Psychosis increasingly seen in former COVID-19 patients

Ivan Agerton pulled his wife, Emily, into their bedroom closet, telling her not to bring her cellphone.

“I believe people are following me,” he said, his eyes flaring with fear.

He described the paranoid delusions haunting him: that people in cars driving into their suburban Seattle culde-sac were spying on him, that a SWAT officer was crouching in a bush in their yard.

It was a drastic change for Agerton, 49, a usually unflappable former Marine and risk-taking documentary photographer whose most recent adventure involved exploring the Red Sea for two months in a submarine. He was accustomed to stress and said neither he nor his family had previously experienced mental health issues.

But in mid-December, after a mild case of COVID-19, he was seized by a kind of psychosis that turned life into a nightmare. He couldn’t sleep, worried he had somehow done something wrong, suspected ordinary people of sinister motives and eventually was hospitalized in a psychiatric ward twice.

“Like a light switch — it happened this fast — this intense paranoia hit me,” Ivan Agerton said in interviews over two months. “It was really single-handedly the most terrifying thing I’ve ever experienced in my life.”

Agerton’s experience reflects a phenomenon that doctors are increasingly reporting: psychotic symptoms emerging weeks after coronavirus infection in some people with no previous mental illness.

Doctors say such symptoms may be one manifestation of brain-related aftereffects of COVID-19. Along with more common issues like brain fog, memory loss and neurological problems, “new onset” psychosis may result from an immune response, vascular issues or inflammation from the disease process, experts hypothesize. Sporadic cases have occurred with other viruses, and while such extreme symptoms are likely to affect only a small proportion of COVID-19 survivors, cases have emerged worldwide.

Much about the condition remains mysterious. Some patients feel urges to harm others or themselves. Others, like Agerton, have no violent impulses but become almost obsessively paranoid. Some need weeks of hospitalization with doctors trying different medications, while others improve faster. Some patients relapse.

Agerton spent about a week in a psychiatric ward in December, missing Christmas with his wife and three children. By mid-January, he seemed to have recovered, and his doctor planned to taper his antipsychotic medication. In February, however, “the paranoia came screaming back,” Agerton said in an interview a day before being hospitalized a second time.

“I have all these questions,” said Dr. Veronika Zantop, a psychiatrist who has treated Agerton since his first hospitalization and who confirmed that he had no previous mental health issues. Among them: “Is this temporary? You know, how long does the risk continue?”

Paranoid delusions more commonly accompany schizophrenia in late adolescence or dementia in older adults, but so far, post-coronavirus psychosis has mostly a±icted patients in their 30s, 40s and 50s.

Another notable difference: Some former COVID-19 patients have realized something was wrong, while typical psychosis patients often “don’t have insight into their symptoms,” Zantop said.

With Agerton, she said, “It’s almost like he had a split self where he was able to say, ‘My brain is telling me that the police are after me.’ And then he was also able to say, ‘I know that’s not true on some level, but it feels like reality to me.’ ”