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What is COVID psychosis? The case of a teenager sheds light on a rare side effect.

COVID is known to affect the brain, causing a variety of symptoms and problems, including loss of smell and taste, headaches, brain fog, confusion, and mental health issues such as depression.

In some cases, it can even trigger psychosis, a break from reality characterized by hallucinations, delusions, agitation, paranoia, and sometimes magical thinking. while that is rare even in adultsresearchers in the UK reported an even more unusual case of psychosis in an unvaccinated 16-year-old boy who was admitted to the hospital for COVID-related shortness of breath and chest pain.

About a week after his COVID infection subsided, he became restless and believed he had special powers, including the ability to read minds. She also heard and saw hallucinations, including Fortnite characters, according to Dr. Zainab Bashir, of Birmingham’s Queen Elizabeth Hospital, and colleagues, who are the authors of the report appearing in the journal Pediatrics.

Psychosis is unusual, but not unheard of from the following viral infections in general, particularly those of the respiratory system. Other brain-related complications of COVID are more common, including stroke, anxiety, insomnia, and confusion.

A study of more than 230,000 COVID patients who fell ill in 2020 found that about 1 in 3 were diagnosed with a neurological or psychiatric condition within six months of infection. However, only about 1.4% were diagnosed with a psychotic disorder.

“It is a very rare occurrence. You are looking at a portion of a portion of patients infected with COVID. But should everyone be worried that they are going to develop COVID psychosis after an infection? No,” said Dr. Jonathan Komisar, an internist and psychiatrist at Duke University Hospital who regularly treats patients with COVID psychosis and other neuropsychiatric symptoms related to the disease.

Still, “it’s certainly not that rare that you shouldn’t be open-minded to the fact that things like this happen,” he said.

Treatment can help, although recovery time may vary

The most striking part of the UK teenager’s case, according to investigators, was the lack of warning signs of what was to come. (Not to mention that she had no personal or family history of psychiatric illness or substance use.)

The boy was first admitted to the hospital for COVID for five days and then sent home. But three days later, his family brought him back after noticing a sudden change in behavior.

The teenager was unusually anxious, not speaking normally, stripping off his underwear and cursing at his parents. At the hospital, the boy said he could see written messages on the ceiling, broke glass in the door to try to escape, was writing in the air while uttering gibberish, and said the “information system in his brain had been deleted”. Meanwhile, he refused to allow doctors to run tests, which he thought would poison him, and was expressing suicidal thoughts.

The teenager was admitted to an adolescent psychiatric ward and given low doses of antipsychotic medication, which helped him gradually improve and gain confidence in the hospital staff. Finally, after three months, he went home.

Six months later, he had fully recovered.

“Regardless of what leads to psychosis, we can at least see it getting better over time and with standard treatment, which I think is important,” Komisar said. “In a way, it’s reassuring.”

dr Mujeeb Shad, an associate professor of psychiatry at the Oregon Health and Science University School of Medicine, published a report on three teenagers, including a 17-year-old patient he treated who developed COVID psychosis three weeks after testing positive. His symptoms ranged from six days to six months, according to the report.

“This virus is one of the most complex we have known, and no one can predict which system it will affect more than another, be it the [central nervous system]the kidneys, the lungs, or even the skin,” Shad told BuzzFeed News.

It’s almost impossible to know if someone will develop psychosis or how severe their case might be, but Shad said it appears adults and people with compromised immune systems may be more vulnerable.

“This can be kind of a self-limiting process that can go on for months, but this happens in a small percentage of a small percentage of people,” Komisar said. “If you start noticing family members or children not acting like themselves or engaging in behavior that is not usual for them, that should raise a red flag and you should get them evaluated.”

Some possible explanations behind the cause of COVID-related psychosis

It’s not clear whether the virus directly infects the brain or attacks certain immune system molecules that then damage brain cells, according to Shad.

The coronavirus is known to enter cells through ACE2 receptors, which normally bind to an enzyme abundant throughout the body, Shad said, which explains, at least in part, why the virus can affect nearly everyone. the cells.

Understanding the relationship between COVID and psychosis is also difficult because many factors can lead to mental health problems or neuropsychiatric symptoms in general, Komisar said, including stress, prescription or recreational drug abuse, brain injuries and, of course, disorders. psychotic or mood themselves.

There doesn’t seem to be a clear link between the severity of an infection and the development or severity of symptoms of psychosis, Shad said. The 17-year-old he treated, for example, experienced only mild respiratory symptoms, a low-grade fever, and some fatigue.

One of the theories explaining COVID psychosis involves an invasion of the central nervous system, with the coronavirus causing direct damage to nerve tissue leading to psychiatric symptoms. Or, Komisar said, the virus can trigger local inflammation in the brain that leads to psychosis.

Another involves a more exaggerated inflammatory response throughout the body. This reaction pumps an excessive amount of cytokines, proteins involved in communication between cells of the immune system that play a key role in inflammation, into the bloodstream, reducing or blocking blood flow to the brain. (This is called a cytokine storm.)

“You can think of it as friendly fire,” Komisar said. “His immune system goes into overdrive and he starts mistaking normal parts of his brain for infections and starts attacking them.”

The coronavirus itself may also be “the straw that broke the camel’s back,” Komisar said, meaning that the infection somehow triggers psychiatric illness in people who may have predisposing risk factors. However, due to a lack of data, clinicians do not have a clear understanding of what those risk factors are.

Corticosteroids, used to treat a number of conditions including cancer, chronic pain, lupus, asthma, and that cytokine storm we mentioned, known to cause psychosis and other mood-altering effects in some people and/or worsen psychosis when given during an episode.

None of the patients with COVID psychosis who appear in the published case reports were taking steroids before their symptoms began, but both Komisar and Shad said it’s important to remember that these drugs should be used with caution.

It is also important to note that people may develop COVID psychosis due to the social and medical stress associated with the illness, not the illness itself. Shad describes two cases of COVID-related psychosis in adolescents in her review.

“We are learning more and more that school closures and the inability to interact with peers have actually caused significant harm in younger populations, reflected in increased suicidality and increased numbers of deaths. suicides in young patients,” he said.

Psychosis after viral infections is well documented.

Psychosis or other neurological symptoms after a viral infection are not common, but they do happen, experts say.

Some of the earlier evidence dates back to the 1918 flu pandemic. Some studies even reveal an association between prenatal exposure to influenza and an increased risk of a diagnosis of schizophrenia.

Narcolepsy, seizures, Guillain-Barré syndromeCases of encephalitis (swelling of the brain) have also been reported after other outbreaks and pandemicsincluding the SARS epidemic in 2003, the H1N1 pandemic in 2009, and the MERS outbreak in 2012.

A 2020 review published in the journal Schizophrenia Research that included data from various epidemics and pandemics such as SARS, Ebola, H1N1, and COVID found that psychosis occurred in 0.9% to 4% of infections.

“The COVID pandemic will provide really important scientific opportunities to learn more about the relationships between viral infections and mental health disorders in general and psychosis in particular,” said Dr. Sarah Morris, Head of the Psychotic Disorders Research Program. of the Translational Research Division of the National Institute of Mental Health. “But it is important to avoid exaggerating the risk. We’re talking about very small percentages in the general population.”


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