Background Confidence in pregnancy outcome data for women with bipolar disorder is compromised by small cohort sizes. However, comprehensive national data have been published over the last decade, but no quantitative synthesis has been established to determine the factors associated with complications in these women. Our goal is to summarise the evidence of population-based data on obstetric complications and neonatal outcomes in women with bipolar disorder compared to women without bipolar disorder. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive search was conducted of PubMed/MEDLINE, Embase, PsycINFO, Web of Science, and Google Scholar from inception to September 26th, 2024. Thirty-six outcomes were extracted from eligible articles for consideration. The study protocol was registered on PROSPERO (CRD42023369031). Findings Fourteen population-based retrospective cohort studies from six high-income countries (Australia, Canada, Hong-Kong, Sweden, Taiwan, and USA) involving 47,954 women with bipolar disorder and their newborns compared to 11,896,577 women without bipolar disorder, published between 2005 and 2024, were identified. During pregnancy, women with bipolar disorders seemed to exhibit an increased risk of gestational diabetes OR = 1.46, (95% Confidence Interval [1.06-2.03]; I2 = 87%), gestational hypertension OR = 1.19 (95% CI [1.02-1.40]; I2 = 41%), antepartum haemorrhage OR = 2.02 (95% CI [1.30-3.13]; I2 = 67%), and pre-eclampsia or eclampsia OR = 1.20 (95% CI [1.05-1.36]; I2 = 67%). At delivery, women with bipolar disorder were observed to face a higher risk of caesarean section OR = 1.35 (95% CI [1.26-1.45]; I2 = 56%), and postpartum haemorrhage OR = 1.39 (95% CI [1.20-1.62]; I2 = 0%). Their newborns also appear to be at high risks of very prematurity OR = 1.84 (95% CI [1.32-2.57]; I2 = 74%), infant death OR = 1.77 (95% CI [1.01-3.13]; I2 = 41%), low birth weight OR = 1.54 (95% CI [1.19-1.99]; I2 = 70%), preterm birth OR = 1.49 (95% CI [1.29-1.72]; I2 = 87%), small for gestational age OR = 1.28 (95% CI [1.14-1.45]; I2 = 57%), and congenital malformations OR = 1.29 (95% CI [1.09-1.53]; I2 = 42%). According to the AMSTAR 2 tool, these results correspond to moderate-quality evidence. Interpretation Despite substantial heterogeneity observed, our fi ndings suggest the presence of a broad spectrum of complications that may affect both pregnant women with bipolar disorder and their newborns. These results can serve as a basis for the development of guidelines for the prevention and management of these complications. We need additional data from other countries, particularly from low-to-moderate income countries.

Background:Antipsychotics are the gold standard treatment for schizophrenia, but many patients who receive treatment experience persistent symptoms. The aim of this network meta-analysis was to determine the efficacy of augmentation drugs for the treatment of schizophrenia. Methods:In accordance with the PRISMA statement, the PubMed, Web of Science, Google Scholar, CENTRAL, clinical trial and EUDRACT databases were searched from inception to May 15th, 2023. To ensure the robustness of the results, only double-blind randomised controlled trials with a low risk of bias (measured by the Risk Of Bias v2 (ROB2) tool) were included. The studies were categorised according to the background regimen: participants were treated with risperidone, mixed antipsychotics or clozapine. A Bayesian network meta-analysis was conducted using a random effects model. PROSPERO register: CRD42023420964. Findings:A total of 44 trials (comprising 45 augmentation drugs and 3358 participants) were included in the analysis. One-third of the drugs (16 drugs) demonstrated significant efficacy vs. placebo for at least one outcome. The most notable effect sizes (ESs) were observed for the use of tropisetron (standard mean difference: -0.83 [95% interval confidence -1.12 to -0.55]), memantine (-0.50 [-0.66 to -0.32]) and minocycline (-0.56 [-0.72 to -0.39]) to treat negative symptoms among patients treated with risperidone (moderate-to-high ESs). Studies involving mixed antipsychotics yielded lower ESs (small-to-moderate). Sodium benzoate (-0.41 [-0.60 to -0.21]) and memantine (-0.23 [-0.36 to -0.11]) were found have significant effects on positive symptoms, while memantine demonstrated efficacy for negative symptoms (-0.32 [-0.45 to -0.19]) and general psychopathology (-0.32 [-0.44 to -0.20]). Studies focusing exclusively on patients treated with clozapine revealed that duloxetine produced the best results (negative symptoms: -1.12 [-1.35 to -0.91]). Sodium benzoate was the only augmentation drug that demonstrated efficacy in relieving persistent positive symptoms (-0.32 [-0.59 to -0.08]) among patients treated with clozapine. Treatment with clozapine in combination with antipsychotics yielded small-to-moderate ESs. Interpretation:The GRADE framework indicated that the quality of the evidence among the included studies was moderate, primarily due to the limited number of randomised controlled trials with a low risk of bias. Important drugs did not appear in these results due to insufficient low-risk-of-bias data for these medications. These results highlight new pathways for treating schizophrenia that should be incorporated into future guidelines after further validation. Funding:No funding.

To investigate the existence of any association between new putative periodontal pathogens and periodontitis. Two independent reviewers conducted electronic literature searches in the MEDLINE (PubMed), EMBASE, DOSS and Google Scholar databases as well as a manual search to identify eligible clinical studies prior to November 2022. Studies comparing the prevalence of microorganisms other than the already-known periodontal pathogens in subgingival plaque and/or saliva samples between subjects with periodontitis and subject with periodontal health were included. Meta-analyses were performed on data provided by the included studies. Fifty studies including a total of 2739 periodontitis subjects and 1747 subjects with periodontal health were included. The Archaea domain and 25 bacterial species (Anaeroglobus geminatus, Bacteroidales [G-2] bacterium HMT 274, Desulfobulbus sp. HMT 041, Dialister invisus, Dialister pneumosintes, Eubacterium brachy, Enterococcus faecalis, Eubacterium nodatum, Eubacterium saphenum, Filifactor alocis, Fretibacterium sp. HMT 360, Fretibacterium sp. HMT 362, Mogibacterium timidum, Peptoniphilaceae sp. HMT 113, Peptostreptococcus stomatis, Porphyromonas endodontalis, Slackia exigua, Streptococcus gordonii, Selenomonas sputigena, Treponema amylovorum, Treponema lecithinolyticum, Treponema maltophilum, Treponema medium, Treponema parvum and Treponema socranskii) were found to be statistically significantly associated with periodontitis. Network studies should be conducted to investigate the role of these newly identified periodontitis-associated microorganisms through interspecies interaction and host-microbe crosstalk analyses.

Introduction: Antipsychotics are the gold standard treatment for schizophrenia, but many patients experience persistent symptoms. The aim of this network meta-analysis is to determine the efficacy of augmentation drugs in schizophrenia.Method: Following PRISMA statement, systematic research has been performed across PubMed, Web of Science, Google Scholar, CENTRAL, clinical trial and EUDRACT, from inception to May 2023. To ensure robustness, only double-blind randomized controlled trials with low risk of bias, using Risk of Bias 2 assessment, were included. Studies were divided considering the background regimen: participants treated with risperidone, mixed antipsychotics or clozapine. A Bayesian network meta-analysis was conducted using a random effects model.Results: A total of 54 trials (comprising 55 augmentation drugs and 3906 participants) were included in the analysis. Out of these, one-third (18 trials) demonstrated significant efficacy vs. placebo in the network analysis in at least one outcome. The most notable effect sizes (ES) were observed for tropisetron, memantine, minocycline, and desmopressin in relation to negative symptoms among patients treated with risperidone (moderate-to-high ES). Studies involving mixed antipsychotics yielded lower ES (small-to-moderate). Sodium benzoate, memantine, and galantamine were found to be significantly effective for positive symptoms, while memantine demonstrated efficacy for negative symptoms and general psychopathology. Studies focusing exclusively on patients treated with clozapine revealed that duloxetine produced the best results, with a high ES for negative symptoms and moderate-to-high ES for depressive symptoms. Sodium benzoate was the only augmentation drug demonstrating efficacy in persistent positive symptoms among patients treated with clozapine. Antipsychotic combinations with clozapine showed small-to-moderate ES. Among these augmentation drugs, none were significantly associated with an increased risk of serious adverse events.Interpretation: These results highlight new pathways for treating schizophrenia that should be incorporated into future guidelines once confirmed.Funding: Damien Etchecopar-Etchart has got a grant for his PhD thesis from the doctoral program "Jeunes Espoirs de la Psychiatrie" (Young Hopes of Psychiatry) supported by the FondaMental Foundation and sponsored by the Bettencourt Schueller Foundation.Declaration of Interest: Damien Etchecopar-Etchart: None. Laurent Boyer: None. Guillaume Fond: None.

In schizophrenia, it is currently thought that stigma experience is increased by psychotic and depressive symptomatology, exposure to stigma at the workplace, and that self-stigma levels vary across countries without knowing the factors explaining these variations. The aim of the present meta-analysis was to synthetize the data of observational studies comprehensively exploring multiple self-stigma dimensions and associated factors. A systematic literature search without language or time restrictions was conducted in Medline, Google Scholar, and Web of Science for studies, last 09/2021. Eligible studies that included ≥80% of patients diagnosed with schizophrenia-spectrum disorders and used a validated scale measuring self-stigma dimensions were meta-analysed using random-effects models, followed by subgroup and meta-regression analyses. Study registration: PROSPERO CRD42020185030. Overall, 37 studies (n = 7717) from 25 countries (5 continents) published between 2007 and 2020 were included, with 20 studies conducted in high-income countries. These studies used two scales with total scores ranging 1–4. The mean estimate of perceived stigma was 2.76 [95% confidence interval (CI) = 2.60–2.94], experienced stigma 2.29 [95% CI = 2.18, 2.41], alienation 2.40 [95% CI = 2.29, 2.52], stereotype endorsement 2.14 [95% CI = 2.03, 2.27], social withdrawal 2.28 [95% CI = 2.17, 2.39] and stigma resistance 2.53 [95% CI = 2.43, 2.63]). Self-stigma levels did not reduce over time. Living outside urban areas, low-income, singleness, unemployment, high antipsychotic dose and low functioning were associated with different stigma dimensions. Some stigma dimensions were lower in studies carried out in Europe compared to other regions. Most studies published since 2007 report that self-stigma is a particular concern for a specific subgroup of patients. This subgroup is characterized by unemployment, high antipsychotic dose and low functioning. We identified important other missing factors that should be explored to improve the effectiveness of public policies and personalized interventions to reduce self-stigma. Importantly, classical illness severity indices (psychotic severity, age at illness onset, illness duration) and sociodemographic variables (age, sex and education) were not associated with self-stigma, moderating previous findings.

Hypersexuality and paraphilic disorders have been associated with increased ADHD in several studies. To determine the prevalence of ADHD in hypersexuality and paraphilic disorders. Three databases (Medline, Web of Science and Google Scholar) were explored. Using random effects models, we calculated the pooled estimate of ADHD prevalence. The leave-1-out method and subgroup analyses were carried out to identify sources of heterogeneity. Seven studies from three countries (N = 730 patients with hypersexuality) were included (including five US studies). The overall estimate of the prevalence of ADHD in patients with hypersexuality or paraphilic disorders was 22.6

Parent history of severe mental illness (PHSMI) may have long-term consequences in adult offspring due to genetic and early environmental factors in preliminary studies. To compare the outcomes associated in subjects with PHSMI to those in patients without PHSMI. The participants with schizophrenia and schizoaffective disorders were recruited in the ongoing FACE-SZ cohort at a national level (10 expert centers) and evaluated with a 1-day-long standardized battery of clinician-rated scales and patient-reported outcomes. PHSMI was defined as history of schizophrenia or bipolar disorders in at least one parent and was included as explanatory variable in multivariate models. Of the 724 included patients, 78 (10.7%) subjects were classified in the PHSMI group. In multivariate analyses, PHSMI patients had a better insight into schizophrenia and the need for treatment and reported more often childhood trauma history compared to patients without PHSMI. More specifically, those with paternal history of SMI reported more severe outcomes (increased childhood physical and emotional abuses, comorbid major depression and psychiatric hospitalizations). PHSMI is associated with increased risk of childhood trauma, major depressive disorder and psychiatric hospitalization and better insight in individuals with schizophrenia. Specific public health prevention programs for parents with SMI should be developed to help protect children from pejorative psychiatric outcomes. PHSMI may also explain in part the association between better insight and increased depression in schizophrenia.

AIM:To assess the effect of surgical root coverage (RC) on dentin hypersensitivity (DH) associated with gingival recession. MATERIALS AND METHODS:Two independent reviewers conducted electronic literature searches in MEDLINE (PubMed), EMBASE, Cochrane Library, Web Of Science, Dentistry & Oral Sciences Source, ScienceDirect, and ClinicalTrials.gov databases as well as a manual search to identify eligible clinical studies from January 2000 to March 2022. Randomized controlled trials (RCTs) comparing two surgical RC techniques or a surgical RC technique with or without adjuvant were included. Meta-analyses were performed on data provided by RCTs. RESULTS:Thirteen RCTs with a total of 701 patients (1086 recessions) were included. The percentage of DH suppression was 70.8% (95% confidence interval [CI] [64.4-76.6]; I2  = 39.2% [3.5-61.8], Q-test = 0.02) after surgical RC. Recession reduction and percentage of RC were both statistically significantly associated with DH suppression (estimate = 0.66 [0.10-1.23], p = .022, R2  = 14.45% and estimate = 0.04 [0.01-0.08], p = .012, R2  = 29.54%, respectively). Coronally advanced flap (CAF) + connective tissue graft showed results statistically more effective than CAF + xenogeneic collagen matrix in DH suppression (73.3% [65.6-79.8] and 61.4% [51.7-70.3], respectively; p = .048). CONCLUSIONS:Success of surgical RC is associated with DH suppression.

Primary Sjögren's syndrome (pSS) is an autoimmune disease with frequent neurological involvement. Memory complaints are common, but their precise patterns remain unclear. We wanted to characterize patterns of neurocognitive profiles in pSS patients with cognitive complaints. Only pSS patients with memory complaints were included, prospectively. Cognitive profiles were compiled through a comprehensive cognitive evaluation by neuropsychologists. Evaluations of anxiety, depression, fatigue, sleep disorders and quality of life were performed for testing their interactions with cognitive profiles. All 32 pSS patients showed at least borderline cognitive impairment, and 17 (53%) exhibited a pathological cognitive profile: a hippocampal profile (37%), a dysexecutive profile (22%), and an instrumental profile (16%) (possible overlap). Regarding the secondary objectives: 37% of patients were depressed, and 48% exhibited a mild-to-severe anxiety trait. Sleep disorders were frequent (excessive daytime sleepiness (55%), high risk for sleep apnea (45%), and insomnia (77%)). Cognitive impairments could not be explained alone by anxiety, depression or sleep disorders. Fatigue level was strongly associated with sleep disorders. Our study highlights that cognitive complaints in pSS patients are supported by measurable cognitive impairments, apart from frequently associated disorders such as depression, anxiety or sleep troubles. Sleep disorders should be screened.

Background In people with schizophrenia, major areas of everyday life are impaired, including independent living, productive activities, social relationships and overall quality of life. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes.Aim The goal of the present study was to identify factors associated with motivation deficits in real-life schizophrenia, and to assess its contribution to impaired functioning and quality of life.Methods Based on previous literature and clinical experience, several factors were selected and grouped into factors potentially explaining motivation deficits. Some of these variables were never investigated before in relationship with motivation deficits.Results In 561 patients with schizophrenia of the national FACE-SZ cohort living in the community, 235 (41.9%) reported severe motivation deficits. These deficits were found to be significantly associated with impaired socially useful activities, psychological and physical quality of life (in almost all domains), alcohol use disorder (aOR = 2.141, p = 0.021), severe nicotine dependence (aOR = 2.906, p < 0.001) independently of age and sex. No significant association was found for body mass index, metabolic syndrome or physical activity level. In the second model, we identified the following modifiable factors associated with motivation deficits: history of suicide attempt (aOR = 2.297, p = 0.001), positive symptoms (aOR = 1.052, p = 0.006), current major depressive episode (aOR = 2.627, p < 0.001), sleep disorders (aOR = 1.474, p = 0.024) and lower medication adherence (aOR = 0.836, p = 0.001) independently of gender, current alcohol use disorder, second-generation antipsychotics and akathisia. No significant association was found for negative symptoms, childhood trauma and inflammation. These results were maintained after removing patients with schizoaffective disorders or those with major depressive disorder.Interpretation Motivation deficits are frequent and remain persistent unmet need in real-world schizophrenia that should be addressed in future guidelines. Based on our results, literature and clinical experience, we recommend to address in priority major depression, sleep, suicide, positive symptoms (when present and as early as possible) and medication adherence to improve motivation deficits of schizophrenia.

Abstract In schizophrenia, it is currently thought that stigma experience is increased by psychotic and depressive symptomatology, exposure to stigma at the workplace, and that self-stigma levels vary across countries without knowing the factors explaining these variations. The aim of the present meta-analysis was to synthetize the data of observational studies comprehensively exploring multiple self-stigma dimensions and associated factors. A systematic literature search without language or time restrictions was conducted in Medline, Google Scholar and Web of Science for studies, last 09/2021. Eligible studies that included ≥ 80% of patients diagnosed with schizophrenia-spectrum disorders and used a validated scale measuring self-stigma dimensions were meta-analyzed using random-effects models, followed by subgroup and meta-regression analyses. Study registration: PROSPERO CRD42020185030. Across 40 studies (n = 7,717) from 25 countries (5 continents), with 20 studies conducted in high-income countries, published between 2007 and 2020 using two scales with total scores ranging 1–4. The mean estimate of perceived stigma was 2.76 [95% confidence interval (CI) = 2.60–2.94], experienced stigma 2.29 [95%CI = 2.18,2.41], alienation 2.40 [95%CI = 2.29,2.52], stereotype endorsement 2.06 [95%CI = 1.88,2.26], social withdrawal 2.28 [95%CI = 2.17,2.39] and stigma resistance: 2.53 [95%CI = 2.43,2.63]). Self-stigma levels did not reduce over time. Living outside urban areas, low income, singleness, unemployment, high antipsychotic dose and low functioning were associated with different stigma dimensions. Some stigma dimensions were lower in studies carried out in Europe compared to other regions. Most studies published since 2007 report that self-stigma is a particular concern for a specific subgroup of patients. This subgroup is characterized by singleness, unemployment, repeated psychiatric hospitalizations and is also probably more depressed, but data are imprecise to confirm this point. We identified important other missing factors that should be explored to improve the effectiveness of public policies and personalized interventions to reduce self-stigma. Importantly, classical illness severity indices (psychotic severity, age at illness onset, illness duration) and sociodemographic variables (age, sex and education) were not associated with self-stigma, moderating previous findings.

Women with schizophrenia and their newborns are at risk of adverse pregnancy, delivery, neonatal and child outcomes. However, robust and informative epidemiological estimates are lacking to guide health policies to prioritise and organise perinatal services. For the first time, we carried out a systematic review and meta-analysis to synthesise the accumulating evidence on pregnancy, delivery, neonatal complications, and infant mortality among women with schizophrenia and their newborns ( N = 43,611) vs. controls ( N = 40,948,272) between 1999 and 2021 (26 population-based studies from 11 high-income countries) using random effects. Women with schizophrenia had higher odds (OR) of gestational diabetes (2.35, 95% CI: [1.57–3.52]), gestational hypertension, pre-eclampsia/eclampsia (OR 1.55, 95% CI: [1.02–2.36]; 1.85, 95% CI: [1.52–2.25]), antepartum and postpartum haemorrhage (OR 2.28, 95% CI: [1.58–3.29]; 1.14, 95% CI: [1.04–1.24]), placenta abruption, threatened preterm labour, and premature rupture of membrane (OR 2.20, 95% CI: [2.02–2.39]; 2.91, 95% CI: [1.57–5.40]; 1.29, 95% CI: [1.06–1.58]), c-section (OR 1.33, 95% CI: [1.22–1.45]), foetal distress (OR 1.80, 95% CI: [1.43–2.26]), preterm and very preterm delivery (OR 1.79, 95% CI: [1.62–1.98]; 2.31, 95% CI: [1.78–2.98]), small for gestational age and low birth weight (OR 1.63, 95% CI: [1.48–1.80]; 1.75, 95% CI: [1.46–2.11]), congenital malformations (OR 1.86, 95% CI: [1.71–2.03]), and stillbirths (OR 2.06, 95% CI: [1.83–2.31]). Their newborns had higher odds of neonatal death (OR 1.41, 95% CI: [1.03–1.94]), post-neonatal death (OR 2.87, 95% CI: [2.11–3.89]) and infant mortality (OR 2.33, 95% CI: [1.81–3.01]). This large‐scale meta‐analysis confirms that schizophrenia is associated with a substantially increased risk of very preterm delivery, stillbirth, and infant mortality, and metabolic risk in mothers. No population-based study has been carried out in low- and middle-income countries in which health problems of women with schizophrenia are probably more pronounced. More research is needed to better understand the complex needs of women with schizophrenia and their newborns, determine how care delivery could be optimised, and define best practices. Study registration: PROSPERO CRD42020197446.

The World Health Organization (WHO) recommends adults complete 150–300 min per week of moderate physical activity or 75–150 min of vigorous physical activity or an equivalent combination of both, to optimize health. To explore the factors associated with adequate MVPA in stabilized outpatients with schizophrenia. 425 stabilized outpatients were recruited in the national FACE-SZ cohort between 2015 and 2018 were evaluated with the International Physical Activity Questionnaire and a 1-day long standardized battery. We explored in multivariate analyses the clinical and pharmacological factors associated with MVPA (model 1) and the biological factors and patient-reported outcomes (model 2). Overall, only 86 (20.2%) of the 425 participants achieved the recommended MVPA threshold. In model 1, the adequate MVPA group was associated with younger age, mood stabilizers prescription and adherence to treatment, independent of sex, positive and depressive symptoms, first-generation antipsychotics prescription, anxiolytic medication, and akathisia. In model 2, adequate MVPA was associated with better glycemic and lipidic profile and better physical and psychological well-being, self-esteem, sentimental life, and resilience independently of age, sex, and current psychotic severity. The expert centers recommend the importance of promoting promote effective MVPA programs for stabilized patients with schizophrenia. Interventions studies suggest that MVPA may be a useful strategy to maximize physical and psychological well-being and self-esteem and potentially to prevent or manage metabolic disturbances.

Background: Peripheral inflammation is associated with impaired prognosis in schizophrenia (SZ). Highly sen-sitive C-reactive protein (hs-CRP) is the most used inflammatory biomarker in daily practice. However, no consensual cut-off has been determined to date to discriminate patients with peripheral inflammation from those without. Aims: To determine if patients with peripheral inflammation between 1 and 3 mg/L had poorer outcomes compared to those with undetectable CRP (< 1 mg/L). Method: Consecutive participants of the FACE-SZ cohort with a hs-CRP < 3 mg/L were included in 10 expert academic centers with a national geographical distribution between 2010 and 2018. Potential sources of inflammation, socio-demographics, illness characteristics, current illness severity, functioning and quality of life and were reported following the FACE-SZ standardized protocol. Results: 580 patients were included, of whom 226 (39%) were identified with low-grade inflammation defined by a hs-CRP between 1 and 3 mg/L. Overweight and lack of dental care were identified as potential sources of inflammation. After adjustment for these factors, patients with inflammation had more severe psychotic, depressive and aggressive symptomatology and impaired functioning compared to the patients with undetectable hs-CRP. No association with tobacco smoking or physical activity level has been found. Conclusions: Patients with schizophrenia with hs-CRP level between 1 and 3 mg/L should be considered at risk for inflammation-associated disorders. Lowering weight and increasing dental care may be useful strategies to limit the sources of peripheral inflammation. Hs-CRP > 1 mg/L is a reliable marker to detect peripheral inflammation in patients with schizophrenia.

Comorbid major depressive disorder (MDD) in schizophrenia (SZ; SZ-MDD) has been identified as a major prognostic factor. However, the prevalence and associated factors of SZ-MDD have never been explored in a meta-analysis. All studies assessing the prevalence of SZ-MDD in stabilized outpatients with a standardized scale or with structured interviews were included. The Medline, Web of Science, PsycINFO, and Google Scholar databases were searched. Using random effects models, we calculated the pooled estimate of the prevalence of SZ-MDD. We used meta-regression and subgroup analyses to evaluate the potential moderators of the prevalence estimates, and we used the leave-one-out method for sensitivity analyses. Of the 5633 potentially eligible studies identified, 18 studies (n = 6140 SZ stabilized outpatients) were retrieved in the systematic review and included in the meta-analysis. The pooled estimate of the prevalence of SZ-MDD was 32.6% (95% CI: 27.9-37.6); there was high heterogeneity (I2 = 92.6%), and Egger's test did not reveal publication bias (P = .122). The following factors were found to be sources of heterogeneity: publication in or after 2015, the inclusion of patients from larger studies, the assessment tools, the inclusion of patients with substance use disorder or somatic chronic diseases, age, education level, the lifetime number of hospitalizations, and antidepressant use. Two-thirds of the extracted variables could not be explored due to an insufficient amount of published data. The prevalence of MDD is high among SZ individuals. Healthcare providers and public health officials should have an increased awareness of the burden of SZ-MDD.

Importance Heterogeneous evidence exists for the association between COVID-19 and the clinical outcomes of patients with mental health disorders. It remains unknown whether patients with COVID-19 and mental health disorders are at increased risk of mortality and should thus be targeted as a high-risk population for severe forms of COVID-19. Objective To determine whether patients with mental health disorders were at increased risk of COVID-19 mortality compared with patients without mental health disorders. Data Sources For this systematic review and meta-analysis, MEDLINE, Web of Science, and Google Scholar were searched from inception to February 12, 2021. Bibliographies were also searched, and the corresponding authors were directly contacted. The search paradigm was based on the following combination: (mental, major[MeSH terms]) AND (COVID-19 mortality[MeSH terms]). To ensure exhaustivity, the term mental was replaced by psychiatric, schizophrenia, psychotic, bipolar disorder, mood disorders, major depressive disorder, anxiety disorder, personality disorder, eating disorder, alcohol abuse, alcohol misuse, substance abuse, and substance misuse. Study Selection Eligible studies were population-based cohort studies of all patients with identified COVID-19 exploring the association between mental health disorders and mortality. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used for abstracting data and assessing data quality and validity. This systematic review is registered with PROSPERO. Main Outcomes and Measures Pooled crude and adjusted odds ratios (ORs) for the association of mental health disorders with mortality were calculated using a 3-level random-effects (study/country) approach with a hierarchical structure to assess effect size dependency. Results In total, 16 population-based cohort studies (data from medico-administrative health or electronic/medical records databases) across 7 countries (1 from Denmark, 2 from France, 1 from Israel, 3 from South Korea, 1 from Spain, 1 from the UK, and 7 from the US) and 19 086 patients with mental health disorders were included. The studies covered December 2019 to July 2020, were of good quality, and no publication bias was identified. COVID-19 mortality was associated with an increased risk among patients with mental health disorders compared with patients without mental health disorders according to both pooled crude OR (1.75 [95% CI, 1.40-2.20]; P < .05) and adjusted OR (1.38 [95% CI, 1.15-1.65]; P < .05). The patients with severe mental health disorders had the highest ORs for risk of mortality (crude OR: 2.26 [95% CI, 1.18-4.31]; adjusted OR: 1.67 [95% CI, 1.02-2.73]). Conclusions and Relevance In this systematic review and meta-analysis of 16 observational studies in 7 countries, mental health disorders were associated with increased COVID-19-related mortality. Thus, patients with mental health disorders should have been targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies. Future studies should more accurately evaluate the risk for patients with each mental health disorder. However, the highest risk seemed to be found in studies including individuals with schizophrenia and/or bipolar disorders.

Psychiatric patients are at risk of hypovitaminosis D and Covid-19-related mortality. In addition to the mental health benefits, vitamin D supplementation may be potentially effective in preventing severe forms of Covid-19 infections. Vitamin D supplementation is not necessary and is not reimbursed in France for this indication. A monthly supplementation of 50,000 IU may be sufficient in most cases. Double the dose is recommended for obese patients. The risk of renal lithiasis is not increased at these doses, even when supplemented in a patient without vitamin D deficiency. The Covid-19 crisis is an opportunity to disseminate vitamin D supplementation in psychiatric patients, as it has been shown to be effective in other respiratory diseases such as mild upper respiratory tract infections and influenza.

Heterogeneous evidence exists for the association between COVID-19 and the clinical outcomes of patients with mental health disorders. It remains unknown whether patients with COVID-19 and mental health disorders are at increased risk of mortality and should thus be targeted as a high-risk population for severe forms of COVID-19.To determine whether patients with mental health disorders were at increased risk of COVID-19 mortality compared with patients without mental health disorders.For this systematic review and meta-analysis, MEDLINE, Web of Science, and Google Scholar were searched from inception to February 12, 2021. Bibliographies were also searched, and the corresponding authors were directly contacted. The search paradigm was based on the following combination: (mental, major[MeSH terms]) AND (COVID-19 mortality[MeSH terms]). To ensure exhaustivity, the term mental was replaced by psychiatric, schizophrenia, psychotic, bipolar disorder, mood disorders, major depressive disorder, anxiety disorder, personality disorder, eating disorder, alcohol abuse, alcohol misuse, substance abuse, and substance misuse.Eligible studies were population-based cohort studies of all patients with identified COVID-19 exploring the association between mental health disorders and mortality.Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used for abstracting data and assessing data quality and validity. This systematic review is registered with PROSPERO.Pooled crude and adjusted odds ratios (ORs) for the association of mental health disorders with mortality were calculated using a 3-level random-effects (study/country) approach with a hierarchical structure to assess effect size dependency.In total, 16 population-based cohort studies (data from medico-administrative health or electronic/medical records databases) across 7 countries (1 from Denmark, 2 from France, 1 from Israel, 3 from South Korea, 1 from Spain, 1 from the UK, and 7 from the US) and 19 086 patients with mental health disorders were included. The studies covered December 2019 to July 2020, were of good quality, and no publication bias was identified. COVID-19 mortality was associated with an increased risk among patients with mental health disorders compared with patients without mental health disorders according to both pooled crude OR (1.75 [95% CI, 1.40-2.20]; P < .05) and adjusted OR (1.38 [95% CI, 1.15-1.65]; P < .05). The patients with severe mental health disorders had the highest ORs for risk of mortality (crude OR: 2.26 [95% CI, 1.18-4.31]; adjusted OR: 1.67 [95% CI, 1.02-2.73]).In this systematic review and meta-analysis of 16 observational studies in 7 countries, mental health disorders were associated with increased COVID-19-related mortality. Thus, patients with mental health disorders should have been targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies. Future studies should more accurately evaluate the risk for patients with each mental health disorder. However, the highest risk seemed to be found in studies including individuals with schizophrenia and/or bipolar disorders.