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COVID-19 and psychosis risk: Real or delusional concern?

Research output: Contribution to journalReview articlepeer-review

Cameron J. Watson, Rhys H. Thomas, Tom Solomon, Benedict Daniel Michael, Timothy R. Nicholson, Thomas A. Pollak

Original languageEnglish
Article number135491
JournalNeuroscience Letters
Accepted/In press2020
Published10 Jan 2021

Bibliographical note

Funding Information: TS is supported by the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections (Grant Nos. IS-HPU-1112−10117 Funding Information: and NIHR200907), NIHR Global Health Research Group on Brain Infections (No. 17/63/110), and the European Union's Horizon 2020 research and innovation program ZikaPLAN (Preparedness Latin America Network), grant agreement No. 734584. Funding Information: BDM has received funding from the UKRI, MRC, Wellcome, BMA, AMS, and NIHR. Publisher Copyright: © 2020 Elsevier B.V. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Historical epidemiological perspectives from past pandemics and recent neurobiological evidence link infections and psychoses, leading to concerns that COVID-19 will present a significant risk for the development of psychosis. But are these concerns justified, or mere sensationalism? In this article we review the historical associations between viral infection and the immune system more broadly in the development of psychosis, before critically evaluating the current evidence pertaining to SARS-CoV-2 and risk of psychosis as an acute or post-infectious manifestation of COVID-19. We review the 42 cases of psychosis reported in infected patients to date, and discuss the potential implications of in utero infection on subsequent neurodevelopment and psychiatric risk. Finally, in the context of the wider neurological and psychiatric manifestations of COVID-19 and our current understanding of the aetiology of psychotic disorders, we evaluate possible neurobiological and psychosocial mechanisms as well as the numerous challenges in ascribing a causal pathogenic role to the infection.

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