During the COVID-19 pandemic, it has been widely recognized that older people and those with pre-existing conditions are at heightened risk for severe illness and death compared to their younger, healthier counterparts. However, when considering pre-existing conditions, much of the focus is on diseases associated with being overweight, such as diabetes and cardiovascular disease.

Those with mental health issues, on the other hand, are often not immediately recognized as a group at increased risk in the face of COVID-19. Nevertheless, those suffering with mental health have been shown to in many cases have worse outcomes from COVID-19. Those with schizophrenia spectrum disorders have increased mortality associated with COVID-19, the reasons for which have not been clear.

One hypothesis around why those with schizophrenia spectrum disorders are more likely than mentally healthy adults to die from COVID-19 is that their antipsychotic medications play some role through their adverse effects. To address this idea, a new study published in JAMA Psychiatry examined whether antipsychotic treatment was associated with increased mortality risk in adults with serious mental illness.

Nearly 500 patients who had had COVID-19 and a pre-existing diagnosis of schizophrenia, schizophrenia affective disorder, or bipolar disorder were included in the study. The average age of participants was 53, and 51.5% of the patients were men while 48.5% were women. Less than half (42.2%) of these patients were on antipsychotic medication. The results showed that antipsychotic treatment did not significantly increase mortality, though a schizophrenia spectrum disorder diagnosis did. Compared to those with bipolar disorder, those with a schizophrenia spectrum disorder were 3 times more likely to die.

Physicians suggest that antipsychotic medication may not be the reason that those with schizophrenia spectrum disorders are at a heightened risk of death from COVID-19. While it is clear that schizophrenia spectrum disorders increase risk of death in the context of COVID-19, the mechanism driving this association is still unclear.

Reference

Nemani K, Conderino S, Marx J, Thorpe LE, Goff DC. Association Between Antipsychotic Use and COVID-19 Mortality Among People With Serious Mental Illness. JAMA Psychiatry. Published online September 22, 2021. doi:10.1001/JAMAPSYCHIATRY.2021.2503