The COVID-19 pandemic presents symptomatic heterogeneity, so the differential diagnosis is even more relevant and more in patients with mental disorders. COVID-19 is a new disease that is under study and affects people over 65 with the greatest severity worldwide. The most frequent psychiatric symptoms are behavioral disturbances and confusional syndrome among those affected.

The objective is to demonstrate the importance of differential diagnosis in patients with psychiatric symptoms and covid-19.

Patients aged 71 and 77, admitted to psychiatry. They present drowsiness that alternates with episodes of psychomotor agitation in which they verbalize fear of the coronavirus. Personal history: bipolar disorder and schizoaffective disorder. Psychopathological exploration: Spatial-temporal disorientation, uncooperative, fluctuating state of consciousness, verborrheic, salty and incoherent speech at times. Dysphoric mood. Psychomotor restlessness predominantly at night, verbal heteroaggressiveness. Negative to ingestion due to odynophagia. Sensory-perceptual alterations and nihilistic delusions “the virus has killed me, I’m already dead.” Upon admission, they present a cough and fever and are treated with azithromycin and dexamethasone for suspected COVID-19. Complementary tests: chest X-ray bilateral pleural effusion. Cranial CT: Diffuse cortical and subcortical brain parenchyma retraction pattern. PCR positive coronavirus.

After overcoming the infection and with psychopharmacological treatment the confusional syndrome remitted.

Confusional syndrome can present with different psychiatric symptoms, so the differential diagnosis is very important and even more so in patients older than 65 years who present somatic pathologies or acute infections. The differential diagnosis of confusional syndrome is key to adequate treatment and favor the prognosis.

Porencephaly is a neurological condition that can develop before or after birth, characterized by cysts located in any place inside the brain parenchyma, which generally are covered by plain walls and encircled by an atrophic crust. It generates a very variable clinic appearance, with severe cases of high disability and slight cases with a light neurological involvement, which also can go unnoticed until adulthood. The prevalence is unknow and the inheritance is autosomal dominant Male patient of 45 years diagnosed with porencephaly with cerebral palsy that affects left half and cognitive disability. His father reports an emerging defiant behavior, mutism and decrease of appetite from a week ago. No triggering stress factors are reported.

Show the importance of include in the differential diagnose hypoactive confusional syndrome.

On urgent medical visit, male comes with ataxic gates which wasn’t shown before. Inhibited attitude, semiflexed staring at floor, with sparing and monosyllabic speech answers, verbalizing discomfort and personal concern. Sleep-wake rhythm disruptions.

Blood tests and drug screening shows no abnormalities Cranial CT: Without acute lesion Urinary infection observed.

It is important to make complementary test to exclude organic frames which could justify acute-subacute psychopathology. In this case, diagnosis was acute confusional syndrome, however, most known presentation is the hyperactive one which include motor hyperactivity, inappropriate behavior or disorganization and alterations of sensory perception. Hypoactive must always be considered, which is the concluding diagnosis in this case.

No significant relationships.