Sheng HW, Wang HG, Wang CZ, Wu J, Huo LJ, Wang RX, Zhou YJ, Zhang XY. Prevalence and clinical characteristics of COVID-19 in inpatients with schizophrenia in Wuhan, China. World J Psychiatry 2022; 12(1): 140-150 [PMID: 35111585 DOI: 10.5498/wjp.v12.i1.140]
Corresponding Author of This Article
Xiang-Yang Zhang, MD, PhD, CAS Key Laboratory of Mental Health, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 10000, China. zhangxy@psych.ac.cn
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hong-Wei Sheng, Jiang Wu, Department of Psychiatry, Wuhan Youfu Hospital, Wuhan 430070, Hubei Province, China
Hong-Gang Wang, Chun-Zhi Wang, Qingdao Mental Health Center, Qingdao University, Qingdao 266000, Shandong Province, China
Li-Jian Huo, Xiang-Yang Zhang, CAS Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing 10000, China
Ruo-Xi Wang, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei Province, China
Yong-Jie Zhou, Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen 510810, Guangdong Province, China
Author contributions: Zhang XY, Zhou YJ, and Sheng HW designed the study; Sheng HY, Wu J, Huo LJ, and Huang W were responsible for collecting the clinical data; Wang HG and Wang CZ collected the literature and cleaned the data; Zhou YJ and Zeng LY did statistical analysis; Zhou YJ and Sheng HW wrote the manuscript; Zhang XY reviewed and revised the manuscript.
Institutional review board statement: The investigation was carried out in accordance with the latest version of the Declaration of Helsinki. The Wuhan Youfu Hospital received approval for this study from the institutional review board of the Institute of Psychology, Chinese Academy of Sciences. Given the urgent need for data collection and retrospective research, no written informed consent was required for these current analyses.
Conflict-of-interest statement: There are no conflicts of interest related to this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author Yongjie Zhou upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang-Yang Zhang, MD, PhD, CAS Key Laboratory of Mental Health, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 10000, China. zhangxy@psych.ac.cn
Received: February 13, 2021 Peer-review started: February 13, 2021 First decision: March 16, 2021 Revised: March 29, 2021 Accepted: November 24, 2021 Article in press: November 24, 2021 Published online: January 19, 2022 Processing time: 338 Days and 9.3 Hours
ARTICLE HIGHLIGHTS
Research background
In contrast to many Western countries, China has maintained its large psychiatric hospitals. The prevalence and clinical characteristics of coronavirus disease 2019 (COVID-19) in inpatients with schizophrenia (SCZ) are unclear.
Research motivation
In the large mental health hospitals in China, the resources for managing this COVID-19 epidemic are very limited, and these SCZ inpatients are expected to be highly contagious.
Research objectives
To assess the prevalence of COVID-19 among inpatients with SCZ and compare the infected to uninfected SCZ patients in a Wuhan psychiatric hospital.
Research methods
We retrospectively collected demographic characteristics and clinical profiles of all SCZ patients with COVID-19 at Wuhan’s Youfu Hospital.
Research results
Among the 504 SCZ patients, 84 had COVID-19, and we randomly sampled 174 who were uninfected as a comparison group. The overall prevalence of COVID-19 in SCZ inpatients was 16.7%. Among these 84 SCZ patients with confirmed COVID-19, the median age was 54 years and 76.2% were male. The most common symptom was fever (82%), and less common symptoms were cough (31%), poor appetite (20%), and fatigue (16%). Compared with SCZ patients without COVID-19, patients with COVID-19 were older (P = 0.006), significantly lighter (P = 0.002), and had more comorbid physical diseases (P = 0.001). Surprisingly, those infected were less likely to be smokers (< 0.001) or to be treated with clozapine (P = 0.03). Further logistic regression showed that smoking [odds ratio (OR) = 5.61], clozapine treated (OR = 2.95), and male (OR = 3.48) patients with relatively fewer comorbid physical diseases (OR = 0.098) were at lower risk of COVID-19. The SCZ patients with COVID-19 presented primarily with fever, but only one-third had a cough, which might otherwise be the most common mode of transmission between individuals.
Research conclusions
Two unexpected protective factors for COVID-19 among these SCZ inpatients are smoking and clozapine treatment.
Research perspectives
Clozapine treatment and smoking may be protective for COVID-19 among SCZ inpatients, perhaps related to nicotine and clozapine immunosuppression, which deserves further exploration.
