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

To the editors,
The population with severe mental disorders (SMD) is a medically and socially vulnerable group for a worse outcome in COVID-19. This population has been identified as high-risk group for COVID-19 due to lower awareness of risk, higher prevalence of cognitive impairment and who have limitations to maintain adequate barriers against virus propagation such as living in long-term care facilities, and people with underlying health conditions obesity, smoking, hypertension, diabetes as well as cardiovascular and respiratory diseases (Kozloff et al., 2020).

However, previous investigations to assess the prevalence of COVID-19 in SMD individuals have yielded to inconsistent results. Thus, Lee et al. (2020) reported that diagnosis of a mental disorder was not associated with increased likelihood of Severe Acute Respiratory Syndrome due to Coronavirus (SARS-CoV) infection, but was related to a slightly higher risk for severe clinical outcomes (Lee et al., 2020), whereas Wang and colleagues informed of an increased risk to be infected, especially those with a recent mental health diagnosis (Wang et al., 2020). On the other hand, a diagnosis of schizophrenia have been linked to increased risk for mortality (Nemani et al., 2021).

Antipsychotics seem to have a beneficial effect against MERS and SARS coronaviruses (Dyall et al., 2017). Interestingly, elopiprazole (a never marketed phenylpiperazine antipsychotic drug) was listed among the 21 most potent compounds to inhibit SARS-CoV infection (Riva et al., 2020) and chlorpromazine protects mice from severe clinical disease and SARS-CoV (Weston et al., 2020). We aimed to investigate the prevalence and prognosis of COVID-19 in an epidemiological cohort of SMD population who are treated with long-acting injectable (LAI) antipsychotic treatment.

An epidemiological retrospective study of SMD patients on LAI antipsychotic treatment with good treatment adherence (at least 80% of prescribed doses from March–November 2020) in the catchment area of the University Hospital Virgen del RocΓ­o, Seville, Spain (encompassing a total population, older than 18 years, of 557.576 individuals) was carried out. A cohort of 698 individuals was analyzed. All procedures were in accordance with the Declaration of Helsinki. Ethical approval was obtained from the local Committee for Ethical Clinical Investigation (2578-N-2020). Prevalence information about infection, hospital and Intensive Care Unit (ICU) admission as well as death due to COVID-19 were displayed in Table 1. Clinical characteristics of SMD population are summarized in Suppplementary material.

Statistical analyses were conducted using SPSS, version 24. X2 test or Fisher’s exact test when expected cell counts were <5 were used to study whether the frequency of observations was significantly different between the general population and LAI users. The level of significance was set at 5%..