'Psychiatric patients at increased risk of COVID-19 hospitalisation and mortality': Study

Chances of dying or being hospitalised following COVID-19 infection in individuals with psychiatric disorders were found to be twice as high in comparison to people without mental disorders, a new study has revealed. This study was initiated by the Immuno-NeuroPsychiatry Network of the European College of Neuropsychopharmacology, was published in the peer-reviewed journal "lancet Psychiatry'. This study also found out that ICU admission rates were not affected. 

This study compiled data from 33 studies conducted in 22 countries, comprising 1,469,731 patients with Coronavirus, of whome 43,938 had mental disorders. 23 studies were included in a random-effects meta-analysis of crude and adjusted odds ratios for COVID-19 related mortality, hospitalisation, and ICU admission in individuals with comorbid pre-existent mental disorders, investigating different diagnostic groups and classes of psychiatric drugs. Individuals with psychotic disorders and mood disorders, as well as patients receiving treatment with antipsychotics or anxiolytics (anxiety-reducing drugs) appeared as the most vulnerable groups for COVID-19-associated mortality. The study also informed that patients with substance use disorders were also at increased risk for hospitalisation following COVID-19.

Study on psychiatric patients and COVID-19

Corresponding author, Dr Livia De Picker, from the University Psychiatric Hospital Campus Duffel, Belgium, said, "Together with many colleagues from national and international psychiatric associations, we have been advocating for priority SARS-CoV-2 vaccination of patients with severe mental illness. However, it quickly became apparent that a lack of high-quality evidence on the mortality and hospitalization risks of patients with mental disorders was blocking implementation of our recommendations by healthcare policymakers."

Dr Livia De Picker said that in several countries, pleas to change the vaccination startegy were discarded by National health authorities with the argument that the current scientific evidence did not distinguish particular groups of psychiatric patients, who have a very high risk for severe COVID-19 hospitalisations, ICUadmittance and death due to COVID. 

Remarking that the study's data revealed a striking contrast in patients with severe mental illness, tthe doctor said that patients with psyhotic disorders in particular are affected by the highest mortality risk, but did not have increased risk of hospital admission. "We know these patients face important barriers to physical healthcare, and our results suggest reduced access to care would have contributed to the increased mortality seen in this group," she added. 

Suggesting that public health authorities need to take targeted action to ensure maximum vaccination uptake for all groups of at-risk patients indentified in the study, De Picker said that close monitoring and adequate hospital referral in patients with mental illness, who develop COVID-19 is needed to counteract possible reduced access to care.

Meanwhile, Author and director of the ImmunoNeuroPsychiatry Network, Professor Marion Leboyer (University of Paris Est Creteil, France) said, "This high-quality study was created through the concerted efforts of many international colleagues working together. Further work is needed to determine the causes of the poor COVID-19 outcomes in psychiatric patients, which might reflect biological processes, such as immune-inflammatory alterations related to the psychiatric disorders."

Leboyer added, "In particular the impact of psychopharmacological treatments requires further study. We found that exposure to antipsychotic and anxiolytic drug treatments initiated before contracting COVID-19 was associated with severe COVID-19 outcomes. Antipsychotics might increase cardiovascular and thromboembolic risks, interfere with an adequate immune response, and cause interactions with drugs used to treat COVID-19."

Asserting that Benzodiazepines are associated with respiratory risk and are known tobe associated with all-cause mortality, Leboyer said that by contrast, some antidepressants were recently shown to have protective effects. In addition, social and lifestyle factors such as diet, physical inactivity, social isolation, high alcohol and tobacco use, and sleep disturbances, and a higher prevalence of somatic comorbidities might also have detrimental effects on COVID-19 prognosis," the professor added. 

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