A qualitative analysis of literature reporting and linking psychosis to COVID-19 infection. Findings from a postgraduate journal club

Acute exacerbations of psychosis have been reported with COVID-19 infection and medications used for its treatment. Terms “psychosis”, “psychotic”, “COVID-19″ and “coronavirus” were searched on “PubMed” and “GOOGLE SCHOLAR”, yielding 84 articles. 14 case reports were selected based on pre-defined criteria and analyzed. Among selected articles,10 attributed psychosis to COVID-19 infection. In 3 articles, psychosis was diagnosed despite concurrent delirium. In 8 and 3 articles respectively, a clear temporal demarcation of psychosis and COVID-19 infection and steroid use was not described. Psychosis can occur secondary to GMC, or exposure to medication. Due process should be followed to ascertain the same. INTRODUCTION: Neurotropic coronavirus infection is associated with numerous neurological and neuropsychiatric manifestations. Such presentations before, during and after the infection have been reported. Among these presentations, acute exacerbations of psychosis have been reportedly linked with COVID-19 infection and medications used for its treatment. METHODOLOGY: Search engines “PubMed” AND “GOOGLE SCHOLAR” were searched using specific search terms during June 2021. Out of 84 articles that came up, we selected 14 articles based on pre-determined inclusion and exclusion criteria. Selected articles were analysed and discussed in the departmental journal club. RESULTS: In 10 articles, diagnosis of psychosis was attributed to COVID-19 infection. In 3 of those articles, despite reporting concurrent delirium like presentation, diagnosis was still reported as psychosis. In 8 articles, the temporal correlation between onset of psychosis, onset of COVID-19 was not clearly demarcated. In 3 articles, clear demarcation between psychosis associated with steroid use and with a general medical condition (COVID-19) was not clearly presented. Only 2 articles did mention using a structured diagnostic system. In patients (3/17) with prior history of psychiatric illness, diagnosis was reported as relapse of psychosis (2/17), without specifying the criteria used for diagnosing a relapse. CONCLUSION: Acute exacerbation of psychosis can occur secondary to a general medical condition (GMC), or after exposure to a medication. However, due process should be followed to ascertain that the psychosis is indeed secondary to a GMC, or a medication, and not a de-novo presentation, or delirium.