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Management of Patients With Severe Mental Illness During the Coronavirus Disease 2019 Pandemic

Educational Objective
To understand how to manage patients with severe mental illness during COVID-19
1 Credit CME

Attention has focused on patients with coronavirus disease 2019 (COVID-19), frontline responders, and attributable deaths, leading to enlarged intensive care unit and ventilator capacities and reduction of elective care. Subsequently, marginalized populations are easily overlooked, such as patients with severe mental illness who are at high risk for medical comorbidities predisposing them to COVID-19 and whose psychiatric condition can worsen owing to COVID-19 infection.

Severe mental disorders, including schizophrenia, bipolar disorder, and major depressive disorder, are chronic conditions that frequently need maintenance treatment to prevent relapse and rehospitalization. However, in the COVID-19 pandemic, many medical procedures have been reduced, leading to the global challenge of balancing provision of medical resources. For example, the serious disruption of normal medical care has reduced functioning of stroke centers across China because of fear of in-hospital cross-infection and lack of experienced stroke care experts.1

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Article Information

Corresponding Author: Kai G. Kahl, MD, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany (kahl.kai@mh-hannover.de).

Published Online: June 24, 2020. doi:10.1001/jamapsychiatry.2020.1701

Conflict of Interest Disclosures: Dr Kahl has been a consultant and/or advisor to or has received honoraria from Eli Lilly, Janssen/J&J, Lundbeck, Neuraxpharm, Otsuka, Pfizer, Servier, Schwabe, Takeda and Trommsdorff/Ferrer. He has provided expert testimony for Neuraxpharm, Servier, and Takeda. Dr Correll has been a consultant and/or advisor to or has received honoraria from Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He has provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He received grant support from the Berlin Institute of Health, Janssen, the National Institute of Mental Health, Patient-Centered Outcomes Research Institute, Takeda, and the Thrasher Foundation. He received royalties from UpToDate and is also a stock option holder of LB Pharma.

References
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Zhao  J , Rudd  A , Liu  R .  Challenges and potential solutions of stroke care during the Coronavirus disease 2019 (COVID-19) outbreak.   Stroke. 2020;51(5):1356-1357. doi:10.1161/STROKEAHA.120.029701PubMedGoogle ScholarCrossref
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Druss  BG .  Addressing the COVID-19 pandemic in populations with serious mental illness.   JAMA Psychiatry. Published online April 3, 2020. doi:10.1001/jamapsychiatry.2020.0894PubMedGoogle Scholar
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Brooks  SK , Webster  RK , Smith  LE ,  et al.  The psychological impact of quarantine and how to reduce it: rapid review of the evidence.   Lancet. 2020;395(10227):912-920. doi:10.1016/S0140-6736(20)30460-8PubMedGoogle ScholarCrossref
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Huhn  M , Nikolakopoulou  A , Schneider-Thoma  J ,  et al.  Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis.   Lancet. 2019;394(10202):939-951. doi:10.1016/S0140-6736(19)31135-3PubMedGoogle ScholarCrossref
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World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance. Published March 13, 2020. Accessed May 19, 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
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