Drawing the Line Between Postacute Sequelae of COVID-19 and Functional Neurologic Disorders: A Daunting Clinical Overlap or Irrelevant Conundrum?

ABSTRACT: Coronavirus disease 2019 (COVID-19) is an acute infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in its multiple variants that classically presents with cough, fatigue, fever, headache, myalgias, and diarrhea. As vaccination becomes widely available and infection rates facilitate herd immunity across the globe, more attention has been given to long-term symptoms that may persist after the index infection, which include impairments in concentration, executive dysfunction, sensory disturbances, depression, anxiety, fatigue, and cough, among other symptoms classified under the umbrella term of postacute sequelae of SARS-CoV-2 infection (PASC).Functional neurologic disorder (FND), also known as conversion disorder and functional neurologic symptom disorder, refers to the presence of one or more symptoms of altered voluntary motor or sensory function that are incompatible with and not better explained by a known neurological or medical condition that causes significant distress and functional impairment. Although the diagnosis of FND may not require the identification of an underlying psychological stressor, being diagnosed with an FND can worsen stigma and shift attention and resources away from other medical concerns that should be concomitantly addressed.This review summarizes the literature on the overlapping nature and discrimination of PASC from FND in COVID-19 survivors. Based on this, we develop a treatment framework that targets unique domains of these complex overlapping presentations, following a multidisciplinary approach with an individualized treatment plan inclusive of physical and psychological interventions focused on functional rehabilitation.

Allotrichophagia: A Unique Case of Parental Adjustment to Filial Pediatric Malignancy.

A 36-year-old Hispanic female patient with gastrointestinal symptoms and weight loss was found to have a trichobezoar in her stomach requiring a surgical removal. Psychiatry team was consulted due to concerns for depression and trichotillomania. The psychiatric evaluation revealed that the patient was not ingesting her own hair - the most common instance in cases of trichotillomania and trichophagia, but her daughter's hair. The patient was doing this as an unconscious, spontaneous response to her daughter's manifest hair loss caused by daughter's malignancy and treatment thereof. The patient was given a diagnosis of Adjustment disorder and treated as such, as the patient's symptoms resolved with her daughter's remission. The patient's cultural background was taken into consideration and the team explored cultural factors that could have mediated such a response. The team also explored the psychodynamic aspects of this case in order to attain a more comprehensive understanding of this patient's unique presentation. To best describe this unusual behavior, we coined a term for such a phenomenon - allotrichophagia (Greek: eating others' hair).

Folie a Deux: Shared Psychotic Disorder in a Medical Unit.

INTRODUCTION: A shared psychotic disorder is a system of delusions shared by two or more individuals. Shared psychotic disorders typically develop in pairs or groups with a close relationship who are socially isolated. The function and affect of those inflicted with shared psychotic disorders usually remain intact. For these reasons, a shared psychotic disorder is seldom identified, diagnosed, and treated. This case describes a shared psychotic disorder incidentally discovered in a medical unit. CASE: The patient was a 47-year-old woman with no known past psychiatric history who had been medically admitted for gastroenteritis. On the day of discharge, a psychiatric consult was requested for "paranoia and bizarre behavior." The patient was seen making statements that she needed security and the FBI to escort her as she left the hospital. Another person in the patient's room was discovered to be the patient's mother who had been staying with her in the hospital. Evaluation of the patient along with observation of her mother revealed that the two shared a complex system of delusions revealing a diagnosis of shared psychotic disorder. Discussion. A shared psychotic disorder is a unique psychiatric diagnosis. It may be even rarer to diagnose in the inpatient medical setting because multiple individuals from a shared system are typically not seen. In this case, the patient and her mother had multiple clinical characteristics of a shared psychotic disorder, including an enmeshed relationship and social isolation. The treatment for shared psychotic disorders involves separation of the individuals and pharmacotherapy with antipsychotics. This case also presented a unique ethical dilemma as the psychiatric team was called to evaluate a patient and found a patient and another individual to have symptoms. CONCLUSION: A shared psychotic disorder is important to consider on the differential when cases of psychosis with delusional systems are seen on medical floors.