University of Wisconsin–Madison Medical College of Wisconsin

Nihilism, Neurocognition, and the Novel Coronavirus: A Case of Acute Onset Cotard’s Syndrome

Caitlin J. McCarthy, MD; Suraj Singh, MD

WMJ. 2023;122(5):377-379

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Introduction: The novel coronavirus (COVID-19) is a respiratory illness that may cause neuropsychiatric sequelae, including persistent psychotic symptoms.

Case Presentation: A 70-year-old White man with no prior psychiatric history presented with altered mental status, Cotard’s syndrome, and rigid delusions of poverty and homelessness 6 weeks after recovering from a mild case of COVID-19. After extensive medical workup revealed no organic etiology, he was treated for psychotic symptoms with an atypical antipsychotic, an antidepressant, and electroconvulsive therapy, with improvement over time.

Discussion: While COVID-19 is primarily a respiratory disease, some individuals may develop new-onset psychiatric or neuropsychiatric symptoms without prior psychiatric history.

Conclusions: To our knowledge, this is the only published case of post–COVID-19 psychotic symptoms treated with electroconvulsive therapy. As the pandemic continues, the total impact of COVID-19 on psychotic symptoms remains to be seen.

Author Affiliations: Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (McCarthy, Singh).
Corresponding Author: Caitlin J. McCarthy, MD, 8701 Watertown Plank Rd, Milwaukee, WI 53226; email; ORCID ID 0000-0002-4553-4829
Funding/Support: None declared.
Financial Disclosures: None declared.
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