A Case Report on Care-Seeking Type Illness Anxiety Disorder after COVID-19 Infection, 2023, Kasi, Lakshmi S. and Moorthy, Bini

SNT Gatchaman

SNT Gatchaman

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A Case Report on Care-Seeking Type Illness Anxiety Disorder after COVID-19 Infection
Kasi, Lakshmi S.; Moorthy, Bini

This case report highlights the diagnostic challenges presented by the overlapping symptoms of illness anxiety disorder (IAD) and long COVID-19 (LC-19). This case report focuses on a 58-year-old woman with care-seeking type IAD in the context of LC-19-associated symptoms. The patient experienced mild COVID-19 in August 2021. Since then, she has reported an increase in LC-19-associated symptoms, including cognitive deficits, breathlessness, fatigue, and anosmia. Despite largely normal laboratory results, imaging, and physical examinations, the patient’s distress and care-seeking behaviors persisted, resulting in the diagnosis of IAD.

Accurately differentiating between LC-19 and IAD is crucial for appropriate patient care. We discuss the importance of recognizing and treating IAD in patients with LC-19-associated symptoms and the need for further research on the correlation between IAD and both COVID-19 and LC-19.

Link | PDF (Case Reports in Psychiatry)
 
The patient has care-seeking type IAD [Illness Anxiety Disorder] in the setting of LC-19-associated symptoms after experiencing mild COVID-19. LC-19 remains poorly defined due to the wide variation in symptom presentation, symptom timeline, and nonspecific nature of LC-19 symptoms. In literature, LC-19 has been described to persist for a minimum of 4 weeks after the onset of COVID-19. Symptoms can last from weeks to months and can be continuous, relapsing, or remitting. The most common symptoms of LC-19 are breathlessness, fatigue, anosmia, and myalgia. The patient had all of these other than myalgia. Other LC-19 symptoms the patient reported include problems with concentration, “brain fog,” loss of appetite, and ageusia. However, the patient also had many other symptoms, including changes in vision, inability to cook, and feeling unable to drive, which have not been described in other cases of LC-19.
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It is also important to note that patients who experienced severe COVID-19 illness, especially those who were hospitalized or needed intensive care, are at increased risk for LC-19 compared to patients who experienced mild COVID-19, like this patient. While the patient has some characteristics of LC-19, some aspects of her presentation are inconsistent with LC-19.
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In contrast, IAD has much clearer diagnostic criteria, which the patient more definitively meets. The patient demonstrated care-seeking behavior and excessive preoccupation with her health for greater than 6 months despite mostly normal laboratory findings, imaging, and physical examinations. This is consistent with IAD. Furthermore, the patient’s symptoms have significantly disrupted her daily functioning, which is also commonly seen in IAD. While the cause of IAD remains unknown, a major risk factor for developing IAD is having an underlying anxiety disorder such as GAD or PTSD, both of which the patient had.
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The patient declined psychotherapy for IAD, which is first-line treatment.
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IAD -> JFC :banghead:
 
poor woman. as if normal lab findings didnt also happen in LC
However, the patient also had many other symptoms, including changes in vision, inability to cook, and feeling unable to drive, which have not been described in other cases of LC-19.
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Fool. Seems she's read about 3 accounts of LC, i've seen loads of people say they cant cook or do other ADLs & dont feel safe to drive. vision disturbance is really common in ME.

It really pisses me off that these thickos who know nothing get to pronounce over us with such authority.

Edit: to correct an error i made in gender of the author & also i missed out the word 'say' ... "i've seen loads of people say they cant cook". I ahvent seen anyone with LC, i have seen them reporting that symptom
 
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Oh and also, they're serial offenders: Case Report: Somatic-Type Delusional Disorder (2023, poster)

Delusional disorder is the presence of one or more delusions for a minimum of a month. Estimated lifetime prevalence is 0.05 to 0.1% in the general population. Treatment of delusional disorder is psychotherapy and antipsychotic medication. One of the six types of delusional disorder is somatic. Somatic-type delusional disorder is a clinical diagnosis after organic and substance-induced causes are ruled out. We are presenting a case report on a 55-year-old white male patient with somatic-type delusional disorder.
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The patient is a 55-year-old male. He first presented at our hospital ED at age 31 in 1999 for numbness, tingling, aching, and electrical shooting pain from his neck down his fingers. In 2004, was started on several pain medications, including oxycodone and hydrocodone. A neurologist determined the patient’s pain was non-radicular and recommended against surgery.

Later that year, he began experiencing back pain, bilateral lower extremity pain, and “cold feet.” An MRI and x-ray provided no explanation for his pain. He scored highly in the depression, anxiety, hysterical, and hypochondriacal scales on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), indicating somatic characteristics.

Over the years, he saw many physicians for his pain. He received a Spinal Epidural Injection, a steroid injection in the subacromial space, a right shoulder arthroscopic surgery and bilateral Occipital Nerve Blocks and Trigger Point Injections. Nothing improved his pain.

He saw outpatient Psychiatry at our hospital at age 48 in 2016. He was started on medication for Major Depressive Disorder (MDD) in 2017. He returned in May 2021 concerned he had Sporothrix schenckii, a fungal infection. He reported brain fog, inability to concentrate, itchiness, stinging, and feeling bugs crawl on him for the past year. He smoked 1 pack of cigarettes daily and occasionally used marijuana. He denied alcohol and other recreational drug use. He did not have any abnormal physical exam findings, skin lesions, erythematous papulonodular lesions or ulcerations characteristic of sporotrichosis. His fungal culture and work up came back negative. He was frustrated no doctor would diagnose him with Sporotrichosis. He self-treated with alcohol wipes, potassium iodide, and pineapple juice, among other methods, which gave him some relief.
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During this time, the patient had Generalized Anxiety Disorder (GAD), MDD, emotional and physical distress, and depressive lows. He had suicidal ideations, which resolved. He was distressed about being labelled as delusional. He deferred dermatology consult since he feared they would deny he had Sporotrichosis. He felt that he grew apart from friends and family due to the infection. In addition to distress, the delusion cost him a great amount of time. He frequently researched Sporotrichosis and went to drastic measures to self-medicate, which could cause him physical harm. On Mental Status Examination, his mood was depressed and anxious. His thought process was circumstantial and easily distractable. He was alert, oriented, cooperative, with normal speech, fair insight, and fair judgement.
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He was treated with loxapine 10 mg daily and diazepam 10mg, which he adhered to. He was recommended therapy but did not partake in it. Although he did not have significant improvement in his delusions and continues to hold onto his delusions to this day, March 2023, loxapine and diazepam reduced his distress.
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Psychotherapy and medication adherence are challenging in patients with somatic-type delusional disorder since they do not believe they are delusional and do not see why they would need to be treated for delusional disorder.
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Somatic-type delusional disorder often results in patients seeking extensive medical care. The disorder can lead to depression, alienation, and harm the patient. The age of onset of somatic-type delusional disorder is undetermined. Our patient was 31 at the onset of his first delusion and 53 for the second. Somatic-type delusional disorder is a diagnosis of exclusion and a clinical diagnosis. Future research may wish to explore using MMPI-2 to help diagnose and/or assess improvement in patients with this disorder. An antipsychotic and diazepam reduced our patient’s distress but did not change his delusions. This is the challenge with delusional disorder.
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JemPD said:
poor woman. as if normal lab findings didnt also happen in LC
Fool. Seems he's read about 3 accounts of LC, i've seen loads of people they cant cook or do other ADLs & dont feel safe to drive. vision disturbance is really common in ME.

It really pisses me off that these thickos who know nothing get to pronounce over us with such authority.
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Agreed. :thumbup:
 
From the article: "Despite largely normal laboratory tests...

What were the abnormal test results? Presumably they were not significant. Although I had a couple significant immune system test results that were said to be normal, that were definitely not.

And, as had been noted before, regular run of the mill tests for ME, and LC are often normal. Searching deeper has found abnormalities for both ME, and LC.
 
Psychotherapy and medication adherence are challenging in patients with somatic-type delusional disorder since they do not believe they are delusional and do not see why they would need to be treated for delusional disorder.

Spot the flaw in the reasoning.
 
Somehow I keep seeing entirely new terms for the same old stuff. Illness anxiety disorder is a new one for me, although there are several nearly identical series of words amounting to the same idea. Today I saw neuroplastic disorder as a replacement term for Central sensitivity syndrome. I'm pretty sure I saw one or two more in the systematic review on hypnotic treatment for FND. And, oh, look at that, there's another one in another paper from the same authors quoted above: Somatic-type delusional disorder. Because why the hell not?

By now there must be well over 50. Maybe even more. We could even be above 100 at this point. And they're all literally what Humpty is to Dumpty. It's amazing what goes on in, frankly I think this deserves to called mass delusion. Ironically.

It's really wild that this case study is entirely based on the ignorance of the clinicians, and the very definition comes from their own inability to understand, it's illness defined on what the clinicians perceive, not what is happening to the patients. What they don't know simply can't exist. This case is actually very typical of LC, but because of whatever alternative notion they have of LC, they don't see it, while this same old mythical made-up stuff fits the bill as long as you don't think about it for a single second. Amazing. It explains so much about human history that this can go on this late in our development.
 
Delusional disorder is the presence of one or more delusions for a minimum of a month. Estimated lifetime prevalence is 0.05 to 0.1% in the general population.
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I would argue we have clear evidence for the presence of ‘delusional disorder’ under the authors’ definition. On the part of the authors, that is. What is worrying is that we are also seeing clear examples of social transmission through research literature and academia.
 
Sid said:
This abuse will continue until we have a laboratory test.
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or they outlaw bigotry propaganda pretending to be an academic area and just say it is hate speech with nutty manifestos being written to pretend it is justified instead of deluded rantings

there used to be or maybe there still is 'eugenics studies' and specific areas with just as nonsense 'science' pretending to back up ideas of other bigotries being somehow 'justified' by coming up with pretend correlations and fake biased tests. SO there is precedence for people knowing what all of this really is and I do not get why people want to play into the charade 'it's help' my backside
 
Peter Trewhitt said:
I would argue we have clear evidence for the presence of ‘delusional disorder’ under the authors’ definition. On the part of the authors, that is. What is worrying is that we are also seeing clear examples of social transmission through research literature and academia.
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Including the inability for the deluded to see that they are deluded, to insist that they are not. The projection is very strong here. The self-awareness, on the other hand, entirely missing.
 
SNT Gatchaman said:
Oh and also, they're serial offenders: Case Report: Somatic-Type Delusional Disorder (2023, poster)
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what nasty, odious, ignorant (and determined to forever stay ignorant by the looks, seeking out nonsense to ensure they don't have to read science that might get in the way of their making up stuff) pieces of work.

Shouldn't allow people like this into professions like medicine or anywhere there will be people who are basically vulnerable power-wise without supervision from others who are sensible independents monitoring them. ANd I'd suggest some serious training in bigotry issues.

And that's kind because if it were down to me the consequences of their propaganda and decisions over others logged for a court of law where they are held responsible for the cascade of impacts that they cause
 
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