Treatment of Major Depression with Psychotic Features and Cotard’s Syndrome after COVID-19 Infection in a Previously Healthy Patient: A Case Report

Abstract

Background: COVID-19 pandemic is related to anxiety, depression, and psychotic symptoms either directly due to invasion or inflammation caused by the virus or indirectly due to related psychosocial stress: fear of infection, social isolation, and financial burden. Case Presentation: We present a 28-year-old female case of post‐COVID major depression with psychotic features and Cotard’s syndrome with no previous psychiatric history. Her complaints initially described the sadness of mood with early morning worsening, diminished interest in almost all activities, anhedonia, increased anxiety, ideas of worthlessness, hopelessness, guilt, decreased sleep, and appetite. Then, she developed severe depression with psychotic features such as delusions of persecution, poverty, and nihilism. Nihilistic delusions included a description of everything coming to an end. She thought that her organs were no more working. Later, she negated her existence and started believing that she was dead. The patient recovered after a combination of sertraline and olanzapine treatment. Conclusions: This case of a COVID-19 patient with psychotic depression and Cotard’s delusion highlights the importance of evaluating mental health status and may contribute to our understanding of the potential risk of central nervous system impairment by SARS-CoV-2 infection.