Increased in-hospital mortality from COVID-19 in patients with schizophrenia

Abstract

Background There is limited information describing the presenting characteristics and outcomes of patients with schizophrenia (SCZ) requiring hospitalization for coronavirus disease 2019 (COVID-19). Aims We aimed to compare the clinical characteristics and outcomes of COVID-19 SCZ patients with those of non-SCZ patients. Method This was a case-control study of COVID-19 patients admitted to 4 AP–HM/AMU acute care hospitals in Marseille, southern France. COVID-19 infection was confirmed by a positive result on polymerase chain reaction testing of a nasopharyngeal sample and/or on chest computed scan among patients requiring hospital admission. The primary outcome was in-hospital mortality. The secondary outcome was intensive care unit (ICU) admission. Results A total of 1092 patients were included. The overall in-hospital mortality rate was 9.0%. The SCZ patients had an increased mortality compared to the non-SCZ patients (26.7% vs. 8.7%, P = 0.039), which was confirmed by the multivariable analysis after adjustment for age, sex, smoking status, obesity and comorbidity (adjusted odds ratio 4.36 [95% CI: 1.09–17.44]; P = 0.038). In contrast, the SCZ patients were not more frequently admitted to the ICU than the non-SCZ patients. Importantly, the SCZ patients were mostly institutionalized (63.6%, 100% of those who died), and they were more likely to have cancers and respiratory comorbidities. Conclusions This study suggests that SCZ is not overrepresented among COVID-19 hospitalized patients, but SCZ is associated with excess COVID-19 mortality, confirming the existence of health disparities described in other somatic diseases.

COVID-19 Prevalence and Mortality Among Schizophrenia Patients: A Large-Scale Retrospective Cohort Study

“… 16 Previous studies have also demonstrated a pattern of higher IHD mortality, yet lower or no increased risk of IHD in schizophrenia, 16 , 30 a finding that has been suggested to be associated with lower help-seeking behavior. 31–33 The higher rates of mortality also confirm the results reported by Fond et al, 10 who found a significantly higher prevalence of schizophrenia diagnoses among individuals admitted to acute care hospitals in France. Previous studies have indicated that aside from baseline physical comorbid illnesses, schizophrenia patients engage in smoking behavior more frequently and are therefore more vulnerable to smoking-related illnesses such as COPD, 16 which is considered a risk factor for COVID-19 mortality.…”

“…Reilev et al 9 performed a population-based study to assess factors that might contribute to a higher risk of severe and fatal COVID-19 disease among Danish individuals, and found that a major psychiatric disorder increased the odds of mortality by 2.4–2.7. To the best of our knowledge, only one study has assessed the association between schizophrenia diagnosis and severity of COVID-19 illness: Fond et al 10 performed a case-control study of 1092 patients admitted to acute care hospitals due to COVID-19 illness in Marseille, France, and found increased mortality rates among patients with schizophrenia (26.7%) compared to patients without schizophrenia (8.7%). Nonetheless, the authors stated that the sample of schizophrenia patients included only 15 cases, and the database suffered from missing data and potential inaccuracies, precluding strong conclusions.…”

“…Nonetheless, the authors stated that the sample of schizophrenia patients included only 15 cases, and the database suffered from missing data and potential inaccuracies, precluding strong conclusions. 10 Thus, the association between schizophrenia and prevalence of infections, as well as with severity of illness, remains to be examined.…”

The Collateral Damage of the COVID-19 Outbreak on Mental Health and Psychiatry

“…Those suffering from schizophrenic psychoses are not just more likely to contract COVID-19, they are more likely to die from it; they are more likely to experience a deterioration of their psychiatric symptoms, and they are more likely to misperceive risk and fail to adopt protective measures [ 25 , 26 , 27 ]. They are particularly vulnerable to the consequences of the pandemic, and rather than have their care funding reduced and redirected to managing COVID-19, they should instead receive increased support.…”

Due to their anti-inflammatory, antioxidant and neurotrophic properties, second-generation antipsychotics are suitable in patients with schizophrenia and COVID-19

“…1 ). Initial reports described increased risk for mortality in hospitalized COVID-19 patients with schizophrenia [ 2 , 3 ]. This phenomenon was attributed to the lack of adherence to public health measures (social distancing, hand washing, and the use of face masks) by patients, the limited availability of health services for patients with mental disease because of hospital saturations, or the delayed medical attention or treatment-seeking.…”