Covid Psychosis: Fact or Fiction?
In keeping with concerns expressed over the last year and a half about the impact of the Covid-19 pandemic both on rates of mental ill-health and the capacity of mental health services to support those in need, recent newspaper articles suggested that the rate of psychosis have increased in the context of the pandemic.
Before addressing the question of whether there really is a higher rate of psychosis as a result of the pandemic, we should first define psychosis. The importance of doing so is highlighted by the fact that one of the articles outlining the apparent increase in the prevalence of psychosis interviewed somebody with a personality disorder, in which psychotic-like states can occur, but it is not considered a true form of psychosis. There is a danger that such reports may create a misleading impression of the scale of the problem.
What is Psychosis?
Psychosis is not a specific mental health condition, but rather a phenomenon that is present in a number of psychiatric disorders. Psychosis refers to a loss of so-called reality testing i.e. the presence of experiences that are out of keeping with what might be considered normal for an individual, given their social, educational and spiritual background.
The most common manifestations of psychosis are hallucinations and delusions. Hallucinations referred to abnormal perceptions in any one of our five senses: touch, smell, hearing, sight and taste. Auditory hallucinations are heard voices, noises or sounds which objectively do not appear to be present i.e. they are only experienced by the person deemed to be psychotic.
Within a Christian context, the question that often arises is whether hearing God’s voice is regarded by psychiatrists as a hallucination. Generally speaking, it would not be regarded in this way as this is considered to be a normal experience (especially for someone who is known to have a strong religious faith).
Delusions are fixed and firmly held beliefs that are usually (but not exclusively) false and cause significant emotional distress for the individual.
What Can Psychosis be Caused by?
The presence of psychotic symptoms is often associated with paranoid schizophrenia, but psychosis can occur in a range of mental health conditions, including severe depression, bipolar affective disorder and schizoaffective disorder. In addition to this, psychosis can be caused by the use of some prescribed and recreational drugs or due to other underlying conditions, such as tumours and inflammation of a part of the brain (encephalitis).
Other recognised causes of psychosis – which can cause people who already have experienced psychosis in the past to relapse or others to experience a psychotic episode for the first time – are psychological trauma and severe stress. Historically caution has been expressed about the role of trauma in causing psychosis, but in recent years there has been research indicating that this can be the case.
The same is true of stress. At a society-wide level, it is well established that rates of psychosis are higher amongst migrant populations e.g. black Africans, black Caribbean and Irish communities in the UK, as well as the Japanese migrant community in Brazil. The theory here is that operating on the margins of society in a foreign country causes a degree of stress that makes these populations more vulnerable to developing psychosis.
Psychosis and Covid-19?
One could therefore extrapolate this point and highlight the significant stress many people have been under over the past year and a half, which might then be deemed to be the factor tipping the balance in favour of psychosis developing in a greater proportion of people. However, I would urge caution in drawing this conclusion.
Firstly, it would be important to break down the various causes of psychosis, as whilst there is overlap between some of the conditions, they should not all be lumped together. Stress may, for example, play a bigger part in causing psychosis as part of a severe depression than it might in leading to the onset of schizophrenia.
It is also important to consider whether other factors may be playing a role. Over the past decade, the strength of cannabis, one of the recreational drugs known to increase the risk of developing psychosis, has increased significantly and there are many newer drugs (referred to as novel psychoactive agents) that can lead to the onset of psychosis. These could all, in theory, be responsible for the spike in cases of psychosis.
In conclusion, although the findings are of interest and concern, we must be careful not to jump the gun and assume that it is necessarily related to the pandemic directly or indirectly.
Here are some websites with further information about psychosis:
If you are concerned that you or a loved one might be exhibiting symptoms of psychosis, you can either contact your GP or go directly to your local Early Intervention Service. This is a specialist mental health service – staffed by a range of mental health professionals – for people with suspected psychosis.
Dr Chi-Chi Obuaya is a Consultant Psychiatrist working in the NHS and in independent practice, as well as a Mind & Soul Foundation Director