Problems related to new crown vaccine for patients with severe mental illness

To combat the global novel coronavirus pneumonia, people have made extraordinary efforts in the development and production of the new crown vaccine, and the early reports on the safety and efficacy of the vaccine also showed potential. However, especially in the early stages of vaccine distribution, the amount of vaccine will be scarce. This raises the question of who should be the first to get vaccinated?

Novel coronavirus pneumonia should be given priority in some groups. Due to physical factors, socioeconomic status, age or occupation, they are highly at risk of developing new coronavirus, persistent sequelae or new crown pneumonia. We advocate that patients with severe mental illness should be given priority in vaccine distribution; Based on the medical and socio-economic risk factors of COVID-19 infection and their incidence rate and mortality rate, vulnerable groups are considered.

People with somatic comorbidities have a high risk of death or long-term or more serious consequences due to the new crown, and thus become the people who should give priority to the distribution of vaccines, including patients with cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, chronic kidney disease, immunodeficiency and cancer. We have previously argued that patients with severe mental illness should be included in this list because of their high risk of comorbidity (although there are other reasons).

The mortality of patients with severe mental illness is 2-3 times that of the general population. Compared with the general population, patients with severe mental illness are more likely to suffer from obesity or physical diseases, such as cardiovascular disease, type 2 diabetes mellitus and respiratory diseases, all of which are the risk factors of poor prognosis. In addition, the proportion of smoking in patients with severe mental illness was 2-3 times that in patients without mental illness. The expression of ACE2 in bronchial epithelial cells of current smokers is higher than that of non-smokers and former smokers. Although novel coronavirus pneumonia was initially thought to be more likely to infect COVID-19 with ACE2 in the airway, epidemiological data did not support the notion that smoking is directly related to new crown pneumonia. However, novel coronavirus pneumonia is commonly associated with smoking and is more common in patients with severe mental illness than in COPD.

The novel coronavirus pneumonia patients with novel coronavirus pneumonia, especially those with severe mental illness, may have higher risk of worse outcomes.

Little is known about the effect of psychotropic drugs on vaccination response. Antipsychotics may have different effects on a variety of cytokines in patients with psychotic disorders, including anti-inflammatory effects in some individuals. However, given the role of vaccination, anti-inflammatory effects may not always be desirable as they may inhibit antibody formation.

Clozapine use is associated with neutropenia, which makes individuals more susceptible to infection. Patients taking clozapine for a long time may have secondary antibody deficiency, and then face the risk of immunodeficiency. Clozapine may be a risk factor for new coronavirus infection, according to a retrospective cohort study. Although a small-scale study showed that influenza vaccine did not affect the serum concentration of clozapine, vaccination may affect the concentration of clozapine through its effect on cytochrome P450 metabolizing enzymes.

In view of novel coronavirus pneumonia and novel coronavirus pneumonia deaths, COVID-19 is a high risk patient with severe mental illness. Safe and effective vaccines should be provided to this group as soon as possible. Future studies should assess the efficacy and safety of vaccines for patients with severe mental illness and their interactions with psychotropic drugs, so that this population can understand the benefits and risks of vaccination.

 

Cindy