Antipsychotics, Schizophrenia, Bipolar Disorder and COVID-19 Deaths

What’s Happening

Adults with serious mental illness (SMI) who take antipsychotic medications do not have an increased risk of death from a COVID-19 infection, according to a retrospective cohort study by Nemani et al published in JAMA Psychiatry. The authors used the electronic health records of 464 patients in the NYU Langone Health system who were diagnosed with SMI – including schizophrenia, schizoaffective disorder, or bipolar disorder – and had COVID-19 between March 3, 2020, and February 17, 2021. Of this total, 196 patients (42.2%) were being treated with an antipsychotic. During the study’s timeframe, 41 patients (8.8%) died within 60 days of their COVID-19 diagnosis. The researchers adjusted for age, BMI, insurance type, and psychiatric diagnosis, and found that antipsychotic treatment was not significantly associated with mortality. However, a schizophrenia diagnosis was associated with a nearly 3-fold risk of death compared to bipolar disorder.

Why It’s Complicated

Previous research discussed the increased risk of mortality from COVID-19 faced by people with a diagnosis of a schizophrenia spectrum disorder. Although this recent study found that taking antipsychotics was not a factor, the cause of this increased risk remains unclear.

Reports & Perspectives

  • A retrospective epidemiological study published earlier this year by Canal-Rivero et al found that adults with SMI who took long-acting injectable (LAI) antipsychotics, and had good adherence to treatment, were less likely to get COVID-19 and had better outcomes than the general population. The authors speculated that antipsychotics could prevent SARS-CoV-2 infection and protect against severe COVID-19.
  • A letter to the editor in the current issue of Schizophrenia Research explores the question of whether antipsychotics can protect against COVID-19. Drs. Luiz Dratcu and Xavier Boland wrote that Canal-Rivero et al’s “counterintuitive” results were an important step in understanding the relationship between COVID-19, SMI, and antipsychotics, citing other studies with different findings. Dratcu and Boland discuss the possible anti-inflammatory effects of antipsychotics and how those may mitigate the immune response to COVID-19.
  • A large-scale retrospective cohort study of 51, 078 people with schizophrenia and age- and sex-matched controls found that people with schizophrenia were less likely to test positive for COVID-19, but they were twice as likely to be hospitalized for it. In addition, Bitan et al found that the risk of mortality from COVID-19 was three times greater for people with schizophrenia than for those in the control group.
  • @NeRDlabPete (Peter Bachman, a child & adolescent clinical psychologist) tweeted about the JAMA article, “Among COVID-19 patients at @nyulangone ‘Schizophrenia spectrum disorder was associated with a near 3-fold increased risk of mortality compared with bipolar disorder,’ even after adjusting for age, BMI, insurance.”

In Practice

Discrimination Drives Risks for Drinking and Depression in Black College Students

What’s Happening

Experiences of racial discrimination put Black college students at risk for alcohol use through increased depressive symptoms in a study by Su et al. Using data from two independent samples of students (with nearly 550 subjects), the team also evaluated the role that ethnic–racial identity plays in the relationship between racial discrimination, depressive symptoms, and alcohol use. They found that having positive feelings about being Black may buffer the risks associated with racial discrimination, but that believing that society views Black people positively may exacerbate the risks associated with discrimination. Interventions targeting both depressive symptoms and alcohol use are needed to improve the health of this population, the authors concluded.

Why It’s Complicated

Dr. Su’s team noted that Black adults tend to suffer more negative social and health consequences related to alcohol use than whites, even though in general, Black adults consume less alcohol. The pathways and risk to alcohol use in Black young adults must be understood to develop prevention and intervention strategies, they wrote.

Reports & Perspectives

  • See Arizona State University’s article about the study and interview with the lead author, Dr. Jinni Su.
  • A previous study lead by Dr. Su examined discrimination and alcohol problems in Black young adults and evaluated blatant (racist events) and subtle (microaggressions) forms of discrimination. The role of racial socialization by parents and friends was also studied.
  • The effects of discrimination and perceived unfairness on medical, psychological, and behavioral outcomes were studied by Resnicow et al in a cross-sectional survey of 2,238 multiethnic adults in Michigan. The authors found that perceived unfairness has a harmful effect on health, which may be one of the ways that discrimination harms health.
  • A qualitative study in the Journal of Adolescent Health explored teen media use, vicarious racism, and perceptions of health. Cohen et al found that teens’ vicarious experiences of racism in the news may have an effect on health, but that peer support may help them cope.
  • NAMI provides a page dedicated to Black mental health, which includes information about barriers to care, how to seek culturally competent care, and a list of resources.
  • The American Psychiatric Association offers a best practice guideline for working with Black patients.

In Practice

Survey Explores Psychologist Attitudes Toward Psychedelic Treatments

What’s Happening

A survey of 366 psychologists in the US found that participants felt cautiously optimistic toward therapeutic psychedelic experiences; they expressed concerns about possible risks and said they lacked an understanding of the effects of psychedelics. The results were published in a cross-sectional quasi-experimental electronic survey study by Davis et al in the Journal of Psychoactive Drugs. The findings point to the need for more education and training for psychologists regarding psychedelics to help reduce stigma about psychedelic therapies, the authors wrote.

Why It’s Complicated

Due to the growing interest in psychedelics during the past two decades, both in research and in the general public, it is important for psychologists to be aware of the potential of psychedelic-assisted therapy because of their role in its implementation, the authors wrote. Despite the progress, there is still significant stigma to overcome when it comes to psychedelics.

Psy-Q Challenge

Is Bufo Alvarius a Potential Psychedelic Therapy or Trend?

Get the Answer

Reports & Perspectives

  • A review of clinical studies investigating psychedelic drugs for therapeutic use for psychiatric disorders is presented in a study by Siegel et al. The authors evaluated 70 registered clinical trials and found that MDMA (45.7%) and psilocybin (41.4%) made up the majority of the studies, with the remainder studying other compounds (ketamine was excluded).
  • A commentary by Dr. Elias Dakwar in the American Journal of Drug and Alcohol Abuse discussed the progress of psychedelic research and focused on a fast-acting compound that is in the very early stages of research: 5-MeO-DMT or toad venom. This substance is found in the venom of the Sonoran Desert toad (Bufo alvarius), in some plants, and can be produced synthetically. Dr. Dakwar’s essay commented on a study in the same issue by Davis et al (see below).
  • Davis et al surveyed 362 adults who used synthetic 5-MeO-DMT in a group setting and found that most participants reported unintended improvements in depression and anxiety. These improvements were associated with more intense mystical experiences and greater spiritual significance and personal meaning of the 5-MeO-DMT experience as reported by participants. (For more about 5-MeO-DMT and toad venom, and an interview with one of this study’s co-author’s, Rafael Lancelotta, see this week’s Psy-Q above)
  • @sciam (Scientific American) tweeted, “The War on Drugs led to a long, dark period where psychedelic drugs were lost to science. Recent studies have reignited the hope that psychedelics could be powerful medicines for mental disorders.”
  • @Drug_Researcher (Matthew W. Johnson, PhD, professor of psychiatry and behavioral sciences at Johns Hopkins who specializes in psychedelics) tweeted, “Axios interviewed me on our new NIH funding for #psychedelic treatment research & why continued NIH support is so important for the future of research with psychedelics!”
  • @NatureMedicine tweeted, “Psychedelics show great promise in treating mental-health conditions, but legal obstacles limit their use. @MasonMarksMD and @CohenProf present a roadmap for wider acceptance and use of psychedelic therapy in the USA.”

In Practice

Last Updated: Oct 7, 2021