The use of antipsychotics (AP) has been linked to nearly 60% increase in the incidence of pneumonia. The study purposes to devise safest treatment regimens for psychiatric patients with underlying respiratory comorbidities. A systematic literature search was conducted. A total of 41 studies were evaluated, which included 33 articles for metaanalysis. The quality of retrieved articles was screened by reviewing independently. The risk of bias in each study was assessed using the Newcastle-Ottawa Scale. Inter-rater agreement calculation was performed using Rayyan QCRI. Statistical analysis was performed using R 4.0.3. The meta-analysis conducted revealed that the risk of pneumonia (OR = 1.66; 95% CI = 1.64-1.68) and respiratory failure (OR = 1.79; 95% CI = 1.61-2.00) were higher in psychotropic users compared to nonusers. Pneumonia risk was higher in second-generation antipsychotic users (OR = 1.12; 95% CI = 1.01-1.25) compared to other antipsychotic users. However, no association was found between firstgeneration antipsychotics and pneumonia compared to other psychotropic exposure (OR = 0.93; 95% CI = 0.86-0.99). Chlorpromazine, sulpiride, and aripiprazole were found to be statistically safer compared to other AP. AP should be of appropriate choice in patients with SARS-CoV-2 infection, recurrent pneumonia history or those with opportunistic infections.

Background A cross-sectional study was conducted using a validated questionnaire among patients on psychotropic medications or their caregivers at a community pharmacy. The study evaluated the effect of various psychotropic drugs on pulmonary function to identify the psychotropic drug class most commonly associated with risk of respiratory disorders. Since psychotropic medications have safety concerns for usage in the general population, their use in people with coronavirus disease (COVID-19) is considered challenging. The study may also serve to draw evidence based practical recommendations for the treatment of people with COVID-19. Results Cronbach’s alpha and Intra class correlation coefficient values were found to be 0.92 and 0.85 respectively. In a sample of 198 patients, benzodiazepines were the commonly used medication among the population (43.9%) followed by selective serotonin re-uptake inhibitors (21.2%), anti-psychotics (15.1%), mood stabilizers (7.6%) and others (12.2%). Statistically significant association was observed between history of benzodiazepine usage, second generation antipsychotics and respiratory disorders (OR 1.56 [1.1–2.3, P < 0.1]). However the use of first generation antipsychotics were found to be less associated with respiratory infections. Conclusion History of benzodiazepine and second generation antipsychotic usage were found to be associated significantly with respiratory disorders including pneumonia and acute respiratory distress. Hence patients on psychotropics should be monitored for respiratory symptoms and choice of anti-psychotic medications should be made on existing clinical evidence. Psychotropic drugs which were found to be safer through the study conducted can be chosen to help improve the quality of psychiatric care in people with COVID-19, also promoting an optimal management of the psychiatric condition without worsening the medical condition due to COVID-19.