Refractoy psychosis after mRNA COVID-19 vaccine

Introduction: The vaccination against SARS-CoV-2 has shown efficacy in decreasing morbidity and mortality. There are several systemic side effects and some neuropsychiatric manifestations described. Case report: A 38-year-old woman was admitted to the Psychiatry of the Conjunto Hospitalar de Sorocaba presenting disorganized behavior and aggressiveness. Six months ago, she received the first dose of the mRNA vaccine for COVID-19 and, around 24 hours later, had systemic adverse effects followed by aggressiveness and delusional thinking of persecutory nature. She had no past clinical or psychiatric reports. Previously, she was perfectly functional. We performed an extensive clinical-laboratorial investigation, and all tests were negatives. Several pharmacological therapies with antipsychotics and mood stabilizers were used, but after more than four months of hospitalization, the improvements observed were just in orientation and behavior, remaining with symptoms of psychosis. Discussion: This is the first report of refractory psychosis after COVID-19 immunization with no improvement of symptoms; there have been related psychoses after COVID-19 immunization. It is suggested that the psychosis occurs by the intense cytokine storm, leading to a high pro-inflammatory status. It is hypothesized that vaccination causes a strong immune response against the SARS-CoV-19; therefore, similarly mechanisms could underlie the psychosis after COVID-19 immunization.