COVID-19 and Psychosis: An Update

Source: Brielle A. Marino

Delusions, paranoia, hallucinations, and thought disorganization—collectively referred to as positive symptoms of psychosis—were surprising findings in a small, but growing number of COVID-19 cases at the start of the pandemic. Even more surprising, perhaps, was that these symptoms were manifesting in individuals with no prior history of mental illness whatsoever. Until now, the prognosis for these individuals was uncertain. Would their psychosis persist even after the viral infection had cleared? Would there be other lasting symptoms? As longitudinal data slowly trickles in, researchers and clinicians alike are beginning to answer these questions.

COVID-19 and Psychosis

In my previous post on this subject, I discussed the first well-documented incidence of psychosis in response to viral infection that occurred during the Spanish influenza pandemic of 1918. Much like the Spanish influenza, it is believed that COVID-19 can produce psychosis via direct penetration of the central nervous system (CNS). This is likely to occur via the olfactory bulb, which is a forebrain structure that helps us detect smells and thus plays a role in taste perception as well. It is not surprising, then, that anosmia (loss of smell) and aguesia (loss of taste) are common neurological symptoms of COVID-19.

Direct penetration of the CNS is not the only theory, however. It has also been proposed that psychosis may result from severe, systemic inflammation noted in COVID-19 infections, or alternatively, as a result of the psychosocial stressors associated with the fear and isolation surrounding the pandemic.

The Outlook

The prognosis for individuals with psychosis induced by COVID-19 depends on the exact cause or mechanism of action. For example, in individuals with a genetic predisposition whose psychotic episode was precipitated by psychosocial stressors surrounding the pandemic, it is possible that long-term management of their psychosis will be required. In these cases, individuals were already likely to develop a psychotic disorder due to genetic factors, and the stress surrounding the pandemic acted as the catalyst for the disorder to manifest itself.

Alternatively, in cases where psychosis was secondary to inflammation or CNS penetration, data suggests that the psychosis should resolve soon after the infection resolves. For example, one case study, in particular, demonstrated a resolution of psychotic symptoms six weeks after their onset (Parker, Slan, Shalev, & Critchfield, 2021).

Seeking Treatment

While most cases of COVID-19 induced psychosis have a relatively good outlook, other neuropsychiatric symptoms from COVID-19 are not as promising. The term "neuropsychiatric symptoms" refers to cognitive symptoms such as issues with memory, attention, and problem-solving. As the data rolls in, there are trends suggesting that cognitive symptoms may persist in some individuals for six months or longer post-recovery from the virus. Delirium, which is often characterized by confusion, poor orientation to time and day, and incoherent thoughts or speech, also seems to persist months after individuals have recovered from COVID-19. The chronicity of neuropsychiatric symptoms appears to be correlated with more severe infections and longer ICU stays.

Time has yet to tell of the permanency of these symptoms, but what we do know is that it is helpful to seek treatment early. Treatment may consist of psychotherapy in addition to cognitive remediation and testing services by a psychologist or neuropsychologist to monitor cognitive symptoms and employ techniques to help manage them.