Lower risk of SARS-CoV2 infection in individuals with severe mental disorders on antipsychotic treatment: A retrospective epidemiological study in a representative Spanish population

Canal‐Rivero, Manuel; Catalán-Barragán, R; Rubio-García, Ana; Garrido-Torres, Nathalia; Crespo‐Facorro, Benedicto; Ruiz‐Veguilla, Miguel

doi:10.1016/j.schres.2021.02.002

Cited by 39 publications

(41 citation statements)

References 7 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…From our point of view, we included in the letter some of the appreciations made by Dr. Toubasi such as the absence in the analyses of factors involved in the complex network of COVID-19 disease. Besides, in the last paragraph of the letter, we have also recognised that the findings were counterintuitive in relation to the data published so far ( Canal-Rivero et al, 2021 ). On the other hand, most of the publications that have reported high rates of mortality or worse prognosis in mental health patients have used electronic records data which are characterized by important limitations such as not including sensitive information in the analyses (e.g., socioeconomic, lifestyle conditions, antipsychotic treatment or adherence to medication).…”

mentioning

confidence: 62%

The role of antipsychotics against COVID-19: A topic for debate

Canal‐Rivero

Catalán-Barragán

Rubio-García

et al. 2021

Schizophrenia Research

Self Cite

View full text Add to dashboard Cite

mentioning

confidence: 62%

The role of antipsychotics against COVID-19: A topic for debate

Canal‐Rivero

Catalán-Barragán

Rubio-García

et al. 2021

Schizophrenia Research

Self Cite

View full text Add to dashboard Cite

“…Sensitivity analyses highlighted an effect of single studies on the overall estimates (appendix 4 pp 37-38). A high proportion of unexplained heterogeneity was identified (OR I²=93•01%, Q=128•76, p<0•0001; aOR I²=89•51%, Q=57•21, p<0•0001), and a subgroup analysis was done to explore whether the diagnostic category explained a Zimering et al (2020) 34 GeMRC (2021) 39 Turk et al (2020) 27 Genet et al (2020) 25 Fond et al (2020) 9 Huls et al (2021) 36 Poblador-Plou et al (2020) 8 Allen et al (2020) 21 Nemani et al (2021) 4 Baillargeon et al (2020) 24 Yang et al (2020) 32 Landes et al (2020) 26 Siso-Almirall et al (2020) 31 Li et al (2020) 30 Reilev et al (2020) 7 Landes et al (2021) 28 Bitan et al (2021) 37 Canal-Riveiro et al (2021) 38 Lee et al (2020) 29 Yanover et al (2020) 33 An et al (2020 proportion of the heterogeneity (appendix 4 pp 39-40). After correction for multiple comparisons, none of the diagnostic categories were found to be consistently associated with an increased risk for ICU admission.…”

Section: Resultsmentioning

confidence: 99%

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

Vai

Mazza

Colli

et al. 2021

The Lancet Psychiatry

212

204

View full text Add to dashboard Cite

Background Mental disorders might be a risk factor for severe COVID-19. We aimed to assess the specific risks of COVID-19-related mortality, hospitalisation, and intensive care unit (ICU) admission associated with any pre-existing mental disorder, and specific diagnostic categories of mental disorders, and exposure to psychopharmacological drug classes.Methods In this systematic review and meta-analysis, we searched Web of Science, Cochrane, PubMed, and PsycINFO databases between Jan 1, 2020, and March 5, 2021, for original studies reporting data on COVID-19 outcomes in patients with psychiatric disorders compared with controls. We excluded studies with overlapping samples, studies that were not peer-reviewed, and studies written in languages other than English, Danish, Dutch, French, German, Italian, and Portuguese. We modelled random-effects meta-analyses to estimate crude odds ratios (OR) for mortality after SARS-CoV-2 infection as the primary outcome, and hospitalisation and ICU admission as secondary outcomes. We calculated adjusted ORs for available data. Heterogeneity was assessed using the I² statistic, and publication bias was tested with Egger regression and visual inspection of funnel plots. We used the GRADE approach to assess the overall strength of the evidence and the Newcastle Ottawa Scale to assess study quality. We also did subgroup analyses and meta-regressions to assess the effects of baseline COVID-19 treatment setting, patient age, country, pandemic phase, quality assessment score, sample sizes, and adjustment for confounders. This study is registered with PROSPERO, CRD42021233984. Findings 841 studies were identified by the systematic search, of which 33 studies were included in the systematic review and 23 studies in the meta-analysis, comprising 1 469 731 patients with COVID-19, of whom 43 938 had mental disorders. The sample included 130 807 females (8•9% of the whole sample) and 130 373 males (8•8%). Nine studies provided data on patient race and ethnicity, and 22 studies were rated as high quality. The presence of any mental disorder was associated with an increased risk of COVID-19 mortality (OR 2•00 [95% CI 1•58-2•54]; I²=92•66%). This association was also observed for psychotic disorders (2•05 [1•37-3•06]; I²=80•81%), mood disorders (1•99 [1•46-2•71]; I²=68•32%), substance use disorders (1•76 [1•27-2•44]; I²=47•90%), and intellectual disabilities and developmental disorders (1•73 [1•29-2•31]; I²=90•15%) but not for anxiety disorders (1•07 [0•73-1•56]; I²=11•05%). COVID-19 mortality was associated with exposure to antipsychotics (3•71 [1•74-7•91]; I²=90•31%), anxiolytics (2•58 [1•22-5•44]; I²=96•42%), and antidepressants (2•23 [1•06-4•71]; I²=95•45%). For psychotic disorders, mood disorders, antipsychotics, and anxiolytics, the association remained significant after adjustment for age, sex, and other confounders. Mental disorders were associated with increased risk of hospitalisation (2•24 [1•70-2•94]; I²=88•80%). No significant associations with mortality were identified for ICU adm...

show abstract

“…In more severe COVID-19 cases, death results from hypoxemic respiratory failure in patients developing severe acute respiratory distress syndrome and is associated, in a substantial portion of patients, with an inflammatory syndrome and cytokine storm (Mehta et al, 2020) that may originate from immune cells (Chen et al, 2020). Longitudinal analysis of the immune response observed in a fatal case of COVID-19 revealed waves of a pro-inflammatory cytokine storm, Th1 and Th2 activation, and markers of T cell exhaustion, apoptosis, cell cytotoxicity, and endothelial activation were until the fatal outcome (Bouadma et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Aripiprazole as a Candidate Treatment of COVID-19 Identified Through Genomic Analysis

et al. 2021

View full text Add to dashboard Cite

Background: Antipsychotics modulate expression of inflammatory cytokines and inducible inflammatory enzymes. Elopiprazole (a phenylpiperazine antipsychotic drug in phase 1) has been characterized as a therapeutic drug to treat SARS-CoV-2 infection in a repurposing study. We aim to investigate the potential effects of aripiprazole (an FDA approved phenylpiperazine) on COVID-19-related immunological parameters.Methods: Differential gene expression profiles of non-COVID-19 vs. COVID-19 RNA-Seq samples (CRA002390 project in GSA database) and drug-naïve patients with non-affective psychosis at baseline and after three months of aripiprazole treatment were identified. An integrative transcriptomic analyses of aripiprazole effects on differentially expressed genes in COVID-19 patients was performed.Findings: 82 out the 377 genes (21.7%) with expression significantly altered by aripiprazole have also their expression altered in COVID-19 patients and in 93.9% of these genes their expression is reverted by aripiprazole. The number of common genes with expression altered in both analyses is significantly higher than expected (Fisher’s Exact Test, two tail; p value = 3.2e-11). 11 KEGG pathways were significantly enriched with genes with altered expression both in COVID-19 patients and aripiprazole medicated non-affective psychosis patients (p adj<0.05). The most significant pathways were associated to immune responses and mechanisms of hyperinflammation-driven pathology (i.e.,“inflammatory bowel disease (IBD)” (the most significant pathway with a p adj of 0.00021), “Th1 and Th2 cell differentiation” and “B cell receptor signaling pathway”) that have been also associated with COVID19 clinical outcome.Interpretation: This exploratory investigation may provide further support to the notion that a protective effect is exerted by aripiprazole (phenylpiperazine) by modulating the expression of genes that have shown to be altered in COVID-19 patients. Along with many ongoing studies and clinical trials, repurposing available medications could be of use in countering SARS-CoV-2 infection, but require further studies and trials.

show abstract

Lower risk of SARS-CoV2 infection in individuals with severe mental disorders on antipsychotic treatment: A retrospective epidemiological study in a representative Spanish population

Cited by 39 publications

References 7 publications

The role of antipsychotics against COVID-19: A topic for debate

The role of antipsychotics against COVID-19: A topic for debate

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

Aripiprazole as a Candidate Treatment of COVID-19 Identified Through Genomic Analysis

Contact Info

Product

Resources

About