What is post-COVID-19 psychosis and who’s at risk?

April 22, 2021 | by Jacqueline Sierzega, PsyD
Categories: Healthy Driven Minds

This blog was originally posted in 2021. Some information may be out of date. For the latest updates on vaccines, testing, screening, visitor policy and post-COVID support, visit EEHealth.org/coronavirus.

Most of us can list the symptoms of COVID-19 without much thought now. Fever. Shortness of breath. Cough. Loss of taste or smell. Fatigue.

And many of us have heard about the potential long-term physical effects of COVID-19.

However, doctors now are researching new mental health side effects from the virus. Though reported in small numbers and considered rare, COVID-19 psychosis has affected patients around the world.

Psychosis is a mental disorder in which patients have an impaired sense of reality. Symptoms of psychosis can include hallucinations, delusions, talking incoherently and agitation.

A New York Times article outlines a handful of cases involving people in their 30s, 40s and 50s who had never been diagnosed with a mental health illness but developed psychosis within weeks after testing positive for COVID-19. Many of the patients had mild symptoms of COVID-19.

The cases highlighted a physical therapist who told her therapist she had repeated visions of her children being murdered and that she had come up with plans to kill her children, a woman who tried to pass her three children through a fast-food drive-thru window because she believed they would be kidnapped, and another man who had hallucinations of monkeys and lions and believed that a family member was an imposter.

In a March 2021 news conference, Illinois Rep. David Welter mentioned a case involving a 48-year-old man who took his own life. The man’s widow told WGN News that her husband had been hospitalized for COVID-19 and put on oxygen. When he returned home, she said he was a “different man” and that he worried about things that were not happening. He died by suicide 16 days after his COVID-19 diagnosis.

The cases have raised concern among clinicians. However, experts agree additional research is needed.

Some research has indicated that the body’s reaction to COVID-19 could lead to inflammation around the brain which in turn can affect a person’s mental health. Researchers believe that the inflammation of the brain could also be responsible for other COVID-19 symptoms such as loss of taste or smell.

Other studies suggest psychiatric effects may be linked to the body’s immune system response to the virus, in which the immune system might remain engaged after the patient recovers physically. This persistent immune activation is a leading explanation for brain fog and memory problems associated with COVID-19.

There are still many unanswered questions about whether genetic makeup or an undetected predisposition for psychiatric illness increases risk, and how long the psychosis lasts. Cases of post-infectious psychosis have occurred with other viruses, including the 1918 Spanish flu and coronaviruses SARS and MERS.

According to the Centers for Disease Control and Prevention, one study found that patients diagnosed with a psychiatric disorder within the past year had a higher incidence of COVID-19 diagnosis than patients without a psychiatric disorder.

Is COVID-19 the cause of psychosis or just a coincidence? We still don’t know the potential effects of COVID-19 on the brain. The study’s authors recommended clinicians be on the lookout for new onset of psychiatric disorders, even in patients with no history of mental illness.

While the risk of post-COVID psychosis is low, patients and their families should watch for new onset of paranoia, believing things are happening that cannot be true, talking or muttering to themselves, or responding to something that no one else can see or hear. More subtle symptoms can include increased irritation and aggression, a decrease in personal hygiene and withdrawal from family and friends.

If you are concerned about your mental health or your loved one’s mental health, reach out to one of our clinicians at Linden Oaks Behavioral Health or call 630-305-5027 for a free behavioral health assessment.

The information in this article may change at any time due to the changing landscape of this pandemic. Read the latest on COVID-19.

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