COVID-19 and Catatonia: A Case Series and Systematic Review of Existing Literature

Scheiner, Nathan S.; Smith, Ashley K.; Wohlleber, Margaret; Malone, Challyn; Schwartz, Ann C.

BACKGROUND: Current observational literature on the mental health impact of the COVID-19 pandemic has focused on anxiety, depression, and sleep-disturbance among the public, healthcare workers, and COVID-19 patients. Case reports suggest catatonia and psychosis may be presenting symptoms of COVID-19 disease with a mechanism postulated to involve central nervous system changes in response to inflammation. There is a lack of robust evidence examining catatonia in this context. We sought to systematically review available case data and contextualize our findings. CASE PRESENTATIONS: We present three cases of patients with catatonia seen at a large metropolitan tertiary care hospital in which their catatonia was likely attributable to SARS-CoV-2 infection. Ms. A is a female in her 50s with no psychiatric history who presented with self-inflicted stab wounds following her COVID-19 diagnosis. Ms. B is a female in her 50s with a history of schizophrenia, but no history of catatonia, who presented with akinetic catatonia, SARS-CoV-2 infection, and Clostridium difficile infection, without respiratory manifestations of COVID-19. Ms. C is a female in her 20s with a history of bipolar disorder (type 1) without catatonic features who presented with akinetic catatonia without the physical symptoms of SARS-CoV-2 infection. DISCUSSION: We present a brief review of six case reports detailing co-occurring catatonia and SARS-CoV-2 infection and one case report of catatonia attributed to the psychological stress of the COVID-19 pandemic in a patient without SARS-CoV-2 infection. We note one additional case of co-occurring catatonia and SARS-CoV-2 infection for which details are not available. COVID-19-associated catatonia may develop secondary to psychological and physical factors. Cases often report anxiety preceding catatonic symptoms. Developing evidence also suggests SARS-CoV-2 may act directly on the central nervous system or via a systemic inflammatory response. One of our cases featured significant anxiety preceding symptoms, and two had co-occurring elevated serum inflammatory markers. We suggest that clinicians should keep a high index of suspicion for both clinically significant anxiety disorders and catatonia.