New onset of mania in COVID-19 infection: A report of two cases

Background: Those who have infected with coronavirus disease 2019 (COVID-19), experience a range of symptoms, from mild and self-resolving respiratory illnesses to severe respiratory complications, as well as a range of the emotional symptoms of fear, guilt, anger, or anxiety due to the need of quarantine isolation. Clinical cases with a new onset of psychiatric symptoms in the acute stage or aftermath of COVID-19 have also been described in the literature. The impact of COVID-19 on psychological health across all stages of illness has become an area of interest in psychiatry. Methods: We at Johor Bahru, Malaysia, would like to report two patients without any history of any known psychiatric illness, who had their first manic episodes during the acute stage of COVID-19 infection. Results: Patient A was a 29-year-old married female patient, had a COVID-19 infection which were treated smoothly. But unfortunately, the devastating news of her husband's hospitalization for COVID-19 infection and the death of her sister-in-law due to the deadly virus came on the day of her discharge. Since she developed a picture of a manic episode with as elated mood, irritability, talkativeness, increased energy, decreased need for sleep, spending spree, reckless driving, excessive ideas concerning COVID-19 infection, and excessive sexual drive. She subsequently responded to treatment and was discharged with daily 600 mg of oral lithium carbonate, 200 mg of oral chlorpromazine, and 1,000 mg of sodium valproate Chrono. Patient B was a 31-year-old married homemaker and she presented herself to the emergency department for stage COVID-19 infection and witnessed resuscitation and eventual deaths of several patients diagnosed with COVID-19 infection. She was so frightened that she had become easily distracted, increasingly irritable, and talkative. Having reduced need for sleep at night, she would repeatedly call her friends and family around the clock to check if they had COVID-19 infection. She claimed to have the power to heal bone fractures with naked eyes. Furthermore, she started to see supernatural creatures around her at home. She subsequently responded to daily 750 mg of lithium carbonate and 1,000 mg of amisulpride during a 14-day inpatient stay. Conclusion: We content that our two patients had a new onset of manic episode after COVID-19 infection. We suggest that manic symptoms may have been triggered through an episode of COVID-19.