In a new review, published in the journal Schizophrenia Research, a team of researchers describes how the current COVID-19 pandemic may affect people with psychosis or those at risk for psychosis. The authors also emphasize the potential difficulties of helping patients with psychosis manage social distancing and other necessary precautions.
Psychosis is a condition that affects how a person perceives reality; it may lead to seeing, hearing or sensing things that are not there. Psychosis can be triggered by a mental or physical illness, medication or extreme stress or trauma.
“COVID-19 is a very stressful experience for everyone, particularly those with complex mental health needs,” said Dr. Ellie Brown, co-lead author on the study. “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.”
“People with psychosis are a population that 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,” said Brown, a research fellow at Orygen, a not-for-profit organization focused on research, advocacy and education to benefit young people’s mental health.
For the study, a research team from Orygen and La Trobe University in Melbourne, Australia conducted a rapid review of contemporary epidemic and pandemic research to help determine the potential impact of COVID-19 on people with psychosis. They discovered that an increase in the prevalence of psychosis as a result of COVID-19 would likely be linked to viral exposure, pre-existing vulnerability and psychosocial stress.
The findings also suggest that individuals with psychosis may present a major challenge and potential infection control risk to clinical teams working with them.
For the review, Brown looked at previously published studies on viruses such as MERS (Middle East respiratory syndrome), SARS (severe acute respiratory syndrome), swine influenza (a human respiratory infection caused by an influenza strain that began in pigs) and other influenzas that have occurred in the past two decades.
Her goal was to see if any of these studies could offer information on how these influenza viruses might impact people with psychosis.
Co-lead author of the research, Professor Richard Gray of La Trobe University said another important finding from the research was that psychotic symptoms, such as hearing voices, may occur in a small number of people with COVID-19.
“Maintaining infection control procedures when people are psychotic is challenging,” Gray said. “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.”
Brown said that although mental health disorders such as depression and anxiety were important to focus on during the COVID-19 pandemic, the community needed to be aware that the smaller but more severe spectrum of mental health conditions could be impacted as well.
Gray agreed. “This is a group that’s probably going to need more support, with isolation, physical distancing, hand washing etc, and clinicians may be the ones who need to be thinking and working on this to assist this vulnerable population,” he said.