Impact of the COVID-19 Pandemic on People with Schizophrenia Spectrum Disorders

Introduction

Individuals suffering from schizophrenia spectrum disorders are at increased risk of contracting COVID-19 for a number of reasons, including the presence of cognitive impairment, lower vigilance to health risks, or increased risk of transmission during hospitalization or in social facilities.

Multiple risks also represent negative prognostic factors affecting morbidity and mortality in patients. These include the widespread prevalence of smoking, up to 60% in this patient group, as well as a higher number of comorbidities compared to the general population. The COVID-19 pandemic indirectly affects the health of individuals with schizophrenia, for example, due to restrictions on social contacts or the impact of stress.

Study Results

Kozloff et al. published a review study on the impact of the pandemic on patients with schizophrenia spectrum and related disorders. According to the authors, besides stress, COVID-19 disease itself might contribute to the exacerbation of psychotic symptoms, through a presumed mechanism associated with immune response.

Significant influences on the course of the mental illness include restrictions on social contacts and healthcare during the current pandemic, making care continuity a critical element in preventing decompensation of the condition. Telemedicine appears to be a suitable alternative, as in other fields.

A randomized controlled clinical trial published before the pandemic outbreak demonstrated high satisfaction with video calls among patients with severe mental disorders. However, the lower compliance of individuals with schizophrenia and the fact that people with psychotic disorders are less likely to use digital technologies may pose a challenge. So-called telepsychiatry and other digital intervention technologies should be considered for outpatient treatment of schizophrenia to maintain continuity of care.

Nemani et al. published a retrospective cohort study evaluating the impact of COVID-19 infection on mortality in patients with mental disorders. A total of 7348 adult patients with COVID-19 infection (26,540 patients total) were monitored for 45 days from laboratory-confirmed COVID-19 infection. The average age of patients was 54 ± 18.6 years, and women made up 53% of the population.

In the patient cohort were individuals with schizophrenia spectrum disorders (n = 75), mood disorders (n = 564), and anxiety disorders (n = 360). After adjusting for demographic and medical risk factors, a significant association between mortality and schizophrenia spectrum disorders was observed (odds ratio [OR] 2.67; 95% confidence interval [CI] 1.48–4.80). No significant association between mortality and COVID-19 infection was observed in individuals with mood and anxiety disorders.

Conclusion

According to available evidence, the ongoing COVID-19 pandemic has a complex impact on the morbidity and mortality of individuals with schizophrenia spectrum disorders. Ensuring continuity of care for patients, whether through personal checks or via telemedicine and other digital technologies, is an important stabilizing element.

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Sources:
1. Kozloff N., Mulsant B. H., Stergiopoulos V., Voineskos A. N. The COVID-19 global pandemic: implications for people with schizophrenia and related disorders. Schizophr Bull 2020 Jul 8; 46 (4): 752–757, doi: 10.1093/schbul/sbaa051.
2. Nemani K., Li C., Olfson M. et al. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry 2021 Apr 1; 78 (4): 380–386, doi: 10.1001/jamapsychiatry.2020.4442.