People get psychosis after COVID-19, prompting scientists to investigate whether the body mistakenly attacks the brain after an infection

“Psychosis is one of the big mysteries of medicine. We have a fairly poor understanding of what causes it and how it develops,” says Dr. Jonathan Rogers, professor in the Department of Psychiatry and Psychology.

Studies show that psychiatric symptoms are common among COVID-19 survivors.

One study of the medical records of more than 200,000 U.S. COVID-19 survivors found that about 13 percent of them first received any psychiatric or neurological diagnosis within six months of infection.

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

But this incidence was about twice as high as in people in the control group (patients who had the flu), according to the study.

This increase may be due to an indirect cause: the psychological stress that comes with COVID-19 disease.

But the study suggests something else could be going on: the virus could be causing the body to attack itself, causing the brain to malfunction.

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

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

But COVID-19 can make that barrier “leaky,” says Dr. Benedict Michael, a professor at the University of Liverpool.

“As a result, immune cells get brain proteins that they wouldn’t otherwise see,” says Michael, who oversees the neurological complications registry after COVID-19.

The immune system then starts attacking brain cells, particularly the NMDA receptors that are on neurons.

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

The scientists noted that another virus, called HSV-1, can cause similar brain problems.

They also pointed to several reported cases of brain inflammation after COVID-19, and anti-NMDA receptor antibodies were found in patients’ blood.

The good news is that such problems can be treated with anti-inflammatory drugs and anti-psychotics.

“We hope that most of them will recover because the brain has not been severely damaged. But psychiatry has a history of all sorts of treatments that are good if you give them to just one patient, but that don’t work when you do clinical trials among a large group of different people,” Michael said.

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