Some COVID-19 Patients Experiencing Psychosis, According to Doctors

Doctors in the U.S. and abroad are reporting that a noteworthy number of COVID-19 patients have experienced psychotic symptoms, The New York Times reports.

Dr. Hisam Goueli, a psychiatrist at South Oaks Hospital in Amityville, New York, explains that patients who are experiencing psychosis have battled COVID-19 and range from their 30s to their 50s, an age range that he says is "very rare for you to develop this type of psychosis." Intriguingly, these patients actually understood that something was wrong with them – which is unusual, as Dr. Goueli explains that most "people with psychosis don't have an insight that they've lost touch with reality."

Reportedly, these patients did not become very sick from COVID-19, experiencing little in the way of respiratory problems. Though the patients did experience neurological symptoms such as vertigo, headaches and diminished smell, according to Dr. Goueli. Anywhere from a few weeks to several months later is when patients began to experience "profound psychosis," he said, "which is really dangerous and scary to all of the people around them." Patients have required weeks of hospitalization in which doctors have had to explore the most helpful and effective medications for treatment.

Such cases include a 42-year-old physical therapist who said that she visualized the murders of her four children, ages 2-10. "It's a horrifying thing that here's this well-accomplished woman and she's like 'I love my kids, and I don't know why I feel this way that I want to decapitate them,'" Dr. Goueli told the Times. The woman's experience of COVID-19 was mild; however, she reported that months later, a voice told her to kill herself and her children.

Doctors in the U.S. and abroad are reporting other similar cases in scientific journals. So far, a British study of neurological and neuropsychiatric complications of COVID-19 in 153 patients found 10 with "new-onset psychosis." In one Spanish hospital, 10 patients were similarly diagnosed.

Dr. Robert Yolken, a neurovirology expert at Johns Hopkins University School of Medicine in Baltimore, said that in post-COVID-19 recovery, the immune systems of some patients might not be able to shut down. Such persistent immune activation is a primary explanation for brain fog and memory problems that COVID-19 survivors have experienced. Emily Severance, a schizophrenia expert at Johns Hopkins, said cognitive and psychiatric effects might result from "something similar happening in the brain" of COVID-19 survivors in recovery.

Dr. Yolken added that this might be due to which brain region the immune response affects, saying "some people have neurological symptoms, some people psychiatric and many people have a combination."

At the moment, experts don't yet know whether genetics or an undetected predisposition to psychosis put some patients at greater risk. Furthermore, cases of psychosis and mania have occurred in patients infected with other viruses, in particular with the SARS and MERS coronaviruses.

Dr. Jonathan Alpert, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine, who co-wrote a report on patients at Montefiore, said "we think that it's not unique to COVID." Dr. Alpert said examining these cases could increase doctors' understanding of psychosis.

There are also other issues COVID-19 "long-haulers" contend with, such as respiratory issues, fatigue, lasting coughs, loss of smell and taste, and brain fog. Christian Sandrock, a UC Davis Health Professor of Pulmonary and Critical Care Medicine, describes the complexity of the long-term effects of COVID-19, saying, "We've had some patients who were profoundly ill in our intensive care unit, then they recovered and had no other symptoms. And some patients will do fine at first and are never admitted to the hospital. Then they have these effects that last and last.

"Some patients may have one of these symptoms and some will have a combination. We just don't know why yet."

Statistics have indicated that symptoms in approximately ten percent of COVID-19 patients won't go away; other studies report upwards of 20 percent. Just how long long-haul symptom last are currently unclear, as some patients have recovered in just a few months while others are still impacted several months later.

Kevin Schattenkirk is an ethnomusicologist and pop music aficionado.

This story is part of our special report: "COVID-19 And You". Want to read more? Here's the full list.