Preexisting Psychiatric Conditions as Risk Factors for Diagnosed Long COVID-19 Syndrome Within Aggregated Electronic Health Record Data.

OBJECTIVE: This study aimed to investigate the frequency of long COVID diagnosis among patients infected with severe acute respiratory syndrome coronavirus 2 with preexisting psychiatric conditions versus those without preexisting psychiatric conditions. METHODS: The TriNetX Analytics platform, an aggregated electronic health record research network containing the deidentified electronic health record data of more than 90 million patients, was queried for patients who were diagnosed with COVID-19 infection based on International Classifications of Disease, Tenth Revision codes. Patients were stratified based on their preexisting psychiatric conditions, and new diagnoses of long COVID were recorded and reported as the primary outcome. RESULTS: Among 1,180,948 patients previously diagnosed with COVID-19, 17,990 patients (1.52%) were diagnosed with long COVID based on the newly implemented International Classifications of Disease, Tenth Revision code "U09: post-COVID-19 condition." After propensity score matching, patients with any preexisting psychiatric diagnosis had a 1.52 (95% confidence interval [CI] = 1.47-1.58) times greater prevalence of diagnosed long COVID within 180 days of infection than patients without preexisting psychiatric diagnoses. Patients with diagnosed anxiety disorders (relative risk [RR] = 1.64; 95% CI = 1.57-1.71), mood disorders (RR = 1.65; 95% CI = 1.57-1.72), bipolar disorder (RR = 1.37; 95% CI = 1.21-1.54), major depressive disorder (RR = 1.69; 95% CI = 1.56-1.83), psychotic disorders (RR = 1.23; 95% CI = 1.06-1.44), and substance use disorders (RR = 1.28; 95% CI = 1.22-1.36) had higher risks for long COVID diagnoses when compared with patients without preexisting psychiatric illness at the time of diagnosis. CONCLUSIONS: Multiple preexisting psychiatric diagnoses are associated with an increased risk of being diagnosed with long COVID after COVID-19 infection.

Three Cases of Reported Improvement in Microsmia and Anosmia Following Naturalistic Use of Psilocybin and LSD.

Cultural awareness of anosmia and microsmia has recently increased due to their association with COVID-19, though treatment for these conditions is limited. A growing body of online media claims that individuals have noticed improvement in anosmia and microsmia following classic psychedelic use. We report what we believe to be the first three cases recorded in the academic literature of improvement in olfactory impairment after psychedelic use. In the first case, a man who developed microsmia after a respiratory infection experienced improvement in smell after the use of 6 g of psilocybin containing mushrooms. In the second case, a woman with anosmia since childhood reported olfactory improvement after ingestion of 100 µg of lysergic acid diethylamide (LSD). In the third case, a woman with COVID-19-related anosmia reported olfactory improvement after microdosing 0.1 g of psilocybin mushrooms three times. Following a discussion of these cases, we explore potential mechanisms for psychedelic-facilitated improvement in olfactory impairment, including serotonergic effects, increased neuroplasticity, and anti-inflammatory effects. Given the need for novel treatments for olfactory dysfunction, increasing reports describing improvement in these conditions following psychedelic use and potential biological plausibility, we believe that the possible therapeutic benefits of psychedelics for these conditions deserve further investigation.

Clinical Presentations and Treatment of Phenibut Toxicity and Withdrawal: A Systematic Literature Review.

OBJECTIVES: This systematic review aimed to identify published articles that evaluated all phenibut toxicity and withdrawal cases to understand better their clinical presentations and treatments. METHODS: A comprehensive literature search was conducted using Medline (Ovid), Embase (Ovid), and Cochrane Library databases to capture all published cases on the presentations and management of phenibut toxicity or withdrawal. RESULTS: Sixty-two cases from 36 studies on presentation and management of phenibut toxicity or phenibut withdrawal were identified. Of all subjects, 80.7% were male. The average age was 30.9 years (SD, 13.2 years; range, 0-71 years). A total of 86.8% reported obtaining phenibut online, and 63.2% reported concomitant substance use with other addictive agents; benzodiazepines and alcohol were the most combined drugs. The average length of hospital stay was 5.0 days (n = 25; SD, 5.4 days; range, 1-25 days) for phenibut toxicity and 7.7 days (n = 20; SD, 7.8 days; range, 0-30 days) for phenibut withdrawals. The most common symptoms reported during phenibut toxicity were altered mental status, somnolence, psychosis, and movement disorders. Of the phenibut toxicity cases, 48.7% required intubation. Benzodiazepines and antipsychotics were most used to treat phenibut toxicity. For phenibut withdrawal cases, 95.7% reported daily use. The most common symptoms reported during phenibut withdrawals were anxiety, irritability or agitation, insomnia, and psychosis. Sixteen (69.6%) of phenibut withdrawal cases required multiple medications for treatment. Benzodiazepines, baclofen, atypical antipsychotics, gabapentanoids, and barbiturates were commonly used to treat phenibut withdrawals. CONCLUSIONS: The seriousness of presentations, combined with the assortments of medications used for both syndromes, reflects the potential dangers of phenibut use and the need for systematized treatment protocols.

Suicide versus Accidental Death by Autoerotic Asphyxiation in a Patient Receiving Intravenous Ketamine for Depression.

Background: Clinical trials have demonstrated that subanesthetic intravenous ketamine exerts antidepressant effects lasting a week or longer postinfusion, as well as antisuicidal effects starting approximately 4 hours postinfusion and lasting 72 hours or longer. These findings have generated considerable enthusiasm within psychiatry. However, reports of treatment-emergent suicide attempts and completed suicides in some patients receiving ketamine or the ketamine enantiomer esketamine have begun to emerge. Here, we contribute to the small literature on suicide-related adverse events and ketamine with an unusual case of a patient who died either by suicide or accidental death via autoerotic asphyxiation approximately four days after a ketamine infusion. Case Presentation. The patient was a 28-year-old man with major depressive disorder, generalized anxiety disorder, panic disorder, obsessive compulsive disorder, autism spectrum disorder without intellectual disability, attention deficit hyperactivity disorder, hypothyroidism, low testosterone, and sleep apnea referred for management of treatment resistant depression. His depression briefly remitted with ketamine, and suicidality briefly disappeared. However, these improvements were short-lived. Four days after his seventh and final scheduled ketamine infusion, the patient was found dead, presumably due to autoerotic asphyxiation. Interestingly, ketamine use has been reported in association with autoerotic asphyxiation. However, given our patient's recent severe suicidality, methods of his past suicide attempts, and family history of suicide, death from suicide seems more likely. Discussion. Here we consider the possibility of whether ketamine may have contributed to the patient's possible suicide, either via a direct worsening of his suicidality or psychological withdrawal following cessation of treatment, given recent concerns about psychological withdrawal's potential role insuicides following esketamine treatment. Conclusions: Though we are uncertain about the patient's cause of death, this case provides an opportunity to highlight important gaps in our understanding of the suicide-related risks of subanesthetic intravenous ketamine treatment for mood disorders and suicidality.