Quote:First Episode Psychosis Following COVID-19 Vaccination: a Case Report

Abstract

Vaccines are crucial to ending the COVID-19 pandemic. An mRNA-based COVID-19 vaccine can cause mild to moderate side effects. A number of cases of cardiac, gastrointestinal, and psychiatric side effects have been reported as rare side effects associated with the COVID-19 vaccine. This article presents a patient, who after the second injection of the mRNA-based COVID-19 vaccine, immediately developed anxiety, nonspecific fear, and insomnia as the prodromal phase of psychosis. Starting from the second week, the patient manifested delusions of persecution, delusions of influence, thoughts insertion, and delusional behaviour, culminating in the suicide attempt. The duration of psychosis was eight weeks, and symptom reduction was observed only after the gradual administration of antipsychotics over four weeks.

The investigations of the patient did not support any structural changes of the brain, any severe medical conditions, a neurological abnormality, a confusion or a state of unconsciousness or alterations in laboratory tests. Psychosis due to the use of alcohol or psychoactive substances was excluded. The psychological assessment of the patient demonstrated the endogenous type of thinking, and the patient had schizoid and paranoid personality traits strongly associated with schizophrenia. This case indicates a strong causal relationship between the mRNA-based COVID-19 vaccine injection and the onset of psychosis. We intend to follow up this case for possible development of schizophrenia and understand that the COVID-19 vaccine could possible play a trigger role in the development of primary psychosis. Longer-term supporting evidence is needed to estimate the prevalence of psychosis following vaccination with the mRNA-based COVID-19 vaccine.

CASE DESCRIPTION

A 45-year-old single Caucasian male without past medical and psychiatric history visited the outpatient psychiatric clinic accompanied by his parents because of bizarre behaviour and an attempted suicide by hanging in the early morning of the visit day. An outpatient psychiatrist referred him for inpatient treatment due to psychosis and a high risk of self-harm.

There is no family history of mental illness to suggest any genetic predisposition to psychiatric morbidity. There were no perinatal complications or neuro-developmental delays in his infancy. His early life experiences were good; he lived in a full family, as an honest child, without significant traumatic experiences. The patient graduated from secondary school and began working as a worker.

At the age of 20, he was episodically using amphetamine and alcohol when going to nightclubs with friends. The patient is unmarried, single, and does not have children but has been in a close relationship with a woman for 5 years in the past.