A case report and first-person account of an individual at risk for psychosis who improved during the COVID-19 pandemic

ABSTRACT

Background

The COVID-19 pandemic is expected to increase stress and mental health symptoms. We present the case of a young man at risk for psychosis who has paradoxically shown symptomatic and functional improvement as a result of circumstances produced by COVID-19. These changes were unexpected given the client’s persistent mental health struggles in the year leading up to the COVID-19 outbreak in the United States and the expectation of an exacerbation of psychotic-like symptoms.

Methods

This report is based on clinical assessments and the client’s first-person account during the height of the pandemic when stay at home orders were in place.

Results

During the pandemic, the client demonstrated increased agency by taking on more responsibility at home and obtaining part-time employment. He showed improvement in his mood and relationships with others, had less symptom-related distress, and significantly reduced his cannabis use. The client interpreted these improvements in terms of changing his mindset toward more adaptive thoughts and engaging in healthy coping skills such as praying, reading, and healthy eating.

Discussion

This case highlights the importance of fostering agency in clients during a time of crisis and ensuring that clinicians be aware of potential biases about mental health symptom exacerbation.

KEYWORDS:

• Psychosis risk
• clinical high risk
• case report
• COVID-19 pandemic
• resilience
• first person account

Acknowledgments

We thank the client who is the subject of this manuscript for sharing his personal experience.

Authors’ contributions

All authors met weekly to conceptualize and design the case study. SNH and CS met with the subject of the report to obtain his first-person account and to communicate with him throughout the development stages of the manuscript. CS and ZRB transcribed the first-person account and CS created the narrative summary. All authors analyzed and interpreted the first-person account to identify themes and quotes. SNH and MFD collected and aggregated diagnostic and clinical data. SNH wrote the initial draft and all authors edited the draft until the manuscript was finalized. CMC is the principal investigator of the grant that provided support for this work. All authors, and the subject of the report, have read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by National Institute of Mental Health under grant [R01MH107558].