Post-COVID psychosis occurs in people with no prior history. The risk is low but episodes are frightening

Far from the respiratory disease it seemed at first, COVID can impact almost all parts of the body, including the brain. For a small number of people, COVID infection may be accompanied by an episode of post-COVID psychosis, a break from reality which can be frightening for the patient and their loved ones.

Psychosis is a condition characterised by confused thoughts, delusions and hallucinations. People with psychosis can struggle to tell what’s real from what isn’t. Psychosis occurs in “episodes” which may last for days or weeks. Since the start of the COVID pandemic, reports of post-COVID psychosis have come from all over the world.

Post-COVID psychosis is different to psychosis seen in other brain illnesses and diseases. So-called “first episode psychosis” is usually seen in teens or young adults in the development of schizophrenia, or alongside dementia in elderly people.

But people experiencing post-COVID psychosis are typically in their 30s, 40s and 50s, and are experiencing psychosis for the first time. They usually do not have any family history of psychosis. People with post-COVID psychosis also frequently have insight into the way they are feeling. They can recognise this is not normal for them, and something has changed in the way they are thinking.

Read more: Early intervention for psychosis might cost more initially but delivers a greater return on investment

Features in common

Based on the small number of reports so far, the start of psychosis has been days, weeks or even months after COVID diagnosis. While the symptoms of post-COVID psychosis can be varied, there are some commonalities: people usually have problems sleeping, followed by paranoid delusions and hallucinations. Some people feel compelled to hurt themselves or others.

The scientific evidence of post-COVID psychosis comes mostly from “case reports”, which are research papers describing symptoms and recovery of individual patients.

In the first and most widely reported case, a 36-year-old American woman developed psychosis approximately four days after she started having mild COVID symptoms. She became delusional, thinking that her partner was trying to kidnap her children. She was convinced she was being tracked through her mobile phone.

After trying to pass her children through a fast-food restaurant drive-through serving counter to protect them, she was taken to hospital for care. After one week of in-patient care to treat her psychosis, she was discharged. Her delusions did not return.

In another case, a 43-year-old Bulgarian man began experiencing psychois two days after he was discharged from hospital for severe COVID.

He believed the doctors had faked the results saying his COVID illness had resolved. He also had delusions that he had already died and his organs were rotten. He became a danger to his family, believing he should kill them to “spare them the same slow suffering”. After two weeks of treatment in hospital, his psychotic symptoms resolved and did not return.

Other case studies have reported people having delusions that patients in the hospital were actors and medical staff were trying to harm them, hearing voices speaking in foreign languages or telling them to take on grand tasks, like saving the earth.