Impact of COVID-19 on patients with psychotic disorders

Patients who have psychotic disorders and/or use antipsychotic drugs have a decreased risk of SARS-CoV-2 infection. However, if they get COVID-19, the risk of hospitalisation and, possibly, death is increased. Appropriate COVID-19-related prevention, detection, and provision of care for people with severe mental illness are called for [1].

People with chronic psychosis have higher rates of physical illness and respiratory infections than the general population. In addition, their symptoms may reduce their ability to comply with restrictive measures. Dr Amir Krivoy (Tel-Aviv University, Israel) and colleagues designed a study to determine whether psychotic disorders or the use of antipsychotic medications are risk factors for infection with SARS-CoV-2 and for a more severe course of illness and mortality.

In the first part of the study, data was analysed of 554,287 people with PCR test results for SARS-CoV-2 infection between 1 March and 31 August 2020. Of these, 33,287 (6%) were found positive. Psychiatric disease and psychotic disorder were associated with a lower risk of a positive PCR test (adjusted OR 0.95 and 0.65, respectively). The use of an antipsychotic drug or an antidepressant was also associated with a lower risk of infection (adjusted OR 0.59 and 0.69, respectively).

In the second part of the study, the same cohort was analysed with a longer follow-up (until 31 December 2020). Among 200,171 people with COVID-19, 9,048 (4.5%) were hospitalised and 1,640 (0.8%) died. A psychotic disorder (n=2,525) was associated with a significantly increased risk for hospitalisation due to COVID-19 (HR 1.59) and death (HR 1.73) compared with people without COVID-19 and a psychotic disorder (see Table). Among people with COVID-19, the use of an antipsychotic drug was also associated with a significantly increased risk for hospitalisation (HR 1.53) and death (HR 1.72). There was a possible association between clozapine use and a slightly increased risk of death following COVID-19.

Table: Psychotic disorder associated with increased risk of COVID-19 hospitalisation and death [1]



 

 

 

 

 

 

1. Krivoy A. Increased risk of poor outcome and death in subjects with schizophrenia affected by COVID-19. S.15.02, ECNP 2021 Congress, 2–5 October.

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Posted on 26 November, 202126 November, 2021