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By downloading this file, you are agreeing to the publisher’s <a href="https://www.psychiatrist.com/terms-of-use">Terms & Conditions.</a></p><p class="tag">Case Report</p>   <h1 class="article-head">Panic Attacks in the Presentation of COVID-19</h1>   <div id="article-byline"> <div class="author"> <p><span class="bold"></span> Tej Joshi, BA, and Rita Suri, MD</p> </div> <div id="publish-date"> <p><span class="bold">Published:</span> November 21, 2024</p> </div> </div>  <div id="articlecontent" class="whitelistip full_article" data-jr="case report" data-pdate="20241121" data-type="pcc" data-sm="24cr03714"><hr><div class="for_mobile"></div><p><strong>P</strong>atients with COVID-19 have been shown to present with higher levels of depression, anxiety, and posttraumatic stress symptoms compared to healthy controls.<sup>1 </sup>Social isolation, limited health care resources, and proinflammatory states have all been postulated as potential contributing mechanisms that can impact mental health.<sup>2 </sup>Uvais<sup>3 </sup>described a patient who developed persistent panic disorder and hypertension that began during a COVID-19 infection. Bhatia et al<sup>4 </sup>reported new-onset panic disorder precipitated by frequent hearing of news of the COVID-19 infection outbreak. We describe a case of panic attacks that occurred repeatedly as part of the constellation of presenting symptomatology for an individual during 2 separate COVID-19 infections.</p> <h3>Case Report</h3> <p>Mr A was a healthy 22-year-old Asian man with no prior psychiatric history who in July 2022 developed the sudden onset of sweating, lightheadedness, fear of losing control, depersonalization, and feelings of dread and doom that peaked within 30 minutes, with residual anxiety that persisted for 2 hours. Over the next couple days, he experienced 2 additional similar episodes, with more minor symptoms that lasted 10 minutes. A telehealth evaluation determined that Mr A met diagnostic criteria for panic attacks, and lorazepam 0.5 mg as needed was prescribed. Three days after the first panic attack, he developed a runny nose and fatigue. The next day Mr A, who had received his third COVID-19 vaccine in November 2021, tested positive for COVID-19. He began treatment with Paxlovid. No subsequent panic attacks occurred.</p><div class="gad-square"> <div class="g-ad-apart boder-x mb-4 "><div class="gad-horiz"><div id="ad-Ros_Mid_Content_1"> <script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script><script>googletag.cmd.push(function() { googletag.display('ad-Ros_Mid_Content_1'); }); </script> </div></div></div></div> <p>In December 2023, Mr A, who had remained free of panic attacks for 18 months and received his fourth COVID-19 vaccine in June 2023, developed symptoms of sneezing, runny nose, headaches, body aches, and fever. Five hours after his physical symptoms began, he described feeling as though a “switch went on,” with the sudden onset of lightheadedness, derealization, sweating, and fear of losing control, followed by anxiety, intense worry, and feelings of doom that lingered for an hour. The next day, he continued to have headaches and sniffles and experienced a second panic attack, similar to the night before. Recalling his previous COVID-19 infection, Mr A took a COVID-19 test, which was positive. Paxlovid treatment was started, and he had no further panic attacks.</p> <h3>Discussion</h3> <p>Mr A’s panic attacks corresponded to the course of his COVID-19 symptoms, with no further episodes after initiation of treatment with Paxlovid, suggesting that they may have been due to COVID-19. Awareness of panic attacks as presenting symptomatology for COVID-19 may be important in the prompt identification of an infection. Potential mechanisms for early neuroinvasion of COVID-19 include neuronal and nonneuronal cell infection of the olfactory bulb and other cranial nerves.<sup>5 </sup>Olfactory bulb invasion can provide single synapse access to specific areas of the amygdala.<sup>6 </sup>Such a pathway could enable early episodic neuropsychiatric amygdala dysregulation, with the onset of symptoms consistent with sporadic panic attacks during the presentation of COVID-19. These effects may manifest with greater frequency as new severe acute respiratory syndrome coronavirus 2 viral variants explore novel mechanisms of infection, replication, and dissemination within the human body.</p> <h2>Article Information</h2> <p><strong>Published Online: </strong>November 21, 2024. <a href="https://doi.org/10.4088/PCC.24cr03714" target="_blank" rel="noopener">https://doi.org/10.4088/PCC.24cr03714</a><br /> © 2024 Physicians Postgraduate Press, Inc.<br /> <em>Prim Care Companion CNS Disord 2024;26(6):24cr03714<br /> </em><strong>Submitted: </strong>January 31, 2024; accepted April 19, 2024.<br /> <strong>To Cite: </strong>Joshi T, Suri R. Panic attacks in the presentation of COVID-19. <em>Prim Care Companion CNS Disord</em>. 2024;26(6):24cr03714.<br /> <strong>Author Affiliations: </strong>Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California (Joshi); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (Suri).<br /> <strong>Corresponding Author: </strong>Rita Suri, MD, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, PO Box 943, PVE, Los Angeles, CA 90274 (<a href="/cdn-cgi/l/email-protection#32404147405b725f57565c57461c47515e531c575647" target="_blank" rel="noopener"><span class="__cf_email__" data-cfemail="bccecfc9ced5fcd1d9d8d2d9c892c9dfd0dd92d9d8c9">[email protected]</span></a>).<br /> <strong>Relevant Financial Relationships: </strong>None.<br /> <strong>Funding/Support: </strong>None.<br /> <strong>Patient Consent: </strong>The patient consented to publish the report, and information has been de-identified to protect anonymity.</p> </p></div>    <input type="hidden" id="journal_type" value="PCC"> <input type="hidden" id="journal_url" value="https://www.psychiatrist.com/pcc/panic-attacks-presentation-covid-19/"> <input type="hidden" id="journal_title" value="Panic Attacks in the Presentation of COVID-19"> <input type="hidden" id="journal_id" value="57820">  <p style="display: none;">Volume: 26 </p> <p>Quick Links: </p>  <div class="trendmd-sec"> <div id="resultshead"></div> <div id="trendmd-suggestions-page"></div> </div>     <a class="btnRed whitelist-pdf-dwld" id="pdflink" style="display:none" href="https://www.psychiatrist.com/read-pdf/57820" target="_blank"> View This PDF ></a> <div class="buy-now-area"> <div class="btn-group"> <button type="submit" name="add-to-cart" onclick="location.href='https://www.psychiatrist.com/read-pdf/57820'" class="btnRed single_add_to_cart_button button alt">Buy Now </button> </div> <div class="text-cont-p"> <h2 class="price"><span class="woocommerce-Price-amount amount"><bdi><span class="woocommerce-Price-currencySymbol">$</span>40.00</bdi></span></h2> <p>Buy this Article as a PDF</p> </div> </div>   <div class="take-onlin" id="new-refs-section"> <h2>References</h2> <div class="row justify-content-between align-items-center"> <div class="col-12 col-lg-6"> <div class="btn-group"> <button onClick="parent.downloadReferencesNew(); return false;" class="btnRed">DOWNLOAD CHECKED REFERENCES</button> </div> </div> <div class="col-12 col-lg-3"> <div class="btn-group"> <button onClick="parent.checkAllNew(); return false;" class="btnRed">CHECK ALL</button> </div> </div> <div class="col-12 col-lg-3"> <div class="btn-group"> <button onClick="parent.unCheckAllNew(); return false;" class="btnRed">UNCHECK ALL</button> </div> </div> </div> <div class="poll"> <div class="form-check articlecontent_ref"> <label class="form-check-label" for="poll1"> <a href="javascript:void(0)" id="ref1" class="anchor refshaa"> </a> <strong>1.</strong> <span class="targetBlank">Guo Q, Zheng Y, Shi J, et al. 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Effects of odor on emotion, with implications. <em>Front Syst Neurosci</em>. 2013;7:66. <a href="https://pubmed.ncbi.nlm.nih.gov/24124415/">PubMed</a> <a href="https://doi.org/10.3389/fnsys.2013.00066">CrossRef</a></span> </label> <div class="div" id="div" style="display:none; padding:10px; margin:10px 0px 10px 50px; background-color:#DDDDDD;"> <p class="miniabstract abstr"></p> <p class="miniabstract" style="text-align:right;"><a href="#" onclick="top.hideAbstractNew('div'); return false;">Hide Abstract</a></p> </div> </div> </div> </div> </div>  </div> <div class="r-sidebar col-12 col-md-5 col-lg-4 for_desktop" data-sidebar="article"> <div class="textwidget"><div class="widget-area"> <div class="g-ad-apart boder-x"><div class="gad-square"> <div id="ad-Ros_Right_Sidebar_1"><p class="advertisement">Advertisement</p><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script><script> googletag.cmd.push(function() { googletag.display('ad-Ros_Right_Sidebar_1'); }); </script></div> </div></div></div></div> <div class="widget-area"> <div class="m-popular"> <h8>RECENT ARTICLES</h8>  <div class="row" data-id="57896" > <div class="col-12 c-blog-list-single">  <div class="c-blog-list-post blue"> <div class="post-cat-title"> <span class="box-icon"></span> <h7><span style="cursor: pointer;" >CASE REPORT</span></h7>  </div> <div class="c-blog-list-post-cont" role="contentinfo"> <div class="row align-item-center"> <div class="col-12"> <h2><a class="sidebar-story-click" href="https://www.psychiatrist.com/pcc/recurrent-catatonia-radiation-hypothyroidism/" aria-label="Go to page">Recurrent Catatonia Following Hypothyroidism</a></h2> <a class="sidebar-story-click" href="https://www.psychiatrist.com/pcc/recurrent-catatonia-radiation-hypothyroidism/" aria-label="Go to page"><h3>The authors present the case of a 41-year-old woman with schizophrenia, in whom hypothyroi...</h3></a> </div> </div> </div> <div class="c-blog-list-post-info"> <h9> Vincent Zhang and others</h9> </div><br /> </div>  </div> </div> <div class="row" style="background:#e9e9e9"> <div class="col-12 c-blog-list-single">  <div class="c-blog-list-post"> <div class="post-cat-title"> <span class="box-icon"></span> <h7><a class="static-story-event-click" href="/collection/emerging-approaches-in-schizophrenia/" aria-label="Go to page"><span style="cursor: pointer;" >EDITORIAL FOCUS</span></a></h7> </div> <div class="c-blog-list-post-cont" role="contentinfo"> <div class="row align-item-center"> <div class="col-12"> <h2><a class="static-story-event-click" href="/collection/emerging-approaches-in-schizophrenia/" aria-label="Go to page">Emerging Approaches in Schizophrenia</a></h2> <h3><a class="static-story-event-click" href="/collection/emerging-approaches-in-schizophrenia/" style="color:black;font-weight:400" aria-label="Go to page">Stay informed with expert videos from Dr. Phillip Harvey and Dr. Christoph Correll regarding new research in schizophrenia. 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Editor: Dr Andrade’s analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that “individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers” and that “baclofen may be particularly useful in patients with liver disease,” deserves comment.1 First, Andrade failed to recall that the first pivotal trial of baclofen, ALPADIR (NCT01738282; 320 patients, as with Bacloville), was negative (see Braillon et al2). Second, Dr Andrade should have warned readers that Bacloville’s results are most questionable, lacking robustness. Although he cited us,3 he overlooked the evidence we provided indicating that the Bacloville article4 was published without acknowledging major changes to the initial protocol, affecting the primary outcome. Coincidentally (although as skeptics, we do not believe in coincidence), the initial statistical team was changed when data were sold to the French pharmaceutical company applying for the marketing authorization in France. As Ronald H. Coase warned, “If you torture the data long enough, it will confess.” </div> </div> </div> </div>   <div class="modal fade" id="related_articles_modal" tabindex="-1" role="dialog" aria-labelledby="exampleModalCenterTitle" aria-hidden="true"> <div class="modal-dialog modal-dialog-centered" role="document"> <div class="modal-content"> <div class="modal-header"> <h5 class="modal-title" id="exampleModalLongTitle">Related Articles</h5> <button type="button" class="close" data-dismiss="modal" aria-label="Close"> <span aria-hidden="true">×</span> </button> </div> <div class="modal-body"> <div id="trendmd-suggestions"></div> </div> <div class="modal-footer"> <button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button> </div> </div> </div> </div> <div class="modal fade" id="toc_articles_modal" tabindex="-1" role="dialog" aria-labelledby="exampleModalCenterTitle" aria-hidden="true"> <div class="modal-dialog modal-dialog-centered" role="document"> <div class="modal-content"> <div class="modal-header"> <h5 class="modal-title" id="exampleModalLongTitle">Table Of Contents</h5> <button type="button" class="close" data-dismiss="modal" aria-label="Close"> <span aria-hidden="true">×</span> </button> </div> <div class="modal-body"> <div id="sections"></div> </div> <div class="modal-footer"> <button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button> </div> </div> </div> </div> <div class="wordpress_loader" id="JCP_loader" style="display:none;"></div> <div class="pswp" tabindex="-1" role="dialog" aria-hidden="true"> <div class="pswp__bg"></div> <div class="pswp__scroll-wrap"> <div class="pswp__container"> <div class="pswp__item"></div> <div class="pswp__item"></div> <div class="pswp__item"></div> </div> <div class="pswp__ui pswp__ui--hidden"> <div class="pswp__top-bar"> <div class="pswp__counter"></div> <button class="pswp__button pswp__button--close" aria-label="Close (Esc)"></button> <button class="pswp__button pswp__button--share" aria-label="Share"></button> <button class="pswp__button pswp__button--fs" aria-label="Toggle fullscreen"></button> <button class="pswp__button pswp__button--zoom" aria-label="Zoom in/out"></button> <div class="pswp__preloader"> <div class="pswp__preloader__icn"> <div class="pswp__preloader__cut"> <div class="pswp__preloader__donut"></div> </div> </div> </div> </div> <div class="pswp__share-modal pswp__share-modal--hidden pswp__single-tap"> <div class="pswp__share-tooltip"></div> </div> <button class="pswp__button pswp__button--arrow--left" aria-label="Previous (arrow left)"></button> <button class="pswp__button pswp__button--arrow--right" aria-label="Next (arrow right)"></button> <div class="pswp__caption"> <div class="pswp__caption__center"></div> </div> </div> </div> </div> <script type="text/javascript"> (function () { var c = document.body.className; 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