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Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State–wide Psychiatric Hospital System

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To identify the key insights or developments described in this article
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Key Points

Question  Is psychotropic medication use associated with differences in the risk of COVID-19 infection among adults with serious mental illness?

Findings  In this cohort study of 1958 inpatients with serious mental illness in a statewide psychiatric hospital system, the use of second-generation antipsychotic medications was associated with a decreased risk of COVID-19 infection; the largest association was observed with the use of paliperidone. Valproic acid use was associated with an increased risk of infection.

Meaning  These results suggest that individual psychotropic medications are associated with differential risks of COVID-19 infection among patients with serious mental illness.

Abstract

Importance  Individuals with serious mental illness are at increased risk of severe COVID-19 infection. Several psychotropic medications have been identified as potential therapeutic agents to prevent or treat COVID-19 but have not been systematically examined in this population.

Objective  To evaluate the associations between the use of psychotropic medications and the risk of COVID-19 infection among adults with serious mental illness receiving long-term inpatient psychiatric treatment.

Design, Setting, and Participants  This retrospective cohort study assessed adults with serious mental illness hospitalized in a statewide psychiatric hospital system in New York between March 8 and July 1, 2020. The final date of follow-up was December 1, 2020. The study included 1958 consecutive adult inpatients with serious mental illness (affective or nonaffective psychoses) who received testing for SARS-CoV-2 by reverse transcriptase–polymerase chain reaction or antinucleocapsid antibodies and were continuously hospitalized from March 8 until medical discharge or July 1, 2020.

Exposures  Psychotropic medications prescribed prior to COVID-19 testing.

Main Outcomes and Measures  COVID-19 infection was the primary outcome, defined by a positive SARS-CoV-2 reverse transcriptase–polymerase chain reaction or antibody test result. The secondary outcome was COVID-19–related death among patients with laboratory-confirmed infection.

Results  Of the 2087 adult inpatients with serious mental illness continuously hospitalized during the study period, 1958 (93.8%) underwent testing and were included in the study; 1442 (73.6%) were men, and the mean (SD) age was 51.4 (14.3) years. A total of 969 patients (49.5%) had laboratory-confirmed COVID-19 infection that occurred while they were hospitalized; of those, 38 (3.9%) died. The use of second-generation antipsychotic medications, as a class, was associated with decreased odds of infection (odds ratio [OR], 0.62; 95% CI, 0.45-0.86), whereas the use of mood stabilizers was associated with increased odds of infection (OR, 1.23; 95% CI, 1.03-1.47). In a multivariable model of individual medications, the use of paliperidone was associated with decreased odds of infection (OR, 0.59; 95% CI, 0.41-0.84), and the use of valproic acid was associated with increased odds of infection (OR, 1.39; 95% CI, 1.10-1.76). Clozapine use was associated with reduced odds of mortality in unadjusted analyses (unadjusted OR, 0.25; 95% CI, 0.10-0.62; fully adjusted OR, 0.43; 95% CI, 0.17-1.12).

Conclusions and Relevance  In this cohort study of adults hospitalized with serious mental illness, the use of second-generation antipsychotic medications was associated with decreased risk of COVID-19 infection, whereas the use of valproic acid was associated with increased risk. Further research is needed to assess the mechanisms that underlie these findings.

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Article Information

Accepted for Publication: March 3, 2022.

Published: May 6, 2022. doi:10.1001/jamanetworkopen.2022.10743

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Nemani K et al. JAMA Network Open.

Corresponding Author: Donald C. Goff, MD, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962 (donald.goff@nyumc.org).

Author Contributions: Drs Nemani and Goff had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Nemani, Williams, Olfson, Finnerty, Clelland, Goff.

Acquisition, analysis, or interpretation of data: Nemani, Williams, Leckman-Westin, Finnerty, Kammer, Smith, Silverman, Lindenmayer, Capichioni, Goff.

Drafting of the manuscript: Nemani, Williams, Capichioni, Goff.

Critical revision of the manuscript for important intellectual content: Nemani, Williams, Olfson, Leckman-Westin, Finnerty, Kammer, Smith, Silverman, Lindenmayer, Clelland, Goff.

Statistical analysis: Williams.

Administrative, technical, or material support: Finnerty, Smith, Silverman, Lindenmayer, Capichioni, Goff.

Supervision: Leckman-Westin, Finnerty, Smith, Goff.

Conflict of Interest Disclosures: Dr Lindenmayer reported receiving grants from Roche, Takeda, Lundbeck, Avanir, GW/Jazz, Neurocrine, and the National Institute of Mental Health outside the submitted work; and having a patent for the Structured Clinical Interview for the Positive and Negative Syndrome Scale (SCI-PANSS) with royalties paid. No other disclosures were reported.

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