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Mueller JK, Ahrens KF, Bauer M, Baune BT, Borgwardt S, Deckert J, Domschke K, Ellwanger R, Fallgatter A, Frodl T, Gallinat J, Gottschalk R, Grabe HJ, Hasan A, Herpertz SC, Hurlemann R, Jessen F, Kambeitz J, Kircher T, Kornhuber J, Lieb K, Meyer-Lindenberg A, Rupprecht R, Scherbaum N, Schlang C, Schneider A, Schomerus G, Thoma A, Unterecker S, Walter M, Walter H, Reif A, Reif-Leonhard C. Prevalence of COVID-19 and Psychotropic Drug Treatment in Psychiatric In-patients in Germany in 2020: Results from a Nationwide Pilot Survey. PHARMACOPSYCHIATRY 2023; 56:227-238. [PMID: 37944561 DOI: 10.1055/a-2177-3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
INTRODUCTION In patients with a pre-existing mental disorder, an increased risk for a first manifestation of a psychiatric disorder in COVID-19 patients, a more severe course of COVID-19 and an increased mortality have been described. Conversely, observations of lower COVID-19 incidences in psychiatric in-patients suggested protective effects of psychiatric treatment and/or psychotropic drugs against COVID-19. METHODS A retrospective multi-center study was conducted in 24 German psychiatric university hospitals. Between April and December 2020 (the first and partly second wave of COVID-19), the effects of COVID-19 were assessed on psychiatric in-patient care, the incidence and course of a SARS-CoV-2 infection, and treatment with psychotropic drugs. RESULTS Patients (n=36,322) were admitted to the hospitals. Mandatory SARS-CoV-2 tests before/during admission were reported by 23 hospitals (95.8%), while 18 (75%) conducted regular testing during the hospital stay. Two hundred thirty-two (0.6%) patients were tested SARS-CoV-2-positive. Thirty-seven (16%) patients were receiving medical treatment for COVID-19 at the psychiatric hospital, ten (4.3%) were transferred to an intermediate/intensive care unit, and three (1.3%) died. The most common prescription for SARS-CoV-2-positive patients was for second-generation antipsychotics (n=79, 28.2%) and antidepressants (SSRIs (n=38, 13.5%), mirtazapine (n=36, 12.9%) and SNRIs (n=29, 10.4%)). DISCUSSION Contrary to previous studies, our results showed a low number of infections and mortality in SARS-CoV-2-positive psychiatric patients. Several preventive measures seem effective to protect this vulnerable group. Our observations are compatible with the hypothesis of a protective effect of psychotropic drugs against COVID-19 as the overall mortality and need for specific medical treatment was low.
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Affiliation(s)
- Juliane K Mueller
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Kira F Ahrens
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany; German Center for Mental Health (DZPG)
| | - Thomas Frodl
- Department of Psychiatry, Otto-von-Guericke University, Magdeburg, Germany
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH, University Aachen, Aachen, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Gottschalk
- Health Protection Authority, City of Frankfurt am Main, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rene Hurlemann
- Department of Psychiatry, School of Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg Essen, Essen, Germany
| | | | - Anja Schneider
- Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Andreas Thoma
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Henrik Walter
- Charité University Clinic Berlin, Freie Universität Berlin, Humboldt- Universität zu Berlin
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
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Mueller JK, Riederer P, Müller WE. Neuropsychiatric Drugs Against COVID-19: What is the Clinical
Evidence? PHARMACOPSYCHIATRY 2022; 55:7-15. [DOI: 10.1055/a-1717-2381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractSince the beginning of the coronavirus disease (COVID)-19 pandemic, the need for
effective treatments for COVID-19 led to the idea of
“repurposing” drugs for antiviral treatment. Several
antipsychotics and antidepressants have been tested for in vitro activity
against the severe acute respiratory syndrome coronavirus 2. Chlorpromazine,
other phenothiazine antipsychotics, and the antidepressant fluoxetine were found
to be rather potent in these studies. However, whether effective plasma
concentrations can be obtained with clinically accepted doses of these drugs is
not clear. Data of COVID-19 patients are not yet available but several clinical
studies are currently underway.The specific serotonin reuptake inhibitor fluvoxamine is a potent Sigma-1
receptor agonist and reduces inflammation in animal models of cytokine-stress.
Accordingly, fluvoxamine treatment was superior to placebo in reducing impaired
respiratory function and other symptoms of inflammation in COVID-19 patients in
a placebo-controlled clinical study and another open clinical trial. The
beneficial effects of fluvoxamine on the course of COVID-19 were recently
confirmed in a large placebo-controlled double-blind trial with several hundred
patients.Inflammation represents a major risk factor for many psychiatric disorders which
explains the high susceptibilitiy of COVID-19 patients for psychiatric diseases.
Many antidepressants and antipsychotics possess anti-inflammatory properties
independent of sigma-1 activity which might be important to reduce psychiatric
symptoms of COVID-19 patients and to improve respiratory dysfunction and other
consequences of inflammation. This might explain the rather unspecific benefit
which has been reported for several cohorts of COVID-19 patients treated with
different psychotropic drugs.
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Affiliation(s)
- Juliane K. Mueller
- Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy,
University Hospital Frankfurt, Frankfurt/M, Germany
| | - Peter Riederer
- Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy,
University Hospital Würzburg, Würzburg, Germany
- University of Southern Denmark Odense, J.B. Winslows Vey Odense,
Denmark
| | - Walter E. Müller
- Department of Pharmacology und Clinical Pharmacy, University Frankfurt,
Frankfurt/M, Germany
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Bauer M, Juckel G. Covid-19: Contributions from Psychopharmacology. PHARMACOPSYCHIATRY 2022; 55:5-6. [DOI: 10.1055/a-1720-8855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The COVID-19 pandemic is causing a major burden on personal health, healthcare
systems and the global economy. For the last two years the COVID-19 pandemic has
dramatically changed our lives in many personal and professional areas. For millions
of us, due to infection rates, but also to protection measures such as lockdowns the
corona pandemic has significantly changed the way we work, how we live, and how we
interact with technology. In addition to the development of effective vaccines,
anti-viral and anti-inflammation strategies are of eminent importance to treat
people with acute infection or at least prevent serious negative outcomes. In
contrast to the fast development of several effective vaccines that were remarkably
available already after one year of the pandemic, novel effective anti-viral
compounds are still in development. The only currently used effective medications
against severe SARS-CoV-2 virus infection are corticosteroids 1.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Carl
Gustav Carus University Hospital, Technische Universität Dresden,
Dresden, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL
University Hospital, Ruhr-Universität Bochum, Bochum,
Germany
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Bonnet U, Claus B, Schaefer M, Kuhn J, Nyhuis P, Scherbaum N, Brüne M, Wakili V, Juckel G. Impact of Psychiatric and Related Somatic Medications on the Duration and Severity of COVID-19: A Retrospective Explorative Multi-center Study from the German Metropolitan Ruhr-area. PHARMACOPSYCHIATRY 2021; 55:30-39. [PMID: 34530483 DOI: 10.1055/a-1559-3904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Several psychiatric and somatic medications are assumed to improve COVID-19-symptoms. These include antidepressants, antipsychotics, and anticonvulsants as well as anticoagulants, statins, and renin-angiotensin-aldosterone-system (RAAS)-inhibitors for somatic comorbid conditions. All these agents may reduce the hyperinflammatory response to SARS/CoV-2 or the related negative cardio-cerebrovascular outcomes. METHODS In a retrospective longitudinal, multi-center inpatient study, we sought to explore the influence of psychiatric medications on COVID-19, comprising the period from diagnosing SARS/CoV-2-infection via PCR (nasopharyngeal swab) up to the next 21 days. Ninety-six psychiatric inpatients (mean age [SD] 65.5 (20.1), 54% females) were included. The primary outcome was the COVID-19-duration. Secondary outcomes included symptom severity and the presence of residual symptoms. RESULTS COVID-19-related symptoms emerged in 60 (62.5%) patients, lasting 6.5 days on average. Six (6.3%) 56-95 years old patients died from or with COVID-19. COVID-19-duration and residual symptom-presence (n=22, 18%) were not significantly related to any substance. Respiratory and neuro-psychiatric symptom-load was significantly and negatively related to prescription of antidepressants and anticoagulants, respectively. Fatigue was negatively and positively related to RAAS-inhibitors and proton-pump-inhibitors, respectively. These significant relationships disappeared with p-value adjustment owed to multiple testing. The mean total psychiatric burden was not worsened across the study. DISCUSSION None of the tested medications was significantly associated with the COVID-19-duration and -severity up to the end of post-diagnosing week 3. However, there were a few biologically plausible and promising relationships with antidepressants, anticoagulants, and RAAS-inhibitors before p-value adjustment. These should encourage larger and prospective studies to re-evaluate the influence of somatic and psychiatric routine medications on COVID-19-related health outcomes.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany.,LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - BenediktBernd Claus
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany.,PedScience, Datteln, Germany
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy, Psychoso-matics and Addiction Medicine, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Jens Kuhn
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Martin Brüne
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Velat Wakili
- Department of Psychiatry, Psychotherapy, Psychoso-matics and Addiction Medicine, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
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