Maria Fagerbakke Strømme, Christoffer Bartz-Johannessen, Eirik Kjelby, Lars Mehlum, Arnstein Mykletun, Rune Andreas Kroken, Erik Johnsen, Rolf Gjestad
Introduction
Associations between psychiatric disorders and mortality have been extensively studied, but limited evidence exists regarding influence of clinical characteristics on mortality risk, at the time of acute psychiatric hospitalization.
Methods
A prospective total-cohort study included all patients consecutively admitted to Haukeland University Hospital's psychiatric acute ward in Bergen, Norway between 2005 and 2014 (n = 6125). Clinical interviews were conducted at the first admission within the study period, and patients were subsequently followed for up to 15 years in the Norwegian Cause of Death Registry. Competing risks regression models were used to investigate associations between clinical characteristics at first admission and the risk of natural and unnatural death during follow-up.
Results
The mean age at first admission and at time of death was 42.5 and 62.8 years, respectively, and the proportion of women in the sample was 47.2%. A total of 1381 deaths were registered during follow-up, of which 65.5% had natural, 30.4% unnatural, and 4.1% unknown causes. Higher age, male sex, unemployment, cognitive deficits, and physical illness were associated with increased risk of natural death. Male sex, having no partner, physical illness, suicide attempts, and excessive use of alcohol and illicit substances were associated with increased risk of unnatural death.
Conclusion
Psychiatric symptoms, except suicide attempts, were unrelated to increased mortality risk. In the endeavor to reduce the increased mortality risk in people with mental disorders, focus should be on addressing modifiable risk factors linked to physical health and excessive use of alcohol and illicit substances.
{"title":"Risk factors for mortality in patients admitted to a psychiatric acute ward: A prospective cohort study","authors":"Maria Fagerbakke Strømme, Christoffer Bartz-Johannessen, Eirik Kjelby, Lars Mehlum, Arnstein Mykletun, Rune Andreas Kroken, Erik Johnsen, Rolf Gjestad","doi":"10.1111/acps.13657","DOIUrl":"10.1111/acps.13657","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Associations between psychiatric disorders and mortality have been extensively studied, but limited evidence exists regarding influence of clinical characteristics on mortality risk, at the time of acute psychiatric hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective total-cohort study included all patients consecutively admitted to Haukeland University Hospital's psychiatric acute ward in Bergen, Norway between 2005 and 2014 (<i>n</i> = 6125). Clinical interviews were conducted at the first admission within the study period, and patients were subsequently followed for up to 15 years in the Norwegian Cause of Death Registry. Competing risks regression models were used to investigate associations between clinical characteristics at first admission and the risk of natural and unnatural death during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age at first admission and at time of death was 42.5 and 62.8 years, respectively, and the proportion of women in the sample was 47.2%. A total of 1381 deaths were registered during follow-up, of which 65.5% had natural, 30.4% unnatural, and 4.1% unknown causes. Higher age, male sex, unemployment, cognitive deficits, and physical illness were associated with increased risk of natural death. Male sex, having no partner, physical illness, suicide attempts, and excessive use of alcohol and illicit substances were associated with increased risk of unnatural death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Psychiatric symptoms, except suicide attempts, were unrelated to increased mortality risk. In the endeavor to reduce the increased mortality risk in people with mental disorders, focus should be on addressing modifiable risk factors linked to physical health and excessive use of alcohol and illicit substances.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139471796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catrine Bakkedal, Frederik Persson, Mikkel Bring Christensen, Margit Kriegbaum, Grimur Høgnason Mohr, John Sahl Andersen, Bent Struer Lind, Christen Lykkegaard, Volkert Siersma, Maarten Pieter Rozing
Background
Type 2 diabetes (T2D) treatment has changed markedly within the last decades. We aimed to explore whether people with severe mental illness (SMI) have followed the same changes in T2D treatment as those without SMI, as multiple studies suggest that people with SMI receive suboptimal care for somatic disorders.
Methods
In this registry-based annual cohort study, we explored the T2D treatment from 2001 to 2015 provided in general practices of the Greater Copenhagen area. We stratified the T2D cohorts by their pre-existing SMI status. T2D was defined based on elevated glycated hemoglobin (≥48 mmol/mol) or glucose (≥11 mmol/L) using data from the Copenhagen Primary Care Laboratory Database. Individuals with schizophrenia spectrum disorders (ICD-10 F20–29) or affective disorders (bipolar disorder or unipolar depression, ICD-10 F30–33) were identified based on hospital-acquired diagnoses made within 5 years before January 1 each year for people with prevalent T2D or 5 years before meeting our T2D definition for incident patients. For comparison, we defined a non-SMI group, including people who did not have a hospital-acquired diagnosis of schizophrenia spectrum disorders, affective disorders, or personality disorders. For each calendar year, we assembled cohorts of people with T2D with or without SMI. We used Poisson regression to calculate the rates per 100 person-years of having at least one biochemical test (glycated hemoglobin, low-density lipoprotein cholesterol, estimated glomerular filtration rate, and urine albumin-creatinine ratio), having poor control of these biochemical results, taking glucose-lowering or cardiovascular medications, or experiencing a clinical outcome, including all-cause mortality and cardiovascular mortality. Three outcomes (cardiovascular events, cardiovascular mortality, and all-cause mortality) were additionally examined and adjusted for age and sex in a post hoc analysis.
Results
From 2001 to 2015, 66,914 individuals were identified as having T2D. In 2015, 1.5% of the study population had schizophrenia spectrum disorder and 1.4% had an affective disorder. The number of people who used biochemical tests or had poor biochemical risk factor control was essentially unrelated to SMI status. One exception was that fewer LDL cholesterol tests were done on people with affective disorders and schizophrenia spectrum disorders at the beginning of the study period compared to people in the non-SMI group. This difference gradually diminished and was almost nonexistent by 2011. There was also a slightly slower rise in UA
{"title":"The development of type 2 diabetes management in people with severe mental illness in the Capital Region of Denmark from 2001 to 2015","authors":"Catrine Bakkedal, Frederik Persson, Mikkel Bring Christensen, Margit Kriegbaum, Grimur Høgnason Mohr, John Sahl Andersen, Bent Struer Lind, Christen Lykkegaard, Volkert Siersma, Maarten Pieter Rozing","doi":"10.1111/acps.13650","DOIUrl":"10.1111/acps.13650","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Type 2 diabetes (T2D) treatment has changed markedly within the last decades. We aimed to explore whether people with severe mental illness (SMI) have followed the same changes in T2D treatment as those without SMI, as multiple studies suggest that people with SMI receive suboptimal care for somatic disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this registry-based annual cohort study, we explored the T2D treatment from 2001 to 2015 provided in general practices of the Greater Copenhagen area. We stratified the T2D cohorts by their pre-existing SMI status. T2D was defined based on elevated glycated hemoglobin (≥48 mmol/mol) or glucose (≥11 mmol/L) using data from the Copenhagen Primary Care Laboratory Database. Individuals with schizophrenia spectrum disorders (ICD-10 F20–29) or affective disorders (bipolar disorder or unipolar depression, ICD-10 F30–33) were identified based on hospital-acquired diagnoses made within 5 years before January 1 each year for people with prevalent T2D or 5 years before meeting our T2D definition for incident patients. For comparison, we defined a non-SMI group, including people who did not have a hospital-acquired diagnosis of schizophrenia spectrum disorders, affective disorders, or personality disorders. For each calendar year, we assembled cohorts of people with T2D with or without SMI. We used Poisson regression to calculate the rates per 100 person-years of having at least one biochemical test (glycated hemoglobin, low-density lipoprotein cholesterol, estimated glomerular filtration rate, and urine albumin-creatinine ratio), having poor control of these biochemical results, taking glucose-lowering or cardiovascular medications, or experiencing a clinical outcome, including all-cause mortality and cardiovascular mortality. Three outcomes (cardiovascular events, cardiovascular mortality, and all-cause mortality) were additionally examined and adjusted for age and sex in a post hoc analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2001 to 2015, 66,914 individuals were identified as having T2D. In 2015, 1.5% of the study population had schizophrenia spectrum disorder and 1.4% had an affective disorder. The number of people who used biochemical tests or had poor biochemical risk factor control was essentially unrelated to SMI status. One exception was that fewer LDL cholesterol tests were done on people with affective disorders and schizophrenia spectrum disorders at the beginning of the study period compared to people in the non-SMI group. This difference gradually diminished and was almost nonexistent by 2011. There was also a slightly slower rise in UA","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139110557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Drevinskaite, A. Kaceniene, A. Patasius, R. Stukas, A. Germanavicius, E. Miseikyte, V. Urbonas, G. Smailyte
Objective
Due to the inconsistency of the evidence about the cancer risk among patients with schizophrenia, the aim of this study was to analyse cancer mortality and morbidity in patients with schizophrenia treated in a single centre in Lithuania during the study period of 1992–2020.
Materials and Methods
A retrospective cohort study was conducted in Vilnius Republican Psychiatric Hospital, the biggest specialised psychiatric hospital in Lithuania, with approximately 5000 hospital admissions annually. The patients' cohort was established by identifying all patients with the diagnosis of schizophrenia (ICD-10 code F20) in the hospital database from 1 January 1992 until 31 December 2017. The cancer cases and cancer deaths in the cohort were identified in the Lithuanian Cancer Register through linkage procedures. The analysis of risk was based on a comparison of observed and expected numbers of cancers and deaths. Expected number of cancer cases were calculated by multiplication of the exact person-years under observation in the cohort by sex, calendar year and a 5-year age-group-specific national incidence and mortality rate. All statistical analyses were carried out using STATA 15 statistical software.
Results
During the follow-up, out of 8553 patients, 673 cases of cancer were diagnosed in both sexes. Statistically significantly lower risk for overall cancer incidence was observed in men (SIR 0.74, 95% CI 0.66–0.83), but not in women (SIR 1.07, 95% CI 0.97–1.18). Statistically significant lower overall cancer mortality risk was observed in men (SMR 0.82, 95% CI 0.70–0.96), while in the women's group, risk of cancer deaths was significantly higher compared to the general population (SMR 1.28, 95% CI 1.11–1.48). We observed lower risk for pancreatic cancer (SIR 0.36, 95% CI 0.14–0.96), non-melanoma skin cancer (SIR 0.54, 95% CI 0.33–0.88) and prostate cancer (SIR 0.69, 95% CI 0.55–0.87) in men and higher risk for malignant neoplasm of liver (SIR 2.58, 95% CI 1.53–4.36) and skin melanoma (SIR 2.03, 95% CI 1.12–3.66) in men and for breast cancer (SIR 1.38, 95% CI 1.14–1.66) and corpus uteri cancer (SIR 1.56, 95% CI 1.18–2.07) in women.
Conclusions
The current results of our study indicate lower risk of overall cancer incidence and mortality in male patients with schizophrenia, while female patients had a higher mortality risk, alongside variations in the risk of different cancer types. This information is important not only for patients, but for healthcare specialists to develop effective disea
研究目的由于有关精神分裂症患者罹患癌症风险的证据不一致，本研究旨在分析 1992-2020 年间在立陶宛一家中心接受治疗的精神分裂症患者的癌症死亡率和发病率：维尔纽斯共和国精神病医院是立陶宛最大的精神病专科医院，每年约有 5000 名患者入院治疗。患者队列的建立是通过识别医院数据库中1992年1月1日至2017年12月31日期间诊断为精神分裂症（ICD-10代码F20）的所有患者。队列中的癌症病例和癌症死亡病例是通过链接程序在立陶宛癌症登记册中确定的。风险分析基于观察到的癌症和死亡人数与预期人数的比较。癌症病例的预期数量是通过将队列中的确切观察年数乘以性别、日历年和 5 年特定年龄组的全国发病率和死亡率计算得出的。所有统计分析均使用 STATA 15 统计软件进行：结果：在随访的 8553 名患者中，男女均有 673 例癌症确诊病例。据统计，男性癌症总发病率风险明显较低（SIR 0.74，95% CI 0.66-0.83），而女性则不然（SIR 1.07，95% CI 0.97-1.18）。据统计，男性总体癌症死亡风险较低（SMR 0.82，95% CI 0.70-0.96），而女性组的癌症死亡风险明显高于普通人群（SMR 1.28，95% CI 1.11-1.48）。我们观察到，男性患胰腺癌（SIR 0.36，95% CI 0.14-0.96）、非黑色素瘤皮肤癌（SIR 0.54，95% CI 0.33-0.88）和前列腺癌（SIR 0.69，95% CI 0.55-0.87）的风险较低，而患肝脏恶性肿瘤的风险较高（SIR 2.58，95% CI 1.53-4.36）和皮肤黑色素瘤（SIR 2.03，95% CI 1.12-3.66）的风险，以及女性乳腺癌（SIR 1.38，95% CI 1.14-1.66）和子宫体癌（SIR 1.56，95% CI 1.18-2.07）的风险：我们目前的研究结果表明，男性精神分裂症患者的总体癌症发病率和死亡率较低，而女性患者的死亡率较高，同时不同类型癌症的发病风险也存在差异。这些信息不仅对患者很重要，而且对医疗专家制定有效的疾病预防干预措施和计划也很重要。
{"title":"Cancer mortality and morbidity among patients with schizophrenia: A hospital-based cohort study, 1992–2020","authors":"M. Drevinskaite, A. Kaceniene, A. Patasius, R. Stukas, A. Germanavicius, E. Miseikyte, V. Urbonas, G. Smailyte","doi":"10.1111/acps.13651","DOIUrl":"10.1111/acps.13651","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Due to the inconsistency of the evidence about the cancer risk among patients with schizophrenia, the aim of this study was to analyse cancer mortality and morbidity in patients with schizophrenia treated in a single centre in Lithuania during the study period of 1992–2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted in Vilnius Republican Psychiatric Hospital, the biggest specialised psychiatric hospital in Lithuania, with approximately 5000 hospital admissions annually. The patients' cohort was established by identifying all patients with the diagnosis of schizophrenia (ICD-10 code F20) in the hospital database from 1 January 1992 until 31 December 2017. The cancer cases and cancer deaths in the cohort were identified in the Lithuanian Cancer Register through linkage procedures. The analysis of risk was based on a comparison of observed and expected numbers of cancers and deaths. Expected number of cancer cases were calculated by multiplication of the exact person-years under observation in the cohort by sex, calendar year and a 5-year age-group-specific national incidence and mortality rate. All statistical analyses were carried out using STATA 15 statistical software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the follow-up, out of 8553 patients, 673 cases of cancer were diagnosed in both sexes. Statistically significantly lower risk for overall cancer incidence was observed in men (SIR 0.74, 95% CI 0.66–0.83), but not in women (SIR 1.07, 95% CI 0.97–1.18). Statistically significant lower overall cancer mortality risk was observed in men (SMR 0.82, 95% CI 0.70–0.96), while in the women's group, risk of cancer deaths was significantly higher compared to the general population (SMR 1.28, 95% CI 1.11–1.48). We observed lower risk for pancreatic cancer (SIR 0.36, 95% CI 0.14–0.96), non-melanoma skin cancer (SIR 0.54, 95% CI 0.33–0.88) and prostate cancer (SIR 0.69, 95% CI 0.55–0.87) in men and higher risk for malignant neoplasm of liver (SIR 2.58, 95% CI 1.53–4.36) and skin melanoma (SIR 2.03, 95% CI 1.12–3.66) in men and for breast cancer (SIR 1.38, 95% CI 1.14–1.66) and corpus uteri cancer (SIR 1.56, 95% CI 1.18–2.07) in women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The current results of our study indicate lower risk of overall cancer incidence and mortality in male patients with schizophrenia, while female patients had a higher mortality risk, alongside variations in the risk of different cancer types. This information is important not only for patients, but for healthcare specialists to develop effective disea","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanni Castellini, Livio Tarchi, Emanuele Cassioli, Valdo Ricca, Giovanni Abbate Daga, Andrea Aguglia, Umberto Albert, Annarita Atti, Stefano Barlati, Giuseppe Blasi, Claudia Carmassi, Giuseppe Carrà, Pasquale De Fazio, Chiara De Panfilis, Giorgio Di Lorenzo, Silvia Ferrari, Arianna Goracci, Carla Gramaglia, Mario Luciano, Giovanni Martinotti, Marco Menchetti, Giulia Menculini, Maria Giulia Nanni, Alessandra Nivoli, Federica Pinna, Maurizio Pompili, Gianluca Rosso, Fabio Sambataro, Gaia Sampogna, Gabriele Sani, Gianluca Serafini, Maria Salvina Signorelli, Sarah Tosato, Antonio Ventriglio, Caterina Viganò, Umberto Volpe, Andrea Fiorillo
Background
A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency.
Methods
An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers—80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors.
Results
A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress.
Conclusions
The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.
{"title":"The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study","authors":"Giovanni Castellini, Livio Tarchi, Emanuele Cassioli, Valdo Ricca, Giovanni Abbate Daga, Andrea Aguglia, Umberto Albert, Annarita Atti, Stefano Barlati, Giuseppe Blasi, Claudia Carmassi, Giuseppe Carrà, Pasquale De Fazio, Chiara De Panfilis, Giorgio Di Lorenzo, Silvia Ferrari, Arianna Goracci, Carla Gramaglia, Mario Luciano, Giovanni Martinotti, Marco Menchetti, Giulia Menculini, Maria Giulia Nanni, Alessandra Nivoli, Federica Pinna, Maurizio Pompili, Gianluca Rosso, Fabio Sambataro, Gaia Sampogna, Gabriele Sani, Gianluca Serafini, Maria Salvina Signorelli, Sarah Tosato, Antonio Ventriglio, Caterina Viganò, Umberto Volpe, Andrea Fiorillo","doi":"10.1111/acps.13649","DOIUrl":"10.1111/acps.13649","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers—80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13649","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Postpartum psychiatric episodes study missed effects of prior pregnancy losses.","authors":"David C Reardon","doi":"10.1111/acps.13652","DOIUrl":"https://doi.org/10.1111/acps.13652","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139039203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ida Christine Tholstrup Gjøde, Thomas Munk Laursen, Anne Dorothee Müller, Anne Ranning, Mala Moszkowicz, Nicoline Hemager, Helene Speyer, Carsten Hjorthøj, Merete Nordentoft, Anne Amalie Elgaard Thorup
Background
Knowledge of the association between parental personality disorders and mental disorders in children is limited. To examine the association between parental personality disorders and the risk of mental disorders in offspring.
Methods
We linked Danish health registers to create a cohort of children born from January 1, 1995, to December 31, 2016. Children were followed until their 18th birthday, diagnosis set, emigration, death, or December 31, 2016. Parental personality disorders according to the International Classification of Diseases (ICD) Eighth or 10th Revision. Poisson regression analyses were used to estimate the incidence risk ratio (IRR) and cumulative incidence of ICD 10th mental disorders in offspring (age 0–17).
Results
The study cohort included 1,406,965 children. For girls, maternal or paternal personality disorder (MPD/PPD) was associated with mental disorders: MPD girls (IRR, 2.74; 95% CI, 2.59–2.89) and PPD girls (IRR, 2.10; 95% CI, 1.94–2.27). Likewise, the risk was increased for both MPD boys (IRR, 2.44; 95% CI, 2.33–2.56) and PPD boys (IRR, 2.04; 95% CI, 1.91–2.18). For girls and boys combined, exposure to two parents with a personality disorder was associated with the highest risk (IRR, 3.69; 95% CI, 3.15–4.33). At age 18, the cumulative incidence of any mental disorder in children of one or two parents with a personality disorder was 34.1% (95% CI, 33.0–35.1), which was twice the cumulative incidence of mental disorders in nonexposed children (15.2% [95% CI, 15.1–15.3]).
Conclusion
Children of parents with a personality disorder were at a 2 to 3.5 times higher risk of mental disorders compared with nonexposed offspring. Possible mechanisms of transmission of mental disorders from parent to child involve genetic, environmental, and gene–environment pathways. More research into these mechanisms and research into preventive interventions is warranted.
{"title":"Association of maternal and paternal personality disorders with risk of mental disorders in children: A nationwide, register-based cohort study of 1,406,965 children","authors":"Ida Christine Tholstrup Gjøde, Thomas Munk Laursen, Anne Dorothee Müller, Anne Ranning, Mala Moszkowicz, Nicoline Hemager, Helene Speyer, Carsten Hjorthøj, Merete Nordentoft, Anne Amalie Elgaard Thorup","doi":"10.1111/acps.13648","DOIUrl":"10.1111/acps.13648","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Knowledge of the association between parental personality disorders and mental disorders in children is limited. To examine the association between parental personality disorders and the risk of mental disorders in offspring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We linked Danish health registers to create a cohort of children born from January 1, 1995, to December 31, 2016. Children were followed until their 18th birthday, diagnosis set, emigration, death, or December 31, 2016. Parental personality disorders according to the International Classification of Diseases (ICD) Eighth or 10th Revision. Poisson regression analyses were used to estimate the incidence risk ratio (IRR) and cumulative incidence of ICD 10th mental disorders in offspring (age 0–17).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study cohort included 1,406,965 children. For girls, maternal or paternal personality disorder (MPD/PPD) was associated with mental disorders: MPD girls (IRR, 2.74; 95% CI, 2.59–2.89) and PPD girls (IRR, 2.10; 95% CI, 1.94–2.27). Likewise, the risk was increased for both MPD boys (IRR, 2.44; 95% CI, 2.33–2.56) and PPD boys (IRR, 2.04; 95% CI, 1.91–2.18). For girls and boys combined, exposure to two parents with a personality disorder was associated with the highest risk (IRR, 3.69; 95% CI, 3.15–4.33). At age 18, the cumulative incidence of any mental disorder in children of one or two parents with a personality disorder was 34.1% (95% CI, 33.0–35.1), which was twice the cumulative incidence of mental disorders in nonexposed children (15.2% [95% CI, 15.1–15.3]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Children of parents with a personality disorder were at a 2 to 3.5 times higher risk of mental disorders compared with nonexposed offspring. Possible mechanisms of transmission of mental disorders from parent to child involve genetic, environmental, and gene–environment pathways. More research into these mechanisms and research into preventive interventions is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139037137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ketevan Marr, Charlotte Maguet, Honor Scarlett, Rosemary Dray-Spira, Caroline Dubertret, Florence Gressier, Anne-Laure Sutter-Dallay, Maria Melchior, Judith van der Waerden
Introduction: Depression is one of the most common co-morbidities during pregnancy; with severe symptoms, antidepressants are sometimes recommended. Social determinants are often linked with antidepressant use in the general population, and it is not known if this is the case for pregnant populations. Our objective was to determine if social determinants are associated with prenatal antidepressant intake via a systematic review and meta-analysis.
Methods: A systematic search of five databases was conducted to identify publications from inception to October 2022 that reported associations with prenatal antidepressant intake (use/continuation) and one or more social determinants: education, race, immigration status, relationship, income, or employment. Eligible studies were included in random effects meta-analyses.
Results: A total of 23 articles describing 22 studies were included. Education was significantly and positively associated with prenatal antidepressant continuation and heterogeneity was moderate. (Odds ratio = 0.83; 95% CI, 0.78 to 0.89; p < 0.00001; I2 = 53%). Meta-analyses of antidepressant use and education, race, and relationship status, and antidepressant continuation and income were not significant with high levels of heterogeneity.
Discussion: While most social determinants in this review were not linked with prenatal antidepressant intake, lower maternal education level does seem to be associated with lower rates of prenatal antidepressant continuation.
Conclusions: Education appears to be linked with prenatal antidepressant intake. The low number of included studies precludes conclusive evidence for other social determinants.
{"title":"Social determinants in prenatal antidepressant use and continuation: Systematic review and meta-analysis.","authors":"Ketevan Marr, Charlotte Maguet, Honor Scarlett, Rosemary Dray-Spira, Caroline Dubertret, Florence Gressier, Anne-Laure Sutter-Dallay, Maria Melchior, Judith van der Waerden","doi":"10.1111/acps.13647","DOIUrl":"https://doi.org/10.1111/acps.13647","url":null,"abstract":"<p><strong>Introduction: </strong>Depression is one of the most common co-morbidities during pregnancy; with severe symptoms, antidepressants are sometimes recommended. Social determinants are often linked with antidepressant use in the general population, and it is not known if this is the case for pregnant populations. Our objective was to determine if social determinants are associated with prenatal antidepressant intake via a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A systematic search of five databases was conducted to identify publications from inception to October 2022 that reported associations with prenatal antidepressant intake (use/continuation) and one or more social determinants: education, race, immigration status, relationship, income, or employment. Eligible studies were included in random effects meta-analyses.</p><p><strong>Results: </strong>A total of 23 articles describing 22 studies were included. Education was significantly and positively associated with prenatal antidepressant continuation and heterogeneity was moderate. (Odds ratio = 0.83; 95% CI, 0.78 to 0.89; p < 0.00001; I<sup>2</sup> = 53%). Meta-analyses of antidepressant use and education, race, and relationship status, and antidepressant continuation and income were not significant with high levels of heterogeneity.</p><p><strong>Discussion: </strong>While most social determinants in this review were not linked with prenatal antidepressant intake, lower maternal education level does seem to be associated with lower rates of prenatal antidepressant continuation.</p><p><strong>Conclusions: </strong>Education appears to be linked with prenatal antidepressant intake. The low number of included studies precludes conclusive evidence for other social determinants.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139037138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marlies Onken, Lukas Lohse, Bénédicte Coulm, Delphine Beghin, Jonathan L Richardson, Eva Bermejo-Sánchez, Cristina Aguilera, Montserrat Bosch, Matteo Cassina, Laurent Chouchana, Marco De Santis, Mine Kadioglu Duman, M Zafer Gören, Diana Johnson, Annie Pierre Jonville Bera, Yusuf C Kaplan, Debra Kennedy, Susan Kwok, Isabelle Lacroix, Marion Lepelley, Alessandra Pistelli, Christof Schaefer, Bernke Te Winkel, Nusret Uysal, Ursula Winterfeld, Naho Yakuwa, Orna Diav-Citrin, Thierry Vial, Katarina Dathe
Objective: In recent years, safety concerns about modafinil exposure during pregnancy have emerged. In particular, increased risks for major congenital anomalies (MCA) and impaired fetal growth were reported, although study results were conflicting. Our investigation aims to examine previously reported safety signals.
Method: Multicenter case series based on data from 18 Teratology Information Services from 12 countries. Modafinil exposed pregnancies with an estimated date of birth before August 2019 were included in this study. For prospectively ascertained pregnancies, cumulative incidences of pregnancy outcomes, rate of nonchromosomal MCA in first trimester exposed pregnancies and percentiles of neonatal/infant weight and head circumference (HC) were calculated. Potential dose-dependent effects on fetal growth were explored by linear regression models. Retrospectively ascertained cases were screened for pattern of MCA and other adverse events.
Results: One hundred and seventy-five prospectively ascertained cases were included, of which 173 were exposed at least during the first trimester. Cumulative incidences for live birth, spontaneous abortion and elective termination of pregnancy were 76.9% (95% CI, 68.0%-84.8%), 9.3% (95% CI, 5.0%-16.9%), and 13.9% (95% CI, 8.1%-23.1%), respectively. Nonchromosomal MCA was present in 3/150 live births, corresponding to an MCA rate of 2.0% (95%CI, 0.6%-6.1%), none were reported in pregnancy losses. Compared to reference standards, birth weight (BW) tended to be lower and neonatal HC to be smaller in exposed newborns (data available for 144 and 73 of 153 live births, respectively). In nonadjusted linear regression models, each 100 mg increase of average dosage per pregnancy day was associated with a decrease in standard deviation score (SDS) of -0.28 SDS (95% CI, -0.45 to -0.10) for BW and of -0.28 SDS (95% CI, -0.56 to 0.01) for HC. Screening of 22 retrospectively reported cases did not reveal any specific pattern of MCA or other adverse outcomes.
Conclusion: The results do not indicate an increased risk of MCA after in utero exposure to modafinil, but a tendency toward lower BW and reduced neonatal HC. However, these findings should be regarded as preliminary. Until further studies allow for a definite conclusion, modafinil should not be used during pregnancy.
{"title":"Effects of maternal modafinil treatment on fetal development and neonatal growth parameters - a multicenter case series of the European Network of Teratology Information Services (ENTIS).","authors":"Marlies Onken, Lukas Lohse, Bénédicte Coulm, Delphine Beghin, Jonathan L Richardson, Eva Bermejo-Sánchez, Cristina Aguilera, Montserrat Bosch, Matteo Cassina, Laurent Chouchana, Marco De Santis, Mine Kadioglu Duman, M Zafer Gören, Diana Johnson, Annie Pierre Jonville Bera, Yusuf C Kaplan, Debra Kennedy, Susan Kwok, Isabelle Lacroix, Marion Lepelley, Alessandra Pistelli, Christof Schaefer, Bernke Te Winkel, Nusret Uysal, Ursula Winterfeld, Naho Yakuwa, Orna Diav-Citrin, Thierry Vial, Katarina Dathe","doi":"10.1111/acps.13643","DOIUrl":"10.1111/acps.13643","url":null,"abstract":"<p><strong>Objective: </strong>In recent years, safety concerns about modafinil exposure during pregnancy have emerged. In particular, increased risks for major congenital anomalies (MCA) and impaired fetal growth were reported, although study results were conflicting. Our investigation aims to examine previously reported safety signals.</p><p><strong>Method: </strong>Multicenter case series based on data from 18 Teratology Information Services from 12 countries. Modafinil exposed pregnancies with an estimated date of birth before August 2019 were included in this study. For prospectively ascertained pregnancies, cumulative incidences of pregnancy outcomes, rate of nonchromosomal MCA in first trimester exposed pregnancies and percentiles of neonatal/infant weight and head circumference (HC) were calculated. Potential dose-dependent effects on fetal growth were explored by linear regression models. Retrospectively ascertained cases were screened for pattern of MCA and other adverse events.</p><p><strong>Results: </strong>One hundred and seventy-five prospectively ascertained cases were included, of which 173 were exposed at least during the first trimester. Cumulative incidences for live birth, spontaneous abortion and elective termination of pregnancy were 76.9% (95% CI, 68.0%-84.8%), 9.3% (95% CI, 5.0%-16.9%), and 13.9% (95% CI, 8.1%-23.1%), respectively. Nonchromosomal MCA was present in 3/150 live births, corresponding to an MCA rate of 2.0% (95%CI, 0.6%-6.1%), none were reported in pregnancy losses. Compared to reference standards, birth weight (BW) tended to be lower and neonatal HC to be smaller in exposed newborns (data available for 144 and 73 of 153 live births, respectively). In nonadjusted linear regression models, each 100 mg increase of average dosage per pregnancy day was associated with a decrease in standard deviation score (SDS) of -0.28 SDS (95% CI, -0.45 to -0.10) for BW and of -0.28 SDS (95% CI, -0.56 to 0.01) for HC. Screening of 22 retrospectively reported cases did not reveal any specific pattern of MCA or other adverse outcomes.</p><p><strong>Conclusion: </strong>The results do not indicate an increased risk of MCA after in utero exposure to modafinil, but a tendency toward lower BW and reduced neonatal HC. However, these findings should be regarded as preliminary. Until further studies allow for a definite conclusion, modafinil should not be used during pregnancy.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138795873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A.J.R. has received grant or research support from Janssen, Otsuka, Compass Pathways, and the Irving S. and Betty Brudnick Endowed Chair in Psychiatry; is a consultant to Daiichi Sankyo, Inc., Sage Therapeutics, Xenon Pharmaceuticals, Neumora Therapeutics, Zydus Pharmaceuticals (USA), Inc., Sandoz, Inc., and Lupin Pharmaceuticals, Inc.; and has received royalties for the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT)®, Clinical Manual for the Diagnosis and Treatment of Psychotic Depression, American Psychiatric Press, 2009; The Evidence-Based Guide to Antipsychotic Medications, American Psychiatric Press, 2010; The Evidence-Based Guide to Antidepressant Medications, American Psychiatric Press, 2012, and from UpToDate®
Major Depression with psychotic features (psychotic depression) is a serious psychiatric illness that presents with a combination of depressed mood and psychosis. The psychotic features commonly manifest as nihilistic-type delusions with overly self-critical beliefs, severe guilt, paranoia, and often the belief that “bad” things are about to happen.1 The presence of psychosis in major depression presents a higher lifetime risk for completed suicide and doubles the risk of a suicide attempt in the acute phase of the disorder.2, 3 Studies have shown that psychotic depression is not uncommon,4 however because the diagnosis is frequently missed, the true prevalence of the disorder may be greater than reported.5
Currently, not a single medication has a Food and Drug Administration (FDA) indication for psychotic depression.4 However, there is a substantial evidence-based research, including meta-analyses, demonstrating the efficacy of combination treatment with an antidepressant and an antipsychotic or electroconvulsive therapy (ECT) for an acute episode of psychotic depression.6-8
A perplexing question has been how long should a patient with psychotic depression successfully treated with an antidepressant and an antipsychotic stay on the antipsychotic medication? Little is known about the efficacy and tolerability of continuing antipsychotic medication for patients with psychotic depression in remission. The question is one of profound clinical importance as the clinician is faced with a conundrum: premature discontinuation has the potential risk of relapse of a severe, life-threatening disorder versus unnecessary continuation exposing the patient to potential serious adverse effects.
In the current issue of Acta Psychiatrica Scandinavia, Al-Wandi and colleagues, using data obtained from Swedish national registries and data bases, compared antidepressant monotherapy and antidepressant/antipsychotic combination treatment for the maintenance phase of unipolar psychotic depression.9 The primary outcome measure was hospital readmission due
{"title":"Maintenance treatment of psychotic depression: Is antipsychotic medication needed?","authors":"Anthony J. Rothschild","doi":"10.1111/acps.13639","DOIUrl":"https://doi.org/10.1111/acps.13639","url":null,"abstract":"<p>A.J.R. has received grant or research support from Janssen, Otsuka, Compass Pathways, and the Irving S. and Betty Brudnick Endowed Chair in Psychiatry; is a consultant to Daiichi Sankyo, Inc., Sage Therapeutics, Xenon Pharmaceuticals, Neumora Therapeutics, Zydus Pharmaceuticals (USA), Inc., Sandoz, Inc., and Lupin Pharmaceuticals, Inc.; and has received royalties for the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT)®, Clinical Manual for the Diagnosis and Treatment of Psychotic Depression, American Psychiatric Press, 2009; The Evidence-Based Guide to Antipsychotic Medications, American Psychiatric Press, 2010; The Evidence-Based Guide to Antidepressant Medications, American Psychiatric Press, 2012, and from UpToDate®</p><p>Major Depression with psychotic features (psychotic depression) is a serious psychiatric illness that presents with a combination of depressed mood and psychosis. The psychotic features commonly manifest as nihilistic-type delusions with overly self-critical beliefs, severe guilt, paranoia, and often the belief that “bad” things are about to happen.<span><sup>1</sup></span> The presence of psychosis in major depression presents a higher lifetime risk for completed suicide and doubles the risk of a suicide attempt in the acute phase of the disorder.<span><sup>2, 3</sup></span> Studies have shown that psychotic depression is not uncommon,<span><sup>4</sup></span> however because the diagnosis is frequently missed, the true prevalence of the disorder may be greater than reported.<span><sup>5</sup></span></p><p>Currently, not a single medication has a Food and Drug Administration (FDA) indication for psychotic depression.<span><sup>4</sup></span> However, there is a substantial evidence-based research, including meta-analyses, demonstrating the efficacy of combination treatment with an antidepressant and an antipsychotic or electroconvulsive therapy (ECT) for an acute episode of psychotic depression.<span><sup>6-8</sup></span></p><p>A perplexing question has been how long should a patient with psychotic depression successfully treated with an antidepressant and an antipsychotic stay on the antipsychotic medication? Little is known about the efficacy and tolerability of continuing antipsychotic medication for patients with psychotic depression in remission. The question is one of profound clinical importance as the clinician is faced with a conundrum: premature discontinuation has the potential risk of relapse of a severe, life-threatening disorder versus unnecessary continuation exposing the patient to potential serious adverse effects.</p><p>In the current issue of Acta Psychiatrica Scandinavia, Al-Wandi and colleagues, using data obtained from Swedish national registries and data bases, compared antidepressant monotherapy and antidepressant/antipsychotic combination treatment for the maintenance phase of unipolar psychotic depression.<span><sup>9</sup></span> The primary outcome measure was hospital readmission due ","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13639","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138578205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael J. Spoelma, Joanne Leidreiter, Adam Bayes, Artin Jebejian, Gordon Parker
Background
Treatment decision-making for individuals with bipolar disorder can be difficult. Recommendations from clinical practice guidelines can be affected by multiple methodological limitations, while pharmaco-epidemiological data suggest great variety in prescription practices across regions. Given these inconsistencies, this study aimed to provide an alternative perspective on the effectiveness of common bipolar disorder maintenance treatments through considering naturalistic data.
Methods
A total of 246 individuals with bipolar disorder (84 bipolar I [BP-I], 162 bipolar II [BP-II]) were recruited through clinics and/or websites. All were euthymic and had trialled at least one mood stabiliser. They completed an online survey containing questions on demographics, clinical variables, symptomatology, and the effectiveness/side effect profiles of any mood stabilisers (MSTs) or atypical antipsychotics (AAPs) that they have taken.
Results
Lithium and lamotrigine were the most commonly prescribed MSTs and the most effective at mood stabilisation. Lithium and lamotrigine appeared marginally more effective for BP-I and BP-II respectively, however, only the latter difference was statistically significant. Furthermore, lamotrigine had the more favourable side effect profile. Amongst the AAPs, quetiapine and olanzapine were the most commonly prescribed, but they were negligibly superior to other AAPs.
Conclusion
This study clearly established a preference for lamotrigine in the maintenance treatment of BP-II. While the literature consistently emphasises the primacy of lithium in bipolar disorder treatment, its side effect profile as observed in this study remains a concern. Future research considering moderators of treatment response and concomitant medications could help to identify further nuances to consider for treatment decision-making.
{"title":"A naturalistic effectiveness study of maintenance therapies for the bipolar disorders","authors":"Michael J. Spoelma, Joanne Leidreiter, Adam Bayes, Artin Jebejian, Gordon Parker","doi":"10.1111/acps.13646","DOIUrl":"10.1111/acps.13646","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Treatment decision-making for individuals with bipolar disorder can be difficult. Recommendations from clinical practice guidelines can be affected by multiple methodological limitations, while pharmaco-epidemiological data suggest great variety in prescription practices across regions. Given these inconsistencies, this study aimed to provide an alternative perspective on the effectiveness of common bipolar disorder maintenance treatments through considering naturalistic data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 246 individuals with bipolar disorder (84 bipolar I [BP-I], 162 bipolar II [BP-II]) were recruited through clinics and/or websites. All were euthymic and had trialled at least one mood stabiliser. They completed an online survey containing questions on demographics, clinical variables, symptomatology, and the effectiveness/side effect profiles of any mood stabilisers (MSTs) or atypical antipsychotics (AAPs) that they have taken.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Lithium and lamotrigine were the most commonly prescribed MSTs and the most effective at mood stabilisation. Lithium and lamotrigine appeared marginally more effective for BP-I and BP-II respectively, however, only the latter difference was statistically significant. Furthermore, lamotrigine had the more favourable side effect profile. Amongst the AAPs, quetiapine and olanzapine were the most commonly prescribed, but they were negligibly superior to other AAPs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study clearly established a preference for lamotrigine in the maintenance treatment of BP-II. While the literature consistently emphasises the primacy of lithium in bipolar disorder treatment, its side effect profile as observed in this study remains a concern. Future research considering moderators of treatment response and concomitant medications could help to identify further nuances to consider for treatment decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13646","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138575798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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