Open Access Clinical Practice Article

Asymptomatic COVID-19 Infection Induced First Episode Psychosis: A Case Series

Riyal Das, Aniket Mukherjee, Sujit Sarkhel, Paramita Roy, Amit Kumar Bhattacharyya

International Neuropsychiatric Disease Journal, Page 16-21
DOI: 10.9734/indj/2022/v17i230196

Aims: We presented 3 similar cases of 1st episode psychosis that occurred after Corona Virus Disease -2019 (COVID-19) infection which we treated at our institute’s on going post-COVID-19 mental health clinic, to provide more evidence to the existing literature and to describe whether an asymptomatic COVID-19 infection can also induce psychosis in previously healthy individuals and tried to elaborate the probable etiology and nature of the psychotic symptoms.

Presentation of the Cases: All the 3 cases had COVID-19 infection, few days before their psychotic symptoms started for the 1st time. They didn’t have any history of regular substance or medication use that are known to induce psychosis or any previous history of psychiatric disease or family history of psychiatric disease, without any abnormality in physical examinations and laboratory investigations. All the cases had history of stress which were not overwhelming (except the 3rd case) and were mostly related to COVID-19 infection and pandemic associated social and financial stress. 1st case (54 years, married male) developed delusion of persecution, delusion of reference, 2nd and 3rd person auditory hallucinations, 2nd case (61 years, widower male) developed delusion of persecution, 2nd person auditory hallucination (commanding type), disinhibited behaviour (disrobing in public) and the 3rd case (32 years, unmarried male) developed delusion of persecution and delusional misidentification (Intermetamorphosis). All of them responded well to commonly used antipsychotics within 4 weeks that prompted a diagnosis of Acute and Transient Psychotic disorder according to ICD-10 criteria.

Discussion: This study points out that even an asymptomatic COVID-19 can induce psychosis for the first time in life, where the etiology most probably is the direct effect of the virus itself on brain or the COVID-19 and pandemic related stress which is supported by the fact that factors like family history of psychiatric disease, substance use or medication use or any comorbidity that can induce psychosis were also absent. The psychopathological findings were persecutory delusion and auditory hallucinations with one case having Intermetamorphosis phenomenon which is a rare finding and perhaps a novel finding in post-COVID-19 Psychosis.

Conclusion: All COVID-19 infected individuals should be screened early for appearance of any symptom that raises the suspicion of psychosis. Large studies are needed to ascertain the etiology of post-COVID-19 psychosis.

Open Access Case Report

Very Early-Onset Schizophrenia in a 7-Year-Old Girl

O. Akinjola, T. M. Agbir, A. N. Edeh, O. O. Omidiji

International Neuropsychiatric Disease Journal, Page 1-4
DOI: 10.9734/indj/2022/v17i230194

Schizophrenia most commonly starts during early adulthood but it can emerge during childhood. Pediatric schizophrenia is used to describe schizophrenia occurring before 18 years of age. It can further be categorized into early onset type which occurs prior to 18 years and the very early onset type occurring prior to 13 years.

Miss AD, a 7-year-old female presented to our facility about 1 year ago with a 3-months history of illness. Initially, she stopped communicating with anyone; there was associated social withdrawal, sluggishness and decline in her academics. A few weeks later, she started talking and laughing to herself and 2 weeks prior to presentation, she started seeing strange things in clear consciousness and claiming her classmates were ganging up against her. Her teachers and parents were ignorant of the nature of her illness at the onset and as such, she was maltreated.

At presentation, a diagnosis of very early onset schizophrenia was made and she was commenced on treatment with oral Risperidone which was gradually increased over a period of 1 year of her ongoing treatment to 2mg total daily dosage. Additionally, oral chlorpromazine and Benzhexol were added; she is currently on 50mg nocte and 0.125mg daily respectively. During the course of her treatment, she showed significant improvement but no complete remission, residual symptoms such as starring on-end with occasional talking and laughing to herself persisted.

Open Access Original Research Article

Compensatory Mechanism of Diet Containing Sulphur-Rich Amino Acids in Restoring Neurotoxico-Nutritional Deficits in Konzo Disease Rat Model

Hebinuchi Amadi, Lekpa Kingdom David, Loveday Ese Oghenemavwe

International Neuropsychiatric Disease Journal, Page 22-31
DOI: 10.9734/indj/2022/v17i230197

Introduction: The present study is aimed at assessing the effect of bitter cassava on blood biochemical parameters of konzo disease induced Wistar rats. Nutritional modification with suphur rich amino acids was used as a measure to correct the impact in rats induced konzo disease.

Method:
25 adult male wistar rats were assigned to 5 experimental groups (i) Control n=5, (ii) cassava only n=5, (iii) cassava + animal feed n=5, (iv) cassava + Eggshell + Brown beans n=5, (v) Eggshell + Brown Beans only n=5. The bitter cassava foods were taken by oral ingestion for a period of 4 weeks. The weights of the rats were checked through the experiment and blood samples were taken from each group into EDTA-lined containers and analyses for blood cyanide, methionine and cysteine levels.

Results: There was significant difference in weight and there was a progressive increase in their success rate as against the cassava only group which decreased in their success rate, hence, differs statistically and significantly (p˂0.05) from the control group. It was observed that the cassava fed group had higher blood level of cyanide far above the normal blood reference range (2.60 – 2.90µg/ml) for cyanides, hence, was seen to be statistically significant as compared to that of the control group. The eggshell and brown beans only group showed high blood levels of methionine that statistically differ significantly (p<0.05) from both the control group and the cassava only group. Blood level of cysteine in the cassava plus eggshell and brown beans group differed significant statistically from the control group.

Conclusion: Sulphur amino acids such as methionine and cysteine are essential for detoxification of the residual cyanogens remaining in insufficiently processed cassava roots. Foods such as cereals and legumes as source of sulphur amino acids should be promoted to prevent paralytic neurotoxico-nutritional disease such as konzo among the poor population.

Open Access Review Article

An Appraisal of the Drug Discovery Process in Neuroscience

M. O. Nwokike, S. I. Ghasi, M. N. Ezenwaeze, A. O. Ogbonna, A. C. Ezinwa, C. C. Offor

International Neuropsychiatric Disease Journal, Page 5-15
DOI: 10.9734/indj/2022/v17i230195

The scientific study of the nervous system is a major area for disease and consequently disease management. The use of drugs to treat neurological disease is the backbone of this sphere of therapy. This review will concentrate of the history, process, constraints and novelty of drug discovery for these disorders. It will enhance understanding and contribute to an improved efficiency of the drug development process. The history of drug discovery in neuroscience follows the pattern of other discoveries in civilisation. Solutions obtained by steeping or soaking natural substances comprised the only source of medicines until data-based processes were developed to; remove impurities from, increase the concentration of, and separate active substances from these extracts. In most cases, the development of a new medicinal drug starts when scientists learn of a target that is involved in a natural process thought to be impaired in function for patients with sicknesses such as Alzheimer's disease. Better medicines that are improvements on current medications are further found to have greater value as they offer benefits over existing ones for disease treatment, prevention or alleviation in terms of potency, safety, tolerability, or convenience. Regulatory agencies are set up to ensure conformity to steps and standards for improved safety and efficacy. In accordance with this, neurological drugs have less success rates and take more time to acquire, than do other drug classes.

Open Access Review Article

Cerebral Autoregulation and Cardiovascular Physiology Dysfunction in Traumatic Brain Injury Cases: A Brief Review

Ahmad Yasin, Nabigha Yushatia, Itzar Chaidir Islam, Andi Ilman Agrabudi, Asilah Nurul Qalbi, Widiana Widjaja

International Neuropsychiatric Disease Journal, Page 32-44
DOI: 10.9734/indj/2022/v17i230198

Introduction: Traumatic brain injury (TBI) is one of the leading causes of death and disability in the early years of life. Post-TBI physiological alterations vary across adult and pediatric patients and severity. This disease affects the quality of life of most people. Acute hemiparesis can cause cognitive impairments. It may also impact mood, memory, and decision-making. Furthermore, parasympathetic dysfunction and sympathetic activation appear to contribute to cardiac injury via modulation of the myocardial inflammatory response via acetylcholine receptors.

Purpose: This review aims to explain the neuronal response and cardiac dysfunction after traumatic brain injury cases.

Methods: The review used Pubmed and Google Scholar to search for articles on traumatic brain injury, neuronal response, and cardiac biomarkers. The articles were chosen for their language, publishing, content, exposure, and outcome. The main reference is obtained from up to 79 articles that meet the inclusion requirements.

Results: TBI can cause localized brain injury or diffuse brain injury from physical trauma such as diffuse axonal injury or brain edema. Repeated concussions raise the likelihood of chronic neurological, cognitive, and behavioral issues. Stress-induced catecholamine surges and inflammatory mediator production in response to trauma may also endanger cardiac disturbances. ECG changes in patients with severe traumatic brain injury are associated with cardiac dysfunction. Cardiac enzymes can be used as a diagnostic tool and indicate the patient's prognosis.

Conclusion: Cerebral autoregulation and cardiac physiological responses have a synergistic relationship in maintaining tissue homeostasis in patients with traumatic brain injury. Patients with TBI may experience cardiac dysfunction as a result of the body’s exaggerated systemic response to brain injury.