Mar 3, 2021
Frank Chen, MD, joins host Lorenzo Norris, MD, to discuss the
impact of the COVID-19 pandemic on patients with schizophrenia.
Chen is the chief medical director for Houston Behavioral
Healthcare Hospital and Houston Adult Psychiatry. He is a speaker
for Alkermes and Otsuka. Dr. Chen has served on advisory boards for
Alkermes, Intracellular Therapies, Otsuka, and Teva
Norris is associate dean of student affairs and administration
at George Washington University. He has no disclosures.
- Schizophrenia is associated with an increased risk of death
from COVID-19, even when controlling for other medical
- Individuals with schizophrenia have many biological and
situational risk factors for COVID-19, including an elevated risk
of metabolic syndrome from antipsychotic medications, higher rates
of nicotine addiction, a greater likelihood of living in a group
setting, limited access to medical care, and the underlying
inflammatory state of schizophrenia.
- An article published in JAMA Psychiatry in January 2021
evaluated a large cohort of patients in a New York health system
and identified schizophrenia as the second most highly associated
risk factor for 45-day mortality from COVID-19, after the risk
factor of advanced age.
- The study controlled for other medical comorbidities to avoid
confounding the results. However, it is essential to remember that
individuals with schizophrenia have environmental and biological
factors that increase their risk of infection and complications
from COVID-19, such as metabolic syndrome, cigarette smoking,
limited access to health care, and living in a group or
- Dr. Chen points out that many patients with schizophrenia
already have skills to adapt to the stresses of the pandemic. For
example, individuals with schizophrenia might already be accustomed
to living with a certain level of fear and uncertainty inherent to
their thought disorder. He also comments that negative symptoms
make social distancing easier for individuals with schizophrenia
than for other people.
- Dr. Chen notes that telepsychiatry has been a boon to treating
individuals with schizophrenia, because using this tool is almost
like making a “home visit.” Telemedicine removes the barriers to
care, such as transport and resistance to coming to the
- Adaptation to telepsychiatry has varied among different patient
populations. Dr. Chen says some of his “higher functioning”
patients with more controlled and stable lives did not want to see
their clinician via video. They preferred the “secure” and more
private setting of an office.
- Ultimately, psychological flexibility and ability to adapt
influence the amount of stress people experience during
Nemani K et al. JAMA Psychiatry. 2021 Jan 27.
doi: 10.1001/jamapsychiatry. 2020.4442.
Mazereel V et al. Lancet. 2021 Feb 3.
Muruganandam P et al. Psychiatry Res. 2020 Jun 29. doi:
Kozloff N et al.
Schizophr Bull. 2020 Jul;46(4):752-7.
Smith BM et al. J
Contextual Behav Sci. 2020 Oct;18:162-74.
Show notes by Jacqueline Posada, MD, associate producer of the
Psychcast; assistant clinical professor in the department of
psychiatry and behavioral sciences at George Washington University,
Washington; and staff physician at George Washington Medical
Faculty Associates, also in Washington. Dr. Posada has no conflicts
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