COVID-19 Induced Psychosis: A silver lining for advancing neurological research on a global level?
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This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.
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WHO Director-General Tedros Adhanom Ghebreyesus warns of a third, and even fourth, wave of COVID-19 infection. We are far from out of the woods, he advises, despite falling death rates in a smattering of countries. Moreover, we can be assured that the pandemic will be coupled with a dramatic increase in mental illness, impacting several billion persons globally, up from roughly 800 million in 2017. Our worldwide mental illness “hangover” is projected to linger for years to come.
Aside from inflicting the psychic wounds resulting from social isolation, economic hardship, and loss, new evidence suggests that COVID-19 may also impact the human brain directly, triggering symptoms of severe mental illness, including hallucination and delusion. New research reveals that as many as one in eight COVID-19 patients develop some form of mental illness—including a smaller number (with no prior history of psychosis), who develop severe psychotic symptoms.
Read the report: Health at a Glance: Europe 2020 – State of Health in the EU Cycle and see the latest OECD data, recommendations and policy advice on Adult Mental Health
As a champion of brain research through One Mind and the Healthy Brains Global Initiative, and in the aftermath of my son’s 30-year lived experience with schizophrenia, I believe that this moment holds great potential for exploring linkages between COVID-19 and the brain. As a private investor, I believe (along with global leaders I have enlisted to join me) that the pandemic offers the opportunity to advance our understanding of physiological mechanisms driving psychosis and other neurological pathology, with new approaches to science and financing.
I reached out to many of the neuroscience researchers across the United States, Canada, Israel and Sweden with whom One Mind has engaged with over the last 27 years, and even some we’ve supported through our Rising Star initiative that underwrites high-risk, out-of-the-box research into brain illness. Were they similarly optimistic about the window that COVID-19 has opened into the investigation of psychosis and other diseases of the brain?
Indeed, there are currently many conversations about how to test a range of hypotheses linking COVID-19, psychosis and other neuropathology: could an over-active immune response be driving neurological symptomatology? Could the COVID-19 disease process push neurotoxins through the blood/brain barrier? Could auto-antibodies—which appear to play a role in COVID-19 "long haulers”—produce psychotic symptoms? Do COVID-19 patients who develop psychiatric symptoms have particular vulnerabilities that COVID-19 exploits? And, if so, what is the nature of these vulnerabilities? Can we harness new mRNA platform technologies, which catapulted forward the development of the Moderna and Pfizer vaccines, to investigate the impact of the COVID-19 virus on the brain?
These experts were enthusiastic about the potential to explore the aetiology of psychosis with COVID-19 patients who had no history of psychosis, but suddenly developed psychiatric symptoms. Researchers have struggled for years with demonstrating causality between immune dysregulation and psychosis. But with COVID-19 patients, researchers have access to a far more detailed clinical history. “We know exactly when the immune insult occurred, and this is tremendously informative in instances where there was no prior history of psychosis”, they told me.
Read more on the Forum Network: "Time for a check-up: The state of mental healthcare in Europe" by Silvana Koch-Mehrin, President & Founder, Women Political Leaders
Part of what makes this a silver-lining moment is the global nature and impact of COVID-19 on brain health. It presents both the opportunity and the necessity to evolve a global research approach to investigate neuropathology. Scientists must be supported to advance integrated, collaborative research on a worldwide scale. Global science—the kind of science interrogating a global threat—entails collaboration every step of the way: devising joint research questions, building global cohorts and trials, ensuring data sharing and harmonisation. Global science paves the way for increased collaboration and integration, as well as supporting clinical trials in poorer countries. It is from this belief that The Healthy Brains Global Initiative was launched in early 2019.
There are, of course, precedents for successful global collaborations. The Global Fund—created in 2002 to pool global resources to invest strategically to fight epidemics of HIV, tuberculosis and malaria—partnered with governmental and technical agencies and the private sector to support programs run by local experts in 100 countries. The ACTIV public-private consortium, led by the Foundation for the National Institutes of Health, built a network of governmental agencies in the United States and Europe and enlisted biopharmaceutical companies and experts in academia to drive the rapid development of COVID-19 vaccines and therapeutics. GAVI is another highly successful global collaborative effort.
The Healthy Brains Global Initiative will build on these successes, advancing global research that will qualitatively advance our understandings of the aetiology of psychosis and other neurological diseases to drive new therapeutic outcomes. The time has come to make brain health, the biggest unmet medical need, a global priority for governments, sovereign funds and philanthropists.
There is no vaccine for mental illness. But by properly funding and prioritising highly collaborative, global research into the physiological basis of all forms of brain disease, we will develop better diagnostics and treatments for the hundreds of millions who await relief and a cure.
Find more about the OECD Virtual Event: Addressing the hidden pandemic: The impact of COVID on mental health, taking place on 15 April 2021
 See https://nypost.com/2021/01/27/1-in-8-COVID-patients-develop-mental-illness-within-months-study/ and https://www.nytimes.com/2020/12/28/health/COVID-psychosis-mental.html
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