A small number of patients with COVID-19 are experiencing severe psychiatric symptoms after recovering from the virus.
The New York Times reports that several doctors observed psychiatric symptoms in recovered COVID-19 patients who had no previously recorded history of mental illness.
Studies in the UK and Spain found that a small number of patients hospitalized with coronavirus developed “psychosis of recent onset”, notes the Times, with similar anecdotal reports from the Midwest.
The Times did not speak to any patient who had experienced psychiatric symptoms, but some doctors have received permission from their patients to describe their cases.
A 42-year-old mother in New York described continuously seeing her children being murdered and said she heard voices telling her to kill her children and herself. In New York City, a 30-year-old man tried to strangle his cousin after convincing himself that they planned to murder him. A 49-year-old man described having heard voices and believed he was the devil.
The doctor who treated the 42-year-old mother, Hisam Goueli, told the Times that the cases were unique due to patients’ self-awareness about the decline in their mental health.
“People with psychosis do not realize that they have lost touch with reality,” said Goueli.
Goueli also noted that it was unusual for the majority of these patients to be between 30 and 40 years old. According to the doctor, the symptoms described by the patients were most often attributed to schizophrenia in younger people or dementia in the elderly.
Experts say the viral effects on the brain can be attributed to the immune system’s response or even to the physical symptoms that patients experience.
“Some of the neurotoxins that are reactions to immune activation can go to the brain, through the blood-brain barrier, and can induce this damage,” said Vilma Gabbay, co-director of the Psychiatric Research Institute at Montefiore Einstein (PRIME).
Experts who spoke to the Times agreed with Gabbay’s assessment, saying that a continued immune response after the patient has recovered can affect the brain, although symptoms may depend on which region of the brain is affected.
Robert Yolken, a professor of neurovirology at Johns Hopkins University, told the Times: “Some people have neurological symptoms, some psychiatric people and many people have a combination.”
The Times notes that similar cases have been seen in previous viruses, such as the Spanish flu of 1918, SARS and MERS. Although the mechanism by which these symptoms arise is not well understood, experts told the Times that studying these patients could help to understand psychosis better.
The length of time that patients suffer from psychiatric symptoms is not certain. One patient described in the Times article recovered in 40 days, while another was still struggling with psychotic symptoms more than two months after being hospitalized.