COVID-19 and Psychosis: Is There a Link?

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What your doctor is reading on Medscape.com:

MAY 08, 2020 — Since the start of the COVID-19 pandemic, most of the research into the SARS-CoV-2 virus has focused on its direct effects on the body with the aim of finding effective treatments and, ultimately, a cure. However, researchers Emily Severance, PhD, and Robert Yolken, MD, are investigating a potential secondary, long-term impact of COVID-19 exposure — greater susceptibility to psychosis.

“Over the years there have been data showing an association between exposure to general respiratory viruses such as the flu and subsequent psychotic episodes. This association was especially evident in studies of the aftermath of the great influenza of 1918,” Severance, assistant professor of pediatrics, Johns Hopkins University, Baltimore, Maryland, told Medscape Medical News.

Against this background, the investigators conducted a 2011 study to determine “whether or not this association with psychosis was specific to influenza, or if other respiratory infections like the coronavirus might also have similar consequences,” said Severance.  

The researchers examined the response of immunoglobulin G against four human coronavirus strains common at the time. Results showed that more than 90% of adults diagnosed with psychoses had high levels of antibodies to one or more of the viruses, and that all four coronaviruses were more seroprevalent in patients versus controls.

Multivariate analyses suggested that two of the coronaviruses — HKU1 and NL63 — may confer particular risk for neuropsychiatric disease.

The current study will build on these earlier findings. The researchers plan to examine adult case-control comparisons of the four less severe coronaviruses (229E, NL63, OC43, HKU1) and quantify the seroprevalence of the more severe forms of the virus, MERS, SARS-CoV-1, and SARS-CoV-2, in patients with psychiatric disorders versus controls.


Growing Body of Evidence

There is a substantial body of literature linking exposure to various pathogens with the subsequent development of psychiatric disorders. One of the most well studied is the parasite Toxoplasma gondii, which is implicated in a number of neuropsychiatric disorders, most notably, schizophrenia.

“It’s an esoteric area of the literature, but it really has a lot of evidence to support a connection between the infectious disease process and the development of psychiatric disorders,” said Severance.

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