Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 119270

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case Series
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : VR01 - VR03 Full Version

Neuroleptic Sensitivity in Psychotic Patients on Stabilised Doses of Psychotropics during Coronavirus Infection: A Case Series

Published: November 1, 2023 | DOI:
Isha Ahluwalia, Neeta Sagar Bobba, Chytanya Deepak Ponangi, MS Reddy

1. Assistant Professor, Department of Psychiatry, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Nagpur, Maharashtra, India. 2. Research Assistant, Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India. 3. Consultant Psychiatrist, Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India. 4. Consultant Psychiatrist, Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India.

Correspondence Address :
Dr. Isha Ahluwalia,
Assistant Professor, Department of Psychiatry, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Nagpur, Maharashtra-442004, India.


The emergence of the coronavirus pandemic has transformed into one of the significant health crises faced by the modern era. Its effects are not just limited to the respiratory system, but detrimental effects on the cardiovascular and neurological systems are also known to occur. While neurological complications such as encephalopathies and stroke are common, the neuropsychiatric effects are mostly described in terms of psychological effects only. The effect of coronavirus on both the pharmacodynamics and pharmacokinetics of various psychotropic medications remains debatable. The present case series aimed to highlight a rare and novel finding of the occurrence of neuroleptic sensitivity in three patients (three male patients) with psychotic illness who were previously on a well-adjusted dosage of psychotropic medications after they suffered from a coronavirus infection. It is only over the years, in the aftermath of the pandemic, that the serious and long-term neuropsychiatric complications and pharmacokinetic changes associated with coronavirus infection will be realised. Therefore, it is advisable to exercise caution when using higher doses of psychotropic medications, considering the increase in neuroleptic sensitivity.


Coronavirus disease-2019, Neurolepsis, Psychosis, Substance use/ addiction

Case Report

Case 1

A 23-year-old male, a known case of bipolar affective disorder, currently in mania with psychotic features, presented to the Outpatient Department (OPD) with complaints of inflated self-esteem, grandiosity, suspiciousness, and increased energy levels. The patient also had a co-morbid cannabis dependence pattern for the past two years. There was nil significant past medical history. The patient was hospitalised and received six sessions of modified Electroconvulsive Therapy (ECT). He was discharged with complete remission on a regimen of divalproate sodium 1000 mg, risperidone 8 mg, trihexyphenidyl 4 mg, lithium carbonate 900 mg, and lorazepam 2 mg.

After two months, the patient presented with a sudden onset of rigidity in all four limbs, tremors in the upper limbs and tongue, increased salvation, and difficulty in deglutition, associated with autonomic disturbances such as tachycardia and a mild grade fever. Investigations revealed mild leukocytosis (12,000/mm) and elevated creatine kinase levels (2487 U/L). The patient was admitted to the high dependency unit, and all psychotropic medications were withheld. Intramuscular promethazine 50 mg was administered thrice a day over two to three days, leading to gradual improvement in Extrapyramidal Symptoms (EPS). However, on the third day, the patient developed altered sensorium and a decrease in oxygen saturation levels, dropping to 80%. Suspecting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) infection, the patient underwent Reverse Transcription-Polymerase Chain Reaction Test (RT-PCR), High-Resolution Computed Tomography (HRCT) of the chest, and Magnetic Resonance Imaging (MRI) of the brain. The patient tested positive for Coronavirus Disease-2019 (COVID-19) infection, with HRCT Chest findings suggestive of a Coronavirus Disease-2019 Reporting And Data System (CO-RADS) score of 5 (1). The MRI brain study showed normal findings. The patient subsequently recovered from the COVID-19 infection and continued to receive regular follow-up for his psychiatric illness without any complications.

Case 2

A 32-year-old male, known to have a mental and behavioural disorder due to the use of multiple substances (opioids, benzodiazepines, and antihistamines) for the past 10 years, developed opioid withdrawal symptoms, including abdominal cramps, body aches, excessive lacrimation, sweating, opioid craving, and subsequent deaddiction regimen. The patient tested negative for SARS-CoV-2 upon admission from the emergency department. During the hospital stay, he developed suspiciousness and fearfulness, leading to the administration of an opioid substitution regimen consisting of naloxone 0.5 mg plus buprenorphine 2 mg, along with risperidone 4 mg and trihexyphenidyl 2 mg for psychotic symptoms. After an initial stabilisation period of one week, the patient was shifted to a deaddiction centre. Within eight days of being transferred, the patient experienced drug-induced EPS such as severe rigidity, excessive salivation, tremors in both upper extremities, slurred speech, and fluctuating sensorium. All psychotropic medications were immediately discontinued, and the patient received intramuscular injection of promethazine 50 mg, along with oral trihexyphenidyl for three days until the drug-induced EPS improved. Subsequently, the patient was transferred to a high dependency unit, where a repeat RT-PCR test came back positive. The HRCT chest scan showed a CO-RADS score of 4, and the brain MRI revealed old lacunar infarcts (1). The patient was then shifted to a COVID-19 care centre, where patient made a full recovery before being transferred back to the deaddiction centre for further management.

Case 3

A 23-year-old male, a follow-up case of paranoid schizophrenia for four years, presented to the OPD. He has co-morbid cannabis dependence and is being treated with clozapine 400 mg, after two failed trials with antipsychotics. Additionally, the patient was taking aripiprazole 15 mg and fluvoxamine 150 mg as an augmentation strategy for obsessive compulsive symptoms. The patient had been in remission until August 2020 when he contracted asymptomatic COVID-19 infection, which recovered without hospitalisation. The patient continued taking his psychotropic medications during the viral infection. However, during the convalescence period, he visited the OPD due to giddiness resulting in a fall and fracture of his left ankle. The patient also experienced tremors and rigidity in both upper limbs. His vital signs were stable, and there were no autonomic disturbances. After a referral to a neurologist, an MRI of the brain and an electroencephalogram were performed, both of which had normal findings. The patient was advised to gradually taper the dose of clozapine to 200 mg, aripiprazole to 5 mg, and fluvoxamine to 50 mg. Subsequently, his giddiness improved completely, and the rigidity and tremors disappeared. However, patient experienced a relapse in psychotic symptoms, which was managed by slowly optimising the clozapine dose to 200 mg and increasing the aripiprazole dose to 15 mg over the next few weeks.


The emergence of the coronavirus pandemic has transformed into one of the most unprecedented and significant health crises faced by the modern era. Since its first reporting in November 2019 in Wuhan, Hubei Province, China, to its global dispersion over a short span of time, there is a major mortality risk associated with the involvement of the respiratory system, leading to extensive lung damage. It also affects other systems such as cardiovascular, renal, and neurological, leading to a high morbid risk both during post and COVID-19 infection (2).

Various neurological symptoms, including encephalitis, encephalopathies, ischemic stroke, post-viral complications such as disseminated encephalomyelitis, and the peripheral Miller-Fisher variant of Guillain-Barre syndrome, have been observed to occur secondary to the infection [3,4]. This substantiates that the novel virus is neurotropic in nature and has neuroinvasive potential (5). The propensity of the virus to cross the blood-brain barrier can be stated as one of the possible mechanisms of invasion into the brain. The interference of the coronavirus with the pharmacokinetics of drugs might lead to an increase in the adverse effects profile in those who were previously well stabilised on specific doses of psychotropic drugs during and after the period of viral infection (6).

The central nervous system invasion of the SARS-CoV-2 virus has been postulated based on a similar analogy of neurotropism in other coronaviruses such as SARS-CoV-1, Middle East respiratory syndrome coronavirus (MERS-CoV), and OC43. The virus binds to the Angiotensin-Converting Enzyme-2 (ACE-2) receptor, found in the lungs, pericytes, and the smooth muscle cell wall in the brain, through its structural spike protein and replicates with the help of proteases such as Transmembrane Serine Protease (TMPRSS) 11A1B, cathepsin B and L, and spike-like protein furin (7). ACE-2 also has a significant co-expression link with Dopa Decarboxylase (DDC), which is a major enzyme in the synthesis of dopamine and serotonin and may alter these pathways (culprit by association strategy) (8). Alteration in dopamine and related pathways such as the nigrostriatal pathway during coronavirus infection can precipitate EPS in patients who are in remission on psychotropic agents.

The SARS-CoV-2 infection is known to increase D1 and D2 receptors, which in turn increases dopamine, causing downregulation of the immune system (IL-6 and IL-8) via lymphocytes, cytokines, etc. (9),(10). This may lead to a cytokine storm, inducing endothelial inflammation of peripheral vessels, causing a leak in the blood-brain barrier and facilitating the dissemination and entry of the virus into the brain, facilitating more drug entry into the brain (4). In patients who have concomitant substance abuse such as nicotine, alcohol, cannabis, and 2opioids, COVID-19 infection might heighten the immunosuppressive action, implying the possible occurrence of an inflammatory reaction and, therefore, a leakage in the blood-brain barrier. This may further lead to excess free drug entry into the brain (11).

In another interesting hypothesis by Braak et al., neurotropic viruses such as SARS-CoV-2 invade the brain through the olfactory or gastrointestinal route and initiate the neurodegenerative process through alpha-synuclein (known to cause parkinsonian symptoms), which then turns into a promiscuous binder and can be transmitted in a prion-like fashion in the substantia nucleus pars compacta (5),(12). Available literature also suggests that the emergence of COVID-19 infection is associated with altered metabolism in the body, which might increase the entry of free drugs into the nervous system, causing various adverse effects (13),(14).

The present case series aimed to highlight the effects of SARS-CoV-2 viral infection on psychiatric patients who were maintaining symptomatically well on prescribed psychotropic medications without any side effects. The sudden emergence of EPS during COVID-19 infection in cases A and B can be explained through the hypothesis of the probable involvement of increased D2 receptors leading to immune dysregulation and altered metabolism of the body, causing a leaky blood-brain barrier and free drug entry into the brain.

Delayed or long-term effects and reactivation of infection due to coronavirus are not uncommon, leading to readmissions and complications after recent infection. In case 3, the patient developed EPS and giddiness soon after recovery from COVID-19 infection, probably due to the initiation of a neurodegenerative process during viral infection or a possible increase in receptor sensitivity. However, the definitive etiology remains debatable. Furthermore, all three patients were predominantly using substances of abuse, predominantly cannabis and opioids, in a pattern of dependence, which could have in turn led to immunosuppression. Therefore, their use might contribute to both the causation of viral illness and subsequent complications associated with their use.


The aftermath of coronavirus infection will unfold in the years to come. The novelty of the present case series highlights the challenges clinicians might face while treating the neuropsychiatric conditions that arise in the post-coronavirus pandemic. The authors intend to emphasise the need for cautious dosing of psychotropic medication in patients infected with COVID-19 during the pandemic. Slow and step-wise optimisation of psychotropics is advisable in the post COVID-19 era to avoid serious drug-related adverse reactions due to a possible increase in neuroleptic sensitivity.


Prokop M, Van Everdingen W, van Rees Vellinga T, Quarles van Ufford J, Stöger L, Beenen L, et al. CO-RADS– A categorical CT assessment scheme for patients with suspected COVID-19: definition and evaluation. Radiology. 2020;296(2):E97-E104. [crossref][PubMed]
Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and multiorgan response. CurrProblCardiol [Internet]. 2020;45(8):100618. [crossref][PubMed]
Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A. Neurological associations of COVID-19. Lancet Neurol. 2020;19(9):767-83. [crossref][PubMed]
Fiani B, Covarrubias C, Desai A, Sekhon M, Jarrah R. A contemporary review of neurological sequelae of COVID-19. Front Neurol. 2020;11:640. [crossref][PubMed]
Pereira A. Long-term neurological threats of COVID-19: A call to update the thinking about the outcomes of the Coronavirus pandemic. Front Neurol [Internet]. 2020;11:308. Available from: [crossref][PubMed]
Ghasemiyeh P, Mohammadi-Samani S. COVID-19 outbreak: Challenges in pharmacotherapy based on pharmacokinetic and pharmacodynamic aspects of drug therapy in patients with mod- erate to severe infection. Heart Lung. 2020;49(6):763-73. [crossref][PubMed]
Iadecola C, Anrather J, Kamel H. Effects of COVID-19 on the nervous system. Cell [Internet]. 2020;183(1):16-27.e1. Available from:[crossref][PubMed]
Nataf S. An alteration of the dopamine synthetic pathway is possibly involved in the pathophysiology of COVID-19. J Med Virol. 2020;92(10):1743-44. [crossref][PubMed]
Khalefah MM, Khalifah AM. Determining the relationship between SARS- CoV-2 infection, do-pamine, and COVID-19 complications. J TaibahUniv Med Sci. 2020;15(6):550-53. Available from: jtumed.2020.10.006. [crossref][PubMed]
Arreola R, Alvarez-Herrera S, Pérez-Sánchez G, Becerril-Villanueva E, Cruz- Fuentes C, Flores-Gutierrez EO, et al. Immunomodulatory effects mediated by dopamine. J Immunol Res. 2016;2016:3160486. Available from: http://dx.doi. org/10.1155/2016/3160486. [crossref][PubMed]
Pavel A, Murray DK, Stoessl AJ. COVID-19 and selective vulnerability to Parkinson’s disease. Lancet Neurol. 2020;19(9):719. Available from: http:// [crossref][PubMed]
Bilbul M, Paparone P, Kim AM, Mutalik S, Ernst CL. Psychopharmacology of COVID-19. Psychosomatics [Internet]. 2020;61(5):411-27. Available from: http:// [crossref][PubMed]
Dhillon H, Sasidharan S, Dhillon G, Singh V, Babitha M. COVID-19: Neuropsychiatric manifestations and psychopharmacology. Ann Indian Psychiatry. 2020;4(2):226-29. [crossref]
Wei Y, Shah R. Substance use disorder in the COVID-19 pandemic: A systematic review of vulnerabilities and complications. Pharmaceuticals (Basel). 2020;13(7):155. Available from:[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/65308.18688

Date of Submission: May 08, 2023
Date of Peer Review: Jul 20, 2023
Date of Acceptance: Sep 05, 2023
Date of Publishing: Nov 01, 2023

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: May 13, 2023
• Manual Googling: Aug 10, 2023
• iThenticate Software: Sep 02, 2023 (2%)

ETYMOLOGY: Author Origin


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)