Progressive Neuropsychiatric Symptoms Following Recurrent COVID-19 Infections in a Previously Healthy Adolescent

Table 3

Distinct patient symptoms and differential diagnoses.

Differential diagnosis	Patient symptoms
Obsessive–compulsive disorder	Ego-dystonic intrusive thoughts (with HI) and urges (compulsions) to act out to control intrusive thoughts (not repetitive or ritualistic)
	Obsession of recurrent, unwanted, intrusive thoughts that were violent in nature, to self, objects, and others, sometimes sexual (of self), and sometimes religious
	Difficult to control compulsions and urges to act aggressively, self-injury, isolate
	Moderate improvement with fluvoxamine, worsened with clonazepam
Psychosis	Decreased socialization (prodromal)
	Level of functioning impacted—school, martial arts, interpersonal relations, and failure to achieve expected level of performance
	Flat affect
	Delusions
	Ideas of reference
	Sensing the presence of an unseen person, “someone reaching out to me”
	Anosognosia
	Family history of schizophrenia
	Age of presentation
	Moderate improvement with antipsychotic
Affective disorder	Racing thoughts
	Flat affect
	Hopeless
	Sadness
	Intermittent suicidal ideation
	Moderate improvement with SSRI
Catatonia	Flat affect
	Decreased movement
	Decreased engagement with the external environment
	Acute onset
	Symptoms did not improve with clonazepam (inconsistent with catatonia)