COVID-19 and diabetic ketoacidosis misdiagnosed as primary anxiety: A case report on medical versus psychiatric causes of anxiety.
DOI:
https://doi.org/10.20453/rnp.v84i1.3937Keywords:
Anxiety, diabetic ketoacidosis, coronavirus infectionsAbstract
Anxiety disorders are of great importance in emergency psychiatry, both because of the frequency with which they occur, and because of the relevance of somatic diseases that can underlie an anxious condition. It is imperative to determine, from the initial diagnostic approach, whether the signs and symptoms of anxiety constitute either a response to stress, are manifestations of an underlying somatic pathology, or are explained as symptoms of a specific, primary psychiatric disorder. Currently, the COVID-19 pandemic --in which Peru has had the highest mortality rate in the world—is overwhelming the health services with complex and confusing pictures in which both the symptoms of the viral infection itself, as well as the of anxious reactions and stress responses are combined. On the basis of an illustrative case, in which the medical screening process was deficient and the patient was labeled as a primary case of “anxiety”, with a regrettably ominous outcome, the literature about medical clearance is briefly reviewed, to categorically highlight the importance of a comprehensive and unbiased diagnostic consideration, based on well-developed and substantiated clinical criteria. On the other hand, the psychiatrist nowadays needs to be updated on the forms of psychopathological presentations associated with the symptoms of COVID-19.
References
Glass SP, Pollack MH, Otto MW, Wittmann CW, Rosenbaum JF. Anxious patients. In: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF (eds). Handbook of General Hospital Psychiatry. 7th ed. New York: Elsevier; 2018. pp. 123-139.
Welch KA, Carson AJ. When psychiatric symptoms reflect medical conditions. Clin Med (Lond). 2018; 18: 80–87.
Fava GA, Morphy MA, Sonino N. Affective prodromes of medical illness. Psychother Psychosom. 1994; 62:141-145.
Vega-Piñero M, Jiménez-Treviño L. Trastornos de ansiedad. En: Chinchilla A, Correas J, Quintero FJ, Vega M (eds.) Manual de urgencias psiquiátricas. 2ª ed. Barcelona: Elsevier; 2010. pp. 393-408.
Querques J, Stern TA. Approach to psychiatric consultations in the general hospital. En: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF (eds). Handbook of General Hospital Psychiatry. 7th ed. New York: Elsevier; 2018. pp. 7-14.
Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health. 2020; 16: 57.
Liao TS, Epstein SA. Anxiety disorders. En: Levenson JL (ed.) Textbook of Psychosomatic Medicine and Consultation-liaison Psychiatry. 3rd ed. Washington DC: American Psychiatric Publishing; 2019. pp. 281-304.
Chennapan K, Mullinax S, Anderson E, Landau MJ, Nordstrom K, Seupaul RA, et al. Medical screening of mental health patients in the emergency department: a systematic review. J Emerg Med. 2018; 55:799-812.
Thrasher TW, Rolli M, Redwood RS, Peterson MJ, Schneider J, Maurer L, et al. ‘Medical clearance’ of patients with acute mental health needs in the emergency department: a literature review and practice recommendations. WMJ. 2019; 118:156-163.
Tucci VT, Moukaddam N, Alam A, Rachal J.Emergency department medical clearance of patients with psychiatric or behavioral emergencies, Part 1. Psychiatr Clin N Am. 2017; 40: 411–423.
David AS. Basic concepts in neuropsychiatry. En: David AS, Fleminger S, Kopelman MD, Lovestone S, Mellers JDC (eds.) Lishman’s Organic Psychiatry. 4a ed. Singapore: Wiley-Blackwell; 2009. p.13.
Oyebode F. SIMS Síntomas mentales: Manual de Psicopatología Descriptiva. 6a ed. Barcelona: Elsevier; 2020. pp.521-544.
Hurwitz TA. Psychogenic unresponsiveness. Neurol Clin. 2011; 29: 995–1006.
Janiak BD, Atteberry S. Medical clearance of the psychiatric patient in the emergency department. J Emerg Med. 2012; 43:866-870.
Reddy PK, Kuchay MS, Mehta Y, Mishra SK. Diabetic ketoacidosis precipitated by COVID-19: a report of two cases and review of literature. Diabetes Metab Syndr. 2020; 14: 1459-1462.
Maletkovic J, Drexler A. Diabetic ketoacidosis and yperglycemic hyperosmolar state. Endocrinol Metab Clin North Am. 2013; 42:677-695.
Concepción-Zavaleta MJ, Armas-Flores CD, Plasencia-Dueñas EA, Coronado-Arroyo JL. Diabetic ketoacidosis during COVID-19 pandemic in a developing country. Diabetes Res Clin Pract. 2020; 168: 108391.
Sahoo S, Mehra A, Grover S. Acute hyperglycemia associated with psychotic symptoms in a patient with type 1 diabetes mellitus: a case report. Innov Clin Neurosci. 2016; 13: 25–27.
Sommerfield AJ, Deary IJ, Frier BM. Acute hyperglycemia alters mood state and impairs cognitive performance in people with type 2 diabetes. Diabetes Care. 2004; 27:2335–2340.
Pal R, Banerjee M, Yadev U, Bhattacharjee S. Clinical profile and outcome in COVID-19 patients with diabetic ketoacidosis: a systematic review of literature. Diabetes Metab Syndr. 2020; 14:1563- 1569.
Bojorquez-Giraldo E. COVID-19 in Peru. Indian J Psychiatry. 2020; 62 (Suppl 3): S498–S501.
Vidal-Anzardo M, Solis G, Solari L, Minaya G, Ayala-Quintanilla B, Astete-Cornejo J, et al. Evaluación en condiciones de campo de una prueba serológica rápida para detección de anticuerpos IgM e IgG contra SARS-CoV-2. Rev Peru Med Exp Salud Publica. 2020; 37: 203-209.
Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7: 875-882.
Dinakaran D, Manjunatha N, Kumar CN, Suresh BM. Neuropsychiatric aspects of COVID-19 pandemic: A selective review. Asian J Psychiatr. 2020; 53: 102188.
Huarcaya-Victoria J. Consideraciones sobre la salud mental en la pandemia de COVID-19. Rev Peru Med Exp Salud Publica. 2020;37: 327-334.
RNP is distributed under a 