Exposure to psychotropic medications and COVID-19 course after hospital admission: Results from a prospective cohort study

https://doi.org/10.1016/j.jpsychores.2023.111199Get rights and content

Highlights

  • Medications may worsen COVID-19 outcomes among patients with mental disorders.

  • Exposure to antipsychotics was associated with worse outcomes of COVID-19 infection.

  • Off-label use of antipsychotics should be limited, especially in frail patients.

Abstract

Objective

There is evidence of a bidirectional association between COVID-19 disease and psychiatric disorders. We aimed to assess whether exposure to psychotropic medications prior to hospitalization was associated with mortality or discharge within 30 days after hospital admission.

Methods

In this prospective study, we included all individuals with a laboratory-confirmed COVID-19 infection who were admitted to the Bologna University Hospital between 1st March 2020 and 31st January 2021. We collected data about pre-existing psychiatric disorders and the use of psychotropic medications at the admission. As univariate analyses, we estimated cumulative incidence functions for 30-day mortality and discharge stratifying by exposure to each of the psychotropic medication classes. Finally, we fitted Cox regression models to estimate cause-specific Hazard Ratios (HR) of 30-day mortality and discharge. Results were adjusted for sociodemographic (age, sex), clinically relevant variables (comorbidity, c-reactive protein levels, severity of disease at presentation, history of smoking, study period), and psychiatric variables (psychiatric disorder diagnosis, number of psychotropic medications).

Results

Out of a total of 1238 hospitalized patients, 316 were prescribed psychotropic medications at the time of admission. Among these, 45 (3.6%) were taking a first-generation antipsychotics (FGA) and 66 (5.3%) a second generation antipsychotic (SGA). Exposure to SGA was associated with increased rates of 30-day mortality (HR = 2.01, 95%CI = 1.02–3.97) and exposure to FGA was associated with decreased rates of 30-day discharge (HR = 0.55, 95%CI = 0.33–0.90).

Conclusion

Patients with COVID-19 infection exposed to FGA and SGA may have worse COVID-19 infection outcomes.

Keywords

Antipsychotics
Comorbidity
COVID-19 course
COVID-19 mortality
Psychotropic drugs

Cited by (0)

1

These authors equally contributed to the supervision of the work. They are both last names.

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