A case study presented at the American Psychiatric Association annual meeting, held virtually May 1 to 3, 2021 described a man aged 23 years who presented with acute psychosis without psychiatric history.

The patient presented at an emergency department in June 2020 with symptoms including auditory and visual hallucinations, thought broadcasting, delusions of reference, and response to internal stimuli. A urinary drug screen identified cannabinoids and he was considered for admission to psychiatry for stabilization to address a risk of self-harm.

Since a routine swab identified him as SARS-CoV-2 PCR positive despite his not showing symptoms of COVID-19 and the hospital did not have a COVID-19 psychiatry unit, the patient was isolated. His psychiatric treatment was conducted via phone and through a glass wall. An attendant monitored him from outside the room and medical staff assessed him from a distance.


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He received olanzapine (titrated to 10 mg daily), followed by risperidone (5 mg daily) and then the long-acting injectable (LAI) paliperidone palmitate (234 mg + 156 mg), which he received prior to discharge.

He was diagnosed with schizophreniform disorder (provisional), with a differential diagnosis of schizophrenia, substance-induced psychotic disorder, and psychotic disorder due to another medical condition.

While most of the patient’s psychotic symptoms resolved, he had residual symptoms at discharge. The patient remained at the hospital for 30 days while patients admitted with acute psychotic disorders had an average length of stay of 10.9 days. He received outpatient psychiatric care and was monitored for long-term complications from COVID-19.

The study researchers said the case “highlights the various challenges that acute psychiatric services and their patients encounter during the COVID-19 pandemic.”

References

Fijtman A, Strong C, Haider SR, Kincaid B, Gagliardi J. Treatment of acute psychosis through a glass wall in a patient with asymptomatic COVID-19. Poster presented at: APA annual meeting May 1-3, 2021. Abstract/Poster: 5231.