Doctors say COVID-19 can lead to psychosis in very rare cases

RALEIGH, N.C. (WNCN) -- Doctors across the world are reporting extremely rare cases of severe psychiatric symptoms apparently brought on by COVID-19.  

Dr. Brian Kincaid is the medical director for psychiatric emergency department services at Duke University Hospital.

He and other Duke doctors published in the medical journal, The BMJ, about their first instance of what they call "COVID-19 associated-psychosis" in a patient with no history of mental illness. Since then, he says Duke has seen one or two more cases like this, and hospitals worldwide have described similar situations. 

“In these types of cases that we’ve seen, their behavior goes into the realm of what we call psychosis,” Dr. Kincaid told Nexstar station WNCN. “Delusions were a prominent symptom in a number of the cases that we’ve seen, feeling that various people were out to get them when we didn’t have any evidence of that; people have described feeling that they are being tracked by specific people on their cellphones in ways that really aren’t possible.”

He said doctors are not sure exactly why COVID-19 could cause these symptoms.

“There are a number of theories that are out there,” Kincaid said. “One is that perhaps there is a sort of excessive inflammatory immune response… Some of these immune-mediated responses can go in and affect cells in the brain to cause these psychotic symptoms.”  

While he said that is the leading theory right now, he added, “Another theory is that the SARS CoV-2 directly can impact the brain.”

COVID-19 isn’t the first virus associated with psychiatric symptoms.

“There are well-known cases of psychosis documented with the 1918 flu pandemic. They saw it also with SARS," Kincaid said.

So how often could COVID-19 cause psychotic symptoms in someone with no history of mental illness?

“I couldn’t really put an estimate to it right now,” said Kincaid. “One in several hundred thousand” he suggested, quickly adding, “But it’s something that needs to be studied more.”

That’s about the odds of getting struck by lightning, but doctors need much more data to truly estimate the chances.  

Kincaid said it is more common for the virus to exacerbate an existing mental illness.

“I’ve seen other patients who had exacerbation of the chronic mental health symptoms or already have a chronic mental illness like schizophrenia who develop psychosis,” he said.  

No matter how rare, Kincaid urges COVID-19 patients to watch for any potential psychiatric symptoms.

“If they start to notice themselves or their family members or their friends developing some behavioral changes, saying odd things, then I think it is important to contact your physician,” he said. “Or if it's severe to go to an emergency department for an evaluation.”