Oliver Freudenreich, MD, FACLP Co-Director, MGH Schizophrenia Clinical and Research Program Associate Professor of Psychiatry Massachusetts General Hospital Harvard Medical School Boston, Massachusetts
Nicholas Kontos, MD, FACLP Director, Fellowship in Consultation-Liaison Psychiatry Assistant Professor of Psychiatry Massachusetts General Hospital Harvard Medical School Boston, Massachusetts
John Querques, MD Vice Chairman for Hospital Services Department of Psychiatry Tufts Medical Center Associate Professor of Psychiatry Tufts University School of Medicine Boston, Massachusetts
Disclosures Dr. Freudenreich has received grant or research support from Alkermes, Avanir, Janssen, and Otsuka, and has served as a consultant to American Psychiatric Association, Alkermes, Janssen, Neurocrine, Novartis, and Roche. Dr. Kontos and Dr. Querques report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
While not as infectious as measles, COVID-19 is more infectious than the seasonal flu virus.17 It can lead to uncontrolled infection within a short period of time, particularly in enclosed settings. Outbreaks have occurred readily on cruise ships and aircraft carriers as well as in nursing homes, homeless shelters, prisons, and group homes.
Patients with SMI are vulnerable hosts because they have many of the medical risk factors18 that portend a poor prognosis if they become infected, including pre-existing lung conditions and heart disease19 as well as diabetes and obesity.20 Obesity likely creates a hyperinflammatory state and a decrease in vital capacity. Patient-related behavioral factors include poor early-symptom reporting and ineffective infection control.
Unfavorable social determinants of health include not only poverty but crowded housing that is a perfect incubator for COVID-19.
Priority treatment goals.The overarching goal during a pandemic is to keep patients with SMI in psychiatric treatment and prevent them from disengaging from care in the service of infection control. Urgent tasks include infection control, relapse prevention, and preventing treatment disengagement and loneliness.
Infection control.As trusted sources of information, psychiatrists can play an important role in infection control in several important ways:
educating patients about infection-control measures and public-health recommendations
helping patients understand what testing can accomplish and when to pursue it
encouraging protective health behaviors (eg, hand washing, mask wearing, physical distancing)
assessing patients’ risk appreciation
assessing for and addressing obstacles to implementing and complying with infection-control measures
