Introduction: Coronavirus disease 2019 (Covid-19) commonly causes respiratory tract involvements, but can also lead to non-respiratory presentations, including psychiatric complications. While it is relatively rare, acute onset psychosis can also be developed following the infection. The exact mechanisms of Covid-19 to cause psychosis and what treatment options should be applied remain unclear.
Case presentation: A 67-year-old woman, who had a history of clinical recovery from Covid-19 two months ago, presented with acute onset psychotic and depressive symptoms that led to a suicide attempt. While she did not have a significant psychiatric and medical history before, she had strong delusions of guilt at the time of her admission to psychiatry, following the suicide attempt. She thought that she had caused the death of her children by infecting them with SARS-CoV-2, although her children were alive. She also believed that she would be prosecuted, imprisoned and televised for causing her children’s death. Her Beck Depression Score was 62 with her depressive, anxious mood and an irritable, a bit blunted affect. The patient was diagnosed as psychotic depression and hospitalized. After hospitalization she developed persecutory delusions about the health personnel and Capgras delusion about her children who visited the psychiatric ward. The symptoms were intractable and resistant to high doses of combined psychotropic medications. And also the brain imaging revealed widespread vascular pathologies that seemed to be developed recently. A short-term methylprednisolone treatment was started. Interestingly, all her persistent symptoms resolved completely just after this treatment.
Conclusion: Covid-19 appears to cause psychiatric consequences through brain involvement. Short-term steroid therapy may be an option for persistent delusions and affective symptoms that develop after Covid-19 and are resistant to psychotropic drugs. It is also a fact that we need further investigation methods to demonstrate the direct presence or neuroinflammatory consequences of Covid-19 in brain.
Key words: Covid-19, brain, psychosis, delusion, depression, inflammation
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