文摘

post-COVID-19时代引入了小说的精神并发症的情况下有机或纯粹的心理本质上由于社会隔离。这份报告详细的最近诊断为强迫症(OCD)和精神分裂症后COVID-19大流行。这个案例的新颖性在于病人的症状出现在COVID-19流行的背景下,未经诱发的风险环境、社会、或生物方面。我们提供了治疗病人在住院治疗,在检查病人破译他的症状的根本原因。虽然有大量的数据表明强迫症COVID-19大流行期间的急性加重普通人群和一个新的精神分裂症的发病由于病毒本身,很少有人了解强迫症或精神分裂症的患病率在大流行。有鉴于此,我们希望能提供更多的信息关于最近诊断为精神病和强迫症在青少年人群。需要大量的研究和数据在这个子集的人口。

1。介绍

冠状病毒病2019年(COVID-19)大流行改变多少个人如何交互的社会人。在高峰期间,COVID-19大流行导致了广泛的社会隔离。大多数的孩子和青少年早期受到这种隔离在关键时刻在他们的社会成熟1]。尽管并存病的老年人更容易发展严重的物理COVID-19并发症,儿童和青少年不得不忍受生物心理社会压力带来的大流行作为他们的日常工作是意外中断(2,3]。

研究表明,隔离和预防策略,如隔离,导致抑郁、焦虑、情绪障碍、睡眠障碍、创伤后应激症状(4]。类似隔离的措施到位COVID-19大流行期间被证明是有害心理健康(5]。此外,研究有关生物心理社会压力带来的COVID-19抑郁,焦虑,无助,担心,恐惧,注意力不集中,抱住,担心,和易怒5- - - - - -7]。一般成年人,研究发现增加精神健康疾病大流行期间,年轻和食不果腹的成年人(风险更高8- - - - - -10]。额外的风险因素包括独居,先前存在的心理和身体健康状况,生活在贫困地区,作为一个少数民族,女性的性别(11]。

除了抑郁和焦虑性症状带来的大流行,病毒本身也与罕见的神经精神并发症(12]。此外,多个案例报告提到最近诊断为强迫症的出现在这两个青少年和成年人,在既存的强迫症COVID-19大流行期间的急性加重(13- - - - - -16]。但是,只有一小部分案例报告已联系COVID-19感染精神病在成人和青少年17,18]。尽管越来越多的文学最近诊断为强迫症在大流行期间,大流行和最近诊断为精神疾病之间的联系仍知之甚少。儿童精神分裂症的发病率小于0.04%,还有信息不足最近诊断为儿童精神分裂症后COVID-19大流行在青少年。

这种情况下报告提出了一个14岁的青少年男性最近诊断为强迫症和精神分裂症后COVID-19流行文学提供洞察力和提供信息,协助未来的管理和指导进一步的研究。

2。医院的课程

病人是一个14岁的白人男性,定居在家里与父母,21岁的哥哥,和19岁的妹妹,与帕拉参加普通类9年级,不知道过去的病史和过去的精神病史的注意缺陷多动症(ADHD)最近被诊断出他的神经学家,他是由他的父母的精神急诊室评估怪异行为。

在评估病人的走向房间,他指出是在自言自语。经评估,病人没有急性窘迫,醒着,警惕,和面向自我,地点和时间,适当培养,平静,规避与评价。患者出现焦虑和坐着他的双手交叉在整个评估。他的影响是平的。在评估病人很少言语,经常用拇指向上或向下试图回答问题。他有一个具体的思维过程和思维贫乏和认为阻塞,通常在几分钟前回应一个问题。当问及他在学校最喜欢的科目,他说“什么”,有相同的响应为爱好,兴趣和未来的计划。当问及原因病人的演讲中,他说“为了安全。“推动进一步的时候,他说“因为我有“然后停止了交谈,拒绝回答尽管鼓励。病人报告说他每晚睡7小时左右,而当要求,他说从8点到6点,当再次要求计算的小时数,他说“13日”表示关注困难和简单的数学水平低于预期他的年龄。 The patient denied any emotional, verbal, physical, or sexual abuse. He denied auditory and visual hallucinations although at times appeared to be responding to internal stimuli, speaking to himself. The patient denied suicidal ideation, homicidal ideation, intent, or plan. He denied using nicotine, alcohol, marijuana, and illicit drugs.

获得了抵押品的历史从病人的母亲,陪同病人到医院。她说,病人一直发展的里程碑,没有困难。报告的病人曾经是“正常,有点安静的孩子。她报告说,他参加一个特许学校没有投诉,COVID-19大流行开始时,他不得不在家做学校远程。在此期间,他的母亲注意到病人已经成为“germaphobic”,反复洗涤,拒绝离开时没有面具,尽管鼓励限制被解除。她说他会在一天中多次反复洗手,说他会花接近一个小时每天洗手。COVID-19后他回到他原来的学校,发现更害羞,更少的社会,和更少的互动比他以前的大流行。病人然后转换到另一个学校,并指出继续各自为政的情况,比他之前的大流行。他母亲报道,病人只会站在一个角落里,坚决拒绝,避免接触人群。她报告说,学校提供了一个个性化的教育计划(IEP)和对位; the IEP was refused, and the para was accepted despite the patient’s resistance. The mother reported that in September of 2022, the patient lost a relative whom the patient was very close with very unexpectedly, unrelated to the COVID-19 pandemic. She reported that since then, the patient had been declining in functioning. He had become almost nonverbal even with his long-time friends. He was noted to get up and dance in the corner of the classroom in the middle of class last week. The patient had also started self-urinating. His mother first noticed small stains on his underwear, but one week before admission when riding the subway, the patient fully urinated on himself without appearing to feel bothered or embarrassed. She also reported that the patient had stopped showering. He had started having “counting tics,” constantly counting under his breath. She reported that he continued to have fair sleep and appetite throughout this time. The mother stated that the patient had been recently evaluated by a neurologist who did an electroencephalogram (EEG) which resulted as normal and was then diagnosed with ADHD and prescribed Vyvanse 20 mg PO daily, which she had not been giving to the patient as she did not agree with the diagnosis of ADHD. She denied the patient using any drugs or alcohol, to the best of her knowledge.

7周的病人住院儿童和青少年精神病学单位由于急性混乱的行为,无法参与活动的日常生活(ADLs)。常规的命脉和实验室被整个住院治疗。头部CT拍摄于入学排除潜在的有机引起患者的行为,并没有注意到急性或慢性异常。头部MRI随后采取和导致了基本正常MRI的头,用一把小松果体囊肿(0.6厘米)的临床意义。病人被发现有一个被动的莱姆免疫球蛋白41 kDa乐队没有临床意义。病人没有明显的痛苦在住院治疗。基于病人的混乱行为如小便自己跳舞在类和负面症状,扁平的影响,观察到失语症,导致扰动在自我保健的能力以及在学校环境一段时间大于6个月,患者被发现符合dsm - 5标准精神分裂症。病人也符合强迫症的标准,基于他的野心是经常洗手大约一个小时每一天,以及避免触碰门把手在回应他的恐惧细菌COVID-19大流行后,差的洞察他的症状。在住院病人有时会承认他害怕去触碰门把手由于害怕COVID-19流行相关细菌的蔓延;在其他时候,他拒绝承认或回答问题相关的强迫性洗手,避免门把手。 The patient was given a dual diagnosis of OCD and schizophrenia. The patient was placed in a supportive structure, milieu, and individualized as well as group therapy. The patient was started on risperidone which was initially started at 0.5 mg at bedtime for disorganized behavior, lorazepam 0.5 mg PO daily for anxiety, and sertraline which was started at 25 mg PO daily and increased after 7 days to 50 mg PO daily for OCD. The patient showed improvement without side effects to treatment. At first, the patient continued to maintain bizarre, disorganized behaviors, such as pacing the same 4 steps in the hallway throughout the day, refusing to open or close doors, dancing in the middle of class, and urinating on himself without appearing to feel distressed or uncomfortable. As a result, medications were titrated, namely, risperidone, which was increased to 0.5 mg PO BID after 7 days; however, these behaviors continued at this dosage. Risperidone was again increased to 1 mg PO BID after another 5 days, and the patient appeared to respond to this dose of medication. As time progressed, with titration of medication and continued structure and therapy, disorganized behaviors such as dancing in the middle of class, repetitive pacing, and self-urinating ceased. However, the patient was never able to provide an explanation for why these behaviors took place aside from “I wanted to” or why these behaviors ceased (“I don’t want to anymore”).

放电时,病人的思维过程仍很大程度上混凝土。他继续回答问题实事求是地和显示与抽象思维困难,他的行为或提供理由。然而,他的行为有所改善。他很平静,合作,更有组织的在他的思想和行为。精神运动活动是在正常范围之内。演讲是犹豫和低速度,节奏,和体积,但自然,而承认当演讲非自发。病人适当地与同事和员工互动。睡眠和食欲都是公平的。病人感到舒适的自己打开和关闭的门,而承认当他不会碰任何门把手,以免细菌。病人当时面向未来的排放和期待花时间与家人和朋友在学校。 The patient was able to care for his ADLs in an age-appropriate fashion. He denied current or past suicidal intent/homicidal intent/auditory and visual hallucinations. Impulse control was good. Insight and judgment were fair. At the time of discharge, his parents did not believe that the patient continued to be a danger to himself or others, and they were comfortable at this time for the patient to be discharged back to his home and follow up with psychiatry as an outpatient. Discussions with parents throughout the hospitalization indicated that the patient had returned to baseline since the COVID-19 pandemic; however, they indicated that before the pandemic, the patient had shown no signs of psychiatric illness. Per his parents, the patient previously interacted with his peers appropriately, met all developmental milestones, and was doing well in all classes. They adamantly denied any family history of psychiatric illness and denied any substance use history in the patient to the best of their knowledge. The patient also denied any substance use history, and toxicology screens obtained in the hospital resulted as negative. As any underlying medical causes have at this point been ruled out, we can assert with reasonable confidence that this patient presented with a primary case of new-onset schizophrenia and new-onset OCD following the COVID-19 pandemic.

3所示。讨论

目前的案例说明了早发性精神分裂症和强迫症患者之前没有精神病史或家族史的精神疾病。精神分裂症可分为早发性精神分裂症(EOS)发生在13至17岁的青少年和早发性精神分裂症(VEOS)礼物或之前12岁(19]。

前病人符合所有相应发育里程碑的起始COVID-19大流行。COVID-19大流行开始时,病人开始变得更加孤僻,证明重复重复洗手等行为。病人最终拒绝离开家没有面具后的波大流行。病人成为非语言向他的家人和朋友但是最终开始有混乱的演讲代表认为阻塞和非自发“事实上”时尚和混乱思想。混乱的行为开始当病人回到学校后峰波COVID-19大流行。他开始在教室里跳舞,最终开始小便自己和停止洗澡。病人无法参与活动的日常生活。初步评估排除有机成因包括脑电图的神经学家,头部CT和MRI和实验室评价包括药物分析。病人最初被诊断为ADHD的神经学家,但进展和恶化的症状,诊断了强迫症和早发性精神分裂症。自闭症谱系障碍被排除由于发病的年龄、症状的程度,没有之前的历史发展迟缓,直到这一点。 The patient was able to reach his baseline through the current medication regimen with scheduled outpatient follow-up. The patient began to vocalize more, and his disorganized speech improved slightly, although he was never able to reason his behaviors and continued to show difficulty with abstract thinking. The pandemic itself became a risk factor for either enhancing or developing psychiatric illnesses within the child and adolescent population, who are vulnerable to such drastic changes in their social environment.

儿童和青少年的心理健康影响主要通过高暴露COVID-19流行病[产生的生物心理社会压力20.]。日常生活常规和社会隔离的破坏学校环境和同伴,和无法理解的后果大流行,使许多儿童和青少年经历压力(7]。在儿童和青少年,压力可能表现为焦虑、易怒、失眠、紧贴行为与情绪困扰的经历社会隔离和亲戚在大流行期间的死亡21]。病人经历了社会隔离当他开始远程学习。这是母亲第一次注意到强迫性行为的症状和体征。在医院,病人的诊断从ADHD强迫症和早发性精神分裂症。先前的研究显示,经常发现强迫症患者在他们的首发精神分裂症的年轻人21]。然而,最近的研究显示,大部分青少年精神分裂症患者还患有强迫症(22]。病人的资料支持最近的文献发现被诊断出患有早发性精神分裂症和强迫症。

在最近几年,已经有病例报告说明最近诊断为躁狂和精神病与无症状的青少年COVID-19感染(23]。假设在这些情况下,COVID-19感染可能引发或加剧了这些患者的精神病和狂躁23]。有一些混淆变量在这些案例报告,包括之前精神历史和滥用药物。目前尚不清楚这些报道如果最近诊断为精神病躁狂和被COVID-19引发感染或生物心理社会压力大流行。然而,这些病人都能够稳定和奥氮平出院。在目前的情况下,病人没有之前COVID-19感染病史或精神病史。有最小的混杂变量可以解释病人的最近诊断为精神症状。根据病人的父母,病人符合所有发育里程碑整个童年,他才开始有症状的大流行。他的症状开始重复洗手和发展混乱的行为和思想。病人能够稳定和放电对利培酮、氯羟去甲安定,舍曲林治疗方案。

有类似强迫症和精神病的报告演示在青春期COVID-19大流行期间(13]。在这种情况下报告,病人也没有之前的精神病史但有积极的尿液药物样品大麻。患者类似的强迫性行为如重复清洁家里,没穿衣服在他的卧室之外,自杀意念,幻听13]。继续隔离,恐惧和焦虑,COVID-19流行带来的一个重要因素,患者的症状恶化。表示当前案件报告中这是类似的生物心理社会压力大流行起了作用在发展中最近诊断为强迫症病人行为和无组织的行为和思想。所不同的是,滥用药物的病人没有历史或积极的尿液药物屏幕。病人也从未表示自杀意念。目前还不清楚如果幻听病人经历过,因为他不会以简单明了的方式回答问题,表现出抽象思维。此外,病人的精神症状持续恶化,即使他能够上学。

研究表明恶化的强迫症患者过去的精神病史的COVID-19流行超过一半的患者有恶化的症状在此期间(24]。然而,仍有有限的研究如何COVID-19流行影响了最近诊断为精神疾病的发展在儿童和青少年没有之前的精神或物质滥用的历史。当前的案例说明了大流行可能发挥了直接作用在精神疾病的发展或增强一个14岁的青少年男性和表明,这种人口是风险的发展最近诊断为精神疾病流行带来的压力。

4所示。结论

当前情况报告强调的出现在一个青少年强迫症和精神分裂症COVID-19大流行的时期。与社会障碍和距离减少和个人慢慢的适应新的postpandemic环境,我们可能会看到一个潜在的精神评估。然而,很少有研究和评价研究的精神病或强迫症在post-COVID-19时代,尤其是在儿童和青少年人群。因此,筛选协议在初级保健设置应该增加。虽然我们目前的情况下,我们无法确定是否精神病或晚早些时候发现在病人的课程在住院的时候,它是有趣的,看看各种心理社会因素可能影响病人的当前的演示,最终看到了进展回到患者的基线通过结构化的治疗和药物治疗。随着越来越多的情况下,像这样的,被发现,我们将能够容易识别并可能防止这类疾病的恶化。通过强调筛查项目的重要性在初级保健和社会设置,如在学校,我们希望增加诊断精神疾病的发病率在上述亚型的人口。

5。限制

限制这种情况下报告包括缺乏跟踪症状的严重程度和发展的开始大流行和跟踪发展里程碑达成的病人在症状出现之前。进一步限制包括病人的不情愿在自我报告所有的症状,因此病人的症状需要观察与有限的历史。

的利益冲突

作者宣称没有利益冲突。