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| Almost immediately, Dr. Hisam Goueli could tell that the patient who came to his psychiatric hospital on Long Island this summer was unusual. |
| 希萨姆·古利(Hisam Goueli)博士几乎立刻就意识到，今年夏天来到他在长岛的精神病院的那名病人不同寻常。 |
| The patient, a 42-year-old physical therapist and mother of four young children, had never had psychiatric symptoms or any family history of mental illness. Yet there she was, sitting at a table in a beige-walled room at South Oaks Hospital in Amityville, N.Y., sobbing and saying that she kept seeing her children, ages 2 to 10, being gruesomely murdered and that she herself had crafted plans to kill them. |
| 该病人是一名42岁的理疗师，是四个孩子的母亲，从未有过精神症状或任何精神疾病家族史。然而，在纽约阿米蒂维尔的南橡树医院(South Oaks Hospital)一间米色墙壁的房间里，她坐在一张桌子旁，哭着说她不断看到自己两到十岁的孩子被残忍杀害，而她自己策划了杀死他们的计划。 |
| “It was like she was experiencing a movie, like ‘Kill Bill,’” Dr. Goueli, a psychiatrist, said. |
| “就好像她在亲历《杀死比尔》(Kill Bill)一样的电影，”古利博士说，他是一名精神科医生。 |
| The patient described one of her children being run over by a truck and another decapitated. “It’s a horrifying thing that here’s this well-accomplished woman and she’s like ‘I love my kids, and I don’t know why I feel this way that I want to decapitate them,’” he said. |
| 据病人描述，她的一个孩子被卡车碾过，另一个孩子被斩首。“这是很可怕的事，明明是个出色的女性，她却说，‘我爱我的孩子，我不知道我为什么会有这种想把他们斩首的感觉，’”他说。 |
| The only notable thing about her medical history was that the woman, who declined to be interviewed but allowed Dr. Goueli to describe her case, had become infected with the coronavirus in the spring. She had experienced only mild physical symptoms from the virus, but, months later, she heard a voice that first told her to kill herself and then told her to kill her children. |
| 关于她的病史，唯一值得注意的是，这名女性在今年春天感染了新冠病毒，她拒绝接受采访，但允许古利博士叙述她的病情。她在感染病毒后只出现了轻微的身体症状，但几个月后，她听到一个声音，先是让她自杀，然后又让她杀了自己的孩子。 |
| At South Oaks, which has an inpatient psychiatric treatment program for Covid-19 patients, Dr. Goueli was unsure whether the coronavirus was connected to the woman’s psychological symptoms. “Maybe this is Covid-related, maybe it’s not,” he recalled thinking. |
| 在南橡树医院，有一个针对新冠患者精神疾病的入院治疗项目，古利博士还不确定新冠病毒是否与这名女性的心理症状有关。“也许这与新冠有关，也许无关，”他回忆自己当时是这么想的。 |
| “But then,” he said, “we saw a second case, a third case and a fourth case, and we’re like, ‘There’s something happening.’” |
| “但后来，”他说，“我们有了第二个、第三个和第四个病例，我们就觉得，‘出事了。’” |
| Indeed, doctors are reporting similar cases across the country and around the world. A small number of Covid patients who had never experienced mental health problems are developing severe psychotic symptoms weeks after contracting the coronavirus. |
| 确实，美国和世界各地的医生都报告了类似的病例。少数从未出现过精神健康问题的新冠患者在感染新冠病毒数周后，出现了严重的精神病症状。 |
| In interviews and scientific articles, doctors described: |
| 在采访和学术论文中，医生是这样描述的： |
| A 36-year-old nursing home employee in North Carolina who became so paranoid that she believed her three children would be kidnapped and, to save them, tried to pass them through a fast-food restaurant’s drive-through window. |
| 北卡罗来纳州一名36岁的养老院员工偏执地认定她的三个孩子会被绑架，为了营救他们，她试图让他们穿过一家快餐店的免下车营业窗口。 |
| A 30-year-old construction worker in New York City who became so delusional that he imagined his cousin was going to murder him, and, to protect himself, he tried to strangle his cousin in bed. |
| 纽约市一名30岁的建筑工人产生了严重的妄想症，认为表亲要谋杀他，为了自我保护，他试图在床上勒死对方。 |
| A 55-year-old woman in Britain had hallucinations of monkeys and a lion and became convinced a family member had been replaced by an impostor. |
| 英国一名55岁女子产生了猴子和狮子的幻觉，还认为自己的一名家人被冒名顶替了。 |
| Beyond individual reports, a British study of neurological or psychiatric complications in 153 patients hospitalized with Covid-19 found that 10 people had “new-onset psychosis.” Another study identified 10 such patients in one hospital in Spain. And in Covid-related social media groups, medical professionals discuss seeing patients with similar symptoms in the Midwest, Great Plains and elsewhere. |
| 除了个别报告，英国对153名新冠住院患者的神经或精神并发症所进行的一项研究发现，有10人出现了“新发精神疾病”。另一项研究在西班牙一家医院发现了10名这样的患者。在与新冠相关的社交媒体群组中，医学专业人士讨论了在美国中西部、大平原和其他地区看到的症状相似的患者。 |
| “My guess is any place that is seeing Covid is probably seeing this,” said Dr. Colin Smith at Duke University Medical Center in Durham, who helped treat the North Carolina woman. He and other doctors said their patients were too fragile to be asked whether they wanted to be interviewed for this article, but some, including the North Carolina woman, agreed to have their cases described in scientific papers. |
| “我猜任何有新冠疫情的地方都可能有这种情况，”达勒姆杜克大学医学中心(Duke University Medical Center)帮助治疗那名北卡州女性的科林·史密斯(Colin Smith)博士说。他和其他医生都表示，他们的患者神经太过脆弱，不能问他们是否愿为本文接受采访，但包括那名北卡州女性在内的一些患者同意在科学论文中描述他们的病情。 |
| Medical experts say they expect that such extreme psychiatric dysfunction will affect only a small proportion of patients. But the cases are considered examples of another way the Covid-19 disease process can affect mental health and brain function. |
| 医学专家表示，他们预计这种极端精神障碍只会影响一小部分患者。但这些病例被认为是新冠的疾病过程以另一种方式影响心理健康和大脑功能的例子。 |
| Although the coronavirus was initially thought primarily to cause respiratory distress, there is now ample evidence of many other symptoms, including neurological, cognitive and psychological effects, that could emerge even in patients who didn’t develop serious lung, heart or circulatory problems. Such symptoms can be just as debilitating to a person’s ability to function and work, and it’s often unclear how long they will last or how to treat them. |
| 虽然最初认为新冠病毒主要导致呼吸困难，但如今有充足证据表明，许多其他症状——包括神经、认知和心理问题——甚至都可能出现在没有严重肺部、心脏或循环系统问题的患者身上。这些症状会削弱一个人的身体功能和工作能力，通常不清楚会持续多久，也不清楚该如何治疗。 |
| Experts increasingly believe brain-related effects may be linked to the body’s immune system response to the coronavirus and possibly to vascular problems or surges of inflammation caused by the disease process. |
| 专家们越来越相信，与大脑相关的影响可能与人体免疫系统对新冠病毒的反应有关，也可能与疾病过程导致的血管问题或炎症激增有关。 |
| “Some of the neurotoxins that are reactions to immune activation can go to the brain, through the blood-brain barrier, and can induce this damage,” said Dr. Vilma Gabbay, a co-director of the Psychiatry Research Institute at Montefiore Einstein in the Bronx. |
| “一些对免疫激活做出反应的神经毒素可以通过血脑屏障进入大脑，导致这种损伤，”布朗克斯区蒙特菲尔·爱因斯坦医院精神病学研究所(Psychiatry Research Institute at Montefiore Einstein)的联席主任维尔玛·加贝(Vilma Gabbay)博士说。 |
| Brain scans, spinal fluid analyses and other tests didn’t find any brain infection, said Dr. Gabbay, whose hospital has treated two patients with post-Covid psychosis: a 49-year-old man who heard voices and believed he was the devil and a 34-year-old woman who began carrying a knife, disrobing in front of strangers and putting hand sanitizer in her food. |
| 加贝表示，脑部扫描、脊髓液分析和其他测试都没有发现任何脑感染，他所在的医院治疗过感染新冠后出现精神疾病的两名患者：一名49岁男性听到声音并认为自己是魔鬼，还有一名34岁女性开始携带刀具，在陌生人面前脱衣服，在食物中加入洗手液。 |
| Physically, most of these patients didn’t get very sick from Covid-19, reports indicate. The patients that Dr. Goueli treated experienced no respiratory problems, but they did have subtle neurological symptoms like hand tingling, vertigo, headaches or diminished smell. Then, two weeks to several months later, he said, they “develop this profound psychosis, which is really dangerous and scary to all of the people around them.” |
| 报告显示，这些患者大都没有因为感染新冠而感受到身体上的极度不适。古利治疗的患者没有出现呼吸问题，但他们确实出现了轻微的神经症状，如手麻、眩晕、头痛或嗅觉减退。然后，他说，在两周到数月的时间里，他们“会发展出这种严重的精神疾病，对他们周围的人来说非常危险可怕。” |
| Dr. Robert Yolken, a neurovirology expert at Johns Hopkins University School of Medicine in Baltimore, said that although people might recover physically from Covid-19, in some cases their immune systems, might be unable to shut down or might remain engaged because of “delayed clearance of a small amount of virus.” |
| 巴尔的摩约翰斯·霍普金斯大学医学院(Johns Hopkins University School of Medicine)的神经病毒学专家罗伯特·尤肯(Robert Yolken)博士说，尽管人们的身体可能从新冠中恢复，但某些情况下，他们的免疫系统可能无法关闭，或可能因为“少量病毒被延迟清除”而继续工作。 |
| Persistent immune activation is also a leading explanation for brain fog and memory problems bedeviling many Covid survivors, and Emily Severance, a schizophrenia expert at Johns Hopkins, said post-Covid cognitive and psychiatric effects might result from “something similar happening in the brain.” |
| 持续的免疫激活也是困扰许多新冠痊愈者的脑雾与记忆问题的主要解释，约翰斯·霍普金斯大学精神分裂症专家艾米丽·斯维伦斯(Emily Severance)表示，新冠痊愈后的认知和精神问题可能是由“大脑中发生的类似情况”造成的。 |
| It may hinge on which brain region the immune response affects, Dr. Yolken said, adding, “some people have neurological symptoms, some people psychiatric and many people have a combination.” |
| 尤肯表示，这可能取决于免疫反应影响了大脑的哪个区域，他补充道，“有些人有神经症状，有些人有精神症状，很多人两者皆有。” |
| Experts don’t know whether genetic makeup or perhaps an undetected predisposition for psychiatric illness put some people at greater risk. Dr. Brian Kincaid, medical director of psychiatric emergency department services at Duke, said the North Carolina woman once had a skin reaction to another virus, which might suggest her immune system responds zealously to viral infections. |
| 专家们不知道是基因构成还是未被发现的精神疾病倾向使得一些人面临更大风险。杜克大学精神急诊科医疗主任布莱恩·金凯德(Brian Kincaid)博士说，北卡罗来纳州这名女性曾对另一种病毒有过皮肤反应，这可能表明她的免疫系统对病毒感染反应活跃。 |
| Sporadic cases of post-infectious psychosis and mania have occurred with other viruses, including the 1918 flu and the coronaviruses SARS and MERS. |
| 1918年的流感病毒以及以及SARS和MERS冠状病毒等其他病毒，也曾出现零星的愈后精神病和狂躁症病例。 |
| “We think that it’s not unique to Covid,” said Dr. Jonathan Alpert, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine, who co-wrote the report on the Montefiore patients. He said studying these cases might help to increase doctors’ understanding of psychosis. |
| “我们认为这并非新冠所独有，”阿尔伯特·爱因斯坦医学院(Albert Einstein College of Medicine)的精神病学与行为科学主席乔纳森·阿尔伯特(Jonathan Alpert)博士说，他参与撰写了关于蒙特菲奥雷医疗中心(Montefiore)患者的报告。他说，研究这些病例可能有助于增加医生对精神疾病的了解。 |
| How long the psychosis lasted and patients’ response to treatment has varied. The woman in Britain — whose symptoms included paranoia about the color red and terror that nurses were devils who would harm her and a family member — took about 40 days to recover, according to a case report. |
| 精神疾病的持续时间和病人对治疗的反应各不相同。据一份病例报告显示，那位对红色产生偏执、认为护士是魔鬼，会伤害她和家人的英国女性花了40天时间康复。 |
| The 49-year-old man treated at Montefiore was discharged after several weeks’ hospitalization, but “he was still struggling two months out” and required readmission, Dr. Gabbay said. |
| 加贝博士说，在蒙特菲奥雷接受治疗的那位49岁男性住院几周后就出院了，但“他出院两个月后仍感到困扰”，需要再次入院。 |
| The North Carolina woman, who was convinced that cellphones were tracking her and that her partner would steal her pandemic stimulus money, didn’t improve with the first medication, said Dr. Jonathan Komisar at Duke, who said doctors initially thought her symptoms reflected bipolar disorder. “When we began to realize that maybe this isn’t going to resolve immediately,” he said, she was given an antipsychotic, risperidone and discharged in a week. |
| 北卡罗来纳州那位确信手机在追踪自己、伴侣会偷走她疫情救助金的女性在第一次用药后，病情并未得到改善，杜克大学的乔纳森·科米萨(Jonathan Komisar)博士说，医生们起初认为她的症状属于躁郁症。他说，“后来我们开始意识到这可能没办法立刻解决问题，”于是给她使用了精神病药物利培酮，一周后她就出院了。 |
| The physical therapist who planned to murder her children had more difficulty. “Every day, she was getting worse,” Dr. Goueli said. “We tried probably eight different medicines,” including antidepressants, antipsychotics and lithium. “She was so ill that we were considering electroconvulsive therapy for her because nothing was working.” |
| 治疗那位计划谋杀自己孩子的理疗师更加困难。“她的情况每天都在变糟，”古利说。“我们大概尝试了八种不同药物，”包括抗抑郁药、精神病药物和锂。“她病得很重，以至于我们考虑对她进行电休克疗法，因为什么都不起作用。” |
| About two weeks into her hospitalization, she couldn’t remember what her 2-year-old looked like. Calls with family were heartbreaking because “‘You could hear one in the background saying ‘When is Mom coming home?’” Dr. Goueli said. “That brought her a lot of shame because she was like, ‘I can’t be around my kids and here they are loving me.’” |
| 住院两周后，她不记得自己两岁小孩的样子了。听到与家人通电话让人心碎，因为“你能听到有人在电话里说，‘妈妈什么时候能回家？’”古利说。“这给她带来很大的羞耻感，因为她觉得，‘我不能和我的孩子在一起，可是电话那边，他们还在爱着我。’” |
| Ultimately, risperidone proved effective and after four weeks, she returned home to her family, “95 percent perfect,” he said. |
| 最终，利培酮被证明有效，四周后，她回到了家人身边，“以95%的健康状态，”他说。 |
| “We don’t know what the natural course of this is,” Dr. Goueli said. “Does this eventually go away? Do people get better? How long does that normally take? And are you then more prone to have other psychiatric issues as a result? There are just so many unanswered questions.” |
| “我们不知道自然病程是怎样的，”古利说。“它最终会消失吗？人们会好起来吗？通常要花多长时间？而人是否会因此更容易出现其他精神问题呢？太多问题都没有答案。” |
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