A letter in reply: Covid-19 induced new-onset psychosis

We appreciate the comments from Al-Mendalawi on our case report, and on the merit of exploring cytokine and immunosuppression in the context of psychosis. In our case report, we overlooked the literature suggesting the potential role of cytokine and immunosuppression in the development of psychosis despite emerging evidence that cytokine profile might be critically associated with COVID-19 and its severity. In line with Al-Mendalawi's assertion, infection by SARS-CoV-2 virus has been widely established to trigger activation of central and peripheral cytokine which may result in cytokine storms and weakening of the blood-brain barrier. Such pathological processes compromise the integrity of the brain circuits leading to consequences such as the onset of obscured consciousness and conditions resembling psychosis. Along with this, the occurrence of overt neurological events as a result of COVID-19 has been observed including triggering of acute and ischemic strokes. The hallmarks of encephalopathy or encephalitis via brain scans have been documented.