Psychopharmacotherapy factor in the variants of COVID-19 course in psychiatric inpatients

The aim of this study is to examine the relationship between the severity and duration criteria of COVID-19 and the psychopharmacotherapy administered to patients in within a psychiatric hospital.

Materials and Methods. We analyzed 169 case histories involving completed clinical cases of COVID-19 treatment in a specialized infectious psychiatric department in St. Petersburg, covering the period from May 2020 to January 2021. Correlation, dispersion, and regression analyses were employed to evaluate severe and mild COVID-19 progression indicators, as well as the duration of persistent SARS-CoV-2 viral shedding. We assessed the clinical and laboratory parameters in patients, along with the psychopharmacotherapy administered, including antidepressants, antipsychotics, and acid sphingomyelinase inhibitors (FIASMA-active drugs).

Results. Cardiovascular diseases emerged as a predictor of severe COVID-19 when combined with an increasing platelet-to-lymphocyte ratio (PLR), increasing the risk of severe course by over two-fold. The use of any psychotropic agents was associated with a 0.9% increase in the risk of severe course of COVID-19 for each unit increase in the systemic inflammation index PLR, specifically in patients with intellectual disability (ICD-10 codes F70-79), when compared to patients with schizophrenia (ICD-10 codes F20-29). High PLR values and the use of FIASMA-active drugs were associated with prolonged COVID-19 duration, while antidepressant therapy and elevated C-reactive protein levels were associated with a reduced predicted duration of viral shedding in 13.8% of variance. Additional consideration of the nosology of psychiatric disorders in the regression model increased the proportion of explained variance to 22.8%.

Conclusion. Consideration should be given to thymoanaleptic therapy for individuals with psychiatric disorders during periods of increased disease incidence leading up to potential SARS-CoV-2 infection, as it may serve as a protective factor against COVID-19. Furthermore, there is no evidence to suggest adverse effects of antipsychotics on the severity and duration of COVID-19. Further research is required to investigate the effects of FIASMA-active psychopharmacological agents within nosologically homogeneous groups.

1. Mosolov SN, Malin DI, Tsukarzi EE, Kostyukova EG. Drug Therapy for Patients with Mental Disorders Who Have a Coronavirus Infection (COVID-19). Sovremennaya terapiya psihicheskih rasstrojstv. 2020;(2):34-39. (InRuss.). https://doi.org/10.21265/PSYPH.2020.18.69.0015.

2. Mosolov SN, Fedorova EYu. The risk of developing cardiovascular disease in bipolar disorder. biological factors and therapy. Terapevticheskii arkhiv. 2022;94(4):579–583. (InRuss.). https://doi.org/10.26442/00403660.2022.04.201455.

3. Neznanov NG, Sorokin MY, Skripov VS, Esina KM. Epidemiology of mental disorders as a marker of psychiatric factors of the COVID-19 pandemic. Rossiiskii psikhiatricheskii zhurnal. 2023;(1):4-13. (InRuss.).

4. Sorokin MYu. Affective and cognitive symptoms in COVID-19 survivors: Implications for organization of Psychiatric Services in the post pandemic and within pandemic period. Byulleten’ medicinskoj nauki. 2022;(3):117–127. (InRuss.). https://doi.org/10.31684/25418475_2022_3_117.

5. Sorokin MYu, Lutova NB, Mazo GE, Neznanov NG, Kasyanov ED, Rukavishnikov GV et al. Structure of anxiety and stress as factors of COVID-19 vaccine acceptance. Obozrenie psihiatrii i medicinskoj psihologii imeni V.M. Bekhtereva. 2021;55(2):52–61. (InRuss.). https://doi.org/10.31363/2313-7053-2021-55-2-52-61. (In Russ.)

6. СSuliman L, Elwasefy M, Farrag NS, Tawab HA, Abdelwahab HW. The platelet-to-lymphocyte ratio versus neutrophil-to-lymphocyte ratio in prediction of covid-19 outcome. Pul’monologiya. 2022;32(6):849–53. (InRuss.). https://doi.org/10.18093/0869-0189-2022-32-6849-853.

7. Bhatt S, Dhar AK, Samanta MK, Suttee A. Effects of current psychotropic drugs on inflammation and immune system. Advances in Experimental Medicine and Biology. 2023;407–434. https://doi.org/10.1007/978-981-19-7376-5_18

8. Bramante CT, Huling JD, Tignanelli CJ, Buse JB, Liebovitz DM, Nicklas JM, et al. Randomized trial of metformin, ivermectin, and fluvoxamine for covid-19. New England Journal of Medicine. 2022;387(7):599–610. https://doi.org/10.1056/nejmoa2201662

9. Correll CU, Solmi M, Croatto G, Schneider LK, Rohani‐Montez SC, Fairley L, et al. Mortality in people with schizophrenia: A systematic review and meta‐analysis of relative risk and aggravating or attenuating factors. World Psychiatry. 2022;21(2):248–71. https://doi.org/10.1002/wps.20994.

10. Hoertel N, Rezaei K, Sánchez-Rico M, DelgadoÁlvarez A, Kornhuber J, Gulbins E, et al. Medications modulating the acid sphingomyelinase/ ceramide system and 28-day mortality among patients with SARS-COV-2: An observational study. Pharmaceuticals. 2023;16(8):1107. https://doi.org/10.3390/ph16081107

11. Hoertel N, Sánchez-Rico M, Gulbins E, Kornhuber J, Carpinteiro A, Abellán M, et al. Association between FIASMA psychotropic medications and reduced risk of intubation or death in individuals with psychiatric disorders hospitalized for severe COVID-19: An observational multicenter study. Translational Psychiatry. 2022;12(1). https://doi.org/10.1038/s41398-022-01804-5

12. Hoertel N, Sánchez-Rico M, de la Muela P, Abellán M, Blanco C, Leboyer M, et al. Risk of death in individuals hospitalized for covid-19 with and without psychiatric disorders: An observational multicenter study in France. Biological Psychiatry Global Open Science. 2023;3(1):56–67. https://doi.org/10.1016/j.bpsgos.2021.12.007.

13. Højlund M, Støvring H, Andersen K, Correll CU, Hallas J. Impact of low‐dose quetiapineuse on glycosylated hemoglobin, triglyceride and Cholesterol Levels. Acta Psychiatrica Scandinavica. 2022;147(1):105–16. https://doi.org/10.1111/acps.13515

14. Maiese A, Manetti AC, Bosetti C, Del Duca F, La Russa R, Frati P, et al. SARS‐Cov‐2 and the brain: A review of the current knowledge on neuropathology in Covid‐19. Brain Pathology. 2021;31(6). https://doi.org/10.1111/bpa.13013

15. Mueller JK, Riederer P, Müller WE. Neuropsychiatric drugs against covid-19: What is the clinical evidence? Pharmacopsychiatry. 2022;55(01):7–15. https://doi.org/10.1055/a-1717-238115.

16. Reis G, dos Santos Moreira-Silva EA, Silva DC, Thabane L, Milagres AC, Ferreira TS, et al. Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with covid-19: The together randomised, platform clinical trial. The Lancet Global Health. 2022;10(1):e42-e51. https://doi.org/10.1016/s2214-109x(21)00448-4

17. Rukavishnikov G, Leonova L, Kasyanov E, Leonov V, Neznanov N, Mazo G. Antimicrobial activity of antidepressants on normal gut microbiota: Results of the in vitro study. Frontiers in Behavioral Neuroscience. 2023;17. https://doi.org/10.3389/fnbeh.2023.1132127

18. Sánchez-Rico M, Edán-Sánchez A, Olfson M, Alvarado JM, Airagnes G, Rezaei K, et al. Antipsychotic use and 28-day mortality in patients hospitalized with COVID-19: A Multicenter Observational Retrospective Study. European Neuropsychopharmacology. 2023:75:93-104. https://doi.org/10.1016/j.euroneuro.2023.06.005

19. Sánchez-Rico M, Rezaei K, Delgado-Álvarez A, Limosin F, Hoertel N, Alvarado JM. Comorbidity patterns and mortality among hospitalized patients with psychiatric disorders and COVID-19. Brazilian Journal of Psychiatry. 2023;45(4). https://doi.org/10.47626/1516-4446-2023-3076

20. Sorokin MY, Kasyanov ED, Rukavishnikov GV, Khobeysh MA, Makarevich OV, Neznanov NG, et al. Determinants of stress levels and behavioral reactions in individuals with affective or anxiety disorders during the COVID-19 pandemic in Russia. Frontiers in Sociology. 2022;7. https://doi.org/10.3389/fsoc.2022.870421

21. Taipale H, Tanskanen A, Mehtälä J, Vattulainen P, Correll CU, Tiihonen J. 20‐year follow‐up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry. 2020;19(1):61–68. https://doi.org/10.1002/wps.20699