Patients with severe mental illness detained in secure forensic hospitals may be at increased risk of adverse outcomes in the event of infection with SARS-CoV-2, according to Irish researchers. Population-based guidance on self-isolation and other precautions based on chronological age may not be sufficient and there was an urgent need for better physical health research and treatment in this group, investigators who carried out a study of patients attending the National Forensic Mental Health Service (NFMHS) at the Central Mental Hospital, Dublin, said.
Writing in the January 2021 edition of the British Journal of Psychiatry (BJP), researchers said secure forensic mental health services treated patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities were also common.
“Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromising conditions,” they wrote. The aim of the study, they added, was to assess risk of adverse outcome in the event of SARS-CoV-2 infection in a complete population of forensic psychiatry patients using structured assessment tools.
To do so, all NFMHS patients (n = 141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools.
The results showed high rates of relevant physical comorbidities in the cohort which had a mean chronological age of 45.5 years.
The most common primary psychiatric diagnosis was schizophrenia (n = 96, 68.1%), followed by schizoaffective disorder (n = 24, 17%) and psychotic depression (n = 4, 3.5%).
Almost 60 per cent of the sample (n = 83) were obese, defined as a BMI ≥ 30; while 20.6 per cent (n = 29) were overweight (BMI = 25–29); 19.9 per cent (n = 28) had a diagnosis of hypertension and 32 (22.7%) had type II diabetes mellitus.
“Although high rates of medical comorbidities are typically found in individuals with treatment-resistant psychoses, the fact that almost one-third of the population of patients of a national forensic mental health service met Covid-Age criteria for high risk, with a Covid-Age ≥70 years, unexpected and concerning,” researchers observed.
BJP; doi: 10.1192/bjo.2020.169.