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2.
J Nerv Ment Dis ; 210(4): 257-263, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1713793

ABSTRACT

ABSTRACT: We aimed to explore the prevalence and determinants of severe COVID-19 disease and mortality in patients with schizophrenia in this study. We conducted a retrospective observational study of 1620 patients with schizophrenia. Of the 1620 patients, 52 (3.2%) tested positive for SARS-CoV-19. Among SARS-CoV-2-positive patients, 40 patients were hospitalized, and 17 patients required intensive care unit admission due to COVID-19 (76.9% and 32.7%, respectively). Severe COVID-19 disease was noted in 17 patients (32.7%) requiring intubation. In the logistic regression analysis, antipsychotic dose, and comorbidity score were independently associated with a greater risk of severe COVID-19 disease in patients with schizophrenia. Our study suggests that factors such as age, sex, comorbidities, and a daily antipsychotic dose may have effects on the poor outcome of SARS-CoV-2 disease in schizophrenia patients. In addition, the current findings propose that mortality may be associated with an older age, comorbidity score, and a longer duration of psychiatric disease among the SARS-CoV-2-positive patients with schizophrenia. However, the findings of our study should be verified in prospective and larger sample studies.


Subject(s)
COVID-19 , Schizophrenia , COVID-19/epidemiology , Comorbidity , Demography , Hospitalization , Humans , Prospective Studies , Retrospective Studies , Risk Factors , SARS-CoV-2 , Schizophrenia/epidemiology
3.
Gen Hosp Psychiatry ; 75: 61-67, 2022.
Article in English | MEDLINE | ID: covidwho-1664940

ABSTRACT

OBJECTIVE: Schizophrenia has been associated with patients' poor quality of life, disability, and hospitalization. As of today, evidence that highlights the association between schizophrenia and coronavirus disease (Covid-19) outcomes remains unclear. This study sought to analyze whether patients with pre-existing schizophrenia are at higher risk for Covid-19 mortality. METHODS: Using specific keywords, we comprehensively searched PubMed, Scopus, OVID, and Cochrane Library sources until November 15th, 2021. All published studies on schizophrenia and Covid-19 were collected. We used Review Manager 5.4 and Comprehensive Meta-Analysis 3 software to conduct statistical analysis. RESULTS: There were 10 studies with 263,207 Covid-19 patients included in the analysis. Evaluation of the data gathered yielded an association between schizophrenia and increased mortality from Covid-19 (RR 2.22; 95%CI: 1.54-3.20, p < 0.00001, I2 = 82% random-effect model). The increased risk of developing mortality from Covid-19 in patients with schizophrenia was significantly influenced by older age (p = 0.0004) and smoking (p = 0.0048). CONCLUSIONS: This study proposes that patients with pre-existing schizophrenia are at risk of developing higher Covid-19 mortality. Patients with schizophrenia need special attention and should be prioritized to receive the SARS-CoV-2 vaccine. REGISTRATION DETAILS: CRD42021293997.


Subject(s)
COVID-19 , Schizophrenia , COVID-19 Vaccines , Humans , Quality of Life , SARS-CoV-2 , Schizophrenia/epidemiology
4.
Eur Psychiatry ; 65(1): e7, 2022 01 24.
Article in English | MEDLINE | ID: covidwho-1648438

ABSTRACT

BACKGROUND: Studies of COVID-19 pandemic biopsychosocial exposure and schizophrenia risk showed contradictory results, were undertaken early in the pandemic, and did not consider lockdowns or COVID-19 infection. Hence, we examined the association between COVID-19 biopsychosocial exposure and incident schizophrenia. METHODS: An interrupted time-series study design was implemented based on Israeli electronic health records from 2013 to 2021 with national coverage. The period coinciding with the COVID-19 pandemic biopsychosocial exposures from March 2020 to February 2021 was classified as exposed, otherwise unexposed. The effect of the COVID-19 pandemic on incident schizophrenia was quantified by fitting a Poisson regression and modeling the relative risk (RR) and corresponding 95% confidence intervals (CI). Three scenarios were projected from the third lockdown to 10 months to forecast incident schizophrenia rates and their associated 95% prediction intervals (PI). RESULTS: The total population (N = 736,356) yielded 4,310 cases of incident schizophrenia over time. The primary analysis showed that the period exposed to the COVID-19 pandemic was associated with a reduced RR (RR = 0.81, 95% CI = 0.73, 0.91, p < 0.001). This conclusion was supported in 12 sensitivity analyses, including scrutinizing lockdowns and COVID-19 infection status. Two of three forecast scenarios projected an incident increase (6.74, 95% PI = 5.80, 7.84; 7.40, 95% PI = 6.36, 8.60). CONCLUSIONS: The reduced risk of schizophrenia during the pandemic suggests no immediate triggering of new onsets either by the virus or the pandemic-induced psychosocial adversities. Once restrictions are lifted, the increased projected presentations have implications for clinicians and healthcare policy.


Subject(s)
COVID-19 , Schizophrenia , Communicable Disease Control , Humans , Pandemics , Risk , SARS-CoV-2 , Schizophrenia/epidemiology
5.
Int J Environ Res Public Health ; 19(1)2021 12 22.
Article in English | MEDLINE | ID: covidwho-1580856

ABSTRACT

Many studies have shown that the COVID-19 pandemic can have a great influence on mental health. However, there is still not enough research to fully understand how people suffering from schizophrenia experience crisis situations such as a pandemic. This qualitative study aims to explore this subject. Ten outpatients suffering from schizophrenia were interviewed in a semi-structured format using an interview designed by the authors for the purpose of this study. The interviews were transcribed, and a conventional qualitative content analysis was conducted. The general themes identified in the content analysis were organized into four categories: first reactions to information about the pandemic; subjective assessment of the pandemic's impact on patients' mental health; patients' attitudes towards the temporary limitations and lockdowns; psychiatric treatment and psychotherapy during the pandemic. A variety of different experiences were observed, but the general conclusion arising from the study suggests that the majority of the interviewed patients coped quite well with the pandemic and that the observed reactions were similar to the reactions of other groups described in the literature. The study also confirmed the importance of the continuity of psychiatric care for patients with schizophrenia.


Subject(s)
COVID-19 , Schizophrenia , Communicable Disease Control , Humans , Pandemics , Qualitative Research , SARS-CoV-2 , Schizophrenia/epidemiology , Schizophrenia/therapy
6.
BMJ Open ; 11(12): e053324, 2021 12 14.
Article in English | MEDLINE | ID: covidwho-1575034

ABSTRACT

INTRODUCTION: People with schizophrenia die about 15-20 years earlier than the general population. A constellation of factors contributes to this gap in life expectancy: side effects of psychotropic drugs, unhealthy lifestyles (inactivity, unhealthy diet) and inequality in the provision of healthcare services. This is a topic of main importance, which requires constant update and synthesis of the literature. The aim of this review is to explore the evidence of physical comorbidity and use of healthcare services in people with schizophrenia. METHODS AND ANALYSIS: We will conduct a systematic literature search in the databases PubMed/MEDLINE, EMBASE, Scopus, Web of Science, PsycINFO and Cochrane Library, Proquest Health Research Premium Collection, in order to identify studies that answer to our research question: Are patients with schizophrenia different from the non-psychiatric population in terms of physical comorbidity and use of healthcare services? Two authors will independently review the studies and extract the data. ETHICS AND DISSEMINATION: This study does not include human or animal subjects. Thus, ethics considerations are not applicable. Dissemination plans include publications in peer-reviewed journals and discussion of results in psychiatric congresses. PROSPERO REGISTRATION NUMBER: CRD42020139972.


Subject(s)
Schizophrenia , Comorbidity , Delivery of Health Care , Health Services , Humans , Psychotropic Drugs , Schizophrenia/epidemiology , Schizophrenia/therapy , Systematic Reviews as Topic
7.
J Manag Care Spec Pharm ; 27(10-a Suppl): S2-S13, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1471241

ABSTRACT

BACKGROUND: Despite therapeutic advances for patients with schizophrenia, improving patient outcomes and reducing the cost of care continue to challenge formulary decision makers. OBJECTIVES: To (1) understand the perspectives of formulary decision makers on challenges to optimal schizophrenia population management and (2) identify best practices and recommendations for mitigating these challenges. METHODS: This mixed-methods study, conducted in a double-blind manner, comprised in-depth telephone interviews with formulary decision makers from February through May 2020, and a web-based follow-on survey that was sent to all participants in October 2020. US-based formulary decision makers were recruited if they were directly involved in schizophrenia drug formulary or coverage decision making for national or regional payers, health systems, or behavioral health centers. Formulary decision makers' perceptions of challenges, policies, and programs related to schizophrenia population health management were assessed generally and in the context of the COVID-19 pandemic. RESULTS: 19 formulary decision makers participated in the interviews and 18 (95%) completed the survey. Participants reported a spectrum of patient- and payer-driven challenges in schizophrenia population health management, including medication nonadherence, high pharmacy and medical costs, and frequent hospitalizations and emergency department visits. Participants noted that COVID-19 had worsened all identified challenges, although patient unemployment (mean score of 2.00 on a scale of 1 [made much worse] to 5 [made much better]) and reduced access to psychiatric care (mean score, 2.12) were most negatively affected. The most common strategies implemented in order to improve schizophrenia population health management included case management (89%), telemedicine (83%), care coordination programs (72%), strategies to mitigate barriers to accessing medication (61%), and providing nonmedical services to address social determinants of health (56%). Participants noted that, ideally, all treatments for schizophrenia would be available on their formularies without utilization management policies in place in order to increase accessibility to medication, but cost to the health plans made that difficult. Whereas 61% of respondents believed that long-acting injectable antipsychotics (LAIs) were currently underused in their organizations, only 28% represented organizations with open access policies for LAIs. Participants believed that among patients with schizophrenia, LAIs were most beneficial for those with a history of poor or uncertain adherence to oral medications (mean score of 4.50 on a scale of 1 [not at all beneficial] to 5 [extremely beneficial]) and those with recurring emergency department visits and inpatient stays (mean score, 3.94). Study participants reported slightly increased use of LAIs (mean score of 3.17 on a scale of 1 [negatively impacted] to 5 [positively impacted]) among their patients with schizophrenia in response to the COVID-19 pandemic; 29% of participants reported easing access restrictions for LAIs. CONCLUSIONS: Participants described persisting challenges and various approaches intended to improve schizophrenia population health management. They also recommended strategies to optimize future health management for this population, including expanding programs to address social determinants of health and mitigating barriers to accessing treatment. DISCLOSURES: This study was funded by Janssen Scientific Affairs, LLC. Roach, Graf, Pednekar, and Chou are employees of PRECISIONheor, which received financial support from Janssen Scientific Affairs, LLC, to conduct this study. Chou owns equity in Precision Medicine Group, the parent company of PRECISIONheor. Lin and Benson are employees of Janssen Scientific Affairs, LLC. Doshi has served as a consultant, advisory board member, or both, for Acadia, Allergan, Boehringer Ingelheim, Janssen, Merck, Otsuka, and Sage Therapeutics and has received research funding from AbbVie, Biogen, Humana, Janssen, Novartis, Merck, Pfizer, PhRMA, Regeneron, Sanofi, and Valeant.


Subject(s)
COVID-19/prevention & control , Clinical Decision-Making/methods , Health Personnel , Population Health Management , Population Health , Schizophrenia/therapy , Antipsychotic Agents/therapeutic use , COVID-19/epidemiology , Double-Blind Method , Female , Follow-Up Studies , Humans , Interviews as Topic/methods , Male , Medication Adherence , Schizophrenia/diagnosis , Schizophrenia/epidemiology
8.
Neuropharmacology ; 201: 108841, 2021 12 15.
Article in English | MEDLINE | ID: covidwho-1466809

ABSTRACT

A strong association between perinatal viral infections and neurodevelopmental disorders has been established. Both the direct contact of the virus with the developing brain and the strong maternal immune response originated by viral infections can impair proper neurodevelopment. Coronavirus disease 2019 (COVID-19), caused by the highly-infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently responsible for a large global outbreak and is a major public health issue. While initial studies focused on the viral impact on the respiratory system, increasing evidence suggest that SARS-CoV-2 infects other organs and tissues including the mature brain. While studies continue to determine the neuropathology associated to COVID-19, the consequences of SARS-CoV-2 infection to the developing brain remain largely unexplored. The present review discusses evidence suggesting that SARS-CoV-2 infection may have persistent effects on the course of pregnancy and on brain development. Studies have shown that several proinflammatory mediators which are increased in the SARS-CoV-2-associated cytokine storm, are also modified in other viral infections known to increase the risk of neurodevelopmental disorders. In this sense, further studies should assess the genuine effects of SARS-CoV-2 infection during pregnancy and delivery along with an extended follow-up of the offspring, including neurocognitive, neuroimaging, and electrophysiological examination. It also remains to be determined whether and by which mechanisms SARS-CoV-2 intrauterine and early life infection could lead to an increased risk of developing neuropsychiatric disorders, such as autism (ASD) and schizophrenia (SZ), in the offspring.


Subject(s)
Autism Spectrum Disorder/epidemiology , COVID-19/epidemiology , Cytokine Release Syndrome/epidemiology , Neurodevelopmental Disorders/epidemiology , Pregnancy Complications, Infectious/epidemiology , Prenatal Exposure Delayed Effects/epidemiology , Schizophrenia/epidemiology , Autism Spectrum Disorder/immunology , Brain/embryology , Brain/immunology , COVID-19/immunology , Cytokine Release Syndrome/immunology , Female , Humans , Infectious Disease Transmission, Vertical , Neurodevelopmental Disorders/immunology , Pregnancy , Pregnancy Complications, Infectious/immunology , Prenatal Exposure Delayed Effects/immunology , Risk Factors , SARS-CoV-2 , Schizophrenia/immunology
9.
Eur Arch Psychiatry Clin Neurosci ; 272(1): 167-168, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1449958

ABSTRACT

A strong link between schizophrenia and a higher mortality rate from SARS-CoV-2 infections has been reported for schizophrenia patients, with a mortality odds ratio (OR) of 2.67 compared to normal patients, after adjustment of the OR for age, sex, race and extra risk factors. In addition, an extensive number of papers have reported a very strong link between schizophrenia and Toxoplasma gondii infections. A meta-analysis of 38 studies of links between schizophrenia and T. gondii antibody seroprevalence resulting from previous infections indicated that the likelihood of T. gondii infection in schizophrenia patients was 2.7 times higher than the general population. In other words, the meta-analysis indicated that schizophrenia patients had an odds ratio of 2.7 of T. gondii infection compared to the general population. This indicates that compared to the general population, schizophrenia patients have virtually the same odds ratio for having a T. gondii infection and for mortality from a COVID-19 infection. This suggests that T. gondii infections, directly or indirectly, have a relationship with higher mortality in COVID-19 patients having schizophrenia. This conclusion would also apply to the general population.


Subject(s)
COVID-19 , Schizophrenia , Toxoplasmosis , Antibodies, Protozoan/blood , COVID-19/mortality , Female , Humans , Male , Risk Factors , Schizophrenia/epidemiology , Seroepidemiologic Studies , Toxoplasma/immunology , Toxoplasmosis/diagnosis , Toxoplasmosis/epidemiology
10.
Asian J Psychiatr ; 66: 102878, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1446352

ABSTRACT

The aim of this article is to analyze publication trends related to schizophrenia, mental health, and depression during COVID-19 in the Asian Journal of Psychiatry. In 2020, 576 articles were identified using bibliometric analysis from scopus.com. According to the results, India had the most articles on schizophrenia, mental health, and depression, followed by China, Australia, Bangladesh, and Japan, during COVID-19. Meanwhile, the most frequently used keywords were schizophrenia (n = 39), COVID-19 (n = 35), mental health (n = 23), depression (n = 22), and adolescents (n = 12). These represent the trend of publications related to the topics discussed in 2020. Moreover, alternative research themes such as life quality, obsessive-compulsive disorder, metabolic syndrome, prevalence, and mental illness can be used in the future.


Subject(s)
COVID-19 , Schizophrenia , Adolescent , Depression/epidemiology , Humans , Mental Health , SARS-CoV-2 , Schizophrenia/epidemiology
16.
Psychiatry Res ; 303: 114081, 2021 09.
Article in English | MEDLINE | ID: covidwho-1294146

ABSTRACT

This study investigated the characteristics of patients with schizophrenia and other psychotic disorders presenting to emergency departments (ED) for psychiatric treatment during the first six months of the COVID-19 lockdown in Melbourne. This cross-sectional data-base study included adult patients in the North West Area Mental Health Service's catchment area who had visited two emergency departments (EDs) during the study period (March 16-September 16, 2020) and the control period (March 16-September 16, 2019). Compared to the control period (n = 467), the lockdown period (n = 451) had a 6.8% more psychotic disorders. This increase was particularly noted for schizophrenia and acute transient psychosis. In a sub-analysis of psychotic disorder group alone, compared to the control period, more patients were discharged to the community in the lockdown period. In another sub-analysis, compared to the mood disorder group, psychotic disorder group included more patients in 26-35 and 46-55 age groups, men, emergency triage category, and hospital admissions and higher mean duration of ED stay in the lockdown period. Overall, patients with psychotic disorders had increased ED presentations and appeared to be in an emergency state when they present to ED during the lockdown.


Subject(s)
COVID-19 , Psychotic Disorders , Schizophrenia , Adult , Communicable Disease Control , Cross-Sectional Studies , Emergency Service, Hospital , Humans , Male , Psychotic Disorders/epidemiology , Retrospective Studies , SARS-CoV-2 , Schizophrenia/epidemiology
17.
Int J Clin Pract ; 75(10): e14528, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1285029

ABSTRACT

BACKGROUND: Increased coronavirus disease 2019 (COVID-19) incidence and mortality in hospitalised patients with psychiatric and neurologic disorders have been reported. METHODS: The clinical records of 198 patients with psychiatric and neurological disorders hospitalised in the Dr Rafael Serrano Psychiatric Hospital in Puebla during the peak of the first wave of the COVID-19 pandemic in Mexico were analysed for psychiatric or neurologic diagnosis, gender, age, medical diagnosis, and COVID-19 prevalence. For patients with COVID-19, the effects of gender, and medical diagnosis were explored. RESULTS: There was an increased COVID-19 prevalence in the studied population (43.94%), compared with the national Mexican (~0.21% to 0.63%) and worldwide average in the general population (~0.13% to 4.28%). However, the mortality rate (5.75%) was lower than that reported in Mexico (11.28%-13.55%), which was higher than the worldwide average (2.95%-4.98%). We detected increased COVID-19 prevalence in patients with comorbidities (odds ratios [OR] 0.4; 95% CI: 0.2-1, P = .0447). Moreover, patients with schizophrenia spectrum disorders have a decreased predisposition to COVID-19 (OR 0.4, 95% CI: 0.2-0.8; P = .0250), as opposed to patients with intellectual disability that are predisposed to COVID-19 (OR 2.2, 95% CI: 0.2-0.8; P = .0434), in comparison with the rest of the hospital population. CONCLUSION: The prevalence of COVID-19 in hospitalised patients with psychiatric disorders is increased compared with that of the general population; however, a lower mortality rate was detected. Also, an increased risk of COVID-19 was detected in patients with comorbidities. Interestingly, the observed variation in COVID-19 prevalence in patients with schizophrenia and intellectual disability was not associated with age or other specific medical diagnoses.


Subject(s)
COVID-19 , Nervous System Diseases , Schizophrenia , Hospitalization , Humans , Mexico/epidemiology , Nervous System Diseases/epidemiology , Pandemics , Prevalence , Retrospective Studies , SARS-CoV-2 , Schizophrenia/complications , Schizophrenia/epidemiology
19.
Perspect Psychiatr Care ; 57(4): 1991-1998, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1211562

ABSTRACT

PURPOSE: This study explored how patients with schizophrenia were provided with social support and treatment compliance during the pandemic. DESIGN AND METHODS: A total of 396 patients with schizophrenia and their relatives were interviewed by telephone calls. FINDINGS: Multiple antipsychotic use and depot antipsychotics were not superior in preventing relapse. A total of 70.2% of the patients wanted to meet with their psychiatrist online but only 7.1% of them were reached online. A total of 59% of patients were able to take their medication thanks to the extension of their drug prescriptions. PRACTICE IMPLICATIONS: Active inclusion of telepsychiatry applications in clinical practice is necessary for patients with schizophrenia. Government policies developed for treatment compliance seem important.


Subject(s)
Antipsychotic Agents , COVID-19 , Psychiatry , Schizophrenia , Telemedicine , Antipsychotic Agents/therapeutic use , Disease Progression , Humans , Pandemics , Patient Compliance , SARS-CoV-2 , Schizophrenia/drug therapy , Schizophrenia/epidemiology
20.
Acta Psychiatr Scand ; 144(1): 82-91, 2021 07.
Article in English | MEDLINE | ID: covidwho-1202211

ABSTRACT

OBJECTIVE: Psychiatric disorders have been associated with unfavourable outcome following respiratory infections. Whether this also applies to coronavirus disease 2019 (COVID-19) has been scarcely investigated. METHODS: Using the Danish administrative databases, we identified all patients with a positive real-time reverse transcription-polymerase chain reaction test for COVID-19 in Denmark up to and including 2 January 2021. Multivariable cox regression was used to calculate 30-day absolute risk and average risk ratio (ARR) for the composite end point of death from any cause and severe COVID-19 associated with psychiatric disorders, defined using both hospital diagnoses and redemption of psychotropic drugs. RESULTS: We included 144,321 patients with COVID-19. Compared with patients without psychiatric disorders, the standardized ARR of the composite outcome was significantly increased for patients with severe mental illness including schizophrenia spectrum disorders 2.43 (95% confidence interval [CI], 1.79-3.07), bipolar disorder 2.11 (95% CI, 1.25-2.97), unipolar depression 1.70 (95% CI, 1.38-2.02), and for patients who redeemed psychotropic drugs 1.70 (95% CI, 1.48-1.92). No association was found for patients with other psychiatric disorders 1.13 (95% CI, 0.86-1.38). Similar results were seen with the outcomes of death or severe COVID-19. Among the different psychiatric subgroups, patients with schizophrenia spectrum disorders had the highest 30-day absolute risk for the composite outcome 3.1% (95% CI, 2.3-3.9%), death 1.2% (95% CI, 0.4-2.0%) and severe COVID-19 2.7% (95% CI, 1.9-3.6%). CONCLUSION: Schizophrenia spectrum disorders, bipolar disorder, unipolar depression and psychotropic drug redemption are associated with unfavourable outcomes in patients with COVID-19.


Subject(s)
COVID-19/mortality , Mental Disorders/epidemiology , SARS-CoV-2/isolation & purification , Bipolar Disorder/drug therapy , Bipolar Disorder/epidemiology , COVID-19/psychology , Denmark/epidemiology , Humans , Male , Mental Disorders/diagnosis , Mood Disorders/diagnosis , Mood Disorders/epidemiology , Risk Factors , Schizophrenia/diagnosis , Schizophrenia/drug therapy , Schizophrenia/epidemiology
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