Additional Confirmation that Schizophrenia May Increase COVID-19 Mortality Risk

What’s happening – A newly published cohort study of adults with schizophrenia reveals that this diagnosis may increase their risk of dying from COVID-19 by almost 3%. In fact, while much attention has been placed on the connection between COVID mortality and a host of chronic health conditions, the researchers discovered that after age, a schizophrenia spectrum diagnosis may be the next highest risk factor for mortality from COVID-19. This high risk, based on the study sample after adjusting for other known risk factors, may be due to the inflammation associated with severe mental illness, as well as chronic stress, which can impair immune system regulation.

The researchers, based at NYU Langone Medical Center and Columbia University, also explored the link between anxiety and COVID mortality, and mood disorders and COVID mortality. They concluded that neither of these conditions increased the risk of death from COVID-19.

The details – Read the full study by Nemani et al in JAMA Psychiatry.

Why it’s complicated – The findings call attention to the importance of ensuring that people with schizophrenia are prioritized to receive the COVID-19 vaccine.

 The perspectives –

  • A round-up of expert responses to the JAMA study published by the Science Media Centre included a reminder that the data was limited to patients with schizophrenia that were receiving medical care. The findings, therefore, may not adequately represent people living with schizophrenia in the broader population who do not have access to care.
  • A related study in Lancet Psychiatry further associated severe mental illness (including schizophrenia) with a number socio-economic factors that increase the risk of COVID-19 infection, including homelessness, difficulty social distancing, and challenges accessing healthcare.
  • The Center for Evidence-Based Medicine reports that public health measures enforced during COVID-19 such as lockdowns and quarantines can be especially detrimental to people with severe mental illness by changing their environment, disrupting their services, and increasing their stress and isolation.

 The conversation ­–

  • @TreatmentAdvCtr (Treatment Advocacy Center) tweets: “Patients who had been diagnosed with disorders on the #schizophrenia spectrum were more than two and a half more times likely to die from #COVID19, according to a new study.”
  • @NAMICommunicate (National Institute on Mental Illness) shares: “How COVID-19 impacts people living with this new study reinforces that people affected by mental illness should be prioritized into receiving the vaccine.”
  • @DrVeronicaKell1 (Dr. Veronica Kelley, Behavioral Health Director San Bernardino County) says: “COVID strikes many vulnerable populations, particularly those with schizophrenia, at alarming rates.”

In practice ­­– People with a psychiatric disorder are at increased risk of inflammation, which over time can worsen a host of diseases. Read how adding COVID-19 infection into the equation– and the related inflammatory response it triggers – can exasperate the problem. See also, how long-term care residents are being underserved when it comes to mental health care during the pandemic.

Adult Psychosis and Depression Linked to Childhood Insulin and BMI Levels

What’s happening – Adult depression and psychosis may have roots going back to childhood, particularly insulin levels and BMI. Researchers exploring this connection recently discovered that having persistent high fasting insulin levels at the age of 9 onward can be linked to psychosis in adulthood. In addition, having a significant increase in BMI before puberty may lead to depression in early adulthood.

These findings, based on data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, call attention to the need to prevent and treat cardiometabolic disorders (and related risk factors) that often co-occur in adults with psychosis and depression.

The details –  Read the full study by Perry et al in JAMA Psychiatry.

Why it’s complicated – In young people with early psychosis, long-acting injectable antipsychotics may be used to control symptoms. Two such atypical antipsychotics (aripiprazole and paliperidone) were associated with significant weight gain and changes in metabolic profile in a study of 59 young persons over a 12-month period, according to a 2020 paper appearing in Early Intervention in Psychiatry. This link underscores the need to educate families about the importance of implementing weight management programs alongside the initiation of medication.

The perspectives –

  • In Acta Psychiatrica Scandinavica, researchers explored whether existing cardiometabolic risk prediction algorithms that include psychiatric predictors could help identify young people who may go on to develop psychosis. Their conclusion was that current algorithms are not fully effective.
  • Frontiers in Endocrinology reports on a cross-sectional study looking at people aged 14 to 35 years in the UK experiencing first-time psychosis and determined that participants had a high prevalence of cardiometabolic risk factors.
  • Pediatrics published the results of a study examining how being overweight or obese in childhood – along with childhood increases in BMI – correlate with cardiometabolic phenotypes in children ages 11- to 12-years-old.

 The conversation—

  • @SIRSGlobal (Schizophrenia International Research Society) tweets: “New @JAMAPsych report links high insulin levels in childhood with later risk of #psychosis in young adults. Findings from a large, prospective analysis of 14,975 individuals.”
  • @NIMHgov (National Alliance on Mental Health) says: “The NIMH-supported Early Psychosis Intervention Network, aimed at determining how to provide the best treatment for individuals experiencing symptoms of early psychosis, continues increasing access to resources for researchers, providers, & families.”
  • @viscidula (Nev Jones, PhD) tweets: “Check out our new paper ‘First-Person Accounts of Change Among Young Adults Enrolled in Coordinated Specialty Care for First-Episode Psychosis’ drawing on interviews with 121 young ppl in the US…”

 In practice – The AACAP annual meeting explored risk factors in youth for anxiety disorders. See also, our clinical primer on first and second-generation antipsychotics.

Psy-Q: This Week’s Challenge

How can antidepressant prescribers address weight gain concerns in adolescents? Lea Lis, MD, answers.

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Is Digital Health the Answer to Mental Health Care Gaps?

What’s happening – While a growing number of Americans are in need of mental and behavioral health services – especially as the COVID pandemic rages on – many are unable to access treatment due to a shortage of mental health care providers. A new consensus statement, compiled by a team of 15 international experts, stresses that digital mental health treatments (DMHT) based on cognitive behavioral therapy (CBT), including video games, smartphone apps, and virtual reality games, may hold the answer to filling in some of these care gaps.

The experts call on policymakers, insurance providers, HCPs, and other stakeholders to find new ways to incorporate evidence-based digital health apps into the healthcare system to improve access to more Americans.

The details – Read the consensus statement in Psychiatric Services.

The perspectives –

  • A piece in Harvard Business Review explores the effectiveness of some of the more common virtual mental health care options and programs and talks about the importance of these models in the midst of COVID-19.
  • The National Institute of Mental Health looks at the pros and cons of mental health apps and digital tools, concluding that much promise exists in this area but also wars of the need for regulation, quality control, and more effective approaches to address privacy concerns.
  • An article in Evidence-Based Mental Health that assessed 10 popular free mental health apps points out the importance of finding better ways to incorporate the latest evidence-based findings into these tools and to ensure better digital health privacy.

The conversation—

  • @imperial_IGHI (Institute of Global Health Innovation) tweets: “We’re increasingly using digital tools for our #MentalHealth. Is having a positive social connection online important to improve depression & anxiety outcomes? We worked together with young people to produce this video for @wellcometrust’s #activeingredientMH commission.”
  • @PsyberGuide (One Mind Psyber Guide/app guide on DMH tools) shares its mental health apps, noting: “February is Black History Month. We’ll be sharing lots of content around Black mental health matters – including curated mental health directories, an app toolkit…”
  • @Base10Partners (an early-stage venture capital firm investing in automation of the economy) shares: “The demand for mental health tools and platforms has skyrocketed in the wake of COVID-19. Base10’s @tjnahigian and @chriszeoli discuss the new landscape and some of the startups enabling the shift to digital-first treatment. 

In practice – See our practitioner’s guide to mental health apps – including how to integrate them into your practice and which ones to recommend to clients. More on the ongoing psychiatrist shortage in our sister publication, Psycom Consumer.

Last Updated: Apr 20, 2021