An increasing number of patients have been presenting with neuropsychiatric signs and symptoms associated with coronavirus disease (COVID-19). We present a case of a 69-year-old female with no prior psychiatric history who was brought to the emergency department due to bizarre behavior and paranoid thoughts for four to six weeks, worsening over the last two weeks. Psychiatric evaluation found that the patient had extreme
restlessness and agitation, poor eye contact, paranoid delusions,
visual hallucinations, and a flat affect with stereotypic repetition of speech and loose associations. The patient's family noted that two months prior she had symptoms of
common cold associated with a severe
cough and 20 pounds of
weight loss. Suspicion for prior
COVID-19 infection prompted an
IgG antibody test, which was positive. Our patient displayed at least three of the signs needed to diagnose
catatonia - agitation, rigidity, and
echolalia - and had a therapeutic response to
lorazepam, confirming suspicions of excited
catatonia. Her seropositivity for
IgG against
COVID-19 suggested a COVID-induced brief
psychotic disorder with
catatonia, which makes this the first known case, to our knowledge, of a patient with delayed onset
catatonia after
COVID-19 infection. This suggests that clinicians should, after ruling out more plausible stressors, suspect possible coronavirus involvement in sudden onset
psychotic disorders, especially in patients who do not fit the demographic of new-onset
schizophrenia-spectrum diagnoses. Further research is needed on the pathophysiology behind
COVID-19 altering neuronal function and
neurotransmitter pathways.