COVID-19 may be associated with idiopathic psychosis. Researchers are trying to figure out why

In May 2020, a 33-year-old mother of three in North Carolina began experiencing symptoms of COVID-19. Four days later, another set of symptoms appeared. She no longer sleeps well and begins to have paranoid delusions that everyone is watching her via her cell phone — culminating in a frenzied scene at a fast food restaurant in which she try to get over her. children through the drive-through window where they will be safe from phones and other hazards.

A restaurant employee called 911, and emergency medical services officers arrived, gathered the family, and rushed to the nearby emergency room of Duke University Medical Center in Durham, where the mother quickly get medical attention quickly. Dr Colin Smith, Dr. Colin Smith, resident of the hospital’s internal psychiatry program, said: ‘She’s in the room, but she’s not making consistent eye contact with each other. patient. “She doesn’t really attract that much. Her thought processes are disorganized”.
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Even so, the patient admitted two things to Smith and the other doctors: She knew her behavior was unusual, and that the changes happened quickly after she was diagnosed with COVID-19.

There is growing evidence that COVID-19 and new episodes of psychosis are linked. North Carolina case, report in British Medical Journal in August 2020, joined a series of case reports published in medical journals during the pandemic detailing episodes of psychosis following a COVID-19 diagnosis. In the July 2020 issue of BJPsyh OpenResearchers report that a 55-year-old British woman, with no history of mental illness, presented to the hospital a few days after recovering from a severe case of COVID-19 with paranoia and hallucinations, believing that The nurses are in disguise and that the monkeys have jumped out of the doctor’s medical bag. In April 2021, other researchers wrote in BMJ case report about a middle-aged British man, also with no prior mental health disorders, who showed up at a London hospital with auditory and visual hallucinations and banged his head against the wall until he bruised his skin. . (A few weeks earlier, he had been recovering from pain with COVID-19 that had landed him in the intensive care unit.) In another case, published in the journal Journal of Psychiatric Practice In March 2021, a 57-year-old man went to Columbia University’s New York Presbyterian Hospital to insist that his wife was poisoning him, that cameras had been placed throughout his apartment, and that the sick Patients in the hospital’s emergency department are being kept under wraps. murdered.

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Dr Aaron Slan, now a fourth-year psychiatrist at Columbia University who cared for patients and co-authored the report, said: “The situation is similar to what we would expect from one person. have schizophrenia. . But the patient also had no history of a mental health disorder and was too old to develop schizophrenia for the first time, which typically occurs between the ages of 20 and 30 for men, Slan noted. What the patient had, as a hospital test showed, was COVID-19.

Cases of COVID-19-related psychosis are rare – although researchers say it’s too early to say exactly how rare – and many experts believe a link between the two conditions, if yes, not causal. In one Review published in 2021 in Nervous lettersA team of researchers in the UK cast doubt on the emerging COVID-19-psychiatric disorder “besieged by both small sample sizes and inadequate attention to risk factors.” potential disturbances”, such as heightened stress, substance abuse, and socioeconomic hardship.

However, researchers are investigating the link. A UK study published in Lancet in October 2020, found that of 153 people diagnosed early with COVID-19 during the pandemic, 10 experienced new-onset psychotic episodes following their COVID-19 diagnosis, and 7 developed onset of psychotic disorders, including mania and mania.

Research published last August in Psychiatric General Hospital took an extensive look at this phenomenon, analyzed 40 scientific articles, including 48 adults from 17 different countries with psychotic episodes related to COVID-19 infection, and tried to find what they have in common. As with Nervous letters The authors of this study found many other variables that could obscure the link between COVID-19 and mental disorders — such as stress, substance use, and medication — but this relationship is still maintained.

“We found postinfectious neuroinflammatory disorders associated with a variety of viral diseases,” said Dr. Samuel Pleasure, professor of neurology at the University of California, San Francisco (UCSF).. “Usually we see it in very small quantities, but here we have [COVID-19] infect tens of millions of people at once”. Even rare cases of mental illness will begin to manifest when the sample population is too large.

There are more questions than answers at this point. It is not yet clear whether the severity of COVID-19 symptoms will develop any role in the likelihood of psychosis. “Clearly there are cases where the neuropsychiatric consequences of COVID are associated with non-serious cases,” says Pleasure. “I believe the quality of the studies at this point is too preliminary, and the ability to really attract these patients to research is really in the early stages, so it’s difficult to pinpoint. .” Similarly, Pleasure says, it’s impossible to say whether people get sick Long COVID– symptoms persist for many months after infection clears – more prone to psychotic symptoms.

There are many possible mechanisms at work, any of which — or a combination — may contribute to the neuropsychiatric symptoms associated with COVID-19. According to Pleasure, the simplest is a direct infection of brain tissue. If that’s the case, the number of COVID-19 patients who have lost their sense of smell and sense of smell suggests that the brain’s sense of smell may have been attacked first by the virus.

“Yes recorded cases where people did early MRI in [COVID-19 disease] Pleasure said. “That added to the idea that maybe it was the entrance.” Once that portal is compromised, the brain as a whole can be exposed.

How the COVID-19 infection reaches the brain is still unclear, but Pleasure and his colleague Dr. Michael Wilson, an associate professor of neurology at UCSF, performed lumbar punctures in three adolescents. with COVID-19, who have developed neuropsychiatric symptoms to test their cerebrospinal fluid. . In two cases, they found antibodies in the fluid that targeted nerve antigens. That presents a clear puzzle: patients with SARS-CoV-2; if so, they should express antibodies to the virus, not their own nerve tissue. But Pleasure quotes research he conducted with a team from Yale University to show that antibodies specific to the coronavirus spike protein can also cross-react with nerve cells, attacking them.

“There is molecular mimicry between the mutant protein and the neuroantigen,” he said. “One of the main hypotheses is that if there’s an antibody that targets the virus, then if you’re unlucky, you’ll also see damage to the host.” In other words, you start with an adaptive immune response to fight the virus, and that turns into an autoimmune response.

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That’s just a theory. There are still other ways in which COVID-19 can affect the brain. Sometimes, an upper respiratory infection can cause the immune system to work poorly and develop antibodies against parts of the brain called NMDA (N-methyl-D-aspartate) receptors, which are the primary excitatory receptor that responds to neurotransmitters. Dr Mudasir Firdosi said a widespread attack on receptors spread throughout the brain can lead to severe and rapid symptoms. Consultant Psychiatrist at Kent and Medway NHS and Social Care Partnership Trust and a co-author of BMJ 2021 paper.

“[NMDA involvement] Firdosi says a very flowery way to become psychotic. Slan agrees: “When someone has sudden psychosis following a viral illness, NMDA antibodies are often used,” he said.

However, another doubt in the development of neuropsychiatric symptoms is the so-called cytokine storm usually occurs after infection with SARS-CoV-2. Cytokines are proteins important for cell signaling produced by the immune system and giving rise to inflammation, which in turn can fight infection. But if the production of cytokines goes unchecked, then extremely severe inflammation throughout the body can occur and brain tissue will not be affected.

“The nerve cells themselves are not invaded, but what happens is a systemic inflammatory response that causes both stress and signaling changes throughout the body,” says Slan. That includes the brain and can precipitate those types [psychotic] symptom.”

Some other evidence that COVID-19 is linked to psychosis comes not from the current scientific literature, but from history. After the influenza pandemic of 1918 and 1919, there was a spike in what is known as encephalitis coma, essentially an early-onset form of Parkinson’s disease that usually doesn’t appear for a number of years after infection. – but what is causing the patient to have a catatonia condition really.

“That flu virus caused post-infectious inflammation that killed brain cells, which in turn led to Parkinson’s disease,” says Pleasure. Books and movies Awakeon patients who temporarily recovered consciousness and clarity after treatment with l-dopa — a precursor of the neurotransmitter dopamine — based on cases of people with that form of Parkinson’s.

The good news is that unlike other forms of chronic mental disorder, most cases that seem to be related to COVID-19 do not appear to last long. Smith and Slan say symptoms may respond to antipsychotic medications such as Risperdal (risperidone) and Zyprexa (olanzapine). Intravenous immunoglobulins – which reduce the overall load of abnormal cells and inflammatory agents – and steroids, which can also reduce inflammation, may also be effective.

By no means is the case of virus-triggered psychosis closed. Even Slan, who has direct experience treating a patient with a mental disorder that appears to be linked to the virus, believes more work remains to be done — and acknowledges the doubts of researchers, who who believe other psychological factors may be at play.

“With the stress of COVID,” he said, “with concerns about mortality, seclusion, all of these represent major psychosocial stressorsand they have the potential to cause short-term psychotic symptoms. “

Of course, even a momentary psychosis is still a psychosis – something no one wants to experience even for a moment. That puts more emphasis on avoiding infection in the first place. “The best way to treat COVID-19 and the risk of psychosis is to prevent it,” says Smith. “Even if neurological complications are rare, vaccination is still the smartest option.”

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