They became psychotic weeks after contracting the virus and had no history of mental illness. There have been reports of cases around the world, although they are expected to remain rare.
It was immediately apparent to Doctorthat the patient who came to his Long Island psychiatric hospital this summer was unusual.
This 42-year-old physical therapist and mother of four young children had no family history of mental illness or psychiatric symptoms. She was seated at a table in a beige-walled room at South Oaks Hospital in Amityville, N.Y., sobbing and saying she kept seeing her children, ages 2 to 10, murdered and that she had planned to commit suicide.
“Her experience was like watching ‘Kill Bill,'” said Doctor, a psychiatrist.
The patient described one of her children being run over by a truck and another being decapitated. There’s something horrifying about this well-accomplished woman saying, “I love my kids, and I don’t know why I feel this way that I want to decapitate them,” he said.
According to Doctor, the woman, who declined to be interviewed but allowed him to describe her case, had become infected with the Coronavirus in the spring. Though she had only experienced mild physical symptoms due to the virus, she heard a voice telling her to die, first to herself and then to her children.
Doctor was unsure whether the Coronavirus was contributing to the woman’s psychological symptoms at South Oaks, which has an inpatient psychiatric treatment program for Covid-19 patients. He thought to himself, “Maybe this has something to do with Covid, maybe it doesn’t.”.
“Then we saw a second case, a third case, and a fourth case, and we were like ‘There’s something happening.’”
Doctors across the country and around the world are reporting similar cases. Few Covid patients who had never suffered from mental health problems are developing severe psychotic symptoms after contracting the virus.
Doctors described the following in interviews and scientific articles:
She tried to pass her children through the drive-through window of a fast-food restaurant, because she was so paranoid she thought they would be kidnapped.
He was a 30-year-old construction worker in New York City who became so delusional that he believed his cousin was going to murder him, so, in order to protect himself, he strangled him.
She became convinced an imposter had replaced a family member and hallucinated monkeys and lions.
Ten people hospitalized with Covid-19 had “new-onset psychosis” in a British study of neurological or psychiatric complications. In another study in Spain, ten such patients were identified. In Covid-related social media groups, medical professionals discuss seeing patients with similar symptoms across the Midwest, Great Plains, and elsewhere.
According to Doctor at Duke University Medical Center in Durham, who helped treat the North Carolina woman, any place seeing Covid is probably seeing this. According to him and other doctors, some patients, including the North Carolina woman, agreed to have their cases described in scientific papers because they were too fragile to be interviewed for the article.
According to medical experts, such extreme psychiatric dysfunction will only affect a small percentage of patients. However, the cases illustrate another way in which Covid-19 disease can affect mental health and brain function.
Although it was initially thought that the coronavirus primarily caused respiratory distress, there is now ample evidence that many other symptoms, including neurological, cognitive and psychological effects, can occur even in patients who don’t develop serious lung, heart or circulatory symptoms. The symptoms can be just as debilitating, and it isn’t always clear how long they will last or how to treat them.
According to experts, brain-related effects may be related to the immune system’s reaction to the Coronavirus and possibly to vascular problems or inflammation triggered by the disease.
“Neurotoxins produced by immune activation can cross the blood-brain barrier and can cause damage to the brain,” said doctor, co-director of the Psychiatry Research Institute at Montefiore Einstein.
There was no sign of brain infection after brain scans, spinal fluid analyses, and other tests, said Doctor, whose hospital treated two patients with post-Covid psychosis: a 49-year-old man who heard voices and thought he was the devil, and a 34-year-old woman who started carrying a knife, disrobing in front of strangers, and putting hand sanitizer in her food.
Most of these patients didn’t get very sick from Covid-19, reports indicate. Doctor’s patients did not have respiratory problems, but they did experience subtle neurological symptoms like hand tingling, vertigo, headaches, or diminished smell. Then, two weeks to several months later, he said, “they develop this profound psychosis, which is really dangerous and scary for everyone around them.”
Additionally, most of the patients were in their 30s, 40s, and 50s. It’s very rare for you to develop this type of psychosis at this age, Doctor said, since such symptoms more commonly accompany schizophrenia in young adults or dementia in the elderly. In contrast, “people with psychosis don’t have the insight that they are losing touch with reality,” as the physical therapist who took herself to the hospital did.
It took doctors weeks to find a medication that helped some post-Covid patients who developed psychosis.
Johns Hopkins University School of Medicine neurovirology expert Robert Yolken said that although people may recover physically from Covid-19, their immune systems might not be able to shut down or might stay active due to “delayed clearance of a small amount of virus..”
As a result of persistent immune activation, many Covid survivors suffer from brain fog and memory problems, and Emily Severance, a schizophrenia expert at Johns Hopkins, said post-Covid cognitive and mental effects might be the result of something similar happening in the brain..”
It may depend on which part of the brain the immune response affects, Yolken explained, with some people experiencing neurological symptoms and others experiencing psychiatric symptoms.
The doctors are pictured from left to right: Jonathan Komisar, Brian Kincaid, and Colin Smith of Duke University Medical Center, who treated a woman whose sudden psychosis made her paranoid that her children were being kidnapped and that her phone was tracking her. Credit…Jeremy Lange from The New York Times
Genetic makeup or an undetected predisposition to psychiatric illness may place some people at greater risk. Psychiatric emergency department medical director Brian Kincaid said the North Carolina woman once had a skin reaction to another virus, suggesting her immune system responds zealously to viruses.
There have been sporadic cases of post-infectious psychosis and mania associated with other viruses, such as influenza 1918 and the Coronaviruses SARS and MERS.
“It’s not unique to Covid,” said doctor, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine, who co-wrote the report on Montefiore patients. Studying these cases might improve doctors’ understanding of psychosis, he said.
Symptoms have ranged widely, some surprisingly severe for a first psychotic episode, experts said. A 46-year-old pharmacy technician whose family brought her to the hospital after she was afraid evil spirits had invaded her home “cried literally for four days” in the hospital, Doctor said.
After being brought to the hospital by the police, the 30-year-old construction worker became “extremely violent,” dismantling a radiator and using its parts to break a window. A chair was also swung at hospital staff by him.
Psychosis duration and treatment response have varied among patients. Symptoms of the British woman included paranoia about the color red and fears that nurses would harm her and a family member. The woman recovered after about 40 days, according to a case report.
The 49-year-old man treated at Montefiore was discharged after several weeks of hospitalization, but “he was still struggling two months later” and required readmission.
She was convinced that her cellphones were tracking her and that her partner would steal the pandemic stimulus money, but did not improve with the first medication, said Duke’s Doctor er symptoms were bipolar disorder-related. In a week, she was discharged after she was given an antipsychotic, risperidone, after it became apparent that the problem was not going to resolve immediately.
It was more difficult for the physical therapist who planned to murder her children. Doctor said her condition was deteriorating every day. We tried eight different medicines, including antidepressants, antipsychotics, and lithium. Because nothing was working for her, we were considering electroconvulsive therapy.
Two weeks into her hospitalization, she couldn’t remember what her 2-year-old looked like. Doctor explained that there were heartbreaking calls with family because “one asked, ‘When will mom be back?'” When she couldn’t be with her children, she felt ashamed.
The risperidone proved effective, and after four weeks, she returned home to her family, “95 percent perfect.”
“We don’t know what the natural course of this will be,” Doctor said. Is this going to go away eventually? Is it possible for people to get better? Can you tell me how long that normally takes? Are you then more likely to develop other psychiatric issues as a result? There are just so many questions left unanswered.”