Development of Schizophrenia in a Genetically Predisposed Individual Following COVID-19

We present a patient who is a 56-year-old female with a psychiatric history of anxiety disorder and a medical history of hypercholesterolemia and hyperthyroidism, who was admitted to the hospital after a witnessed seizure at an inpatient psychiatric facility. This patient’s family history is significant for her mother experiencing unspecified psychotic disorder that required psychiatric hospitalization. Our patient was first admitted to the psychiatric hospital after exhibiting worsening paranoid delusions and hallucinations that began several months prior. The patient had reportedly begun locking herself in the restroom and screaming “get out, they’re spying on me”, referring to her next-door neighbors whom she began exhibiting paranoia towards upon discharge from her hospital stay for COVID-19. At first, the patient believed her neighbors were “too noisy” during their home renovations, and more recently believed they were infiltrating her mind with “radio waves”. While in the hospital, we increased the dosage of Quetiapine that she was receiving at the inpatient psychiatric facility. To enhance a supportive environment at home, psychoeducation regarding her presentation and management was provided to her nephew. After stabilizing her medical conditions, the patient was discharged back to the inpatient psychiatric facility where she was originally admitted involuntarily. The dual hit hypothesis denotes the significance of genetic vulnerability compounded by environmental factors in the pathogenesis of schizophrenia. Our patient has a genetic predisposition to psychotic disorders based on her mother’s psychiatric history. She later developed a severe case of COVID-19 infection that required ICU-level of care, which has likely served as the environmental insult that instigated the development of a psychotic syndrome. COVID-19 has been shown in recent studies to trigger an inflammatory response and alter the biochemical profile in the nervous system. The long-term and downstream effects of COVID infection, which may include long COVID and psychosis, remain a topic of intense research interest. In the case of our patient, her genetic predisposition to psychosis, coupled with COVID-19 infection, has led to the development of schizophrenia in accordance with the dual hit hypothesis. We are hopeful that further investigation into the relationship between COVID-19 infection and the development of primary psychotic disorders will yield further insights into the pathogenesis of psychosis and post-COVID psychiatric symptoms.