Hallucinations in Hospitalized Rehabilitation Patients with COVID-19

RESEARCH OBJECTIVES: To describe the characteristics of hallucinations in hospitalized rehabilitation patients with coronavirus disease 2019 (COVID-19). DESIGN: An observation study of case series. SETTING: Acute inpatient rehabilitation public hospital. PARTICIPANTS: Patients with COVID-19 who were admitted to the acute inpatient rehabilitation unit (ARU) during a four-month period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To describe the characteristics of hallucinations in hospitalized rehabilitation patients with COVID-19. RESULTS: Eight (21.6%) of a cohort of 37 patients admitted to the ARU with COVID-19 exhibited visual hallucinations. Most of the visual hallucinations occurred during their ICU stay. The mean age of the eight patients was 56.5-year-old (range: 38 – 71). There were seven males and one female. Seven of the eight patients exhibited peduncular hallucinations, four were associated with auditory components, five with tactile components. One patient's hallucinations were characterized by a duplication of an extra finger, an enlargement of an upper extremity, a tactile hallucination of crawling bugs, and a somatic component of abnormal positioning of an extremity. The content of the hallucinations was related to the fearful and threatening situations in three patients and the experience of seeing deceased family members in two patients. Five of the patients had ICU delirium. Seven patients had COVID-19 pneumonia and one patient developed respiratory distress secondary to Guillain-Barre Syndrome. One patient experienced posterior reversible encephalopathy syndrome which was associated with visual hallucinations. Four patients had anxiety, four had depression, and one had both anxiety and depression. None had a pre-existing history of psychiatric illness, but one had a pre-existing history of methamphetamine use. All eight patients had evidence of cognitive impairment. Hallucinations of six patients resolved spontaneously but those of two patients had persisted during their ARU stay. The negative experience of hallucinations warranted further multidisciplinary support during their recovery. CONCLUSIONS: Visual hallucinations can be encountered among hospitalized patients with COVID-19. It is uncertain whether these hallucinations were directly or indirectly related to the SARS-CoV-2 infection. AUTHOR(S) DISCLOSURES: No conflict to declare in all authors.