Covid Psychosis

Condition can cause serious, but temporary, psychotic episodes

Ben Price, 48, from Morris, Illinois, was a loving husband, father, and a dedicated business owner and farmer.

In February 2021, Ben contracted Covid-19. His symptoms landed him in the hospital for five days, during which he received the antiviral medication remdesivir and supplemental oxygen. Two days after returning home, he began acting unusual, anxiously pacing around the house.

“He was very worried and panicked about getting farm field work done, even though it was February and not even a possibility. You could not rationalize with him. He would stand and stare out the window,” his wife Jennifer Price says.

With no pre-existing mental health conditions, Ben’s behavior worried her. Doctors prescribed him antianxiety medication, and Price assumed he was experiencing Covid brain fog.

However, 16 days after his diagnosis, Ben died by suicide.

Price now believes her husband was experiencing Covid-19-induced psychosis — a condition that involves severe psychotic symptoms, such as losing a grip on reality.

Psychosis is when a person’s thoughts and perceptions are disturbed, and they may see and hear things that others do not.

Covid psychosis is “a relatively new term,” says Royce Lee, MD, associate professor of psychiatry and behavioral neuroscience at the University of Chicago Medicine. Generally, he says, “We are talking about a psychotic episode where it’s determined — not with a 100% certainty but with some high percent certainty — that the psychotic episode [might] not have happened had the person not gotten Covid.”

What causes Covid psychosis?

Though Covid psychosis is new, studies have shown that people with Covid-19 may experience other neurologic or psychiatric effects after they’ve had the disease.

One large-scale study published in The Lancet Psychiatry looked at the health records of more than 230,000 people who had Covid-19. In the six months after they had contracted it, one in three experienced a psychiatric or neurological illness, with 13% receiving their first such diagnosis.

Anxiety, mood, and substance use disorders were most common. However, the researchers also discovered serious neurological complications, such as brain hemorrhage, ischemic stroke, and dementia, especially in people who were severely ill from Covid.

While more research about Covid psychosis is needed, Danesh Alam, MD, medical director of behavioral health at Northwestern Medicine Central DuPage Hospital, says there are a small number of cases showing up in literature and in doctors’ offices.

“For a small number of patients, the diagnosis is new. In some cases, people with no history of mental health challenges have reported developing severe psychotic symptoms after being diagnosed with Covid-19,” Alam says.

When diagnosing Covid psychosis, Alam says physicians first exclude other potential medical causes and conditions, such as medications linked to psychotic episodes or encephalitis (inflammation of the brain often due to infection).

Although there is not a psychological diagnostic test that can detect Covid psychosis, a study published in Nature Neuroscience shows that the virus’s spike protein can cross the blood-brain barrier in mice.

Also, some postmortem Covid brains show changes that are typically seen in psychiatric disorders, Alam says.

Covid-19 can cause blood vessel damage and inflammation in the brain. That inflammation can lead to neurological issues and cognitive impairment, such as having an Alzheimer’s-like dementia.

“Covid psychosis and the severe neurological effects are very real and happening more than people are aware.”

Some evidence shows that people who get Covid-19 who have pre-existing psychiatric disorders, such as schizophrenia, may be prone to developing Covid psychosis, Lee says.

“Some of that could be [post-traumatic stress disorder] or trauma-related worsening, but in some of these cases we think the inflammation is the problem,” he says.

Lee says research shows that inflammation caused by the body’s immune response to the virus may drive Covid psychosis in people without pre-existing mental health conditions.

“We now understand that most psychiatric disorders — and psychosis in particular — are related in some way to inflammation in the body and brain. Covid is a virus that causes a lot of inflammation,” Lee says. Brain imaging of those with Covid psychosis backs up this theory, showing signs of inflammation, he adds.

Treating Covid psychosis

Physicians currently use medications for depression to treat Covid psychosis.

“The [logic] is that depression may [also] be an inflammatory process,” Alam says. So medications that target the brain’s inflammatory processes for depression may help with inflammation in Covid psychosis.

Covid psychosis appears to be temporary, and people need medication only on a short-term basis.

“The pandemic is young still, and we don’t have any real long-term data. We do know what we see on a brain scan [during psychosis] goes away after a period of time, and it’s not a permanent kind of brain damage,” Lee says.

If you notice symptoms in yourself or a loved one, Lee recommends seeing a psychiatrist and neurologist. Reach out to your primary care doctor for references.

“What we generally see once a diagnosis is made is a sense of relief in the family and patient,” Lee says.

Jennifer Price has made it her mission to spread awareness by sharing her husband’s story. In honor of him, she created a petition on Change.org asking the Biden-Harris administration to add a neurology expert to the White House Coronavirus Task Force to investigate Covid psychosis. She also started a foundation, Live in Hope for Ben Price, to spread awareness.

“[Covid psychosis] is real and can impact anyone who has no prior history of mental illness. I have received numerous stories from across the country with the same devastating scenario. Covid psychosis and the severe neurological effects are very real and happening more than people are aware,” Price says. “Sharing Ben’s story can help save other lives and already has.”

Covid and Neurological Symptoms

In previous pandemics, such as the 1918 flu pandemic, cases of psychiatric disorders were documented and written about in neurological journals for about 10 years after the pandemic, says Royce Lee, MD, associate professor of psychiatry and behavioral neuroscience at UChicago Medicine.

“We know viral illnesses, such as HIV, herpes, and a number or viruses can trigger all sorts of neurological and psychiatric symptoms. It looks like Covid is one of those pandemics that is doing that,” Lee says.

Clinicians assess medical history and symptoms to determine if a person is experiencing brain fog, long-haul Covid, or Covid psychosis.

When someone experiences brain frog, symptoms might include tiredness and mental fatigue. “Brain fog is quite common,” Lee says.

Long-haul Covid involves lingering neurological symptoms — such as loss of taste and smell, headaches, difficulty sleeping, and brain fog — for many weeks or months after the virus is gone.

Psychosis, which is less common, includes symptoms that disrupt a sense of reality, including paranoia, hearing voices, or seeing things that are not there.

Treatment differs depending on the diagnosis.

“The challenge with long-haulers is that they aren’t getting better, and it’s hard to treat some of the unexplained neurological symptoms,” says Danesh Alam, MD, medical director of behavioral health at Northwestern Medicine Central DuPage Hospital. “However, for psychosis, there is good treatment that works short-term — antipsychotic medication.”