A recent case report suggests that the coronavirus pandemic can influence symptoms in patients with schizophrenia, triggering coronavirus-related delusions and hallucinations. The report was published in Psychiatry Research.

Evidence suggests that the COVID-19 pandemic has pervasive mental health consequences, eliciting fear and anxiety responses in the public. This new report brings up the question of how these responses might be seen in patients with existing diagnoses.

“An area of key concern”, the study authors say, “is the potential of the psychological context of the pandemic to exacerbate existing psychiatric conditions and influence the manifestation of their symptomatology”.

“It is reasonable to expect that media coverage of exceptional circumstances will influence the content of delusional thoughts, especially in crises like infectious disease pandemics or after assassinations”.

The case report describes a 43-year-old man with schizophrenia who was brought to a psychiatric hospital after experiencing hallucinations related to COVID-19. These symptoms occurred during the initial phase of the COVID-19 outbreak in Germany.

“The patient had been hearing his neighbours’ voices (both males and females) blaming him, as a former ambulanceman, for not taking sufficient care of his parents who could have died of a COVID-19. The voices also claimed that all of the neighbours could also have COVID-19 as a result of his negligence”, the authors say.

“He also believed that he was being observed by cameras at his home and he personally expected to have immunity to COVID-19 after already being infected by a Chinese message through a WhatsApp group”.

The patient had previously been hospitalized with similar symptoms in 2011 and 2019 and had been diagnosed with paranoid psychosis and acute polymorphic psychotic disorder. He had been discharged in both instances after being treated with olanzapine and had been taking paliperidone every three months since 2019.

The patient was presenting with auditory hallucinations and was described as “very tense and anxious with a slightly depressed mood”. Through treatment, which included the administration of olanzapine, lorazepam, and palliperidone, the patient gradually stopped hearing voices completely and his anxiety and tension appeared to decrease. He also reported that he no longer suspected that his family was infected with COVID-19.

Since symptoms were successfully treated in hospital, the authors suggest that a decrease in paliperidone serum level near the end of the three-month treatment period may have paved the way for the onset of the pandemic-related hallucinations.

The authors state that their findings demonstrate that the coronavirus pandemic can influence the presentation of a patient with paranoid psychosis and trigger a psychotic episode characterized by paranoid hallucinations and unrealistic concerns.

The authors conclude with implications for the media. They say, “measured, balanced and responsible reporting of the COVID-19 crisis in the media will be important to minimize the risk of overreactions in at risk persons and to avoid entry into psychotic episodes”.

The case report, “COVID-19 paranoia in a patient suffering from schizophrenic psychosis – a case report”, was authored by M. Fischer, A.N. Coogan, F. Faltraco, and J. Thome.