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

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.

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