A man who became manic after being infected with coronavirus got so delirious he confessed to his wife that he used to have sex with men, doctors have revealed.
The unidentified 41-year-old, who was treated at St Thomas’ Hospital in London, also became ‘highly aroused’ and uninhibited, questioning and inappropriately touching nurses tasked with treating him.
He also became obsessed with ‘grandiose ideas’ and tried to smear water on fellow patients as if he were baptising them, medics said in a bizarre case report.
The man was sick with a cough and fever for 10 days before he ended up in hospital and tested positive for Covid-19, which doctors believe triggered unusual symptoms.
He eventually had to be sectioned under the Mental Health Act because he became so out of control.
Describing the experience in his own words after recovering as ‘fascinating’, the man said he thought he was ‘trying to help the doctors as much as I could’.
He added: ‘I began to think that I was part of a TV show, in which I was sent back from the future to save the NHS, and I was curious to see how this would end.’
The doctors said it was possible his episode was the first sign of a condition such as bipolar disorder — but did not diagnose him with that and instead put it down to the coronavirus despite admitting they can’t prove it for certain.
One mental health expert told MailOnline it is well documented that immune system reactions can affect the brain and trigger mania such as what the man suffered, calling his episode ‘bizarre but not extreme’.
There is growing evidence that Covid-19 can affect the brain and nervous system in various ways, the most common of which is losing the sense of smell and taste.
There is growing evidence that the coronavirus, and the body’s immune response to it, can affect the brain and trigger mental health symptoms (stock image of a brain scan)
Writing in the BMJ Case Reports medical journal, Dr Jamie Mawhinney and colleagues said: ‘This is, to the best of our knowledge, the first report of an acute episode of mania or psychosis as a result of SARS-CoV-2 infection.’
The man went to A&E in the early hours of the morning at the London hospital where Prime Minister Boris Johnson was treated for Covid-19.
He had woken in the middle of the night feeling like his ‘brain was racing’ and telling his wife he thought he would die, doctors reported.
He had told his wife about sex he had had with men, ‘mostly’ before they were married, which she had never heard him talk about before.
The man also confessed to other ‘uncharacteristic’ sexual behaviours and became uninhibited and acted inappropriately while in the hospital.
In the report the doctors said: ‘He was loud and highly aroused with sexual disinhibition and overfamiliar behaviour, inappropriately questioning and touching members of staff.
‘His speech was pressured, and his mood subjectively and objectively elevated.
‘His thoughts were grandiose with persecutory elements, and he had persistent strong religious ideas, manifestations of which included attempts to anoint fellow patients with water.
‘He also obsessively wrote down every personal interaction and bodily sensation. He said he found this experience “liberating”.’
The man’s behaviour became so uncontrollable he had to be sedated and was transferred to intensive care and supported with ventilation.
Investigations confirmed that he was positive for SARS-CoV-2 – the virus which causes Covid-19 – but the virus was not found in his spinal fluid, which would have proved it was in his central nervous system and could have travelled to the brain.
After 24 hours on ventilation, he was moved to a ward where his coronavirus symptoms lessened, but mental state remained abnormal.
COVID-19 CAUSES DELIRIUM AND STROKE IN ‘HIGHER THAN EXPECTED’ PATIENTS
Infection with the coronavirus can cause delirium, stroke and nerve damage in ‘a higher than expected number of patients’, a study has found.
Experts from University College London have reported a ‘concerning increase’ amid the pandemic of a rare brain inflammation known to be triggered by viral infections.
Typically seen in children, acute disseminated encephalomyelitis — or ‘ADEM’, for short — affects the both the brain and spinal cord.
The condition — which can follow on from minor infections such as colds — sees immune cells activated to attack the fatty protective coating that covers nerves.
The researchers have warned that clinicians need to be aware of the risk of neurological effects to help early diagnoses and improve patient outcomes.
‘We identified a higher than expected number of people with neurological conditions such as brain inflammation,’ said paper author and consultant neurologist Michael Zandi of the University College London.
The appearance of these conditions, he added, ‘did not always correlate with the severity of respiratory symptoms.’
‘We should be vigilant and look out for these complications in people who have had COVID-19.’
‘Whether we will see an epidemic on a large scale of brain damage linked to the pandemic — perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic — remains to be seen.’
The researchers also found that other neurobiological complications — including delirium, stroke and nerve damage — appear to be associated with coronavirus.
In their study, Dr Zandi and colleagues studied 43 patients — aged from 16-85 — with both neurological symptoms and either confirmed or suspected COVID-19 that were treated at the National Hospital for Neurology and Neurosurgery in London.
According to the researchers, many of the patients did not experience any of the respiratory symptoms often associated with the coronavirus.
Among the cohort, the team identified 10 cases of temporary brain dysfunction with delirium, eight cases of strokes and eight cases with nerve damage.
There were also 12 cases of brain inflammation — with nine of such patients being diagnosed with ADEM.
Under normal circumstances, the London-based team said that they would only see around one adult patient with ADEM per month, on average — but that this figure has increased to at least one patient per week amid the pandemic.
Further studies are needed to identify exactly why some COVID-19 patients are developing neurological complications, the researchers concluded.
‘By day eight, his behaviour had escalated further culminating in a security call and emergency sedation for the safety of himself, the ward staff and other patients,’ the report said.
Psychiatric assessment found features consistent with acute mania – a state of extreme energy and arousal which can be euphoric but lead to violence – and he was detained under the Mental Health Act.
Mania is often conceived as a mirror image to depression, with the two moods associated with bipolar disorder.
The man was transferred to an psychiatric hospital and commenced on regular olanzapine – used to treat schizophrenia and certain types of bipolar disorder.
Twelve days after being sectioned, the patient’s mania finally subsided and he was discharged.
Reflecting on his experience, the man said: ‘I was taken to hospital on the 4th April with what I would describe as the worst headache of my life. At this time, I had been suffering with the symptoms of Covid-19 for over a week.
‘I was in hospital for a total of 20 days with psychosis and mania, which I experienced as fascinating.
‘This may seem strange from an outside perspective, but I was, in my mania, trying to help the doctors as much as I could, while at the same time trying to make sense of my condition.
‘For my family and friends it was frightening. Luckily, they had a lot of support from each other, and from the great team of doctors at St. Thomas hospital.’
On follow-up, doctors revealed the man was slowly being weaned off antipsychotics while his wife said he is now back to ‘his baseline level of function’.
The doctors said they couldn’t rule out the first manic episode of bipolar disorder – which the patient’s sister had been diagnosed with previously.
But it was clear the drastic changes in behaviours started at the same time as his tell-tale coronavirus symptoms.
Professor Anthony S. David, director at the University College London Institute of Mental Health and author of ‘Into the Abyss: a neuropsychiatrists notes on troubled minds’, told MailOnline the man’s condition was ‘bizarre but actually not so extreme’
He said: ‘Psychiatrists talk about hypomania – a mild form of mania with elevated mood and feeling “high” – but mania proper includes delusions, typically grandiose, e.g. that one is god or has special powers, talking very fast, spending money and being disinhibited sexually. So this is what mania looks like.
‘Mania can be triggered by stress, lack of sleep, physical illness, drugs etc – but you have to have a predisposition. This man’s family history is probably relevant.’
He said that doctors are seeing growing numbers of neurological symptoms of Covid-19, but that they usually seemed to be caused by the immune system, rather than the virus itself getting into the brain – although this was possible, too.
Professor David added: ‘Fever on its own disrupts thinking and could be enough to tip someone over into mania, if they were predisposed. A change in sleep-wake cycle is another cause.
‘The immune system can affect the brain – that is why we all feel generally yuck when we have an infection, even if the infection is in another part of the body. Inflammatory chemicals and cells circulate and some can affect the brain.
‘The more specific effect – which is rare but well recognised following other viruses – is that an immune response is triggered and the antibodies end up attacking the person’s brain in an effort to kill the virus – sort of “collateral damage”.
‘Depending where the damage is concentrated, this can cause delusions as well as affecting consciousness, memory etcetera.’
He said some medications being used to treat coronavirus, such as steroids, are known to cause mania and psychosis. The man is not known to have been receiving treatment before his episode began, however.
Doctors pointed out Covid-19 manifests in a number of ways affecting multiple systems – including the central nervous system (CNS).
The coronavirus enters human cells by latching onto ACE-2 receptors on the surface.
Although the lungs are the key site for expressing ACE-2 in the body, it is also found in endothelial cells in the brain. This may provide a route into the CNS.
Previous reports have linked SARS-CoV-2 in the development of viral encephalitis – inflammation of the brain causing delirium, changes in personality and confusion.
Yesterday University College London revealed study findings that the coronavirus can cause delirium, stroke and nerve damage in ‘a higher than expected number of patients’.
Experts from University College London have reported a ‘concerning increase’ amid the pandemic of a rare brain inflammation known to be triggered by viral infections.
Of the patients they studied with altered brain function, none had detectable levels of the coronavirus in the brain or spinal fluid – much like the 41-year-old case report.
This, they explained, suggests that the virus did not directly cause the neurological symptoms and that some complications of COVID-19 ‘might come from [one’s] immune response, rather than the virus itself.’
They said it ‘remains to be seen’ if the pandemic causes an epidemic of brain damage.
