Altered oculomotor signatures of emotional conflict and valence processing in late-life depression.

The differential diagnosis of acute psychiatric symptoms in adolescents often requires navigating complex presentations that include biological predispositions, substance use histories, and potential underlying medical conditions. Recent literature has increasingly highlighted how systemic physiological stressors, such as Coronavirus Disease 2019 (COVID-19), can produce profound neuropsychiatric complications, including delirium with severe agitation in pediatric patients. For example, a 2022 two-person case series was among the first to identify that COVID-19 could produce delirium with agitation in adolescent patients []. Notably, an adolescent in that case series who also used cannabis was noted to have a longer hospital course, more medications at higher dosages, and more use of five-point restraints than a patient who had never used cannabis. When these novel viral exposures are combined with known risk factors, such as a family history of schizophrenia and daily cannabis use, clinicians frequently arrive at diagnoses like substance-induced psychosis or first-episode primary psychosis. However, the reliance on these established narratives can lead to diagnostic overshadowing in which anomalous symptoms are erroneously attributed to the pre-existing psychiatric diagnosis. This is known as anchoring bias, in which physicians focus on a single piece of information to formulate a diagnosis without sufficiently adjusting to additional information []. The current case study examines the apparent development of anchoring bias in the treatment of a complex presentation that included psychosis, delirium, mania, and catatonia in the context of substance use and COVID-19 infection.