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Severe mental disorders and COVID-19: a one-year systematic review

Abstract Background Social isolation and lack of availability in psychiatric outpatient services cause a risk for symptom exacerbation and relapse in severe mental disorders. Since March 2020, the COVID-19 pandemic has resulted in strict social restrictions globally. There is some evidence on people with mental health disorders having poorer access to health services during COVID-19 pandemic. Individual studies evaluating psychic health in severe mental disorders have so far showed heterogeneous effects. Methods A literature search was conducted in PubMed on 17th February 2021 using keywords (COVID-19) AND (schizophrenia OR psychosis OR bipolar disorder OR psychotic depression) and limiting the detailed search to individual studies with the focus on (1) direct psychic consequences or (2) trends in service utilization in severe mental disorders. Case reports, reviews, consensus statements, commentaries, opinion and discussion papers, as well as studies on COVID-19 infection in psychiatric patients were excluded. Results The most common types of studies comprised retrospective evaluations on emergency service use (7 studies) and outcome studies in various patient groups (11 studies). Repeated findings included a marked decrease in overall emergency services use and an increased proportion of involuntary referrals in schizophrenia spectrum. The levels of psychological distress increased in several diagnostic groups. Conclusions Lockdowns and restrictions in health services during pandemic have implicated a heightened distress for mentally ill and a downturn in acute services for individuals with psychotic disorders.