A “small but important” number of people will develop COVID-19–related psychosis, according to a rapid review published online in Schizophrenia Research. According to the researchers, the development of psychosis would likely be associated with exposure to the virus or steroids, preexisting vulnerability, and psychosocial stress.
The prediction comes following a review of research about the effect that epidemics and pandemics have on psychosis and is based on moderate, if low-quality, evidence, according to the researchers.
“COVID-19 is a very stressful experience for everyone, particularly those with complex mental health needs,” study co-lead author Ellie Brown, DCounsPsych, a research fellow at Orygen in Melbourne, Australia, said in a press release. “We know that psychosis, and first episodes of psychosis, are commonly triggered by substantial psychosocial stresses. In the context of COVID-19, this could include stress relating to isolation and having to potentially remain within challenging family situations.”
The review included 14 papers from 13 studies that had been published between 2004 and 2020. Through their review, the researchers found that incident cases of psychosis among people who had been exposed to a virus during an epidemic or a pandemic ranged from 0.9% to 4%. Heightened vigilance for symptoms of psychosis in patients with COVID-19 is warranted, researchers advised.
Limited evidence suggests patients responded well to low-dose antipsychotics such as aripiprazole, researchers reported.
Another finding of the rapid review, which considered various aspects of psychosis during the COVID-19 era, was that patients with psychosis may present a major challenge and infection control risk to clinicians and to the community. They may be less likely to comply with physical distancing and personal hygiene requirements.
“This is a group that’s probably going to need more support with isolation, physical distancing, hand washing, etc., and clinicians may be the ones who need to be thinking and working on this to assist this vulnerable population,” study co-lead author Richard Gray, PhD, of La Trobe University in Melbourne, Australia, said in a press release.
Brown E, Gray R, Lo Monaco S, et al. The potential impact of COVID-19 on psychosis: a rapid review of contemporary epidemic and pandemic research. Schizophrenia Research. 2020 May 6;[Epub ahead of print].