Dysregulated inflammation may predispose patients with serious mental illnesses to severe COVID‑19 (Review)

Abstract

Genetic and nongenetic factors associated with an increased inflammatory response may mediate a link between severe coronavirus disease 2019 (COVID‑19) and serious mental illness (SMI). However, systematic assessment of inflammatory response‑related factors associated with SMI that could influence COVID‑19 outcomes is lacking. In the present review, dietary patterns, smoking and the use of psychotropic medications are discussed as potential extrinsic risk factors and angiotensin‑converting enzyme (ACE) insertion/deletion (I/D) gene polymorphisms are considered as potential intrinsic risk factors. A genetics‑based prediction model for SMI using ACE‑I/D genotyping is also proposed for use in patients experiencing severe COVID‑19. Furthermore, the literature suggests that ACE inhibitors may have protective effects against SMI or severe COVID‑19, which is often linked to hypertension and other cardiovascular comorbidities. For this reason, we hypothesize that using these medications to treat patients with severe COVID‑19 might yield improved outcomes, including in the context of SMI associated with COVID‑19.

Keywords: angiotensin‑converting enzyme; coronavirus disease 2019; diet; inflammation; psychotropic drugs; serious mental illness; smoking.

Figure 1.

Proposed factors leading to more severe COVID-19 in patients with SMI. COVID-19, coronavirus disease 2019; SMI, serious mental illness; ACE, angiotensin-converting enzyme; PUFA, polyunsaturated fatty acids.