So far, reports of people losing touch with reality after a SARS-CoV-2 infection seem to be extremely rare. Doctors aren’t sure if the virus or something else is to blame, but figuring out whether there’s a link could deepen our understanding of the many ways COVID-19 can affect our health in both the short- and long-term. Here’s what we know so far about psychosis and COVID-19.
Cases of Psychosis in People With COVID-19
On December 28, 2020, the New York Times reported on a number of cases where patients with no history of mental illness experienced psychotic episodes within weeks of getting the virus that causes COVID-19. One person had paranoia that her children were at imminent risk of being kidnapped. Another had hallucinations of monkeys and a lion, and someone else sobbed for days out of fear that “evil spirits had invaded her home.” Doctors told the newspaper that psychosis made some patients extremely violent as well. In addition to news media, medical literature and journals have also described incidents of psychosis in people with the novel coronavirus. In June 2020, Lancet Psychiatry released a study on neurological and psychiatric complications in 153 people who were hospitalized with COVID-19 in the U.K. It found that 39 people had altered mental status, 10 of whom had new-onset psychosis. Other journals have also described cases of new-onset psychosis in people with COVID-19 in Spain and Italy. A January article in Neuroscience Letters, which focuses on “rapid publication of short, high-quality papers” for neuroscientists, looked at dozens of people with possible SARS-CoV-2 infections who had psychosis. Some of the people in the case series had auditory hallucinations, mania, delusions, and acute delirium, among other psychiatric symptoms. It’s important to note that while the risk of psychosis after getting COVID-19 is alarming, current research indicates that it’s extremely rare. “It doesn’t mean it doesn’t need to be taken seriously or investigated, but it’s important to convey to the world that this is not a rampant problem,” says Florian P. Thomas, MD, chair of the department of neurology and the Neuroscience Institute at Hackensack University Medical Center. He also works closely with Hackensack Meridian Health’s COVID Recovery Center.
Investigating the Cause of Psychosis
So far, no large-scale studies on the relationship between COVID-19 and psychosis have been published, making it difficult to determine exactly what’s causing the condition. Some experts believe it may be the result of heightened inflammation related to the virus, says Sheneen Lalani, DO, an internal medicine doctor who has worked the frontlines in COVID-19 wards in hospitals in New York City and Texas. “In the case of COVID, experts believe it could be linked to the severe inflammatory response and vascular changes. Neurotoxins released during this inflammatory response could also be contributing,” she explains. “Neuroinvasion by the virus (as seen by some viruses that cause meningitis) is also a possibility.” This psychological phenomenon isn’t unique to COVID-19, though. Psychosis has also been known to be a rare symptom of other types of infections, adds Dr. Lalani. “Anytime patients have a serious severe inflammatory or infectious process in the body, there is always a risk of confusion or some psychiatric manifestation. We see confusion often with severe sepsis patients,” she says. It’s possible that people experience psychological symptoms as a result of the circumstances around their illness and treatment, whether it’s for COVID-19 or another disease. “You can develop delirium, or an acute confusional state, due to a fever, changes in blood chemistry, reactions to medications you’re receiving, change in environment, lack of sleep, all those things,” says Laurie Jacobs, MD, chair and professor of medicine at Hackensack Meridian School of Medicine and Hackensack Meridian Health, and director of Hackensack Meridian Health’s COVID Recovery Center. “Acute psychosis can be from the COVID-19 infection itself, or all the things associated with being sick.” Another possibility? Coincidence. Around 3% of all people will experience psychosis at one point in their lives, according to the National Institute of Mental Health. Some of the people who had psychiatric symptoms after a SARS-CoV-2 infection may have already been likely to experience psychosis, and the two conditions happened to occur at the same time. “Just because someone had COVID does not mean that COVID caused the psychosis,” says Dr. Thomas. Further investigation is needed to understand whether there’s a physiological connection between COVID-19 and psychosis, and if so, how it works. The good news is that people with psychosis tend to respond well to treatment and eventually make a recovery. “Currently, any severe neuropsychiatric manifestations are being treated with antipsychotics. Some patients that have been on antipsychotics before admission are also restarted on their regular medications,” says Dr. Lalani.
COVID-19 and Other Neurological Symptoms
While psychosis is very rare among people with COVID-19, other neurological issues seem to be more common among “long haulers,” or people who experience symptoms for months after their infection. “A year into the pandemic, we’re still at the stage of individual case reports for psychosis, but we have numerous large case series of the neurological manifestations of COVID,” says Dr. Thomas. Brain fog, in particular, is a common concern among people with long-lasting symptoms, says Dr. Jacobs. Others also experience frequent headaches, difficulty sleeping, and debilitating fatigue. “If you listen to the long-haulers, a lot of them sound like they have chronic fatigue syndrome, or myalgic encephalomyelitis. People who had normal energy levels their entire lives, productive careers and family lives, see everything come to a standstill. It can devastate the person’s existence and outlook on life,” says Dr. Thomas. Doctors say it’s important to continue researching the relationship between COVID-19 and psychosis, as well as other neurological symptoms. Getting a better understanding of these conditions could allow doctors to anticipate the long-term health effects of COVID-19 and ultimately find ways to help people feel better. The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page. If you or someone you know is experiencing psychosis, get in touch with a medical professional right away. Antipsychotic medication and mental health support can help people recover from a psychotic episode.
