A concerning trend of ‘post-COVID psychosis’ has experts baffled

post covid psychosis
Photo via Flat Earth Theatre/Flickr (CC BY-SA 2.0)
  • This story is regularly updated for relevance. Last updated: May 26, 2021

Medical experts are still learning about the side effects suffered by “long covid” patients. Symptoms include fatigue, headache, difficulty breathing, and even skin symptoms lasting weeks to months post-infection. Some doctors are even seeing patients experience neurological, cognitive, and psychological effects from COVID-19. These cases, which are being referred to as “post-COVID psychosis,” have cropped up even among those who didn’t develop severe lung, heart, or circulatory problems.

Symptoms have manifested into severe psychotic breakdowns in a small number of patients, sometimes weeks after contracting COVID-19. Like the physical effects of the virus, post-COVID psychosis can be just as debilitating to a patient’s ability to function.

A British study examined the neurological and neuropsychiatric complications of patients hospitalized with COVID-19. It found that 10 out of 153 people experienced new-onset psychosis. A different study out of Spain came to similar results.

In many cases, patients reported no previous psychiatric history. The majority of patients tracked were in their 30s, 40s, or 50s when experiencing symptoms.

Dr. Hisam Goueli, a family medicine specialist at South Oaks Hospital in Amityville, New York, told the New York Times it’s “very rare for you to develop this type of psychosis in this age range.” Typically, the tracked symptoms are found in young people with schizophrenia or older patients with dementia.

While treating a 42-year-old physical therapist and mother of four young children, Goueli witnessed the psychosis firsthand. His patient had never previously experienced psychiatric symptoms, nor did she have a family history of mental illness. Despite this, the woman sought help after voices began telling her to murder her children.

Goueli said, “People with psychosis don’t have an insight that they’ve lost touch with reality,” but in many of these instances, patients do seem to understand that something is wrong. This is displayed in the physical therapist who sought help. But that is just one case out of dozens.

In a March 26 daily briefing, healthcare research company Advisory Board spoke with Ivan Agerton, a 49-year-old documentary photographer living in Seattle. Agerton had no personal or family history of mental illness, but he began experiencing crippling paranoia and auditory hallucinations weeks after recovering from a mild COVID-19 case.

“Like a light switch—it happened this fast—this intense paranoia hit me,” Agerton said. He believed neighbors were spying on his family and police were tracking his movements. “It was really single-handedly the most terrifying thing I’ve ever experienced in my life,” he said.

USA Today featured a man named Ben Price—who, before being infected, had a big, boisterous personality filled with love. But he committed suicide after his bout with COVID, and his wife, who believed he suffered from psychosis, said, “It was shocking and devastating and so completely out of his character.”

These symptoms may seem unusual, but they may not be unique to COVID-19, according to Dr. Jonathan Alpert, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine.

Though rare, post-infectious psychosis and mania cases have occasionally been found in other viruses, including the 1918 flu, along with SARS and MERS. Alpert believes studying these cases could be key to understanding COVID-19 psychosis and how the disease can affect mental health and brain function.

Many experts are starting to believe these neurological side effects may be linked to the body’s immune response to COVID-19. Temporary damage to the brain could be exacerbated by surges of inflammation caused by the virus.

“Some of the neurotoxins that are reactions to immune activation can go to the brain, through the blood-brain barrier, and can induce this damage,” Dr. Vilma Gabbay, co-director of the Psychiatry Research Institute at Montefiore Einstein in the Bronx, told the Times. This persistent immune activation could also explain “brain fog” and other memory problems plaguing some COVID-19 survivors.

Can psychosis caused by COVID-19 be treated?

Just as these psychosis cases tend to be rare and unique, response to treatment has likewise varied from patient to patient. Some patients who developed psychosis have required weeks of hospitalization and multiple medications before doctors find something that works.

One woman in North Carolina, who became convinced that cellphones were tracking her and that her partner intended to steal her pandemic stimulus money, didn’t improve after the first round of medication. Dr. Jonathan Komisar, who practices internal medicine at Duke, told the Times that doctors initially thought her symptoms were indicative of bipolar disorder. 

The woman was given an antipsychotic drug called risperidone when it became clear the “issue wasn’t going to resolve immediately.” After taking the drug, Komisar says she was discharged after one week. Antidepressants, antipsychotics, and lithium were also administered to the woman, who harbored fears she might hurt her family. After four weeks of treatment, she returned home to her family “95%” back to normal.

“Every day, she was getting worse. We tried probably eight different medicines,” Goueli said. He noted the patient was “so ill that we were considering electroconvulsive therapy” because nothing else was working.

Ultimately, Goueli says there are “just so many unanswered questions” about why some people experience post-COVID psychosis and others do not.

“We don’t know what the natural course of this is,” Goueli said. “Does this eventually go away? Do people get better? How long does that normally take? And are you then more prone to have other psychiatric issues as a result?”

Sources: New York Times, Advisory Board, Science Direct, NCBI

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