Cheng Wan-Ju, Shih Hong-Mo, Su Kuan-Pin, Hsueh Po-Ren
Department of Public Health, China Medical University, 100 Sec.1, Jingmao Rd., Taichung, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Road, Miaoli, Taiwan; Department of Psychiatry, China Medical University Hospital, 2 Yude Road, Taichung, Taiwan.
Department of Public Health, China Medical University, 100 Sec.1, Jingmao Rd., Taichung, Taiwan; Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Brain Behav Immun. 2023 Nov;114:255-261. doi: 10.1016/j.bbi.2023.08.024. Epub 2023 Aug 28.
Coronavirus disease 2019 (COVID-19) has been found to have a greater impact on individuals with pre-existing psychiatric disorders. However, the underlying reasons for this increased risk have yet to be determined. This study aims to investigate the potential factors contributing poor outcomes among COVID-19 patients with psychiatric disorders, including delayed diagnosis of infection, vaccination rates, immune response, and the use of psychotropic medications.
This retrospective cohort study analyzed medical records of 15,783 adult patients who were diagnosed with COVID-19 infection by positive PCR tests between January and September 2022 at a single medical center. We identified psychiatric diagnoses using ICD-9 diagnostic codes from the preceding 3 years before COVID infection. Primary outcome was in-hospital mortality and secondary outcomes were severe illness requiring intensive care or mechanical ventilation, and hospitalization within 45 days after a positive COVID-19 test. We compared the rates of outcomes, viral load, vaccination status at the time of positive test, psychotropic medications prescription within 90 days prior, antiviral medication use, and blood inflammation markers between patients with and without psychiatric disorders. The Cox proportional hazard model was used to examine the association of psychiatric diagnoses, vaccination status, and psychotropic medication prescription with poor outcomes.
Patients with psychiatric disorders demonstrated higher rates of severe illness (10.4% v.s. 7.1%) and hospitalization (16.4% vs. 11.3%), as well as a shorter duration to in-hospital mortality (6 vs. 12.5 days) compared to non-psychiatric patients. Psychiatric patients had higher vaccination rates and lower levels of inflammatory markers than non-psychiatric patients. Antipsychotic medication use was associated with in-hospital mortality (hazard ratio [HR] = 4.79, 95% confidence interval [CI] = 1.23-18.7), while being unvaccinated was associated with hospitalization (HR = 1.81, 95% CI = 1.29 to 2.54) and severe illness (HR = 3.23, 95% CI = 1.95 to 5.34) among patients with psychiatric disorders. Sedatives prescription was associated with all poor outcomes in general patients.
Considering the narrow time window between a positive COVID-19 test and poor outcomes, healthcare providers should undertake close monitoring of patients with preexisting psychiatric disorders during the initial days after a positive PCR test. Furthermore, caution should be taken when prescribing psychotropic medications, with special attention to antipsychotics.
2019冠状病毒病（COVID-19）已被发现对患有既往精神疾病的个体有更大影响。然而，这种风险增加的潜在原因尚未确定。本研究旨在调查导致COVID-19合并精神疾病患者预后不良的潜在因素，包括感染的延迟诊断、疫苗接种率、免疫反应以及精神药物的使用。
这项回顾性队列研究分析了2022年1月至9月在单一医疗中心通过PCR检测呈阳性而被诊断为COVID-19感染的15783例成年患者的病历。我们使用COVID感染前3年的ICD-9诊断代码确定精神疾病诊断。主要结局是住院死亡率，次要结局是需要重症监护或机械通气的重症疾病，以及COVID-19检测呈阳性后45天内的住院情况。我们比较了有精神疾病和无精神疾病患者的结局发生率、病毒载量、检测呈阳性时的疫苗接种状况、90天内的精神药物处方、抗病毒药物使用情况以及血液炎症标志物。采用Cox比例风险模型来检验精神疾病诊断、疫苗接种状况和精神药物处方与不良结局之间的关联。
与无精神疾病的患者相比，患有精神疾病的患者重症疾病发生率（10.4%对7.1%）和住院率（16.4%对11.3%）更高，且住院死亡率的持续时间更短（6天对12.5天）。精神疾病患者的疫苗接种率高于非精神疾病患者，炎症标志物水平低于非精神疾病患者。使用抗精神病药物与住院死亡率相关（风险比[HR]=4.79，95%置信区间[CI]=1.23-18.7），而在患有精神疾病的患者中，未接种疫苗与住院（HR=1.81，95%CI=1.29至2.54）和重症疾病（HR=3.23，95%CI=1.95至5.34）相关。在普通患者中，使用镇静剂与所有不良结局相关。
考虑到COVID-19检测呈阳性与不良结局之间的时间窗口较窄，医疗保健提供者应在PCR检测呈阳性后的最初几天对患有既往精神疾病的患者进行密切监测。此外，在开具精神药物时应谨慎，尤其要注意抗精神病药物。
