Mechanisms of new-onset psychosis during the COVID-19 pandemic: What ignited the fire?

Abstract

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has been associated with the emergence of various psychiatric illnesses, although very little literature has focused on the effect of COVID-19 on psychosis. Preliminary data have shown possible increases in new-onset psychosis. METHODS: Using MEDLINE, we performed a review of the current literature to identify the mechanisms by which pandemics may increase psychosis risk and generate evidence-based recommendations to control surges of psychosis. We identified 85 relevant studies, of which 34 were case reports on psychosis during the COVID-19 pandemic. RESULTS: Underlying mechanisms of psychosis include direct viral mechanisms, such as neuroinflammation linked with the coronavirus, and nonviral mechanisms, such as stress, isolation, and uncertainty. CONCLUSIONS: Improvement of our understanding of the pathophysiology of psychosis related to COVID-19 along with implementation of strategies to fight against stress and social isolation in addition to awareness campaigns regarding new-onset psychotic symptoms are much needed to optimize early detection and management of psychosis.