Background/Significance
The Coronavirus Disease 2019 (COVID) is a significant driver of morbidity and mortality worldwide, and, despite the advent of several vaccines, genetic variants and the complexities of population health management threaten to maintain it as such. Data are emerging as to the scope of neuropsychiatric manifestations and sequelae of COVID infection; in terms of severe acute manifestations, delirium appears to be highly prevalent.1 Previous work has suggested that COVID delirium may, by virtue of its etiopathogenesis, present with stereotyped syndromes (eg, with abulia, alogia, rigidity), which may distinguish it from delirium associated with other illnesses.2 Our study aims to elucidate the clinical characteristics of COVID delirium, as compared to non-COVID delirium.
Methods
We conducted an exploratory retrospective chart review using electronic health record (EHR) data from all adults who were admitted to Massachusetts General Hospital and received in-person psychiatric consultation for delirium March – May 2020, grouped by whether or not a current diagnosis of COVID was given. In each group within the cohort, we assessed variables relating to demographics; medical and psychiatric history; medication use prior to admission and in-hospital; vital signs; laboratory and imaging findings; and features of neuropsychiatric examination. Between COVID-status groups, we made multiple comparisons, including of the rates between previously described unique features of COVID delirium to determine whether these features are more common in delirious patients with COVID.
Results
Seventy-three COVID-negative delirious patients and 36 COVID-positive delirious patients were ultimately included in analysis. These groups were not significantly different in sex distribution (∼60% male), median age (mid-60s), or race (mostly white). Those with COVID-delirium were more likely to have come from a skilled nursing or rehabilitation facility (p = .001); to have had a history of psychosis (p = .043) but lower medical comorbidity burden (p = .003); and to have demonstrated myoclonus, hypertonia, withdrawal, akinesia, abulia, and alogia (p < 0.05). They were also more likely to be treated with ketamine (p = .005), PO/TD alpha-adrenergic agents (p = .014), and enteral antipsychotics (p = .007).
Discussion
Confirming prior work, abulic-spectrum features were more common in COVID-delirium than in other deliria.
Conclusions
Our results may facilitate safer and more efficacious management and rehabilitation, and greater understanding of the neuropsychiatry of COVID infection.
References
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1.
Kennedy, M., Helfand, B. K. I., Gou, R. Y., Gartaganis, S. L., Webb, et al. (2020). Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA Network Open, 3(11), e2029540.
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2.
Beach, S. R., Praschan, N. C., Hogan, C., Dotson, S., Merideth, F., Kontos, N., Fricchione, G. L., & Smith, F. A. (2020). Delirium in COVID-19: A case series and exploration of potential mechanisms for central nervous system involvement. Gen Hosp Psych, 65, 47–53.