Viral respiratory infections and psychosis: A review of the literature and the implications of COVID-19

• Published in: Neuroscience and biobehavioral reviews 2021-08, Vol.127, p.520-530
• Main Authors: Kulaga, Stephanie S., Miller, Christopher W.T.
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Coronavirus; COVID-19; Female; Humans; Infant, Newborn; Inflammation; Influenza; Maternal infection; Neurodevelopment; Pregnancy; Psychosis; Psychotic Disorders; Review; SARS-CoV-2; Schizophrenia; Viral infections; Virus Diseases - complications
• ISSN: 0149-7634; 1873-7528; 1873-7528
• DOI: 10.1016/j.neubiorev.2021.05.008

•Viral respiratory infections are historically associated with psychosis.•Viruses likely increase the risk of developing schizophrenia via immune activation.•COVID-19 can cause both neuropsychiatric symptoms and massive immune response.•Other human coronaviruses have been associated with psychotic disorders.•COVID-19 may increase risk for later development of psychotic disorders. The historical association between respiratory infections and neuropsychiatric symptoms dates back centuries, with more recent literature highlighting a link between viral infections and schizophrenia. Maternal influenza infection during pregnancy has been associated with the development of schizophrenia in offspring. Viral infections in neonates, children, and adolescents have also been associated with later development of schizophrenia. Neuroinvasive and/or systemic infections are thought to increase risk for psychopathology via inflammatory mechanisms, particularly when exposure occurs during critical neurodevelopmental windows. Several human coronaviruses (HCoVs) have been associated with psychotic disorders and increasing reports of the neuropsychiatric manifestations of COVID-19 suggest it has neuroinvasive properties similar to those of other HCoVs. These properties, in conjunction with its ability to generate a massive inflammatory response, suggest that COVID-19 may also contribute to future psychopathology. This review will summarize the psychopathogenic mechanisms of viral infections and discuss the neuroinvasive and inflammatory properties of COVID-19 that could contribute to the development of psychotic disorders, with a focus on in utero, neonatal, and childhood exposure.