Coronovirus infection as a novel delusional topic.

Delusional topics tend to rapidly incorporate popular hot topical issues. Thus, the current coronavirus COVID-19 pandemic has rapidly reached delusional themes in patients with psychiatric disorders. Here we present the clinical case of a Spanish woman with bipolar disorder that included coronavirus infection in her delusional themes even faster than the real infection reached mainland Spain.

To the editor:

Although delusional core themes tend to be the same throughout different epochs (i.e., persecution, grandiosity, guilt, religion, hypochondria, love, or jealous), clinicians commonly notice how delusions tend to rapidly incorporate popular hot topical issues (Stompe et al., 2003). Hence, delusions are dynamic and often represent a combination of psychopathology and external events.

The current coronavirus COVID-19 pandemic, expanded to 213 countries over the world with 2,810,325 confirmed cases and 193,825 deaths by April 27 (World Health Organization, 2020), represents the most critical global crisis in recent years and will probably have a social and psychological impact in all our lives. Nevertheless, even before to rise such this critical situation, in the early phase of the coronavirus outbreak, the disease became a topic of global concern across nations with an unprecedented speed of dissemination (Stoye, 2020; Xiang et al., 2020).

Despite, obviously, the focus has been on people infected, and their medical management, which has even required a complete reorganization of many national health services (Legido-Quigley et al., 2020), psychological and psychiatric aspects of coronavirus infection are also being taken into account. Thus, the necessity of appropriate mental health care for health professionals has been pointed out (Chen et al., 2020; Lai et al., 2020), and recommendations for psychological crisis intervention for people affected by COVID-19 have widely emerged (Duan and Zhu, 2020). However, less attention has been paid to the potential worsening of people with previous mental disorders (Yao et al., 2020).

In this connection, psychiatrists have observed how coronavirus has rapidly reached delusional themes, even faster than the infection itself. Here, we present one early case of delusional contents related to COVID-19 infection.

M. is a 41-year-old woman admitted to the psychiatric inpatient facility of Fundación Jiménez Díaz Hospital in Madrid, Spain, diagnosed with bipolar disorder since 2010. She gave her consent to report her case. In a previous admission, in 2011, she exhibited megalomaniac delusions with sexual references. After that, she was stable for eight years. Two weeks before the admission, on 21.02.2020, she dropped the treatment and suffered a relapse consisting of a manic episode with psychotic symptoms. She presented to us with restlessness and dysphoric mood, accelerated and verbiage speech, and a tendency to derailment and tangentially. Sexual disinhibition and inappropriate contact were also shown. Delusional thoughts appeared progressively. Firstly, erotomanic delusional contents were in line with the exalted mood and sexual disinhibition, and afterwards delusions became focused in the novel coronavirus outbreak. She explained in terror she had a sense of unreality and noticed that the world changed around her, people seemed different, behaving strangely. Eventually, she realized that the people who acted differently were actually zombies, infected with the coronavirus. M. thought the world was heading for a zombie apocalypse as what the virus was doing was turning infected people into zombies.

In this moment, M. had no respiratory symptoms, had no fever or any other symptom which may indicate a COVID-19 infection.

These delusional thoughts regarding the COVID-19 appeared in a Spanish citizen, resident in Madrid, on February 21st, 2020. The first case of COVID-19 infection in Spain dated January 31st, 2020, on the Canary island of La Gomera. The first confirmed case in Madrid was declared on February 25st, four days after our patient started to include the novel coronavirus in her delusional contents (MSCBS, 2020). Unfortunately, M. did develop the infection eventually. On March 2nd, she started having fever around 38 °C, and one week later she had shortness of breath. COVID-19 PCR test was repeatedly negative (on March 15th and March 17th) although radiologic pattern suggested COVID-19 pneumonia, in this situation, she was treated as COVID-19 according to our hospital protocols, in March 25th PCR was finally positive and confirmed the infection.

This case report illustrates how the current COVID-19 pandemic affects the pathoplasty of the delusion, as the main topic in this patient was rapidly adapted to current events. As the COVID-19 situation was turning into a matter of concern in the general population, it becomes increasingly included in the delusional contents of patients with psychiatric disorders. In this case, it is of particular interest the speed at which a current topic is included as a delusional thought. There was a 21 days gap between the first declared infection by COVID-19 in Spain and the delusional symptoms presented by this patient. Furthermore, this delusional case appeared in Madrid before the first real case of infection, and even long before than the dramatic current situation in Madrid, with more than 200,000 cases by the end of April and a critical situation overwhelming our Health System (MSCBS, 2020).

Authors' contributions

Santiago Ovejero had the idea of report this clinical case, he made the preliminary draft with the clinical information.

Enrique Baca-Garcia contributed to drafting the first version and literature search.

Maria Luisa Barrigón made the literature search and made the first draft on the basis of the preliminary information.

All authors have reviewed and approved the final version.

Role of funding sources

This case report has no specific funding.

Declaration of competing interest

None.