Abstract: Original Investigation | Psychiatry 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 Katlyn Nemani, MD; Sharifa Z. Williams, DrPH; Mark Olfson, MD; Emily Leckman-Westin, PhD; Molly Finnerty, MD; Jammie Kammer, PhD; Thomas E. Smith, MD; Daniel J. Silverman, MD; Jean-Pierre Lindenmayer, MD; Gillian Capichioni, BS; James Clelland, PhD; Donald C. Goff, MD Abstract Key Points 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. Question Is psychotropic medication use associated with differences in the risk of COVID-19 infection among adults with serious mental illness? OBJECTIVE To evaluate the associations between the use of psychotropic medications and the risk Findings In this cohort study of 1958 of COVID-19 infection among adults with serious mental illness receiving long-term inpatient inpatients with serious mental illness in psychiatric treatment. a statewide psychiatric hospital system, the use of second-generation DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed adults with antipsychotic medications was serious mental illness hospitalized in a statewide psychiatric hospital system in New York between associated with a decreased risk of March 8 and July 1, 2020. The final date of follow-up was December 1, 2020. The study included 1958 COVID-19 infection; the largest consecutive adult inpatients with serious mental illness (affective or nonaffective psychoses) who association was observed with the use received testing for SARS-CoV-2 by reverse transcriptase–polymerase chain reaction or of paliperidone. Valproic acid use was antinucleocapsid antibodies and were continuously hospitalized from March 8 until medical associated with an increased risk of discharge or July 1, 2020. infection. Meaning These results suggest that EXPOSURES Psychotropic medications prescribed prior to COVID-19 testing. individual psychotropic medications are associated with differential risks of 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 COVID-19 infection among patients with serious mental illness. 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 + Invited Commentary + Supplemental content Author affiliations and article information are listed at the end of this article. 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..