Mortality in association with antipsychotic medication use and clinical outcomes among geriatric psychiatry outpatients with COVID-19.

OBJECTIVES: Older adults are particularly vulnerable to the negative consequences of antipsychotic exposure and are disproportionally affected by higher mortality from coronavirus disease 2019 (COVID-19). Our goal was to determine whether concurrent antipsychotic medication use was associated with increased COVID-19 mortality in older patients with preexisting behavioral health problems. We also report on findings from post-COVID follow-ups. DESIGN: Retrospective observational study. PARTICIPANTS: Outpatients at a geriatric psychiatric clinic in New York City. MEASUREMENTS: Demographic and clinical data including medication, diagnosis and Clinical Global Impression Severity (CGI-S) scales on outpatients who had COVID-19 between February 28th and October 1st 2020 were extracted from the electronic health records (EHR) from the hospital. RESULTS: A total of 56 patients were diagnosed with COVID-19 (mean age 76 years; median age 75 years) and 13 (23.2%) died. We found an increased mortality risk for patients who were prescribed at least one antipsychotic medication at the time of COVID-19 infection (Fisher's exact test P = 0.009, OR = 11.1, 95% confidence interval: 1.4-96.0). This result remains significant after adjusting for age, gender, housing context and dementia (Logistic regression P = 0.035, Beta = 2.4). Furthermore, we found that most patients who survived COVID-19 (88.4%) recovered to pre-COVID baseline in terms of psychiatric symptoms. Comparison of pre- and post-COVID assessments of CGI-S for 33 patients who recovered from COVID-19 were not significantly different. CONCLUSION: We observed a higher COVID-19 mortality associated with concurrent antipsychotics use in older patients receiving behavioral health services. The majority of patients in our geriatric clinic who recovered from COVID-19 appeared to return to their pre-COVID psychiatric function. More precise estimates of the risk associated with antipsychotic treatment in older patients with COVID-19 and other underlying factors will come from larger datasets and meta-analyses.

The role of religion in the well-being of older adults with schizophrenia.

OBJECTIVES: This study examined a community sample of older adults with schizophrenia to determine whether there were differences in religiousness with their age peers, to examine the relationship between religiousness and psychotic symptoms, and to see whether religiousness has direct or stress-buffering effects on quality of life. METHODS: The schizophrenia group consisted of 198 community-dwelling persons aged 55 and older who developed schizophrenia before age 45.A community comparison group (N=113) was recruited using randomly selected block groups. A seven-item religiousness scale was developed that consisted of three dimensions (salience, coping, and attendance). An adaptation of Pearlin and colleagues' Stress Process Model was used to examine the direct and buffering effects of religiousness on quality of life. RESULTS: Persons with schizophrenia had significantly lower levels of religiousness than their age peers, although this was due to less frequent religious attendance (four times a year versus once a month). Religiousness was not significantly associated with psychotic symptoms, nor did it have any buffering effects on the relationship between psychosis and quality of life. Religiousness had a significant, albeit modest, independent additive effect on quality of life, and it did not have any buffering effects on the four stressors that were significantly associated with quality of life. CONCLUSIONS: Religiousness may have a favorable impact on the quality of life of older adults with schizophrenia, and it must be considered along with other therapeutically important agents.