People Diagnosed with Schizophrenia Face Disproportionate COVID-19 Burden

The global pandemic has an outsized impact on people diagnosed with schizophrenia, further exacerbating health and economic disparities.

Madison Natarajan, MS
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A recent article, published in Schizophrenia Bulletin, identifies the factors that disproportionately impact individuals diagnosed with schizophrenia and related disorders during the COVID-19 pandemic. The researchers, a team from the Centre for Addiction and Mental Health in Toronto, address the increased risk of infection, adverse mental health consequences, and the implications for treatment facilities and clinical research on schizophrenia. The article urges rapid implementation measures to decrease the risk of transmission, and the importance of maintaining continuity of care. 

“People living with schizophrenia are at greater risk for adverse outcomes, including death, because compared with the general population, they typically have poorer physical health, greater socioeconomic disadvantage, and are more socially disconnected, and experience pervasive stigma and discrimination,” the authors write. 

Schizophrenia is a contested diagnosis that captures a diverse range of experiences, often characterized by psychotic symptoms, such as paranoia, delusions, or hallucinations. The diagnostic label is also problematic as it is more frequently applied to racial and ethnic minorities and can be used by professional staff to justify coercive measures and strip service-users of legal rights and autonomy.

People living with a diagnosis of schizophrenia are overrepresented within vulnerable populations that are seeing large outbreaks of the virus, including prisoners, individuals experiencing homelessness, or those who live in congregate housing where social distancing is near impossible.

Compounding these risk factors are the physical conditions that are more common in people taking antipsychotic medications, such as cardiovascular disease, diabetes, and chronic respiratory disease. The authors highlight additional risk factors for those being treated with the common antipsychotic Clozapine, as there is an associated risk of death from pneumonia, related to the side effects of the drug. 

Also, those experiencing symptoms related to psychosis are at an increased likelihood of having comorbid substance abuse disorders, and the current pandemic changes their ability to access substances and substance use treatments, which can lead to withdrawal syndromes. 

Previous virus outbreaks, such as the 2003 Severe Acute Respiratory Syndrome (SARS) pandemic, have been associated with elevated rates of psychological distress and the increased diagnosis of psychiatric disorders in the general population. For individuals with symptoms associated with schizophrenia, social support is correlated with recovery measures, as well as broad community support, such as casual contacts with the general population. Social distancing has disrupted these casual contacts, and the isolation may increase the risk for suicide and result in increased distress. 

Research conducted on the pandemic in China and South Korea indicates that inpatient psychiatric units were often subject to COVID-19 outbreaks. Identified factors contributing to this outbreak were lack of ventilation due to sealed windows and restrictions. 

However, the outbreak could have an even more significant impact on outpatient settings due to traditional treatment methods, which emphasizes in-person contacts in the community and visiting patients in their homes. Abrupt changes to how mental health services are delivered can increase the risk of distress and disengagement. 

As providers make the transition to phone and video consultation, there is a dearth of research on the suitability of telepsychiatry for schizophrenia. Additionally, virtual care cannot completely replace in-person care for treatment as the administration of antipsychotic medications often requires in-person injections and regular blood work. The researchers also suggest that long-acting injectable antipsychotics and clozapine may be useful in reducing hospitalizations. However, it should be noted that one of the authors disclosed a conflict of interest with Eli Lilly, a company that sells clozapine (brand name: Clozaril). 

In response to these challenges and elevated risk factors, the authors propose the following recommendations to mitigate the effects on COVID-19 on people diagnosed with schizophrenia: 

  1. Address the social determinants of health, including ensuring safe and comfortable housing and strategies to reduce health disparities.
  2. Generate guidelines for resource allocation that protects vulnerable populations by ensuring fair and consistent decision-making.
  3. Find ways for families, neighbors, and community-based programs to maintain a social connection while still adhering to physical distancing.
  4. Continue delivery of basic needs through government agencies and programs.
  5. Develop ways for inpatient settings to reduce the risk of infection and make contingency plans to introduce alternate personnel if frontline staff becomes ill.
  6. Prescribers, patients, and caregivers should weigh the risks and benefits of telepsychiatry and treatments that must be delivered in person.
  7. Researchers and review boards should work together to substitute remote assessments and delivery methods to allow studies to safely continue when possible.

 

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Kozloff, N., Mulsant, B. H., Stergiopoulos, V., & Voineskos, A. N. (2020). The COVID-19 Global Pandemic: Implications for people with schizophrenia and related disorders. Schizophrenia Bulletin. https://doi.org/10.1093/schbul/sbaa051 (Link)

 

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Madison Natarajan, MS
Madison Natarajan is a master’s level psychotherapist and current doctoral student at the University of Massachusetts Boston. As a researcher, her focus is on the impact of religious trauma on female sexual development, specifically assessing the subculture of the evangelical purity movement. Madison has a family history that has been intertwined with psychiatric care, ranging from family members who were institutionalized to those practicing psychiatry, both in the US and India. Madison seeks to challenge the current structure of psychiatric care in the West and disseminate honest and empowering information to the community at large.

14 COMMENTS

  1. Disadvantage.
    And who’s fault is that?
    Who discriminates against the disadvantaged? I mean where it matters to the person’s wellness.
    Would it be hospitals? Police? Perhaps psychiatry also?

    Must be difficult to inject via zoom. Then of course there is the option of rapid withdrawal. Pretend that the resulting episode or suicide was the stress from Covid.

  2. Madison, I’m sorry you still believe schizophrenia is a valid disease, since the entire DSM was debunked as “invalid” by the head of NIMH in 2013.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    By chance do you know that the “schizophrenia treatments,” the antipsychotics/neuroleptics, can create both the positive and negative symptoms of schizophrenia? The positive symptoms, like psychosis and hallucinations, can be created via antipsychotic induced anticholinergic toxidrome. And the negative symptoms can be created via neuroleptic induced deficit syndrome.

    https://en.wikipedia.org/wiki/Toxidrome
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    Which means it’s highly likely that a vast majority of the “schizophrenia” patients, may likely have been turned into “schizophrenics,” with the treatments themselves. I hope you will look into my concern, and research this for yourself.

    And perhaps some day you may help people wean off the neurotoxic neuroleptics, although weaning off the psychiatric drugs can also result in a ‘drug withdrawal induced super sensitivity manic psychosis.’ Which can be bad for many people, but it’s not bad for all people.

    Some of us are much better off the, psychosis creating, antipsychotics. And my ‘drug withdrawal induced super sensitivity manic psychosis’ merely took the form of an awakening to my dreams, and eventually a born again type story.

    But, of course, those of us who were initially neurotoxic poisoned to cover up malpractice, by an unethical PCP, and the medical evidence of the abuse of our child, for an evangelical pastor. We were not “mentally ill” to begin with, we were dealing with malpractice and child abuse covering up criminals. And this is a systemic problem with my former evangelical religion. I’d be one of the “widows” mentioned in the Preface of this book.

    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false
    https://virtueonline.org/lutherans-elca-texas-catastrophe-coming-lesson-episcopalians

    An ethical pastor of another religion did even confess this medical/religious, systemic child abuse covering up partnership/”conspiracy,” to be known as “the dirty little secret of the two original educated professions.” So it’s probably a systemic problem for most religions.

    I hope you don’t choose to cover up child abuse or rape for any religion, as many psychologists and psychiatrists have apparently been doing for seemingly over a century.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    And all this systemic child abuse covering up by the “mental health” system is by DSM design.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    I hope you do challenge the current structure of psychiatric care in the West and disseminate honest and empowering information to the community at large.

  3. Yes. Note the author doesn’t even say “people diagnosed with schizophrenia,” but “people with schizophrenia.” Then goes on to list a bunch of “risk factors” which are socio-political and completely external to the individual or any fake “disease.”

  4. “Schizophrenia is a contested diagnosis that captures a diverse range of experiences, often characterized by psychotic symptoms, such as paranoia, delusions, or hallucinations.”

    I will repeat what I have said before. The “psychotic” symptoms you mention as characteristic of “schizophrenia”, were regarded as (only possible) secondary manifestations to the 4 A’s Bleuler mentioned over 100 years ago: abnormal associations, autistic behavior and thinking, abnormal affect and ambivalence. Psychiatry has attempted to reclassify the “disease” to conform with their “treatment” of choice, i.e. antipsychotics.

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