Small Psychosis Increase a Concern During COVID-19 Pandemic

Ellie Brown, MD

Psychosis is among the mental health issues expected to increase because of the coronavirus disease 2019 (COVID-19) pandemic.

A team, led by Ellie Brown, MD, the National Center of Excellence in Youth Mental Health in Australia, examined the impact of epidemics and pandemics have on psychosis based on a rapid review of all available research.

Since the beginning of the COVID-19 pandemic, lawmakers and infectious disease specialists have suggested new social distancing measures in order to limit exposure to the virus.

However, social distancing is also associated with a range of adverse psychological effects, such as fear, anxiety, and worry. Physical distancing is also linked to decreased motor activity, changes to diet, and decreased exposure to sunlight.

Investigators believe the pandemic could have a substantial impact on the cumulative mental health of the population due to the exposure of psychosocial stress.

Previous research shows a psychosis diagnosis was linked to viral exposure, treatments used to manage the infection, and psychosocial stress.

However, clinical management of this patient population proved to be challenging when adherence to infection control procedures was made a top priority.

The investigators sought to identify changes in incidence cases of psychosis or being identified as ultra-high risk of psychosis. They also wanted to discovered whether changes reported in the form and content of psychotic symptoms, whether there is a change in demand for inpatient and community-based crisis services for individuals with psychosis, and if there is a deterioration in the physical health of people with psychosis.

The researchers also examined whether the number of individuals with psychosis committing or attempting suicide changed and whether there is an increase in the number of people with psychosis who experience social issues like homelessness, unemployment, domestic violence, and loneliness.

Finally, they looked at how patients with psychosis experience the preventative measures put in place during pandemics.

Studies included in the report were primary research that included participants who had a psychotic disorder or were considered to be at high risk of psychosis and have been exposed to an epidemic or pandemic.

The investigators extracted data on country, design, participants, epidemic/pandemic, and measures and outcomes including incident cases, use of psychiatric services, physical health and well-being, behaviors towards preventative measures put in place, and functional outcomes.

The team reviewed 14 studies and found the reported incidence cases of psychosis in people infected with a virus was between 0.9-4.0%.

“The main finding from our rapid review is that there is moderate (if low quality) evidence to suggest 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,” the authors wrote. “Psychosis in patients with coronavirus may present a major challenge and potential infection control risk to clinical teams.”

They also found limited evidence suggesting low dose antipsychotics is effective in this patient group.

The investigators believe clinical advice for managing psychosis during viral outbreaks should be based on the ever-changing evidence and increased vigilance for psychosis symptoms in patients with COVID-19 is needed.

The World Health Organization has advocated for rapid reviews in providing informative summaries of issues like psychosis and the mental health services they use.

The study, “The potential impact of COVID-19 on psychosis: A rapid review of contemporary epidemic and pandemic research,” was published online in Schizophrenia Research.