Transient Psychotic Relapse Following COVID-19 in a Stable Schizophrenia Patient on Paliperidone Palmitate: A Case Report

Schizophrenia is a chronic psychiatric disorder marked by severe disturbances in thought, perception, and behavior. Long-acting injectable (LAI) antipsychotics, such as paliperidone, are widely used to promote sustained remission and ensure medication adherence, especially in patients prone to relapse. However, the COVID-19 pandemic has introduced unique challenges, with studies indicating that infections like COVID-19 may exacerbate psychiatric symptoms through neuroinflammatory pathways. This report presents the case of Ms. X, a 48-year-old Emirati female patient with chronic schizophrenia, who achieved long-term stability on paliperidone LAI at 150 mg monthly. For almost two years, she remained stable with notable improvements in delusional and paranoid symptoms, supported by structured therapeutic care, supportive psychotherapy, occupational therapy, and family involvement. However, in August 2024, Ms. X contracted COVID-19, which triggered a sudden relapse marked by acute persecutory delusions, heightened suspicion, and avoidance behavior, despite ongoing adherence to her LAI regimen. Following her recovery from COVID-19, Ms. X's psychotic symptoms remitted without changes to her antipsychotic treatment, and she returned to her baseline functioning. This case highlights the sensitivity of chronic schizophrenia to physiological stressors such as viral infections, underscoring the importance of vigilant monitoring and comprehensive care during periods of illness. It also contributes to the growing body of evidence suggesting that infections can induce transient yet significant psychiatric relapses in otherwise stable schizophrenia patients, emphasizing the intricate interplay between physical and mental health. This case underscores the complex interplay between physical and mental health in schizophrenia and highlights the need for further research into infection-induced psychiatric exacerbations.