Though psychosis is a rare complication with potentially severe symptoms, management is possible.

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The COVID-19 pandemic has had a severe impact on mental health in the United States and beyond, increasing rates of stress, anxiety, depression, and even suicidal ideation.

As 2020 research notes, the coronavirus pandemic is associated with “highly significant levels of psychological distress.” According to experts, reducing the adverse effects on mental health should be a top priority for international public health.

Some of the effects of COVID-19 could linger for years to come. Mental health effects may be more significant among individuals who’ve contracted the virus, especially marginalized groups who’ve been disproportionately affected.

But a lesser-known, long-term mental health effect of the virus looms in the shadows. COVID psychosis, a rare mental disorder, has affected a small number of individuals worldwide who contracted the virus.

While COVID psychosis can cause severe symptoms and episodes of psychosis, experts say that cases are expected to remain rare.

COVID psychosis is a mental health condition experienced in connection with COVID-19 that may cause symptoms and episodes of psychosis. However, little is known about COVID psychosis and more research is needed.

Psychosis is a symptom of certain mental health conditions that impairs an individual’s sense of reality. It can be associated with:

  • hallucinations
  • delusions
  • incoherent speech
  • agitation

A recent New York Times article on this condition detailed the accounts of several anonymous cases, but empirical evidence in broader populations is still lacking.

A 2020 study in Britain found that 10 out of 153 participants with neurological or psychiatric symptoms hospitalized with COVID-19 had “new-onset psychosis.”

Another 2020 study documented 10 patients at a hospital in Spain who had both COVID-19 and symptoms of psychosis. None of the individuals had a previous history of psychosis.

While 2021 research shows that people with prior mental health conditions may have a higher risk of COVID-19, there’s not enough evidence to suggest that those with mental health conditions could be more likely to develop COVID psychosis.

The symptoms of COVID-19 can vary wildly from one person to the next, including respiratory, neurological, cognitive, and psychological effects.

Although many people recover from COVID-19 within a few weeks, some individuals with long COVID may experience physical and neurological symptoms for several months or more.

COVID-19 and neurological symptoms

In fact, 2021 research identified as many as 50 long-term symptoms associated with the coronavirus, including several neuropsychiatric symptoms such as:

COVID psychosis symptoms

A 2021 study investigated a small case report of three teens with mild or asymptomatic cases of COVID-19 who experienced a sudden onset of severe symptoms associated with psychosis, such as:

Other COVID psychosis symptoms may include:

  • auditory or visual hallucinations
  • severe anxiety
  • depression
  • panic
  • bizarre behavior
  • disorganized speech
  • preoccupied with internal thoughts

The causes of COVID psychosis are not fully understood. Anonymous reports published in the Times indicate that most individuals who developed COVID psychosis had no history of mental illness, even in their families.

Some experts suggest that brain-related effects from COVID-19 may be linked to the body’s immune system response or vascular problems and inflammation caused by the disease process.

“There are possibilities that some of the neurotoxins resulting from the immune reactions may pass the blood-brain barrier into the brain, which may cause this severe mental disorder,” says Daniel Boyer, MD, a researcher specializing in molecular biology, pharmacology, and pathology at the Farr Institute.

The relationship between age and immunity may also be a factor. For instance, a 2021 study concluded that pediatric patients with COVID-19 and neuropsychiatric symptoms, such as severe anxiety and delusional psychosis, “may have anti–SARS-CoV-2 and antineuronal antibodies in their CSF [cerebral spinal fluid] and may respond to immunotherapy.”

Because cases are rare and very little is known about COVID psychosis, treating this complication often means managing symptoms of psychosis.

Medication

The first step in treating psychosis typically involves medication to help reduce hallucinations and manage other related symptoms.

As the Times article notes, people with COVID psychosis typically did not respond to only one type of medication.

Instead, they were admitted to in-patient psychiatric care and prescribed different medications until doctors determined the best course of treatment, such as:

Therapy

Psychotherapy can help you manage symptoms of psychosis and cope with any stress and anxiety you may feel related to your diagnosis. Your therapist can also help educate your loved ones on how to best support you.

It’s unclear how long symptoms associated with COVID psychosis could persist. But research indicates that the condition is unlikely to be long term.

As one 2020 study notes, “there have been no detailed reports of patients developing persistent psychotic symptoms following COVID-19.”

The research indicates that some patients developed transient delirium (with and without hypoxia) following COVID-19, in addition to other neurological manifestations.

In some cases, COVID-19 can lead to mental and neurological complications, particularly those at risk of developing psychosis.

Some 2021 research shows a link between mood disorders and COVID-19, as well as a link between mood disorders and COVID-related psychoses. But it’s still too soon to tell whether people with mood disorders may be more susceptible to COVID psychosis.

“It’s going to take more time and research before this question can be answered with any degree of scientific certainty,” says Meghan Marcum, PhD, a clinical psychologist with AMFM Healthcare.

Sleep disturbances and mood disorders

“The research has shown people with mood disorders may be at increased risk for contracting COVID, possibly due to problems with sleep that often accompany mood disorders,” she adds.

Marcum says people with mood disorders may experience sleep disturbances that could affect the body’s ability to fight the virus. Research from 2018 shows a link between mood disorders, insomnia, and weakened immunity.

Killer T-cells, which fight off viruses, are not generated at the levels needed to fight off COVID-19 when sleep is impaired. Even one night of sleep deprivation causes a drastic decline in killer T-cells,” Marcum says.

Self-care and immunity

In addition, those with mood disorders may also be less likely to engage in self-care activities that can help promote healthy immune function.

Marcum explains that when depression is severe, it can sometimes be difficult to get out of bed and engage in simple tasks like showering, proper hand-washing, and eating healthily. “These risk factors can make an individual more susceptible to the virus,” she says.

COVID psychosis is a rare mental health condition impacting a small number of people globally who developed COVID-19. Researchers know little about this condition, which is associated with symptoms and episodes of psychosis.

Experts say that more research is needed to determine other environmental or biological factors that could affect the onset of COVID psychosis.

While COVID psychosis can affect people without any history of mental illness, those with mental health conditions may be at a higher risk of COVID-19, according to the CDC.

Those living with a mental health condition may benefit from taking higher precautions to safeguard themselves against the virus and any possible long-term effects on their well-being.

Talking with your doctor or therapist can help if your mental well-being has worsened since the beginning of the pandemic. If you need mental health support but don’t know where to start, you can read Psych Central’s guide on seeking help.