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Significant Number of People Will Develop Coronavirus-Related Psychosis

By: Sai Srihaas Potu

In February 2003, an outbreak of atypical pneumonia occurred in southern China. The infection, subsequently named “severe acute respiratory syndrome” (SARS), was spread by travelers to many parts of the world. The outbreak was so rampant that the World Health Organization issued warnings about international travel. In Hong Kong, within the short span of 6 months, more than 3000 people were infected with SARS, and, of them, more than 300 died.

Recently, researchers have completed a rapid review of contemporary epidemics and pandemic research to assess the potential impact of COVID-19 on people with psychosis. The research found an increase in the prevalence of psychosis as a result of COVID-19 would likely be associated with viral exposure, pre-existing vulnerability, and psychosocial stress. It also suggested that people with psychosis may present a major challenge and potential infection control risk to clinical teams working with them.

Psychosis is one mental health condition that requires specific attention. For one, the association between influenza infection and psychosis have been reported since the Spanish Flu pandemic in the eighteenth century and subsequent acute “psychoses of influenza” have been documented during multiple pandemics. A further point is that this population may be particularly at risk from the stress associated with physical distancing measures. While the use of mobile phones and technology continues to increase for people with psychosis, rates are still lower than in the general population. This may mean that physical distancing and reduction in social connectedness has a substantial effect on this group of individuals as they do not compensate as much with other methods of communication.

The COVID-19 outbreak may profoundly impact population mental health because of exposure to substantial psychosocial stress. An increase in incident cases of psychosis may be predicted. Clinical advice on the management of psychosis during the outbreak needs to be based on the best available evidence. Psychosis diagnosis was associated with viral exposure, treatments used to manage the infection, and psychosocial stress. Clinical management of these patients, where adherence to infection control procedures is paramount, was challenging. Increased vigilance for psychosis symptoms in patients with COVID-19 is warranted. How to support adherence to physical distancing requirements and engagement with services in patients with existing psychosis requires careful consideration.

Another impact the COVID-19 pandemic may have is on the nature and content of the psychotic pathology of people with psychosis or at risk of psychosis. Clinicians working in mental health services have given anecdotal reports of increased paranoia [content] around contamination from being in close contact with other people. The association between psychosis and a range of psychosocial factors, including stressful life events, has been extensively explored, suggesting it is an important risk fact for the onset of symptoms

The research suggests a small but important number of patients will develop coronavirus related psychosis that is likely associated with steroid or viral exposure, pre-existing vulnerability, and psychosocial stress. Psychosis in patients with coronavirus may present a major challenge and potential infection control risk to clinical teams.

The academics say common mental health conditions such as depression and anxiety are important to tackle during the COVID-19 pandemic but adds that people living with conditions at the most severe end of the mental health spectrum can be affected as well.


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