COVID-19 distresses the depressed while schizophrenic patients are unimpressed: a study on psychiatric inpatients

Abstract

The COVID-19-pandemic has distressed most people all over the world during spring 2020, and the situation has been particularly hard on patients with mental disease (Frank et al., 2020; Hao et al., 2020, Hernández-Huerta et al., 2020, Tian et al., 2020). Two months after the beginning of the lock-down with social distancing, job losses and fear of infection, we have examined a sample of psychiatric inpatients in the middle of May 2020 in order to quantify mental and somatic distress and compare between different diagnostic groups. The following scores were used: Clinical Global Impression (CGI; Billen et al., 2020); the Perceived Stress Scale (PSS; Klein et al., 2016), and a summary score of Stress-Related Somatic complaints (SRS): headache, lower back pain, exhaustion, difficulties falling asleep, insomnia, irritability, hostility, restlessness, boredom, altered eating habits, maldigestion scores for each item was between 0 for “never” and 6 for “almost permanently”. We examined a sample of 139 patients (61m, 78f) with a mean age of 48 years (from 18 to 92). Among these 139 patients, 17 suffered from disorders due to psychotropic substances (ICD-10 F1.x), 26 were diagnosed with schizophrenia and related disorders (F2.x), 89 presented with affective disorders (F3.x), and 7 individuals had other psychiatric diagnoses. CGI in the total sample was 4.9 (SD 1.0) and was significantly higher in women compared to men (t-test, p = 0.03). There were no significant differences between the F1 (dependence), F2 (psychosis) and F3 (affective disorders) groups regarding the CGI-score. PSS and SRS were highest in the affective disorders group compared to the rest of the sample (ANOVA; both p ≤ 0.0001). ANCOVA showed that this difference remained significant when controlled for gender (ANCOVA; both p ≤ 0.0001). CGI was not significantly correlated with stress perceived during the last month (PSS; Spearman coefficient; p > 0.05), but with the SRS (Spearman coefficient; p ≤ 0.0001) in the total group. The subgroup with affective disorders showed the highest correlations between CGI and PSS or SRS, whereas no such relationship at all was observed in the schizophrenia and related disorders group. This may indicate a differential effect of a global crisis for patients with affective and psychotic disorders. Collective anguish will resound more strongly in vulnerable individuals whose emotions are in need of a corresponding narrative, while patients with schizophrenia are occupied with serious intrinsic issues and unperturbed by comparably mundane worldly business. Antipsychotic treatment does contribute its share to the pseudo-resilience in the F2-group. Patients with affective disorders are more likely to seek help in times of crisis, while self-isolating patients with schizophrenia and similar diseases are in need to be found.