DOI QR코드

DOI QR Code

Supporting Patients With Schizophrenia in the Era of COVID-19

COVID-19 유행 시기의 조현병 환자 지원

  • Kim, Sung-Wan (Department of Psychiatry, Chonnam National University Medical School)
  • 김성완 (전남대학교 의과대학 정신건강의학교실)
  • Received : 2021.10.04
  • Accepted : 2021.10.10
  • Published : 2021.10.30

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has drastically impacted our society and health care system. People with schizophrenia are more vulnerable to this burden of illness and related societal changes. In addition, they are more susceptible to the transmission of COVID-19 and have a significantly higher mortality rate compared to the general population. In a recent study, vaccinated patients with schizophrenia showed a greatly decreased mortality level similar to that of the general population. However, patients with schizophrenia were less likely to be vaccinated. Mental health professionals should provide them with appropriate information on prevention strategies against COVID-19 and vaccination. Long-lasting social distancing and social disconnection can make people with schizophrenia more vulnerable to loneliness and depression. Furthermore, patients with schizophrenia may face challenges continuing psychiatric treatment due to the COVID-19 pandemic. Social support and suitable mental health services using novel technologies should be developed and provided to patients with schizophrenia.

Keywords

Acknowledgement

본 논문 집필에 자료 정리와 아이디어를 제공해주신 전남대학교병원 정신건강의학과 이주연, 유승형, 김주완, 전민, 김하늬, 나미수, 조서현, 백선화, 진윤태, 김지수, 박진영, 김예진 선생님을 포함한 교실원 및 연구원(조안나, 이미영, 최윤아, 전다혜, 김미나), 그리고 광주북구정신건강복지센터 선생님들께 감사드립니다.

References

  1. Kim M, Park IH, Kang YS, Kim H, Jhon M, Kim JW, et al. Comparison of psychosocial distress in areas with different COVID-19 prevalence in Korea. Front Psychiatry 2020;11:593105. https://doi.org/10.3389/fpsyt.2020.593105
  2. Ryu S, Park IH, Kim M, Lee YR, Lee J, Kim H, et al. Network study of responses to unusualness and psychological stress during the COVID-19 outbreak in Korea. PLOS One 2021;16:e0246894. https://doi.org/10.1371/journal.pone.0246894
  3. Mueller AL, McNamara MS, Sinclair DA. Why does COVID-19 disproportionately affect older people? Aging (Albany NY) 2020;12:9959-9981. https://doi.org/10.18632/aging.103344
  4. Kim SW, Su KP. Using psychoneuroimmunity against COVID-19. Brain Behav Immun 2020;87:4-5. https://doi.org/10.1016/j.bbi.2020.03.025
  5. Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry 2020;7:e21. https://doi.org/10.1016/s2215-0366(20)30090-0
  6. Xiang YT, Zhao YJ, Liu ZH, Li XH, Zhao N, Cheung T, et al. The COVID-19 outbreak and psychiatric hospitals in China: managing challenges through mental health service reform. Int J Biol Sci 2020;16:1741-1744. https://doi.org/10.7150/ijbs.45072
  7. Kim SW, Park WY, Jhon M, Kim M, Lee JY, Kim SY, et al. Physical health literacy and health-related behaviors in patients with psychosis. Clin Psychopharmacol Neurosci 2019;17:279-287. https://doi.org/10.9758/cpn.2019.17.2.279
  8. Mazereel V, Van Assche K, Detraux J, De Hert M. COVID-19 vaccination for people with severe mental illness: why, what, and how? Lancet Psychiatry 2021;8:444-450. https://doi.org/10.1016/S2215-0366(20)30564-2
  9. Pinkham AE, Ackerman RA, Depp CA, Harvey PD, Moore RC. COVID-19-related psychological distress and engagement in preventative behaviors among individuals with severe mental illnesses. NPJ Schizophr 2021;7:7. https://doi.org/10.1038/s41537-021-00136-5
  10. Lerner AM, Folkers GK, Fauci AS. Preventing the spread of SARS-CoV-2 with masks and other "low-tech" interventions. JAMA 2020;324:1935-1936. https://doi.org/10.1001/jama.2020.21946
  11. Jung HR, Park C, Kim M, Jhon M, Kim JW, Ryu S, et al. Factors associated with mask wearing among psychiatric inpatients during the COVID-19 pandemic. Schizophr Res 2021;228:235-236. https://doi.org/10.1016/j.schres.2020.12.029
  12. Lee YR, Lee JY, Park IH, Kim M, Jhon M, Kim JW, et al. The relationship among medical usage regarding COVID-19, knowledge about infection, and anxiety: structural model analysis. J Korean Med Sci 2020;35:e426. https://doi.org/10.3346/jkms.2020.35.e426
  13. Barlati S, Nibbio G, Vita A. Schizophrenia during the COVID-19 pandemic. Curr Opin Psychiatry 2021;34:203-210. https://doi.org/10.1097/YCO.0000000000000702
  14. Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry 2021;20:124-130. https://doi.org/10.1002/wps.20806
  15. Nemani K, Li C, Olfson M, Blessing EM, Razavian N, Chen J, et al. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry 2021;78:380-386. https://doi.org/10.1001/jamapsychiatry.2020.4442
  16. Fond G, Nemani K, Etchecopar-Etchart D, Loundou A, Goff DC, Lee SW, et al. Association between mental health disorders and mortality among patients with COVID-19 in 7 countries: a systematic review and meta-analysis. JAMA Psychiatry 2021:e212274.
  17. Vai B, Mazza MG, Delli Colli C, Foiselle M, Allen B, Benedetti F, et al. Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis. Lancet Psychiatry 2021;8:797-812. https://doi.org/10.1016/S2215-0366(21)00232-7
  18. Barcella CA, Polcwiartek C, Mohr GH, Hodges G, Sondergaard K, Niels Bang C, et al. Severe mental illness is associated with increased mortality and severe course of COVID-19. Acta Psychiatr Scand 2021;144:82-91. https://doi.org/10.1111/acps.13309
  19. Tzur Bitan D, Krieger I, Kridin K, Komantscher D, Scheinman Y, Weinstein O, et al. COVID-19 prevalence and mortality among schizophrenia patients: a large-scale retrospective cohort study. Schizophr Bull 2021;47:1211-1217. https://doi.org/10.1093/schbul/sbab012
  20. Tzur Bitan D, Kridin K, Cohen AD, Weinstein O. COVID-19 hospitalisation, mortality, vaccination, and postvaccination trends among people with schizophrenia in Israel: a longitudinal cohort study. Lancet Psychiatry 2021;8:901-908. https://doi.org/10.1016/S2215-0366(21)00256-X
  21. Lee SW, Yang JM, Moon SY, Yoo IK, Ha EK, Kim SY, et al. Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study. Lancet Psychiatry 2020;7:1025-1031. https://doi.org/10.1016/S2215-0366(20)30421-1
  22. Shinn AK, Viron M. Perspectives on the COVID-19 pandemic and individuals with serious mental illness. J Clin Psychiatry 2020;81:20com13412.
  23. Dickerson F, Schroeder J, Katsafanas E, Khushalani S, Origoni AE, Savage C, et al. Cigarette smoking by patients with serious mental illness, 1999-2016: an increasing disparity. Psychiatr Serv 2018;69:147-153. https://doi.org/10.1176/appi.ps.201700118
  24. Steiner J, Jacobs R, Panteli B, Brauner M, Schiltz K, Bahn S, et al. Acute schizophrenia is accompanied by reduced T cell and increased B cell immunity. Eur Arch Psychiatry Clin Neurosci 2010;260:509-518. https://doi.org/10.1007/s00406-010-0098-x
  25. Wang AK, Miller BJ. Meta-analysis of cerebrospinal fluid cytokine and tryptophan catabolite alterations in psychiatric patients: comparisons between schizophrenia, bipolar disorder, and depression. Schizophr Bull 2018;44:75-83. https://doi.org/10.1093/schbul/sbx035
  26. Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of anti-psychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015;14:119-136. https://doi.org/10.1002/wps.20204
  27. Villasante-Tezanos AG, Rohde C, Nielsen J, de Leon J. Pneumonia risk: approximately one-third is due to clozapine and two-thirds is due to treatment-resistant schizophrenia. Acta Psychiatr Scand 2020;142:66-67. https://doi.org/10.1111/acps.13184
  28. Ferraris A, Szmulewicz AG, Posadas-Martinez ML, Serena MA, Vazquez FJ, Angriman F. The effect of antipsychotic treatment on recurrent venous thromboembolic disease: a cohort study. J Clin Psychiatry 2019;80:18m12656.
  29. Reilev M, Kristensen KB, Pottegard A, Lund LC, Hallas J, Ernst MT, et al. Characteristics and predictors of hospitalization and death in the first 11 122 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: a nationwide cohort. Int J Epidemiol 2020;49:1468-1481. https://doi.org/10.1093/ije/dyaa140
  30. Poblador-Plou B, Carmona-Pirez J, Ioakeim-Skoufa I, Poncel-Falco A, Bliek-Bueno K, Pozoet MC, et al. Baseline chronic comorbidity and mortality in laboratory-confirmed COVID-19 cases: results from the PRECOVID study in Spain. Int J Environ Res Public Health 2020;17:1-14.
  31. 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 2021 in press.
  32. Perry RJ, Tamborska A, Singh B, Craven B, Marigold R, Arthur-Farraj P, et al. Cerebral venous thrombosis after vaccination against COVID-19 in the UK: a multicentre cohort study. Lancet 2021;398:1147-1156. https://doi.org/10.1016/S0140-6736(21)01608-1
  33. Kim HW, Jenista ER, Wendell DC, Azevedo CF, Campbell MJ, Darty SN, et al. Patients with acute myocarditis following mRNA COVID-19 vaccination. JAMA Cardiol 2021:e212828.
  34. Lorenz RA, Norris MM, Norton LC, Westrick SC. Factors associated with influenza vaccination decisions among patients with mental illness. Int J Psychiatry Med 2013;46:1-13. https://doi.org/10.2190/pm.46.1.a
  35. Tzur Bitan D. Patients with schizophrenia are under-vaccinated for COVID-19: a report from Israel. World Psychiatry 2021;20:300-301. https://doi.org/10.1002/wps.20874
  36. Miles LW, Williams N, Luthy KE, Eden L. Adult vaccination rates in the mentally ill population: an outpatient improvement project. J Am Psychiatr Nurses Assoc 2020;26:172-180. https://doi.org/10.1177/1078390319831763
  37. Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open 2020;3:e2019686. https://doi.org/10.1001/jamanetworkopen.2020.19686
  38. Kim SW, Park IH, Kim M, Park AL, Jhon M, Kim JW, et al. Risk and protective factors of depression in the general population during the COVID-19 epidemic in Korea. BMC Psychiatry 2021;21:445. https://doi.org/10.1186/s12888-021-03449-y
  39. Lee YR, Chung YC, Kim JJ, Kang SH, Lee BJ, Lee SH, et al. Differential pathways of the effects of COVID-19-related stress and fear on depression between patients with schizophrenia and the general population. NPJ Schizophr 2021 in press.
  40. Brown E, Gray R, Lo Monaco S, O'Donoghue B, Nelson B, Thompson A, et al. The potential impact of COVID-19 on psychosis: a rapid review of contemporary epidemic and pandemic research. Schizophr Res 2020;222:79-87. https://doi.org/10.1016/j.schres.2020.05.005
  41. Muruganandam P, Neelamegam S, Menon V, Alexander J, Chaturvedi SK. COVID-19 and severe mental illness: impact on patients and its relation with their awareness about COVID-19. Psychiatry Res 2020;291:113265. https://doi.org/10.1016/j.psychres.2020.113265
  42. Kim SW, Kim JJ, Lee BJ, Yu JC, Lee KY, Won SH, et al. Clinical and psychosocial factors associated with depression in patients with psychosis according to stage of illness. Early Interv Psychiatry 2020;14:44-52. https://doi.org/10.1111/eip.12806
  43. Ryu S, Nam HJ, Kim JM, Kim SW. Current and future trends in hospital utilization of patients with schizophrenia in Korea: a time series analysis using National Health Insurance Data. Psychiatry Investig 2021;18:795-800. https://doi.org/10.30773/pi.2021.0071
  44. Ryu S, Nam HJ, Baek SH, Jhon M, Kim JM, Kim SW. Decline in hospital visits by patients with schizophrenia early in the COVID-19 outbreak in Korea. Clin Psychopharmacol Neurosci 2021 in press.
  45. Zhand N, Joober R. Implications of the COVID-19 pandemic for patients with schizophrenia spectrum disorders: narrative review. BJPsych Open 2021;7:e35. https://doi.org/10.1192/bjo.2020.157
  46. Kim SW. Psychosocial intervention for patients with schizophrenia. J Korean Neuropsychitr Assoc 2018;57:235-243. https://doi.org/10.4306/jknpa.2018.57.3.235
  47. Siskind D, Honer WG, Clark S, Correll CU, Hasan A, Howes O, et al. Consensus statement on the use of clozapine during the COVID-19 pandemic. J Psychiatry Neurosci 2020;45:222-223. https://doi.org/10.1503/jpn.200061
  48. McClay E. Clozapine drug monitoring during COVID-19 for stable adult patients. Available at https://www.sps.nhs.uk/articles/clozapine-drug-monitoring-in-primary-care-during-covid-19-for-stable-patients/. Last updated 15 September 2021.
  49. Jeong SH, Kim YS. Challenges in prescribing clozapine in the era of COVID-19: a review focused on immunological implications. Clin Psychopharmacol Neurosci 2021;19:411-422. https://doi.org/10.9758/cpn.2021.19.3.411
  50. Taipale H, Tanskanen A, Mehtala J, Vattulainen P, Correll CU, Tiihonen J. 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry 2020;19:61-68. https://doi.org/10.1002/wps.20699
  51. de Leon J, Ruan CJ, Verdoux H, Wang C. Clozapine is strongly associated with the risk of pneumonia and inflammation. Gen Psychiatr 2020;33:e100183. https://doi.org/10.1136/gpsych-2019-100183
  52. Shah RR, Smith RL. Inflammation-induced phenoconversion of polymorphic drug metabolizing enzymes: hypothesis with implications for personalized medicine. Drug Metab Dispos 2015;43:400-410. https://doi.org/10.1124/dmd.114.061093
  53. Clark SR, Warren NS, Kim G, Jankowiak D, Schubert KO, Kisely S, et al. Elevated clozapine levels associated with infection: a systematic review. Schizophr Res 2018;192:50-56. https://doi.org/10.1016/j.schres.2017.03.045
  54. Ostuzzi G, Papola D, Gastaldon C, Schoretsanitis G, Bertolini F, Amaddeo F, et al. Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations. BMC Med 2020;18:466-481.
  55. Bishara D, Kalafatis C, Taylor D. Emerging and experimental treatments for COVID-19 and drug interactions with psychotropic agents. Ther Adv Psychopharmacol 2020;10:2045125320935306.
  56. National Institute for Health Research. Long-acting injectable (LAI) antipsychotics-How to manage patients on long-acting injectable (LAI, or depot) antipsychotics during the COVID-19 pandemic. Available from URL:http://oxfordhealthbrc.nihr.ac.uk/wp-content/uploads/2020/09/4.-Antipsychotic-depots-and-LAIs-COVID-guidance_v6.1-2-column.pdf.
  57. Kim SW, Lee BJ, Cheon EJ, Won SH, Jo A, Kim JM, et al. Effectiveness of switching to long-acting injectable aripiprazole in patients with recent-onset and chronic schizophrenia. Clin Psychopharmacol Neurosci 2021 in press.
  58. Lee JY, Kim M, Jhon M, Kim JW, Ryu S, Kim JM, et al. Factors associated with a negative emotional response to news media and nationwide emergency text alerts during the COVID-19 outbreak in Korea. Psychiatry Investig 2021;18:825-830. https://doi.org/10.30773/pi.2021.0087
  59. Kozloff N, Mulsant BH, Stergiopoulos V, Voineskos AN. The COVID-19 global pandemic: implications for people with schizophrenia and related disorders. Schizophr Bull 2020;46:752-757. https://doi.org/10.1093/schbul/sbaa051
  60. Kopelovich SL, Turkington D. Remote CBT for psychosis during the COVID-19 pandemic: challenges and opportunities. Community Ment Health J 2021;57:30-34. https://doi.org/10.1007/s10597-020-00718-0
  61. O'Donoghue B, O'Connor K, Thompson A, McGorry P. The need for early intervention for psychosis to persist throughout the COVID-19 pandemic and beyond. Ir J Psychol Med 2021;38:214-219. https://doi.org/10.1017/ipm.2020.56
  62. Kim JW, Stewart R, Kang SJ, Jung SI, Kim SW, Kim JM. Telephone based interventions for psychological problems in hospital isolated patients with COVID-19. Clin Psychopharmacol Neurosci 2020;18:616-620. https://doi.org/10.9758/cpn.2020.18.4.616
  63. Kim SW, Lee GY, Yu HY, Park JH, Lee YS, Kim JW, et al. Development of smartphone application for cognitive behavioral therapy-based case management in patients with schizophrenia. Korean J Schizophr Res 2016;19:10-16. https://doi.org/10.16946/kjsr.2016.19.1.10
  64. Kim SW, Lee GY, Yu HY, Jung EI, Lee JY, Kim SY, et al. Development and feasibility of smartphone application for cognitive behavioural case management of individuals with early psychosis. Early Interv Psychiatry 2018;12:1087-1093. https://doi.org/10.1111/eip.12418
  65. Mindlink YouTube channel. Available from URL: https://www.youtube.com/c/마인드링크.
  66. Kim SW. 2020 Gwangju Mental Health and Welfare Commission Annual report. Gwangju: Gwangju Mental Health and Welfare Commission;2020.
  67. Ryu S, Nam HJ, Jhon M, Lee JY, Kim JM, Kim SW. Trends in suicide deaths before and after the COVID-19 outbreak in Korea. Front Psychiatry 2021 in press.
  68. Kim SW, Kim JK, Jhon M, Lee HJ, Kim H, Kim JW, et al. Mindlink: a stigma-free youth-friendly community-based early intervention centre in Korea. Early Interv Psychiatry 2021;15:1389-1394. https://doi.org/10.1111/eip.13076
  69. Sham PC, O'Callaghan E, Takei N, Murray GK, Hare EH, Murray RM. Schizophrenia following pre-natal exposure to influenza epidemics between 1939 and 1960. Br J Psychiatry 1992;160:461-466. https://doi.org/10.1192/bjp.160.4.461