COVID-19 Pandemic Could Cause Spike in Psychosis Cases, Scientists Warn

The COVID-19 pandemic could cause a spike in people suffering from psychosis, according to scientists. To predict how the ongoing COVID-19 pandemic may affect rates of the condition, where people lose touch with reality, researchers assessed 14 existing papers on the coronavirus as well as past outbreaks of SARS, MERS and the flu. The review was published in the journal Schizophrenia Research. The team concluded: "There is moderate (if low quality) evidence to suggest a small but important number of patients will develop coronavirus-related psychosis." This was linked to drugs used on COVID-19 patients—such as certain steroids—the effects of the virus itself on the body, a person's pre-existing vulnerability to the mental condition, and the psychosocial stress of coping with an emerging infectious disease, as well as the measures to combat it—such as social distancing. For instance, people who experience episodes of psychosis may be less likely to have access to technology like cell phones, the authors said, meaning social distancing may have a "substantial effect" on this group. The scientific literature also showed that treating these patients for their mental health issues while trying to prevent the spread of infection could be challenging.

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One study cited by the authors in an area where COVID-19 was common reported a 25 percent year-on-year spike in cases of schizophrenia, a disorder whose symptoms include psychosis, in January 2020. That study involved 13,783 psychiatric patients from Xuzhou Oriental People's Hospital and featured 35,909 control patients. Its authors pinned the blame on psychosocial stress and social distancing measures. However, as the increase in cases was relatively small the spike may have happened at random, argued the authors of the review. Links have been made previously to viral outbreaks and mental illness, the team explained. "The association between influenza infection and psychosis has been reported since the Spanish Flu pandemic in the eighteenth century and subsequent acute 'psychoses of influenza' have been documented during multiple pandemics," they wrote. Ellie Brown, who researches psychosis at Australia's University of Melbourne, said in a statement: "COVID-19 is a very stressful experience for everyone, particularly those with complex mental health needs. "We know that psychosis, and first episodes of psychosis, are commonly triggered by substantial psychosocial stresses. In the context of COVID-19, this could include stress relating to isolation and having to potentially remain within challenging family situations." Brown said those who suffer from psychosis "are particularly vulnerable in the current COVID-19 pandemic and their needs are often overlooked. This research shows that their thoughts around contamination, and their understanding around concepts such as physical distancing, may be different from the wider population." She told Newsweek her team was inspired to carry out the review because, as clinical researchers, they had noticed the pandemic was "having a substantial impact on our clients with psychosis." They had heard similar reports for their international colleagues. Those who are worried they or a loved one are experiencing coronavirus-related psychosis should contact their family doctor and explain their concerns in detail, said Brown. Richard Gray, professor of clinical nursing at La Trobe University, Melbourne, who co-lead the work, said in a statement: "Maintaining infection control procedures when people are psychotic is challenging. "In order for them not to become potential transmitters of the virus, clinicians and service providers may benefit from specific infection control advice to mitigate any transmission risk." Asked about the limitations of the review, Gray told Newsweek: "COVID-19 is a new disease and we understand very little about the psychological impact it will have both in the short and long term, which is why it is important that we are cautious about our conclusions and recommendations. This is true for both the general public and individuals with existing mental health problems." The review adds to growing concern that the COVID-19 pandemic could spark a mental, as well as physical, health crisis. A day after the paper was published, Devora Kestel, director of the World Health Organization's mental health department, told reporters at a press briefing attended by Reuters: "The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently." Kestel made the comments as she unveiled a U.N. report and guidance on the topic. According to Johns Hopkins University, more than 4.3 million cases of coronavirus infection have been confirmed, 297,465 people have died, and 1.5 million are known to have recovered. The U.S. is the country with the most reported cases, as the graph below by Statista shows. This article has been updated with comment from Ellie Brown and Richard Gray.