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People contract psychosis after COVID-19, prompting scientists to investigate if body mistakenly attacks brain after infection


A health worker holds a woman’s hand at King’s College Hospital in London in January 2021. Kirsty Wigglesworth / AP Photo

  • Some patients develop symptoms of psychosis after infection with COVID-19.

  • It is possible that the stress of the pandemic is at the origin of the psychiatric problems.

  • But some scientists believe it could be the virus causing the body to attack the brain.

In 2020, a day after developing symptoms of COVID-19, a 30-year-old man began to think he could talk to his deceased loved ones.

The man, who had no history of mental illness, became convinced the religious kidnapping was imminent, according to a case report released in August.

This psychotic episode lasted for more than a month, in which the man knocked on a door, pushed his mother around and thought he was undergoing radiation experiences, according to the report.

She was given antipsychotic drugs, but they had little effect. It wasn’t until after he was given medications commonly used to treat autoimmune diseases that he improved, according to the case study.

“Psychosis is one of the great puzzles in medicine. We have a fairly poor understanding of what causes it and how it develops,” Dr Jonathan Rogers, clinician and psychiatric researcher at University College London, told Insider.

Research suggests that psychiatric symptoms are common in COVID-19 survivors.

A study of the health records of more than 200,000 U.S. patients with COVID-19 found that about 13% were first diagnosed with psychiatric or neurology within six months of infection.

Psychosis – a particular psychiatric condition that is much more serious – affected only 0.42% of this group.

But that frequency was about double that of people in the control group (flu patients), according to the study.

That kind of increase could be for an indirect reason: the psychological stress that comes with having COVID-19, said two scientists who spoke to Insider.

But research suggests something else could be happening: the virus could cause the body to attack itself, causing the brain to malfunction.

The theory is that the virus causes anti-NMDA receptor encephalitis, an autoimmune reaction that causes inflammation of the brain. This in turn can cause psychosis.

Usually, the brain is protected from the immune system by a structure called the blood-brain barrier.

But COVID-19 could make that barrier “leak,” said University of Liverpool clinician Dr Benedict Michael.

“This then exposes immune cells to brain proteins that they otherwise wouldn’t see,” said Michael, who oversees a registry of neurological complications after COVID-19.

The immune system then begins to attack brain cells, especially NMDA receptors which are carried by neurons.

This makes the neurons less sensitive to stimulation. “It’s a similar effect to ketamine,” he said, referring to the powerful sedative.

Scientists have noted that another virus, called HSV-1, can cause similar brain problems.

They also reported a handful of recorded cases of brain inflammation after COVID-19 and some showing anti-NMDA receptor antibodies in patients’ blood.

The good news is that this kind of problem should be treatable with anti-inflammatory drugs and antipsychotics.

“We hope the majority make a reasonable recovery as there hasn’t been a lot of brain damage,” Micheal said.

But Rogers and Michael both said the theory should be taken with a grain of salt. There are only a small number of documented cases of psychosis after COVID-19, let alone where antibody levels have been measured, they said.

The presence of anti-NMDA receptor antibodies may be unrelated to psychosis, Michael said.

“It is possible that there is an immunological basis for these individual psychological cases, but I don’t think that is proven in terms of treatment,” he said.

“Psychiatry has a history of all kinds of treatments that are good if you give them to one patient, but don’t look so good when you do a clinical trial,” he said.

Read the original article on Business Insider

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