Berit Libutzki, Benno Neukirch, Andreas Reif, Catharina A. Hartman
Objective
A thorough and comprehensive knowledge base on the extent of comorbidity of attention-deficit/hyperactivity disorder (ADHD) and somatic conditions is needed.
Method
We compared the prevalence of a wide range of somatic conditions in individuals with and without ADHD and described sex and lifecourse differences. Individuals with an ADHD diagnosis (N = 87,394) and age and sex-matched individuals without an ADHD diagnosis were identified from a large health claims dataset representative of the general German population, including both primary and specialized care (N = 4.874,754). Results were provided for the full sample as well as stratified for sex and age (<12 years, 13–17 years, 18–29 years, 30–59 years, ≥60 years).
Results
The results showed that ADHD is associated with a wide variety of somatic conditions across the entire lifecourse. Specifically neurological disorders such as Parkison's disease (odds ratio [OR]: 5.21) and dementia (OR: 2.23), sleep-related disorders (OR: 2.38) and autoimmune disorders affecting the musculoskeletal, digestive, and endocrine system (fibromyalgia OR: 3.33; lupus OR: 2.17) are strongly and significantly associated with ADHD. Additionally, ADHD is associated with higher occurrence of common acute diseases typically treated by the general practitioner, hinting at an overall general lower health status. Sex differences in somatic comorbidity were not prominent. Age differences, in contrast, stood out: in particular endocrine, cardiovascular, and neurological disorders had an early onset in individuals with compared to individuals without ADHD.
Conclusion
This research underlines the high burden of disease due to somatic conditions among individuals with ADHD. The findings indicate the need for preventive measures to reduce comorbidity.
{"title":"Somatic burden of attention-deficit/hyperactivity disorder across the lifecourse","authors":"Berit Libutzki, Benno Neukirch, Andreas Reif, Catharina A. Hartman","doi":"10.1111/acps.13694","DOIUrl":"10.1111/acps.13694","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>A thorough and comprehensive knowledge base on the extent of comorbidity of attention-deficit/hyperactivity disorder (ADHD) and somatic conditions is needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We compared the prevalence of a wide range of somatic conditions in individuals with and without ADHD and described sex and lifecourse differences. Individuals with an ADHD diagnosis (<i>N</i> = 87,394) and age and sex-matched individuals without an ADHD diagnosis were identified from a large health claims dataset representative of the general German population, including both primary and specialized care (<i>N</i> = 4.874,754). Results were provided for the full sample as well as stratified for sex and age (<12 years, 13–17 years, 18–29 years, 30–59 years, ≥60 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results showed that ADHD is associated with a wide variety of somatic conditions across the entire lifecourse. Specifically neurological disorders such as Parkison's disease (odds ratio [OR]: 5.21) and dementia (OR: 2.23), sleep-related disorders (OR: 2.38) and autoimmune disorders affecting the musculoskeletal, digestive, and endocrine system (fibromyalgia OR: 3.33; lupus OR: 2.17) are strongly and significantly associated with ADHD. Additionally, ADHD is associated with higher occurrence of common acute diseases typically treated by the general practitioner, hinting at an overall general lower health status. Sex differences in somatic comorbidity were not prominent. Age differences, in contrast, stood out: in particular endocrine, cardiovascular, and neurological disorders had an early onset in individuals with compared to individuals without ADHD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This research underlines the high burden of disease due to somatic conditions among individuals with ADHD. The findings indicate the need for preventive measures to reduce comorbidity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"105-117"},"PeriodicalIF":5.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13694","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157030","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}
To determine whether the rates of readmissions and suicide vary in psychotic unipolar depression based on whether patients receive maintenance electroconvulsive therapy (M-ECT) following the initial series of ECT, and to examine if there is an age-dependent association.
Methods
We used Swedish national registries to identify hospitalized patients with psychotic unipolar depression, treated 2008–2019 who received ECT during their hospital stay. The patients who received subsequent M-ECT within 14 days after discharge were compared with those who did not. The primary composite outcome was time to readmission due to a psychiatric disorder, suicide attempt, or suicide within 2 years from discharge. Data were analyzed using Cox regression adjusted for previous psychiatric admissions, age, sex, comorbidity, and pharmacological treatment. We also conducted a within-individual analysis using the sign-test, with patients having ≥1 hospital episode followed by M-ECT and ≥1 hospital episode without M-ECT.
Results
A total of 1873 patients were included, of which 130 received M-ECT. There was no statistically significant group difference regarding the primary outcome in the whole sample. However, when stratified by age, there was a significant difference in favor of M-ECT for patients >65 years (adjusted hazard ratio 0.55, 95% confidence interval 0.35–0.87). The within-individual analysis, including 46 patients, significantly favored M-ECT.
Conclusion
M-ECT was not associated with a differential risk of the composite of readmission and suicide in psychotic depression. Among patients >65 years, M-ECT was significantly associated with a decreased risk of the outcome. The possibility of residual confounding cannot be excluded.
{"title":"Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression","authors":"Ahmed Al-Wandi, Mikael Landén, Axel Nordenskjöld","doi":"10.1111/acps.13711","DOIUrl":"10.1111/acps.13711","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine whether the rates of readmissions and suicide vary in psychotic unipolar depression based on whether patients receive maintenance electroconvulsive therapy (M-ECT) following the initial series of ECT, and to examine if there is an age-dependent association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used Swedish national registries to identify hospitalized patients with psychotic unipolar depression, treated 2008–2019 who received ECT during their hospital stay. The patients who received subsequent M-ECT within 14 days after discharge were compared with those who did not. The primary composite outcome was time to readmission due to a psychiatric disorder, suicide attempt, or suicide within 2 years from discharge. Data were analyzed using Cox regression adjusted for previous psychiatric admissions, age, sex, comorbidity, and pharmacological treatment. We also conducted a within-individual analysis using the sign-test, with patients having ≥1 hospital episode followed by M-ECT and ≥1 hospital episode without M-ECT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1873 patients were included, of which 130 received M-ECT. There was no statistically significant group difference regarding the primary outcome in the whole sample. However, when stratified by age, there was a significant difference in favor of M-ECT for patients >65 years (adjusted hazard ratio 0.55, 95% confidence interval 0.35–0.87). The within-individual analysis, including 46 patients, significantly favored M-ECT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>M-ECT was not associated with a differential risk of the composite of readmission and suicide in psychotic depression. Among patients >65 years, M-ECT was significantly associated with a decreased risk of the outcome. The possibility of residual confounding cannot be excluded.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 3","pages":"148-159"},"PeriodicalIF":5.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13711","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157117","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}
Giulia Cossu, Goce Kalcev, Federica Sancassiani, Diego Primavera, Davide Gyppaz, Thurayya Zreik, Mauro Giovanni Carta
Background
The community treatment order (CTO) is designed to deliver mental healthcare in the community and has been introduced in around 75 jurisdictions worldwide. It constitutes a legal obligation in which individuals with severe mental illness must adhere to out-of-hospital treatment plans. Despite intense criticism and the debated nature of published evidence, it has emerged as a clinical and policy response to frequent hospital readmissions and to enhance adherence in cases where there is refusal of pharmacological treatments. This systematic review outlines findings on CTO long-term adherence, after mandatory outpatient treatment has ended, in studies that include people with psychiatric disorders.
Method
Following PRISMA guidelines, we performed a review of published articles from PubMed, PsycINFO, EMBASE, and CINAHL up to January 15, 2023. We included studies that assessed adherence after CTO ends. The study is registered with PROSPERO number CRD42022360879.
Results
Six independent studies analyzing the main indicators of long adherence: engagement with services and medication adherence, were included. The average methodological quality of the studies included is fair. Long-term adherence was assessed over a period ranging from 11 to 28 months. Only two studies reported a statistically significant improvement. Regarding the remaining studies, no positive correlation was observed, except for certain subgroup samples, while in one study, medication adherence decreased.
Conclusion
Scientific evidence supporting the hypothesis that CTO has a positive role on long-term adherence post-obligation is currently not sufficient. Given the importance of modern recovery-oriented approaches and the coercive nature of compulsory outpatient treatment, it is necessary that future studies ensure the role of CTO in effectively promoting adherence.
{"title":"The long-term adherence following the end of Community Treatment Order: A systematic review","authors":"Giulia Cossu, Goce Kalcev, Federica Sancassiani, Diego Primavera, Davide Gyppaz, Thurayya Zreik, Mauro Giovanni Carta","doi":"10.1111/acps.13709","DOIUrl":"10.1111/acps.13709","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The community treatment order (CTO) is designed to deliver mental healthcare in the community and has been introduced in around 75 jurisdictions worldwide. It constitutes a legal obligation in which individuals with severe mental illness must adhere to out-of-hospital treatment plans. Despite intense criticism and the debated nature of published evidence, it has emerged as a clinical and policy response to frequent hospital readmissions and to enhance adherence in cases where there is refusal of pharmacological treatments. This systematic review outlines findings on CTO long-term adherence, after mandatory outpatient treatment has ended, in studies that include people with psychiatric disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we performed a review of published articles from PubMed, PsycINFO, EMBASE, and CINAHL up to January 15, 2023. We included studies that assessed adherence after CTO ends. The study is registered with PROSPERO number CRD42022360879.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six independent studies analyzing the main indicators of long adherence: engagement with services and medication adherence, were included. The average methodological quality of the studies included is fair. Long-term adherence was assessed over a period ranging from 11 to 28 months. Only two studies reported a statistically significant improvement. Regarding the remaining studies, no positive correlation was observed, except for certain subgroup samples, while in one study, medication adherence decreased.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Scientific evidence supporting the hypothesis that CTO has a positive role on long-term adherence post-obligation is currently not sufficient. Given the importance of modern recovery-oriented approaches and the coercive nature of compulsory outpatient treatment, it is necessary that future studies ensure the role of CTO in effectively promoting adherence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"78-90"},"PeriodicalIF":5.3,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141150279","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}
{"title":"The relationship between alcohol use disorder and suicide by means: Context dependent","authors":"Shannon Lange, Jürgen Rehm","doi":"10.1111/acps.13710","DOIUrl":"10.1111/acps.13710","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 3","pages":"178-179"},"PeriodicalIF":5.3,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955306","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}
{"title":"Clarifying the relationship between physical injuries and risk for suicide attempt","authors":"Vrinda Kabra, Rahul Mathur, Nishtha Chawla","doi":"10.1111/acps.13695","DOIUrl":"10.1111/acps.13695","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"118-119"},"PeriodicalIF":5.3,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955293","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}
Benzodiazepine (BDZP) and/or z-hypnotic dispensing during pregnancy has increased globally, as have rates of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis aimed to estimate the association between gestational exposure to BDZP and/or z-hypnotics and diagnosis of ASD or ADHD in offspring.
Methods
We searched MEDLINE, EMBASE, and SCOPUS from inception till December 2023 for relevant English-language articles. Outcomes of interest were risk of ASD and ADHD, two independent primary outcomes, in children exposed anytime during pregnancy to BDZP and/or z-hypnotics versus those unexposed. Secondary outcomes were trimester-wise analyses. Using a random effects model, we pooled the overall and trimester-wise hazard ratios (HRs), with 95% confidence intervals (CIs), separately for risk of ASD and ADHD.
Results
We found six eligible retrospective cohort studies and no case–control studies. There was no increased risk of ASD associated with anytime gestational BDZP and/or z-hypnotic exposure (primary outcome, HR, 1.10; 95% CI, 0.81–1.50; 4 studies; n = 3,783,417; 80,270 exposed, 3,703,147 unexposed) nor after first trimester exposure (HR, 1.15; 95% CI, 0.83–1.58; 3 studies; n = 1,539,335; 70,737 exposed, 1,468,598 unexposed) or later trimester exposures. A very small but significantly increased risk of ADHD was noted with anytime gestational exposure to these drugs (primary outcome, HR, 1.07; 95% CI, 1.03–1.12; 4 studies; n = 2,000,777; 78,912 exposed, 1,921,865 unexposed) and also with (only) second trimester exposure (HR, 1.07; 95% CI, 1.03–1.12; 3 studies; n = 1,539,281; 33,355 exposed, 1,505,926 unexposed). Findings were consistent in sensitivity analyses.
Conclusion
Gestational exposure to benzodiazepines or z-hypnotics was not associated with an increased risk of ASD and with only a marginally increased risk of ADHD in offspring. Given the likelihood of confounding by indication and by unmeasured variables in the original studies, our findings should reassure women who need these medications for severe anxiety or insomnia during pregnancy.
{"title":"Gestational exposure to benzodiazepines or z-hypnotics and neurodevelopmental disorders in offspring: Systematic review and meta-analysis","authors":"Chittaranjan Andrade, Natarajan Varadharajan, Sharmi Bascarane, Vikas Menon","doi":"10.1111/acps.13696","DOIUrl":"10.1111/acps.13696","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Benzodiazepine (BDZP) and/or z-hypnotic dispensing during pregnancy has increased globally, as have rates of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis aimed to estimate the association between gestational exposure to BDZP and/or z-hypnotics and diagnosis of ASD or ADHD in offspring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, EMBASE, and SCOPUS from inception till December 2023 for relevant English-language articles. Outcomes of interest were risk of ASD and ADHD, two independent primary outcomes, in children exposed anytime during pregnancy to BDZP and/or z-hypnotics versus those unexposed. Secondary outcomes were trimester-wise analyses. Using a random effects model, we pooled the overall and trimester-wise hazard ratios (HRs), with 95% confidence intervals (CIs), separately for risk of ASD and ADHD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found six eligible retrospective cohort studies and no case–control studies. There was no increased risk of ASD associated with anytime gestational BDZP and/or z-hypnotic exposure (primary outcome, HR, 1.10; 95% CI, 0.81–1.50; 4 studies; <i>n</i> = 3,783,417; 80,270 exposed, 3,703,147 unexposed) nor after first trimester exposure (HR, 1.15; 95% CI, 0.83–1.58; 3 studies; <i>n</i> = 1,539,335; 70,737 exposed, 1,468,598 unexposed) or later trimester exposures. A very small but significantly increased risk of ADHD was noted with anytime gestational exposure to these drugs (primary outcome, HR, 1.07; 95% CI, 1.03–1.12; 4 studies; <i>n</i> = 2,000,777; 78,912 exposed, 1,921,865 unexposed) and also with (only) second trimester exposure (HR, 1.07; 95% CI, 1.03–1.12; 3 studies; <i>n</i> = 1,539,281; 33,355 exposed, 1,505,926 unexposed). Findings were consistent in sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gestational exposure to benzodiazepines or z-hypnotics was not associated with an increased risk of ASD and with only a marginally increased risk of ADHD in offspring. Given the likelihood of confounding by indication and by unmeasured variables in the original studies, our findings should reassure women who need these medications for severe anxiety or insomnia during pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"65-77"},"PeriodicalIF":5.3,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140943288","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}
<p>In this issue of <i>Acta Psychiatrica Scandinavica</i>, Popiolek et al. present data on the effect of effect of electroconvulsive therapy (ECT) on time to readmission in patients with bipolar disorder hospitalized for a manic episode.<span><sup>1</sup></span> This is yet another high-quality ECT research paper facilitated by the comprehensive patient registries in Sweden, which allow investigation of a myriad of clinical questions at the population level. While their main analysis did not show a difference in time to readmission in patients treated with and without ECT, a subset of patients who had hospital admissions both with ECT and without ECT, showed a trend to longer time to readmission when they had received ECT. As one might expect, patients treated with ECT had more severe lifetime bipolar illness. ECT was administered to patients in 7.3% of 12,337 admissions, which is actually quite a high rate. I suspect that if a similar study was done in the United States, it would be under 1%.</p><p>In another recent report using CGI data from a largely overlapping clinical cohort, the Swedish group showed an 85% response rate of mania to ECT, with greater severity of illness associated with higher response.<span><sup>2</sup></span> Indeed, the most important message from both these reports is that ECT is a very effective treatment for acute mania.</p><p>ECT is grossly underutilized overall, and particularly in bipolar disorder.<span><sup>3, 4</sup></span> For some reason, it has been difficult for the field to fully embrace the use of ECT for all episode types in bipolar disorder, despite a substantial evidence base supporting its efficacy and safety for these clinical situations. When the US Food and Drug Administration reclassified the ECT device in 2018, it was for catatonia and a severe depressive episode in the context of unipolar or bipolar disorder, but there was no mention of mania.<span><sup>5, 6</sup></span> This is an egregious oversight and the work of our Swedish colleagues with their national register data is an extremely helpful way to bolster the evidence base. Although physicians even in the United States are not technically bound by FDA “cleared indications,” (the FDA does not regulate the practice of medicine, and physicians are free to prescribe ECT as they deem indicated, similar to the “off label” use of medications), it is still reassuring to be able to point to high-quality data for the use of ECT in manic episodes.</p><p>Of course, the ECT literature has been replete with such evidence for decades. A PubMed search of “electroconvulsive mania” returns nearly 500 citations; the search “electroconvulsive bipolar” returns nearly 2000. The review article, <i>Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience</i> by Mukerjhee et al. from the <i>American Journal of Psychiatry</i> in 1994 is a classic in the field.<span><sup>7</sup></span> The graphical representation of PubMed citations over tim
{"title":"Electroconvulsive therapy (ECT) for mania: Hiding in plain sight","authors":"Charles H. Kellner","doi":"10.1111/acps.13693","DOIUrl":"10.1111/acps.13693","url":null,"abstract":"<p>In this issue of <i>Acta Psychiatrica Scandinavica</i>, Popiolek et al. present data on the effect of effect of electroconvulsive therapy (ECT) on time to readmission in patients with bipolar disorder hospitalized for a manic episode.<span><sup>1</sup></span> This is yet another high-quality ECT research paper facilitated by the comprehensive patient registries in Sweden, which allow investigation of a myriad of clinical questions at the population level. While their main analysis did not show a difference in time to readmission in patients treated with and without ECT, a subset of patients who had hospital admissions both with ECT and without ECT, showed a trend to longer time to readmission when they had received ECT. As one might expect, patients treated with ECT had more severe lifetime bipolar illness. ECT was administered to patients in 7.3% of 12,337 admissions, which is actually quite a high rate. I suspect that if a similar study was done in the United States, it would be under 1%.</p><p>In another recent report using CGI data from a largely overlapping clinical cohort, the Swedish group showed an 85% response rate of mania to ECT, with greater severity of illness associated with higher response.<span><sup>2</sup></span> Indeed, the most important message from both these reports is that ECT is a very effective treatment for acute mania.</p><p>ECT is grossly underutilized overall, and particularly in bipolar disorder.<span><sup>3, 4</sup></span> For some reason, it has been difficult for the field to fully embrace the use of ECT for all episode types in bipolar disorder, despite a substantial evidence base supporting its efficacy and safety for these clinical situations. When the US Food and Drug Administration reclassified the ECT device in 2018, it was for catatonia and a severe depressive episode in the context of unipolar or bipolar disorder, but there was no mention of mania.<span><sup>5, 6</sup></span> This is an egregious oversight and the work of our Swedish colleagues with their national register data is an extremely helpful way to bolster the evidence base. Although physicians even in the United States are not technically bound by FDA “cleared indications,” (the FDA does not regulate the practice of medicine, and physicians are free to prescribe ECT as they deem indicated, similar to the “off label” use of medications), it is still reassuring to be able to point to high-quality data for the use of ECT in manic episodes.</p><p>Of course, the ECT literature has been replete with such evidence for decades. A PubMed search of “electroconvulsive mania” returns nearly 500 citations; the search “electroconvulsive bipolar” returns nearly 2000. The review article, <i>Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience</i> by Mukerjhee et al. from the <i>American Journal of Psychiatry</i> in 1994 is a classic in the field.<span><sup>7</sup></span> The graphical representation of PubMed citations over tim","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 1","pages":"3-4"},"PeriodicalIF":6.7,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13693","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140920146","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}
Katie Scott, Claire O'Donovan, Giulio Emilio Brancati, Pablo Cervantes, Rafaella Ardau, Mirko Manchia, Giovanni Severino, Janusz Rybakowski, Leonardo Tondo, Paul Grof, Martin Alda, Abraham Nunes
Introduction
The aim of this study was to determine whether the clinical profiles of bipolar disorder (BD) patients could be differentiated more clearly using the existing classification by diagnostic subtype or by lithium treatment responsiveness.
Methods
We included adult patients with BD-I or II (N = 477 across four sites) who were treated with lithium as their principal mood stabilizer for at least 1 year. Treatment responsiveness was defined using the dichotomized Alda score. We performed hierarchical clustering on phenotypes defined by 40 features, covering demographics, clinical course, family history, suicide behaviour, and comorbid conditions. We then measured the amount of information that inferred clusters carried about (A) BD subtype and (B) lithium responsiveness using adjusted mutual information (AMI) scores. Detailed phenotypic profiles across clusters were then evaluated with univariate comparisons.
Results
Two clusters were identified (n = 56 and n = 421), which captured significantly more information about lithium responsiveness (AMI range: 0.033 to 0.133) than BD subtype (AMI: 0.004 to 0.011). The smaller cluster had disproportionately more lithium responders (n = 47 [83.8%]) when compared to the larger cluster (103 [24.4%]; p = 0.006).
Conclusions
Phenotypes derived from detailed clinical data may carry more information about lithium responsiveness than the current classification of diagnostic subtype. These findings support lithium responsiveness as a valid approach to stratification in clinical samples.
{"title":"Phenotypic clustering of bipolar disorder supports stratification by lithium responsiveness over diagnostic subtypes","authors":"Katie Scott, Claire O'Donovan, Giulio Emilio Brancati, Pablo Cervantes, Rafaella Ardau, Mirko Manchia, Giovanni Severino, Janusz Rybakowski, Leonardo Tondo, Paul Grof, Martin Alda, Abraham Nunes","doi":"10.1111/acps.13692","DOIUrl":"10.1111/acps.13692","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The aim of this study was to determine whether the clinical profiles of bipolar disorder (BD) patients could be differentiated more clearly using the existing classification by diagnostic subtype or by lithium treatment responsiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included adult patients with BD-I or II (<i>N</i> = 477 across four sites) who were treated with lithium as their principal mood stabilizer for at least 1 year. Treatment responsiveness was defined using the dichotomized Alda score. We performed hierarchical clustering on phenotypes defined by 40 features, covering demographics, clinical course, family history, suicide behaviour, and comorbid conditions. We then measured the amount of information that inferred clusters carried about (A) BD subtype and (B) lithium responsiveness using adjusted mutual information (AMI) scores. Detailed phenotypic profiles across clusters were then evaluated with univariate comparisons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two clusters were identified (<i>n</i> = 56 and <i>n</i> = 421), which captured significantly more information about lithium responsiveness (AMI range: 0.033 to 0.133) than BD subtype (AMI: 0.004 to 0.011). The smaller cluster had disproportionately more lithium responders (<i>n</i> = 47 [83.8%]) when compared to the larger cluster (103 [24.4%]; <i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Phenotypes derived from detailed clinical data may carry more information about lithium responsiveness than the current classification of diagnostic subtype. These findings support lithium responsiveness as a valid approach to stratification in clinical samples.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"91-104"},"PeriodicalIF":5.3,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13692","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140678960","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}
Marie Reeberg Sass, Anne Mette Brandt Christensen, Margit Lykke Christensen, Ema Gruber, Helle Nerdrum, Lone Marianne Pedersen, Maximilian Resch, Troels Højsgaard Jørgensen, Claus T. Ekstrøm, Jimmi Nielsen, Tina Vilsbøll, Anders Fink-Jensen
Introduction
Overweight and obesity constitute a major concern among patients treated at forensic psychiatric departments. The present clinical feasibility study aimed at investigating the extent to which glucagon-like peptide 1 receptor agonist (GLP-1RA) treatment with once-daily liraglutide 3.0 mg could be a feasible pharmacological treatment of these conditions in patients with schizophrenia spectrum disorders hospitalised in forensic psychiatry.
Methods
The 26-week, open-label feasibility study included participants aged 18–65 years diagnosed with a severe mental illness and hospitalised at a forensic psychiatric department. At the time of inclusion, all participants fulfilled the indication for using liraglutide as a treatment for overweight and obesity. Participants' baseline examinations were followed by a 26-week treatment period with liraglutide injection once daily according to a fixed uptitration schedule of liraglutide, with a target dose of 3.0 mg. Each participant attended seven visits to evaluate the efficacy and adverse events. The primary endpoint was the number of “completers”, with adherence defined as >80% injections obtained in the period, weeks 12–26. Determining whether liraglutide is a feasible treatment was pre-defined to a minimum of 75% completers.
Results
Twenty-four participants were included in the study. Sex, male = 19 (79.2%). Mean age: 42.3 [25th and 75th percentiles: 39.1; 48.4] years; body mass index (BMI): 35.7 [31.7; 37.5] kg/m2; glycated haemoglobin (HbA1c): 37 [35; 39] mmol/mol. Eleven out of 24 participants (46%) completed the study. For the completers, the median net body weight loss after 26 weeks of participation was −11.4 kg [−15.4; −5.9]. The net difference in HbA1C and BMI was −2.0 mmol/mol [−4; −1] and −3.6 kg/m2 [−4.7; −1.8], respectively. The weight change and reduction in HbA1c and BMI were all statistically significant from baseline.
Conclusion
The study did not confirm our hypothesis that liraglutide is a feasible treatment for a minimum of 75% of the patients initiating treatment with liraglutide while hospitalised in a forensic psychiatric department. The high dropout rate may be due to the non-naturalistic setting of the clinical trial. For the proportion of patients compliant with the medication, liraglutide 3.0 mg was an efficient treatment for overweight.
{"title":"Liraglutide 3.0 mg once daily for the treatment of overweight and obesity in patients hospitalised at a forensic psychiatric department: A 26-week open-label feasibility study","authors":"Marie Reeberg Sass, Anne Mette Brandt Christensen, Margit Lykke Christensen, Ema Gruber, Helle Nerdrum, Lone Marianne Pedersen, Maximilian Resch, Troels Højsgaard Jørgensen, Claus T. Ekstrøm, Jimmi Nielsen, Tina Vilsbøll, Anders Fink-Jensen","doi":"10.1111/acps.13690","DOIUrl":"10.1111/acps.13690","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Overweight and obesity constitute a major concern among patients treated at forensic psychiatric departments. The present clinical feasibility study aimed at investigating the extent to which glucagon-like peptide 1 receptor agonist (GLP-1RA) treatment with once-daily liraglutide 3.0 mg could be a feasible pharmacological treatment of these conditions in patients with schizophrenia spectrum disorders hospitalised in forensic psychiatry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 26-week, open-label feasibility study included participants aged 18–65 years diagnosed with a severe mental illness and hospitalised at a forensic psychiatric department. At the time of inclusion, all participants fulfilled the indication for using liraglutide as a treatment for overweight and obesity. Participants' baseline examinations were followed by a 26-week treatment period with liraglutide injection once daily according to a fixed uptitration schedule of liraglutide, with a target dose of 3.0 mg. Each participant attended seven visits to evaluate the efficacy and adverse events. The primary endpoint was the number of “completers”, with adherence defined as >80% injections obtained in the period, weeks 12–26. Determining whether liraglutide is a feasible treatment was pre-defined to a minimum of 75% completers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four participants were included in the study. Sex, male = 19 (79.2%). Mean age: 42.3 [25th and 75th percentiles: 39.1; 48.4] years; body mass index (BMI): 35.7 [31.7; 37.5] kg/m<sup>2</sup>; glycated haemoglobin (HbA1c): 37 [35; 39] mmol/mol. Eleven out of 24 participants (46%) completed the study. For the completers, the median net body weight loss after 26 weeks of participation was −11.4 kg [−15.4; −5.9]. The net difference in HbA1C and BMI was −2.0 mmol/mol [−4; −1] and −3.6 kg/m<sup>2</sup> [−4.7; −1.8], respectively. The weight change and reduction in HbA1c and BMI were all statistically significant from baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study did not confirm our hypothesis that liraglutide is a feasible treatment for a minimum of 75% of the patients initiating treatment with liraglutide while hospitalised in a forensic psychiatric department. The high dropout rate may be due to the non-naturalistic setting of the clinical trial. For the proportion of patients compliant with the medication, liraglutide 3.0 mg was an efficient treatment for overweight.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 1","pages":"35-47"},"PeriodicalIF":6.7,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140616141","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}
Ivana Clark, Phoebe Wallman, Siobhan Gee, David Taylor
<p>Long-acting antipsychotics are accepted to be more effective than oral antipsychotics in reducing the risk of hospitalisation and relapse in schizophrenia. In our previous 5-year mirror-image study, we reported a significant reduction in hospital admissions and fewer days spent in hospital for people prescribed 3-monthly paliperidone (PP3M) after stabilisation on 1-monthly (PP1M).<span><sup>1</sup></span> We now report the outcomes of the sixth year of this study.</p><p>Our primary objective was to use a mirror image model to evaluate hospital admissions and bed days before and after the initiation of PP1M followed by PP3M in those who continued treatment for 3 years. Full details of methods used have been previously described.<span><sup>1</sup></span> The same patient cohort as previously defined was followed up for additional 12 months.</p><p>As before, 76 patients met inclusion criteria. Of this total baseline cohort, 52 patients (68%) continued on PPLAIs for 36 months, 19 patients (25%) discontinued within 36 months of initiation and 5 patients (7%) were lost to follow-up. The mean age on PPLAI initiation was 42 years; 54 were male. The majority of our baseline cohort was initiated on PP1M as inpatients (<i>n</i> = 49, 69%). Ethnicity breakdown was as follows: Asian (<i>n</i> = 4), Black (<i>n</i> = 44), Mixed background (<i>n</i> = 4), Other (<i>n</i> = 2), White (<i>n</i> = 17). On average, patients received PP1M for 10 months before starting PP3M. The most commonly prescribed maintenance dose was 100 mg a month (<i>n</i> = 31 [44%]) followed by 150 mg (<i>n</i> = 25, 35%), 75 mg (<i>n</i> = 12, 17%) and 50 mg (<i>n</i> = 3, 4%). From the original 76 starters, 19 patients discontinued over 36 months, for the following reasons: patient refusal (<i>n</i> = 10), perceived inefficacy (<i>n</i> = 5), unrelated health condition (‘kidney problems’ [<i>n</i> = 1] and cancer [<i>n</i> = 1]) and adverse effects (weight gain [<i>n</i> = 1] and raised liver function tests [<i>n</i> = 1]).</p><p>In those continuing on PPLAI for 3 years (<i>n</i> = 52), the mean number of admissions per year was 0.53 (SD 0.49) before PPLAI initiation and 0.01 (SD 0.06) (<i>p</i> < 0.001) afterwards. The mean number of bed days a year was 31.3 days (SD 48.8) before PPLAI and 12.4 days (SD 23.6) (<i>p</i> < 0.001) after. The majority of the bed days recorded in the period after PPLAI was started were from the index admission. Only two patients registered bed days after initiation (discounting the initial admission bed days). Both patients started PPLAI as inpatients. No patient starting PPLAI as an out-patient had bed days in the 3 years after initiation.</p><p>The use of PP3M after stabilisation on PP1M was associated with a considerable reduction in bed days and hospital admissions. During the observational period, only 8 of 71 patients started on PP1M/3 M (9.9%) were admitted to hospital. The majority of our patient cohort (80%) had been admitted to hospital at
{"title":"Long term impact of 3-monthly paliperidone palmitate on hospitalisation in patients with schizophrenia: Six-year mirror image study","authors":"Ivana Clark, Phoebe Wallman, Siobhan Gee, David Taylor","doi":"10.1111/acps.13691","DOIUrl":"10.1111/acps.13691","url":null,"abstract":"<p>Long-acting antipsychotics are accepted to be more effective than oral antipsychotics in reducing the risk of hospitalisation and relapse in schizophrenia. In our previous 5-year mirror-image study, we reported a significant reduction in hospital admissions and fewer days spent in hospital for people prescribed 3-monthly paliperidone (PP3M) after stabilisation on 1-monthly (PP1M).<span><sup>1</sup></span> We now report the outcomes of the sixth year of this study.</p><p>Our primary objective was to use a mirror image model to evaluate hospital admissions and bed days before and after the initiation of PP1M followed by PP3M in those who continued treatment for 3 years. Full details of methods used have been previously described.<span><sup>1</sup></span> The same patient cohort as previously defined was followed up for additional 12 months.</p><p>As before, 76 patients met inclusion criteria. Of this total baseline cohort, 52 patients (68%) continued on PPLAIs for 36 months, 19 patients (25%) discontinued within 36 months of initiation and 5 patients (7%) were lost to follow-up. The mean age on PPLAI initiation was 42 years; 54 were male. The majority of our baseline cohort was initiated on PP1M as inpatients (<i>n</i> = 49, 69%). Ethnicity breakdown was as follows: Asian (<i>n</i> = 4), Black (<i>n</i> = 44), Mixed background (<i>n</i> = 4), Other (<i>n</i> = 2), White (<i>n</i> = 17). On average, patients received PP1M for 10 months before starting PP3M. The most commonly prescribed maintenance dose was 100 mg a month (<i>n</i> = 31 [44%]) followed by 150 mg (<i>n</i> = 25, 35%), 75 mg (<i>n</i> = 12, 17%) and 50 mg (<i>n</i> = 3, 4%). From the original 76 starters, 19 patients discontinued over 36 months, for the following reasons: patient refusal (<i>n</i> = 10), perceived inefficacy (<i>n</i> = 5), unrelated health condition (‘kidney problems’ [<i>n</i> = 1] and cancer [<i>n</i> = 1]) and adverse effects (weight gain [<i>n</i> = 1] and raised liver function tests [<i>n</i> = 1]).</p><p>In those continuing on PPLAI for 3 years (<i>n</i> = 52), the mean number of admissions per year was 0.53 (SD 0.49) before PPLAI initiation and 0.01 (SD 0.06) (<i>p</i> < 0.001) afterwards. The mean number of bed days a year was 31.3 days (SD 48.8) before PPLAI and 12.4 days (SD 23.6) (<i>p</i> < 0.001) after. The majority of the bed days recorded in the period after PPLAI was started were from the index admission. Only two patients registered bed days after initiation (discounting the initial admission bed days). Both patients started PPLAI as inpatients. No patient starting PPLAI as an out-patient had bed days in the 3 years after initiation.</p><p>The use of PP3M after stabilisation on PP1M was associated with a considerable reduction in bed days and hospital admissions. During the observational period, only 8 of 71 patients started on PP1M/3 M (9.9%) were admitted to hospital. The majority of our patient cohort (80%) had been admitted to hospital at","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 1","pages":"48-50"},"PeriodicalIF":6.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578230","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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