Collaborative Care Key for Schizophrenia and Bipolar I Disorder Care During COVID-19

A collaborative-care model is essential for caring for individuals with schizophrenia or bipolar I disorder (BP-I) during and after the COVID-19 pandemic, according to new research from BMC Psychiatry.

A panel of 15 experts and stakeholders reviewed findings of a systematic literature search and discussed the impact of the COVID-19 pandemic on mental health care, clinical practice, and management of individuals with schizophrenia and BP-I. Studies were found in the PubMed OVID Medline and CINAHL databases.

The central question was “How has the COVID-19 pandemic impacted the ability of adult individuals diagnosed with schizophrenia or bipolar I disorder to access appropriate treatment, including the use of a long-acting injectable antipsychotic (LAI)?”

Some studies indicated people with serious mental illness were at a higher risk for COVID-19 infection: individuals with schizophrenia (adjusted odds ratio [AOR] 9.89), individuals with BP-1 (AOR 7.69). Individuals with schizophrenia had higher mortality in the 45 days following COVID-19 diagnosis.

Treatment challenges for individuals with schizophrenia or BP-I at the beginning of the COVID-19 pandemic included reduced access to services, early psychiatric discharge, and disruption to in-person psychiatric care, which may have increased the risk for suicide and relapse, a study showed. Mental health conditions represented about 50% of US telehealth claims in January 2021, which was 30% higher compared with January 2020.

LAI use decreased as in-person consultations decreased at the beginning of the pandemic and as institutions and health care providers frequently did not prioritize the procedures. Others provided LAI via office-based drive-up/walk-through clinics and at-home service providers.

The roundtable participants recommended integrating collaborative care, increasing telehealth and home-based treatment, and implementing clinical workflows to provide in-person LAI Injection services.

“The team-based, multidisciplinary approach of the collaborative-care model provides coordinated mental health care to implement the appropriate treatment plan,” the panel participants said. “However, to date, most collaborative care initiated in primary care has focused on depression and anxiety, not bipolar disorders or schizophrenia. Integrating all aspects of patient care should be extended to people with severe mental illness to ensure they also continue to have access to their individual level of physical and mental health care during and postpandemic, including access to prescription treatment, such as LAIs.”

They said psychiatrists may need to provide some general medical services for patients with mental health disorders who have little or no access to a general physician. Hybrid models will likely continue, requiring investment in human resources to train, manage, and support virtual care, they said. They also recommended psychiatrists utilize a trauma-informed and shared decision-making approach to individual patient care, including when discussing LAIs.

“Framing the discussions toward common patient-focused goals, such as taking fewer pills or a lower total amount of antipsychotic medication over time, are benefits that each individual can own, be responsible for, and acknowledge as their own goals and values will bring focus to what is motivating for individuals,” the panel noted.

According to panel participants, psychiatrists should consider including family members and caregivers, individual education, disease awareness, and destigmatization of severe mental illness in the collaborative-care model.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. This research was supported by Lundbeck LLC and Otsuka. Please see the original reference for a full list of disclosures.

Reference

Correll CU, Chepke C, Gionfriddo P, et al. The post COVID-19 healthcare landscape and the use of long-acting injectable antipsychotics for individuals with schizophrenia and bipolar I disorder: the importance of an integrated collaborative-care approach. BMC Psychiatry. Published online January 10, 2022. doi:10.1186/s12888-022-03685-w

This article originally appeared on Psychiatry Advisor