# A retrospective risk factor analysis in psychiatric inpatients with COVID‐19 from 2020 to 2023 at a neuropsychiatric hospital in Tokyo

## TL;DR

This study identifies risk factors for severe COVID-19 in psychiatric patients, highlighting age, aspiration pneumonia, and antipsychotic use.

## Contribution

The study provides phase-specific insights into risk factors for severe COVID-19 among psychiatric inpatients in Tokyo.

## Key findings

- Aspiration pneumonia and older age were consistently linked to severe COVID-19 across study phases.
- Antipsychotic use was a risk factor in one phase but not in another, indicating variability over time.
- Moderate II or higher COVID-19 was a strong predictor of all-cause mortality.

## Abstract

To identify the factors associated with the severity and prognosis of coronavirus disease 2019 (COVID‐19) in patients with psychiatric or neurological disorders.

We retrospectively analyzed the clinical characteristics and treatment outcomes of 349 patients with those disorders who were admitted for COVID‐19 at the National Center of Neurology and Psychiatry between June 2020 and March 2023. The study period was divided into three phases: June–December 2020, January–December 2021, and January 2022 to March 2023 according to the differences in types of COVID‐19 variants and our clinical care systems. Differences across phases were analyzed using the Kruskal–Wallis test. Logistic regression was performed to identify factors associated with moderate II or higher COVID‐19 and all‐cause mortality.

A total of 36 (10.3%), 107 (30.7%), and 206 (59.0%) patients were admitted in the first, second, and third phases, respectively. The average age of the patients was 66.4 ± 17.9 years, and 47% of them were female. Aspiration pneumonia complicated by COVID‐19 was strongly associated with moderate II or higher (odds ratio [OR] = 10.871, p < 0.001), antipsychotics (OR = 1.947, p = 0.034), transfer from psychiatric hospitals (OR = 2.878, p = 0.006), and older age (≥65 years, OR = 4.467, p < 0.001) were significant risk factors for moderate II or higher COVID‐19. Moderate II or higher COVID‐19 significantly predicted all‐cause mortality (OR = 32.658, p = 0.001). Phase‐stratified analyses indicated that older age (Phase 2: OR 3.69; Phase 3: OR 4.75) and aspiration pneumonia (Phase 3: OR 13.9) were consistently associated with moderate II or higher COVID‐19, whereas the association with antipsychotic use was phase‐dependent (significant in Phase 2: OR 4.74, but not in Phase 3: OR 1.12).

These findings suggest that patients with psychiatric disorders, particularly elderly individuals or those with aspiration pneumonia, are associated with moderate II or higher COVID‐19. Further prospective observational studies are warranted.