as “Acute and Transient Psychotic Disorder (ATPD)”, according to the International Classification of Diseases for Mortality and Morbidity Statistics-11. The patient did not satisfy the current criteria for acute stress disorder or posttraumatic stress disorder; all other common differential diagnoses including mood disturbances with prominent psychotic features were also ruled out. There is no history of other stressors such as sleepless travel or sudden loss of job. There is no history of substance use such as cannabis or alcohol.
The patient was hospitalized in male psychiatric ward. During hospital admission, the patient was agitated, slightly worried, and had persecutory delusions with no perceptual abnormalities. He was treated with risperidone 2 mg at night and Alprazolam 0.25 mg three times a day, with a progressive resolution of symptoms. After 5 days of admission, the patient developed insight and full remission of symptoms ward and was discharged. The patient was discharged on risperidone 2 mg and alprazolam 0.25 mg at night. Remission was also confirmed by relatives and reported full functionality in his job after 1 week and 1-month follow-up.
| Discussion|| |
After lockdown in India on March 24, 2020, there are mental health concerns such as anxiety, worries, and insomnia. As the disease progresses, there are increasing concerns regarding health, mental health, and livelihood. To prevent from the negative impact of the coronavirus, the World Health Organization has urged to take necessary precautions.
Our case shows the age of onset at 30 years. Castagnini and Foldager (2013) reported pandemic-related ATPD cases of 15–64 year old from the Danish psychiatry register and found that ATPDs tends to peak around the mid-30s in females and early adulthood in males.
In our case, the psychotic episode was of short duration. Valdés-Florido et al. in a case series from Spain reported that four patients met the criteria of reactive psychosis episode triggered by stress related to COVID-19 pandemic which was short lived but showed a high rate of recurrence and low diagnostic stability over time. Brooks et al. from a review of literature reported that quarantine results in multiple stressors such as worries about a longer duration of quarantine, fear of infection, frustration, inadequate information and supplies and financial losses. Experience of quarantine also plays a significant impact; negative experience results in long-term consequences in an individual.
COVID-19 pandemic stress directly triggers the psychotic disorder. We may now witness an increasing number of brief psychotic disorder patients due to more number of quarantine and home isolation. Good mental health can be achieved by providing proper education about days of quarantine, providing clear communication, and what to do while in quarantine. To deal with the situation of psychological distress and promoting adaptive coping strategies, counseling and psychological first aid services will be helpful.
| Conclusion|| |
Quarantine leads to stress and social isolation in individuals, which can result in psychosis. Proper education and communication about quarantine reduces psychotic episodes while there is a need for early detection and intervention services to improve the outcome of psychosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wang HT, Huang FL, Hu ZL, Zhang WJ, Qiao XQ, Huang YQ, et al
. Early-life social isolation-induced depressive-like behavior in rats results in microglial activation and neuronal histone methylation that are mitigated by minocycline. Neurotox Res 2017;31:505-20.
Depp CA, Moore RC, Perivoliotis D, Holden JL, Swendsen J, Granholm EL. Social behavior, interaction appraisals, and suicidal ideation in schizophrenia: The dangers of being alone. Schizophr Res 2016;172:195-200.
Lim MH, Gleeson JF. Social connectedness across the psychosis spectrum: Current issues and future directions for interventions in loneliness. Front Psychiatry 2014;5:154.
Cacioppo JT, Hawkley LC. Social isolation and health, with an emphasis on underlying mechanisms. Perspect Biol Med 2003;46:S39-52.
World Health Organization. International Classification of Diseases for Mortality and Morbidity Statistics (11th
revision). World Health Organization; 2018. Available from: https://icd.who.int/browse11/l-m/en
. [Last accessed on 2020 Aug 15].
Yao H, Chen JH, Xu YF. Rethinking online mental health services in China during the COVID-19 epidemic. Asian J Psychiatr 2020;50:102015.
Castagnini A, Foldager L. Variations in incidence and age of onset of acute and transient psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2013;48:1917-22.
Valdés-Florido MJ, López-Díaz Á, Palermo-Zeballos FJ, Martínez-Molina I, Martín-Gil VE, Crespo-Facorro B, et al
. Reactive psychoses in the context of the COVID-19 pandemic: Clinical perspectives from a case series. Rev Psiquiatr Salud Ment 2020;13:90-4.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al
. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.
D′Agostino A, D'Angelo S, Giordano B, Cigognini AC, Chirico ML, Redaelli C, et al
. Brief psychotic disorder during the national lockdown in Italy: An emerging clinical phenomenon of the COVID-19 pandemic. Schizophr Bull 2020;Sbaa112. doi: 10.1093/schbul/sbaa112.
Patel A, Jernigan DB. Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak-United States, December 31, 2019−February 4, 2020. Morb Mortal Wkly Rep 2020;69:7.