COVID-19 in People With Schizophrenia: Potential Mechanisms Linking Schizophrenia to Poor Prognosis

Mohan, Mohapradeep; Perry, Benjamin Ian; Saravanan, Ponnusamy; Singh, Swaran P.

doi:10.3389/fpsyt.2021.666067

Cited by 31 publications

(28 citation statements)

References 117 publications

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“…In general, individuals with premorbid mental disorders seem to be predisposed to strongly respond to critical and stressful life events (e.g., [12]). Related to the current pandemic, they were found to exhibit higher COVID-19 infection rates [11,13], an increased risk of adverse outcomes from COVID-19 [14][15][16], or both [13,17]. Moreover, they have been suggested to be particularly susceptible for worsening of their mental health condition in response to pandemic-related stressors, in terms of an exacerbation or relapse of psychopathology or de novo onset of psychiatric symptoms.…”

Section: Introductionmentioning

confidence: 99%

Medium-term and peri-lockdown course of psychosocial burden during the ongoing COVID-19 pandemic: a longitudinal study on patients with pre-existing mental disorders

Bartels¹,

Heßmann²,

Schmidt

et al. 2021

Eur Arch Psychiatry Clin Neurosci

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While the COVID-19 pandemic continues, patients with pre-existing mental disorders are increasingly recognized as a risk group for adverse outcomes. However, data are conflicting and cover only short time spans so far. Here, we investigate the medium-term and peri-lockdown-related changes of mental health outcomes in such patients in a longitudinal study. A cohort of 159 patients comprising all major mental disorders (ICD-10 F0-F9) were interviewed twice with the Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) to evaluate psychosocial burden, psychiatric symptoms and resilience at the end of the first (April/May 2020) and the second lockdown in Germany (November/December 2020). For the primary outcome “psychosocial burden” ratings also comprised retrospective pre-pandemic (early 2020) and very early states during the pandemic (March 2020). For all diagnostic groups, psychosocial burden varied significantly over time (p < 0.001) with an increase from the pre-pandemic to the initial phase (p < 0.001), followed by a steady decrease across both lockdowns, normalizing in November/December 2020. Female gender, high adjustment disorder symptom load at baseline and psychiatric comorbidities were risk factors for higher levels and an unfavorable course of psychosocial burden. Most psychiatric symptoms changed minimally, while resilience decreased over time (p = 0.044 and p = 0.037). The longitudinal course of psychosocial burden indicates an initial stress response, followed by a return to pre-pandemic levels even under recurrent lockdown conditions, mimicking symptoms of an adjustment disorder. Strategies for proactive, specific and continuous treatment have to address resilience capacities before their depletion in the pandemic aftermath, especially for patients with additional risk factors.

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Section: Introductionmentioning

confidence: 99%

Medium-term and peri-lockdown course of psychosocial burden during the ongoing COVID-19 pandemic: a longitudinal study on patients with pre-existing mental disorders

Bartels¹,

Heßmann²,

Schmidt

et al. 2021

Eur Arch Psychiatry Clin Neurosci

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show abstract

“…Globally, by August 2021, there were about 210 million confirmed cases of COVID-19, including 4.4 million deaths (4). There is some evidence that the determining factors of the severity of infection with SARS-CoV-2 are more possibly related to host factors but not viral genetic variation (5), which has been confirmed by several clinical studies. Pre-existing conditions, such as lung disease, cardiovascular disease, kidney disease, type 2 diabetes, hypertension, and psychiatric illness, significantly increase the likelihood of severe symptoms as well as mortality in patients with COVID-19 (5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 75%

“…There is some evidence that the determining factors of the severity of infection with SARS-CoV-2 are more possibly related to host factors but not viral genetic variation (5), which has been confirmed by several clinical studies. Pre-existing conditions, such as lung disease, cardiovascular disease, kidney disease, type 2 diabetes, hypertension, and psychiatric illness, significantly increase the likelihood of severe symptoms as well as mortality in patients with COVID-19 (5)(6)(7)(8)(9)(10). In a recent study, the prevalence of schizophrenia was 3.6% in 7,341 patients with COVID-19, much higher than the 0.66% prevalence in the general population (11)(12)(13).…”

Section: Introductionmentioning

confidence: 75%

Immune Response Is Key to Genetic Mechanisms of SARS-CoV-2 Infection With Psychiatric Disorders Based on Differential Gene Expression Pattern Analysis

Xia

Chen

et al. 2022

Front. Immunol.

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Existing evidence demonstrates that coronavirus disease 2019 (COVID-19) leads to psychiatric illness, despite its main clinical manifestations affecting the respiratory system. People with mental disorders are more susceptible to COVID-19 than individuals without coexisting mental health disorders, with significantly higher rates of severe illness and mortality in this population. The incidence of new psychiatric diagnoses after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is also remarkably high. SARS-CoV-2 has been reported to use angiotensin-converting enzyme-2 (ACE2) as a receptor for infecting susceptible cells and is expressed in various tissues, including brain tissue. Thus, there is an urgent need to investigate the mechanism linking psychiatric disorders to COVID-19. Using a data set of peripheral blood cells from patients with COVID-19, we compared this to data sets of whole blood collected from patients with psychiatric disorders and used bioinformatics and systems biology approaches to identify genetic links. We found a large number of overlapping immune-related genes between patients infected with SARS-CoV-2 and differentially expressed genes of bipolar disorder (BD), schizophrenia (SZ), and late-onset major depressive disorder (LOD). Many pathways closely related to inflammatory responses, such as MAPK, PPAR, and TGF-β signaling pathways, were observed by enrichment analysis of common differentially expressed genes (DEGs). We also performed a comprehensive analysis of protein–protein interaction network and gene regulation networks. Chemical–protein interaction networks and drug prediction were used to screen potential pharmacologic therapies. We hope that by elucidating the relationship between the pathogenetic processes and genetic mechanisms of infection with SARS-CoV-2 with psychiatric disorders, it will lead to innovative strategies for future research and treatment of psychiatric disorders linked to COVID-19.

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“…Research has shown that disease-related immune dysregulation may provide some explanation for the higher susceptibility of people with SMI for severe clinical outcomes of COVID-19 (42,83,119,120). Hyperactivation of the immune system, leading to excess release of pro-inflammatory cytokines (hypercytokinemia) or a "cytokine storm" (cytokine release syndrome), seems to play a major role in the process of disease aggravation in patients with COVID-19 infection (121)(122)(123)(124)(125)(126)(127).…”

Section: Factors Underlying the Association Between Smi And Covid-19-...mentioning

confidence: 99%

COVID-19-Related Mortality Risk in People With Severe Mental Illness: A Systematic and Critical Review

et al. 2022

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Background: Increasing clinical evidence suggests that people with severe mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder (BD), and major depressive disorder (MDD), are at higher risk of dying from COVID-19. Several systematic reviews examining the association between psychiatric disorders and COVID-19-related mortality have recently been published. Although these reviews have been conducted thoroughly, certain methodological limitations may hinder the accuracy of their research findings.Methods: A systematic literature search, using the PubMed, Embase, Web of Science, and Scopus databases (from inception to July 23, 2021), was conducted for observational studies assessing the risk of death associated with COVID-19 infection in adult patients with pre-existing schizophrenia spectrum disorders, BD, or MDD. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).Results: Of 1,446 records screened, 13 articles investigating the rates of death in patients with pre-existing SMI were included in this systematic review. Quality assessment scores of the included studies ranged from moderate to high. Most results seem to indicate that patients with SMI, particularly patients with schizophrenia spectrum disorders, are at significantly higher risk of COVID-19-related mortality, as compared to patients without SMI. However, the extent of the variation in COVID-19-related mortality rates between studies including people with schizophrenia spectrum disorders was large because of a low level of precision of the estimated mortality outcome(s) in certain studies. Most studies on MDD and BD did not include specific information on the mood state or disease severity of patients. Due to a lack of data, it remains unknown to what extent patients with BD are at increased risk of COVID-19-related mortality. A variety of factors are likely to contribute to the increased mortality risk of COVID-19 in these patients. These include male sex, older age, somatic comorbidities (particularly cardiovascular diseases), as well as disease-specific characteristics.Conclusion: Methodological limitations hamper the accuracy of COVID-19-related mortality estimates for the main categories of SMIs. Nevertheless, evidence suggests that SMI is associated with excess COVID-19 mortality. Policy makers therefore must consider these vulnerable individuals as a high-risk group that should be given particular attention. This means that targeted interventions to maximize vaccination uptake among these patients are required to address the higher burden of COVID-19 infection in this already disadvantaged group.

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COVID-19 in People With Schizophrenia: Potential Mechanisms Linking Schizophrenia to Poor Prognosis

Cited by 31 publications

References 117 publications

Medium-term and peri-lockdown course of psychosocial burden during the ongoing COVID-19 pandemic: a longitudinal study on patients with pre-existing mental disorders

Medium-term and peri-lockdown course of psychosocial burden during the ongoing COVID-19 pandemic: a longitudinal study on patients with pre-existing mental disorders

Immune Response Is Key to Genetic Mechanisms of SARS-CoV-2 Infection With Psychiatric Disorders Based on Differential Gene Expression Pattern Analysis

COVID-19-Related Mortality Risk in People With Severe Mental Illness: A Systematic and Critical Review

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