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The prevalence of anorexia nervosa has been on the rise. Exploring key factors in treating this condition as well as psychological factors influencing the onset and maintenance of the disorder can increase the chance of treatment success.
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Key Clinical Message: This article emphasizes that patients presenting with COVID-19 infection especially presenting with predominantly gastrointestinal symptoms and a history of eating disorder or even other mental disorders should be evaluated thoroughly and differential diagnoses should be considered. Clinicians should keep in mind that eating disorders may happen after COVID infection or vaccination. Abstract: The emergence and global spread of the 2019 novel coronavirus (COVID-19) have caused a significant mental health burden on communities around the world. Factors related to COVID-19 affect mental health in the general community, but may have more adverse effects on individuals with pre-existing mental illnesses. Additionally with the new living conditions and increased focus on hand hygiene and fear of contracting COVID-19, depression, anxiety, and obsessive-compulsive disorder (OCD) are more likely to be exacerbated. Eating disorders such as anorexia nervosa (AN) have exhibited an alarming increase due to social pressure especially through social media. Also, many patients reported relapses since the commencement of the COVID-19 pandemic. We report five cases of AN that developed or exacerbated after COVID-19 infection. Four patients have newly developed (AN) and one case relapsed after COVID-19 infection. Also, one of the patient's symptoms exacerbated after remission following a COVID-19 vaccine shot. The patients were managed medical and non-medically. Three of cases have reported improvements while two other cases were lost because of poor compliance. It might be possible that people with history of eating disorder, or other mental disorders may be more susceptible to newly develop or exacerbate eating disorders after COVID-19 infection especially when symptoms are gastrointestinal dominant. There is currently minimal evidence on the specific risk of COVID-19 infection in patients with AN and reporting cases of AN after COVID-19 infection could help learn the risk, prevent and manage patients. Clinicians should keep in mind that eating disorders may happen after COVID infection or vaccination.
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Background: Increasing reports of manic episodes in patients during acute infection with COVID-19 have been documented since the pandemic began, including individuals without a previous personal or family history of bipolar disorder. As infections and autoimmunity have putative roles in bipolar disorder, we aimed to document the clinical presentations, associated stressors, family aggregation patterns, and brain imaging and electroencephalographic correlates with a series of patients with episodes of mania that emerged shortly after COVID-19 infections. Methods: We obtained all relevant clinical information from 12 patients whose first manic episode started within a month of COVID-19 infection and were treated at Rasool-e-Akram hospital and Iran psychiatric hospital, two tertiary medical centers in Tehran, Iran, in 2021. Results: Patients had a mean age of 44. The interval between the onset of symptoms of COVID and mania ranged between 0 and 28 days (mean: 16.25, median: 14 days); it was observed to be shorter in patients with a family history of mood disorders but not in those receiving corticosteroids. Alongside a descriptive overview of our sample, we provide detailed narrative descriptions of two of the cases for illustrative purposes and discuss our observations in the context of other cases reported elsewhere and the state-of-the-art regarding infectious diseases, COVID-19, and bipolar disorder as reported in previous literature. Conclusion: Our case series documents observational and naturalistic evidence from a dozen of cases of mania in the context of acute COVID-19, which, while limited, calls for analytical research of the phenomenon, and points at a family history of bipolar disorder and the use of corticosteroids as factors for particular focus.