Approaching differential diagnosis and decisional capacity assessment in the context of COVID-19 conspiracy beliefs: A narrative review and clinical discussion.

OBJECTIVE: COVID-19 conspiracy theories have become widespread since the onset of the pandemic and compound the existing challenges of decisional capacity assessment. This paper aims to review the literature pertaining to decisional capacity assessment in the context of COVID-19 conspiracy beliefs and synthesize a practical approach with an emphasis on differential diagnosis and clinical pearls for the practicing physician. METHODS: We reviewed papers on decisional capacity assessment and differential diagnosis in the context of COVID-19 conspiracy beliefs. A literature search was conducted using the US National Library of Medicine's PubMed.gov resource and Google Scholar. RESULTS: The resulting article content was utilized to synthesize a practical approach to decisional capacity assessment in the context of COVID-19 conspiracy beliefs. Specifically, aspects related to the history, taxonomy, evaluation, and management are reviewed. CONCLUSIONS: Appreciating the nuanced differences between delusions, overvalued ideas, and obsessions while with integrating the non-cognitive domains of capacity into the assessment are crucial to navigating the wide differential diagnosis of COVID-19 conspiracy beliefs. It is important to attempt to clarify and optimize patient decision-making abilities by addressing circumstances, attitudes, and cognitive styles specific to patients with seemingly irrational beliefs about COVID-19.

The sound of music: A rare case of auditory Charles Bonnet syndrome in an elderly male.

BACKGROUND: Auditory Charles Bonnet syndrome describes a rare condition that presents with sensorineural hearing loss, which can result in musical hallucinations. METHODS: A Hispanic man, age 78, with no previous psychiatric history was evaluated at our clinic with a complaint of hearing voices and music. The patient was noted to have received cochlear implantation in his right ear in 2013, due to bilateral sensorineural hearing loss. He had auditometric testing completed in 2013 following the onset of hallucinations. RESULTS: Routine laboratory workup was unremarkable. Computed tomography of the brain revealed mucosal thickening in the left maxillary sinus and mild generalized cerebral atrophy. Over the course of 4 months, treatment with donepezil led to improvement in symptomatology. The Brief Psychiatric Rating Scale score decreased substantially from 15 to 6 over an 8-week period. The Clinical Global Impression-Severity scale score decreased from 4 to 2 and the Clinical Global Impression-Improvement scale score increased from 0 to 1 over the same period. CONCLUSIONS: Auditory Charles Bonnet syndrome should be considered in patients endorsing auditory hallucinations with hearing loss in whom the etiology is not clearly due to a psychiatric condition. The role of acetylcholine requires further elucidation; however, donepezil demonstrated efficacy in the treatment of musical hallucinations in our patient.