Psychiatric patients may be extra vulnerable to Covid-19: study

The coronavirus-related mortality rate is much higher among psychiatric patients than among the general population, researchers from Nijmegen and Utrecht found after analyzing a special register.

The register contains information about 143 psychiatric patients who got Covid-19. Eighteen of them died, Trouw reports. That amounts to a mortality rate of 12 percent, while the RIVM estimated the average percentage of Covid-19 patients who died in 2020 at 1 to 6 percent.

“We expected the death rate to be higher than average, but not twice as high,” researcher Daphne Everaerd, a psychiatrist affiliated with Radboudumc in Nijmegen, said to the newspaper.

Most psychiatric patients live at home and not in care institutions, where the Covid-19 mortality rate is also higher. The researchers could not say whether vaccination coverage played a role in the higher mortality rate.

The researchers analyzed a Case Register opened by the Dutch Psychiatric Association (NVvP) in April 2020 due to early concerns that psychiatric patients were more likely to become seriously ill or die from the coronavirus. It was already known that psychiatric patients are more susceptible to infections because of poor physical conditions. The register is not a complete picture of all coronavirus infections among psychiatric patients. Patients with severe illnesses, like psychotic disorders, are overrepresented in the Case Register, while patients with addictions and intellectual disabilities are underrepresented.

The researchers found that psychiatric patients who had neuropsychiatric symptoms during the coronavirus infection, such as delirium and anxiety, often had a more severe course of the disease. The risk of death also seems to be higher in that group. Coronavirus patients with no previous psychiatric complaints who got neuropsychiatric symptoms during Covid-19 also became sicker, but their death rate was significantly lower.

According to Violet van Dee, a researcher at UMC Utrecht, these symptoms can serve as an “early signal for a more severe course” of Covid-19. “The problem with people with a psychiatric illness is that the new symptoms are more difficult to recognize. Perhaps they are suppressed by medicines like antipsychotics. It is important to be aware of this,” she said to Trouw.

The researchers stressed that their findings are not hard conclusions but indications that are in line with international studies. The results of their analysis were published in the Tijdschrift voor Psychiatrie on Monday.