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
Retrospective 1,958 consecutive psychiatric patients in the USA, showing higher cases and lower mortality with fluvoxamine, without statistical significance. There was only 25 fluvoxamine patients.
risk of death, 97.5% lower, RR 0.03, p = 1.00, treatment 0 of 16 (0.0%), control 38 of 953 (4.0%), NNT 25, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of case, 29.8% higher, RR 1.30, p = 0.16, treatment 16 of 25 (64.0%), control 953 of 1,933 (49.3%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Nemani et al., 6 May 2022, retrospective, USA, peer-reviewed, 12 authors, study period 8 March, 2020 - 1 July, 2020.
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
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
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.
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
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
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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
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