The Strange Case of Psychosis and a Global Pandemic
This week’s guest blog is written by Sarah Hemingway. Sarah started her PhD research at the University of Bristol in 2019. She was awarded the Sylvia and Christine Wastall Scholarship to study: The association between childhood language development and adolescent psychotic experiences in a general population sample.
The Strange Case of Psychosis and a Global Pandemic
As restrictions ease, it seems an age since entering a shop mask free and terms like ‘social distancing’ were not being part of our vernacular. It has actually been a little over a year since the Coronavirus was declared a global pandemic by the World Health Organisation, a worldwide spread of a potentially severe respiratory virus, causing symptoms we have all become familiar with. Yet, in the short time of living with Covid-19, it is revealing sides of itself that are proving to be more interesting and complex than originally thought, particularly long-Covid, where people experience its effects longer than expected. Even stranger, are reports of severe psychosis occurring weeks, sometimes months, after having Covid, particularly in those with no previous history of mental health problems.
Psychosis is a yet-to-be fully explained phenomenon, which can be defined as a loss of contact with reality and is a topic of great interest to me. I am currently researching specific parameters of language in childhood and its possible associations with later psychotic experiences for my PhD at the University of Bristol. The anecdotal cases of psychosis in people who have had Covid came to my attention after reading the observations of clinicians in an online article. Psychosis was reported to mostly occur in people aged between 30 to 50 years of age and seemed unrelated to illness severity1. Though still considered rare, there has been a rising number of post-Covid cases of psychosis worldwide, and along with other neurological, psychological, and cognitive complications, it has quickly become of empirical interest. Recently, a surveillance study in the UK investigated 153 people who had Covid and found 43% (10 out of 23 cases) of those judged to have a neuropsychiatric disorder, had new onset psychosis2.
My initial response to all of this was: How can something which affects the lungs, affect the brain? It got me pondering how the virus allows psychosis to manifest. Does the virus travel from the lungs to the brain? Is it caused by an inflammatory, neurotoxic, or ongoing immune response? Perhaps, it is not a direct consequence of the virus and instead a response to treatment, or the experience of Covid in relation to other risk factors e.g., increased stress or diminished social contact and support, induces psychosis? Answers to these questions, and whether Coronavirus plays a role, are still being scientifically sought. Though in June this year, a yet-to-be peer reviewed longitudinal study found structural changes in the brains of those who had been infected, particularly the loss of grey matter in areas involved in memory, taste, and smell3. There is also the possibility of the virus entering the brain via the olfactory nerve located in the nasal cavity, which borders the brain4. These findings may explain why some people experience ‘brain fog’, and a loss of taste, and smell.
The emergence of psychosis following a viral infection is not a new finding. As early as the 18th century, psychotic episodes have been linked to viral epidemics and pandemics. Most notably, the ‘psychoses of influenza’ was widely documented in the Russian influenza pandemic of the late 1800s, through to the Spanish influenza outbreak (1918-1919). Psychosis has also been documented in the 21st Century, particularly during the Swine flu pandemic (2009-2010)5, and even in two previous Coronavirus outbreaks, with SARS-CoV (Severe Acute Respiratory Syndrome) in 2002 and MERS-CoV (Middle East Respiratory Syndrome) in 20126. Though post-Covid psychosis is being investigated, it may have a future impact on mental health services.
[1] https://www.nytimes.com/2020/12/28/health/covid-psychosis-mental.html
2 https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30287-X/fulltext
3 https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v1.full
4 https://www.nature.com/articles/d41586-021-01693-6
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054463/
6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200363/