Can new onset psychosis occur after mRNA based COVID-19 vaccine administration? A case report

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349391

Published online 2021 Aug 8

The COVID-19 pandemic continues to have a deleterious impact on mental health at multiple levels. Fear of infection, stress related to social isolation, work, financial or family loss can lead to mood symptoms, anxiety or substance abuse. COVID-19 infection is associated with a host of neuropsychiatric symptoms, including psychosis, even in individuals without previous mental illness. Many of these symptoms have been associated with a COVID-19-induced hyperinflammatory state. The host reaction to COVID-19 vaccines may recreate a mild version of the actual infection. The development of COVID-19 vaccines is unarguably a great stride in the management of the pandemic. We report a case of a man with new onset psychosis after administration of an mRNA-based COVID-19 vaccine.

A 31-year-old, single Hispanic male without past medical or psychiatric history, was brought to the emergency room by police because of erratic and bizarre behavior. He was found to be anxious, guarded, superficial and grandiose. He reported becoming ‘clairvoyant’, being able to talk with dead people, hearing ‘people drumming outside his house’ and the constant voice of a co-worker whom he believed to be a paramour- it was later confirmed that there was no romantic relationship. All these symptoms began one month ago, after receiving the first dose of an mRNA-based COVID-19 vaccine, and markedly worsened three weeks later after receiving the second dose. Previously, he was asymptomatic, working full-time as an office manager. Although functional in adolescence and adulthood, he described himself as a loner, with an inclination to overly spiritual ideas, and able to communicate directly with God. He had a few close friends and romantic relationships.

>It has been hypothesized that a COVID-19 triggered cytokine storm may increase the risk of psychosis. Coincidentally, schizophrenia has been linked to a pro-inflammatory status

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056514

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1.6. Common symptoms in “Long COVID”

Common symptoms in people with “Long COVID” are profound fatigue, breathlessness, cough, chest pain, palpitations, headache, joint pain, myalgia and weakness, insomnia, pins and needles, diarrhea, rash or hair loss, impaired balance and gait, neurocognitive issues including memory and concentration problems and worsened quality of life. In people with “Long COVID” one or more symptoms may be present.

Researchers identified two main patterns of symptoms in people with long COVID: they are 1) fatigue, headache and upper respiratory complaints (shortness of breath, sore throat, persistent cough and loss of smell) and 2) multi-system complaints including ongoing fever and gastroenterological symptoms [20]. Survivor Corps report shows that 26.5% of people with Long COVID experienced painful symptoms [27-PP45] [29]. In patients with long COVID some of the symptoms are first reported 3–4 weeks after the onset of acute symptoms [20].

Profound fatigue is a common problem and one study showed that at 10 weeks of follow up after SARS-CoV-2 infection; more than 50% of people were suffering from fatigue. There was no association between development of fatigue, COVID-19 severity and level of inflammatory markers. Female sex and diagnosis of depression/anxiety is more common in those with fatigue [30]. Post viral fatigues are commonly reported in people with viral infections like EBV, Ebola, influenza, SARS and MERS. In the absence of any other reason, if fatigue persists for 6 months or longer it is called chronic fatigue syndrome. Up to 40% of patients who recovered from SARS of 2003 have chronic fatigue. The presence of chronic oxidative and nitrosative stress, low-grade inflammation and impaired heat shock protein production were among the proposed mechanisms for muscle fatigue. Profound fatigue is a challenge not only to the patient but also the healthcare provider, as there are no objective methods to diagnose it with certainty. >Disruption of trust in the doctor-patient relationship can occur in such settings [31].