Risk factors for poor COVID-19 outcomes in patients with psychiatric disorders

Outpatient Antipsychotic Use and Severe COVID-19: Avoiding the Impact of Age in a Real-World Data Study

“…Off-label AP prescription ratios vary widely among countries, but some of the factors most strongly associated with off-label use are being institutionalized, manifesting psychotic symptoms, and requiring restraints during hospitalization ( Wang et al., 2021 ). These 3 factors tend to be related with needing sedation more frequently or presenting with more serious comorbidities, which are, in turn, associated with more severe forms and higher COVID-19 mortality ( Wang et al., 2021 ; Cheng et al., 2023 ).…”

“…The impossibility of adjusting for some of these confounding variables may result in part of the effects found in other studies on AP use and its link with severe COVID-19 outcomes being attributable to possible confounding by indication (on- or off-label). Moreover, many markers associated with poor COVID-19 prognosis, such as smoking, hypertension, diabetes, and cardiovascular or respiratory diseases ( Zheng et al., 2020 ; Cheng et al., 2023 ), are highly prevalent among patients with mental diseases ( Kozloff et al., 2020 ; Canal-Rivero et al., 2021 ).…”

“…We feel that our study could well have important clinical and public health implications. Previous studies have found AP to be associated with an increased risk of severe COVID-19 outcomes ( Reilev et al., 2020 ; Bliek-Bueno et al., 2021 ; Harrison et al., 2021 ; Cascini et al., 2022 ; Chen et al., 2023 ; Cheng et al., 2023 ; Secnik et al., 2023 ), which could have led to the partial or complete suspension of the treatment in patients for whom its use is indeed indicated. The results of our study would indicate that, for the group aged younger than 65 years, at least, suspension of AP treatment would not be justified because it might do considerable harm at individual, social, economic, and healthcare levels.…”

“…Studies that have evaluated the association between AP and COVID-19 outcomes display inconsistent results. While on the one hand, AP use has been associated with a higher risk of susceptibility ( Cascini et al., 2022 ), severe illness ( Cheng et al., 2023 ; Fico et al., 2023 ), and COVID-19 mortality ( Poblador-Plou et al., 2020 ; Reilev et al., 2020 ; Bliek-Bueno et al., 2021 ; Harrison et al., 2021 ; Vai et al., 2021 ; Cascini et al., 2022 ; Chen et al., 2023 ; Cheng et al., 2023 ; Fico et al., 2023 ; Secnik et al., 2023 ), on the other hand, a reduction in ( Liberman et al., 2022 ; Nemani et al., 2022 ) or absence of effect on susceptibility ( Nemani et al., 2022 ) and mortality ( Diez-Quevedo et al., 2021 ; Nemani et al., 2021 ; Visser et al., 2023 ) has also been reported. As possible sources of these inconsistencies, the following have been suggested: (1) most of the studies have been conducted with institutionalized patients with some type of psychiatric disease and/or advanced age, and there are only a few population-based studies ( Boland and Dratcu, 2021 ); (2) a great proportion of these studies do not evaluate the effect of AP by reference to active ingredient or generation ( Boland and Dratcu, 2021 ); (3) off-label prescription of AP in patients of advanced age with dementia or delusions is an indicator of frailty, a condition that is, in turn, a potential risk factor for mortality or other severe COVID-19 outcomes ( Hewitt et al., 2020 ; Kastora et al., 2021 ; Pranata et al., 2021 ; Sablerolles et al., 2021 ); and lastly, (4) many studies that have evaluated the association between AP use and COVID-19 have relied on secondary databases ( Reilev et al., 2020 ; Bliek-Bueno et al., 2021 ; Diez-Quevedo et al., 2021 ; Nemani et al., 2021 , 2022 ; Cascini et al., 2022 ; Liberman et al., 2022 ; Chen et al., 2023 ; Secnik et al., 2023 ; Visser et al., 2023 ), which pose difficulties in terms of measuring degree of frailty ( Reilev et al., 2020 ; Bliek-Bueno et al., 2021 ; Cascini et al., 2022 ; Liberman et al., 2022 ; ...…”

Risk of COVID‐19 Hospitalization and Protection Associated With mRNA Vaccination Among US Adults With Psychiatric Disorders

“…Largely prior to the availability of COVID‐19 vaccines, psychiatric disorders and especially severe psychiatric disorders such as bipolar and psychotic disorders have been identified as risk factors for severe COVID‐19, COVID‐19‐associated hospitalization, and mortality [ 1 , 2 , 3 , 4 , 5 ]. Possible reasons include impaired immune function, chronic inflammation, comorbid medical conditions, behavioral risk factors (e.g., smoking, substance abuse), and barriers to accessing healthcare services [ 6 , 7 , 8 , 9 , 10 ].…”