Virginia Research Day 2022

Medical Resident Research Case Reports

03 Psychiatric Disorder Following COVID-19 Infection

Zonaira Shabbir, DO; Amber Stephens, DO Corresponding author: Zonaira.Shabbir@LPNT.net

SOVAH Health Family Medicine Residency

Context: The COVID-19 pandemic not only affects physical health but also mental health. The current pandemic is changing priorities for the general population and has been challenging the agenda of health professionals. Case Report: A 55-year-old African American female presented as a hospital follow-up for hypertension management. She had been admitted for hypertensive urgency and COVID-19 infection. Initially, management focused on controlling hypertension with close follow-up. At subsequent office visits she reported ongoing panic attacks and was started on anti-anxiety medications with close follow up with the physician and behavioral therapist. She was also referred to a psychiatrist. There was no improvement in her anxiety after multiple medication adjustments. Her mood quickly escalated, developed emotional liability and eventual flat affect. Family note that before the diagnosis and treatment of COVID -19, the patient was able to care for herself without assistance, had good mood, no history of depression, or anxiety. Due to the recent pause in working, her family had reported increased

stress at home due to financial-related issues. Medical Hx: Hypertension. Surgical Hx: Hysterectomy. Family Hx: Hypertension, Diabetes. Social Hx: Divorced, Lives at home with her son, and is independent. Works at a manufacturing factory. Smokes 5 cigarettes per day. No alcohol or illicit drug use. Pertinent Review of systems: Panic attack, anxiety/worry, depression, headaches, nausea, blurry vision, dyspnea. Pertinent Physical Examination: Well- dressed African American female. BP 203/112, HR 65, RR 20, temp 97.3, Sat 100% RA, alert and oriented x3, anxious, hyperventilating, worried, depressed, poor eye contact, tearful and complete flat affect. Diagnosis: New onset uncontrolled hypertension concomitant COVID-19 infection further complicated by new-onset panic

attacks, anxiety, and depression. Treatment: Initiated citalopram with

hydroxyzine as needed for panic attacks with close follow up with behavioral therapist and PCP. Medication changed to venlafaxine with hydroxyzine as needed, and behavioral therapy. Eventual referral to Psychiatry and Neurology due to a sudden worsening in mental status. Comment: There has been an increase in cases of anxiety and depression associated with COVID-19. Many patients with no history of anxiety or depression have experienced low mood and anxiety with the rise of COVID-19 infection and have been initiated on medication/cognitive behavioral therapy. This patient had abrupt onset of panic attacks and anxiety with a quick turnover to severe depression and flat affect. The patient’s mood fluctuated abruptly throughout the course. This leaves health care providers at a crossroad of appropriately managing patient mental health during a global pandemic.

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