Progressive Neuropsychiatric Symptoms Following Recurrent COVID-19 Infections in a Previously Healthy Adolescent
Table 3
Distinct patient symptoms and differential diagnoses.
Differential diagnosis
Patient symptoms
Obsessive–compulsive disorder
Ego-dystonic intrusive thoughts (with HI) and urges (compulsions) to act out to control intrusive thoughts (not repetitive or ritualistic)
Obsession of recurrent, unwanted, intrusive thoughts that were violent in nature, to self, objects, and others, sometimes sexual (of self), and sometimes religious
Difficult to control compulsions and urges to act aggressively, self-injury, isolate
Moderate improvement with fluvoxamine, worsened with clonazepam
Psychosis
Decreased socialization (prodromal)
Level of functioning impacted—school, martial arts, interpersonal relations, and failure to achieve expected level of performance
Flat affect
Delusions
Ideas of reference
Sensing the presence of an unseen person, “someone reaching out to me”
Anosognosia
Family history of schizophrenia
Age of presentation
Moderate improvement with antipsychotic
Affective disorder
Racing thoughts
Flat affect
Hopeless
Sadness
Intermittent suicidal ideation
Moderate improvement with SSRI
Catatonia
Flat affect
Decreased movement
Decreased engagement with the external environment
Acute onset
Symptoms did not improve with clonazepam (inconsistent with catatonia)