Tomas Hajek, Orestes Forlenza, Marcelo Nicolela, Ann-Eva Christensen, Henrik Vorum, René Ernst Nielsen
Background
Glaucoma is an optic neuropathy caused by neurodegenerative loss of retinal ganglion cells (RGC). Mechanisms that contribute to RGC death include some of the same mechanisms involved in bipolar disorders (BD) and are the same mechanisms which are targeted by lithium (Li). We conducted a pharmacoepidemiological, population study in Denmark testing the links between Li prescriptions and risk of glaucoma.
Study Design
A nationwide, register-based historical, prospective cohort study of participants who were alive and over the age of 18 between January 1, 1996 and December 31, 2019. Participants were followed from the start of study until censoring or glaucoma.
Study Results
A total of 7,683,398 individuals (51.3% females) contributing 121,366,461 person-years were included in the study. In the general population, Li exposure was associated with developing glaucoma (HR = 1.10, 95% CI = 1.02–1.19, p = 0.01), but this association was not present in the population with BD (HR = 1.07, 95% CI = 0.93–1.22, p = 0.34). In the cumulative dosage analyses of the entire population, people with no Li prescription (HR = 0.78 95% CI = 0.66–0.93, p = 0.01) and between 365 defined daily doses (DDDs) and 5 × 365 DDDs of Li showed significantly reduced risk of glaucoma, relative to at least one prescription (HR = 0.79, 95% CI = 0.64–0.99, p < 0.05).
Conclusion
BDs as indexed by Li prescription are associated with a greater risk of glaucoma. This is in keeping with generally increased rates of medical comorbidities in BD. While there was no clear dose–response relationship, some of the higher cumulative exposures to Li might be protective relative to a single prescription.
背景：青光眼是一种由视网膜神经节细胞退行性丧失引起的视神经病变。导致RGC死亡的机制包括一些与双相情感障碍（BD）相同的机制，并且与锂（Li）靶向的机制相同。我们在丹麦进行了一项药物流行病学和人口研究，测试Li处方与青光眼风险之间的联系。研究设计：一项全国性的、基于登记册的历史前瞻性队列研究，研究对象是1996年1月1日至2019年12月31日期间18岁以上的在世参与者。参与者从研究开始一直被跟踪到青光眼。研究结果：该研究共纳入7683398人（51.3%为女性），共121366461人年。在一般人群中，Li暴露与青光眼相关（HR = 1.10, 95% CI = 1.02-1.19, p = 0.01），但这种关联在BD人群中不存在（HR = 1.07, 95% CI = 0.93-1.22, p = 0.34）。在整个人群的累积剂量分析中，没有Li处方的人群（HR = 0.78 95% CI = 0.66-0.93, p = 0.01），在365限定日剂量（DDDs）和5 × 365 DDDs之间的人群，相对于至少一个处方（HR = 0.79, 95% CI = 0.64-0.99, p），青光眼的风险显著降低（HR = 0.79, 95% CI = 0.64-0.99）。这与双相障碍的医学合并症发生率普遍上升是一致的。虽然没有明确的剂量-反应关系，但相对于单一处方，一些较高的Li累积暴露可能具有保护作用。
{"title":"Does Lithium Lower the Risk of Glaucoma—A Danish Nationwide Study","authors":"Tomas Hajek, Orestes Forlenza, Marcelo Nicolela, Ann-Eva Christensen, Henrik Vorum, René Ernst Nielsen","doi":"10.1111/acps.70010","DOIUrl":"10.1111/acps.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Glaucoma is an optic neuropathy caused by neurodegenerative loss of retinal ganglion cells (RGC). Mechanisms that contribute to RGC death include some of the same mechanisms involved in bipolar disorders (BD) and are the same mechanisms which are targeted by lithium (Li). We conducted a pharmacoepidemiological, population study in Denmark testing the links between Li prescriptions and risk of glaucoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>A nationwide, register-based historical, prospective cohort study of participants who were alive and over the age of 18 between January 1, 1996 and December 31, 2019. Participants were followed from the start of study until censoring or glaucoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Results</h3>\u0000 \u0000 <p>A total of 7,683,398 individuals (51.3% females) contributing 121,366,461 person-years were included in the study. In the general population, Li exposure was associated with developing glaucoma (HR = 1.10, 95% CI = 1.02–1.19, <i>p</i> = 0.01), but this association was not present in the population with BD (HR = 1.07, 95% CI = 0.93–1.22, <i>p</i> = 0.34). In the cumulative dosage analyses of the entire population, people with no Li prescription (HR = 0.78 95% CI = 0.66–0.93, <i>p</i> = 0.01) and between 365 defined daily doses (DDDs) and 5 × 365 DDDs of Li showed significantly reduced risk of glaucoma, relative to at least one prescription (HR = 0.79, 95% CI = 0.64–0.99, <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>BDs as indexed by Li prescription are associated with a greater risk of glaucoma. This is in keeping with generally increased rates of medical comorbidities in BD. While there was no clear dose–response relationship, some of the higher cumulative exposures to Li might be protective relative to a single prescription.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"308-315"},"PeriodicalIF":5.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558561","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}
Maurizio Pompili, Isabella Berardelli, Salvatore Sarubbi, Elena Rogante, Mariarosaria Cifrodelli, Denise Erbuto, Dorian A. Lamis, Ross J. Baldessarini
Objectives
Lithium treatment reduces the risk of recurring episodes in bipolar disorder (BD) and probably also in major depressive disorder (MDD) and has evidence of antisuicidal effects. Study objectives were to test for effects of adding lithium treatment for one year to a year of other treatments on risks of illness recurrence, suicidal ideation, and suicide attempts.
Methods
We compared 296 major mood disorder outpatients for 12 months with treatment that did not include lithium versus 12 months with lithium included. We considered differences in the recurrence of new episodes of illness, new suicidal ideation and suicide attempts, and estimated time to these outcomes with survival analyses.
Results
With lithium treatment included, there were marked reductions in episode recurrences (3.12-fold), suicidal ideation (4.78-fold), and suicide attempts (6.54-fold) in both BD and MDD patients, with corresponding delays to these outcomes.
Conclusions
Adding lithium treatment was strongly associated with reduced risk and delay of clinical recurrence, suicidal ideation and suicide attempts in both BD and MDD outpatients.
{"title":"New Episodes and Suicidal Risks in Bipolar and Major Depressive Disorder Patients During Versus Before Long-Term Treatment With Lithium","authors":"Maurizio Pompili, Isabella Berardelli, Salvatore Sarubbi, Elena Rogante, Mariarosaria Cifrodelli, Denise Erbuto, Dorian A. Lamis, Ross J. Baldessarini","doi":"10.1111/acps.70002","DOIUrl":"https://doi.org/10.1111/acps.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Lithium treatment reduces the risk of recurring episodes in bipolar disorder (BD) and probably also in major depressive disorder (MDD) and has evidence of antisuicidal effects. Study objectives were to test for effects of adding lithium treatment for one year to a year of other treatments on risks of illness recurrence, suicidal ideation, and suicide attempts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compared 296 major mood disorder outpatients for 12 months with treatment that did not include lithium versus 12 months with lithium included. We considered differences in the recurrence of new episodes of illness, new suicidal ideation and suicide attempts, and estimated time to these outcomes with survival analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>With lithium treatment included, there were marked reductions in episode recurrences (3.12-fold), suicidal ideation (4.78-fold), and suicide attempts (6.54-fold) in both BD and MDD patients, with corresponding delays to these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adding lithium treatment was strongly associated with reduced risk and delay of clinical recurrence, suicidal ideation and suicide attempts in both BD and MDD outpatients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"290-298"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929569","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":"Comment on “Three Distinct Pathways to First Episode Mania and Psychosis: Latent Class Analysis of Antecedent Psychopathology”","authors":"Rachana Mehta, Ranjana Sah","doi":"10.1111/acps.70008","DOIUrl":"https://doi.org/10.1111/acps.70008","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"316-317"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929568","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}
Elisa Westman, Tuire Prami, Alvar Kallio, Ilona Iso-Mustajärvi, Joel Jukka, Paavo Raittinen, Maarit J. Korhonen, Anita Puustjärvi, Sami Leppämäki
Introduction
ADHD is often associated with comorbid psychiatric conditions. Differential diagnosis between other conditions and ADHD is not always clear, and patients are sometimes initially treated for another disorder instead. ADHD diagnosis and appropriate ADHD treatment potentially reduce the need for medication of the other disorder. Reaching high adherence to and persistence with ADHD medication is challenging. This nationwide cohort study aimed to describe not only ADHD medication use but also the use of other drugs in ADHD patients compared to controls.
Methods
Nationwide care and prescription registers were used to identify incident ADHD patients of any age between 2015 and 2020. Four controls were matched to each ADHD patient by age, gender, and residence. Analyses included data from 1.1.2010 to 31.12.2021.
Results
Study cohort included 66,146 ADHD patients and 256,270 controls, with a total follow-up of 1,123,412 years. Sustained and extended-release methylphenidate were the two most commonly used first-line ADHD drugs across all age groups. Simultaneous use of different ADHD drugs was rare. Primary adherence was very high, with 95% of the patients purchasing their prescribed medication in general and 80% doing so within 10 days. Persistence with medication was the highest among the youngest patients. A decrease in purchases was observed during the summer holidays in school-age children and adolescents. In adults, antidepressant use often preceded ADHD diagnosis and decreased after ADHD treatment initiation, unlike in controls at the same time. In young children, antibiotics and anti-inflammatory drug use was higher in ADHD patients than in controls, especially before ADHD identification.
Conclusion
As far as we know, this is the first study to describe changes in the use of non-ADHD medications in relation to ADHD identification. In adults, antidepressant use decreased after ADHD treatment initiation, and in children, antibiotic and anti-inflammatory use showed more prominent decrease compared to controls of the same age. The data indicated high primary adherence to ADHD medication, and the youngest children remained on continuous ADHD medication the longest. The effect of summer holidays was visible in the purchase data.
{"title":"Use of Antidepressants Decreased After Initiation of ADHD Treatment in Adults—A Finnish Nationwide Register Study Describing Use of ADHD and Non-ADHD Medication in People With and Without ADHD","authors":"Elisa Westman, Tuire Prami, Alvar Kallio, Ilona Iso-Mustajärvi, Joel Jukka, Paavo Raittinen, Maarit J. Korhonen, Anita Puustjärvi, Sami Leppämäki","doi":"10.1111/acps.70007","DOIUrl":"https://doi.org/10.1111/acps.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>ADHD is often associated with comorbid psychiatric conditions. Differential diagnosis between other conditions and ADHD is not always clear, and patients are sometimes initially treated for another disorder instead. ADHD diagnosis and appropriate ADHD treatment potentially reduce the need for medication of the other disorder. Reaching high adherence to and persistence with ADHD medication is challenging. This nationwide cohort study aimed to describe not only ADHD medication use but also the use of other drugs in ADHD patients compared to controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Nationwide care and prescription registers were used to identify incident ADHD patients of any age between 2015 and 2020. Four controls were matched to each ADHD patient by age, gender, and residence. Analyses included data from 1.1.2010 to 31.12.2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Study cohort included 66,146 ADHD patients and 256,270 controls, with a total follow-up of 1,123,412 years. Sustained and extended-release methylphenidate were the two most commonly used first-line ADHD drugs across all age groups. Simultaneous use of different ADHD drugs was rare. Primary adherence was very high, with 95% of the patients purchasing their prescribed medication in general and 80% doing so within 10 days. Persistence with medication was the highest among the youngest patients. A decrease in purchases was observed during the summer holidays in school-age children and adolescents. In adults, antidepressant use often preceded ADHD diagnosis and decreased after ADHD treatment initiation, unlike in controls at the same time. In young children, antibiotics and anti-inflammatory drug use was higher in ADHD patients than in controls, especially before ADHD identification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>As far as we know, this is the first study to describe changes in the use of non-ADHD medications in relation to ADHD identification. In adults, antidepressant use decreased after ADHD treatment initiation, and in children, antibiotic and anti-inflammatory use showed more prominent decrease compared to controls of the same age. The data indicated high primary adherence to ADHD medication, and the youngest children remained on continuous ADHD medication the longest. The effect of summer holidays was visible in the purchase data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"203-215"},"PeriodicalIF":5.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768058","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}
Amanda Medeiros Fernandes, Emilly Sampaio de Lima, Tainá Conrado Ferreira, Giovanna Cavalcante Pardi, Fabio Gomes de Matos e Souza, Luísa Weber Bisol
{"title":"In the Assessment of Childhood Maltreatment and Cognitive Function in Bipolar Disorder All Variables Should Be Taken Into Consideration","authors":"Amanda Medeiros Fernandes, Emilly Sampaio de Lima, Tainá Conrado Ferreira, Giovanna Cavalcante Pardi, Fabio Gomes de Matos e Souza, Luísa Weber Bisol","doi":"10.1111/acps.70009","DOIUrl":"https://doi.org/10.1111/acps.70009","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"397-398"},"PeriodicalIF":5.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197121","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}
Simone Normark, Marie Kim Wium-Andersen, Merete Osler, Ida Kim Wium-Andersen
Objective
To investigate the association of psychosis with subsequent risk of dementia and to explore any impact of age at psychosis onset.
Methods
Using the Danish National health registries, a total of 39,022 patients with a diagnosis of psychosis and a matched sample of 195,109 individuals without psychosis were included in the study. All individuals were born between 1910 and 1959 and were a minimum of 18 years of age in 1969. The risk of being diagnosed with dementia was analyzed using Cox proportional hazard regression with adjustment for sociodemographic variables and alcohol use disorder. Analyses were stratified by age of psychosis onset (< 45/45+ years) and age at follow-up in three categories (60–70, 70–80, and 80 or above).
Results
During mean 16.8 years of follow-up, 18,653 (12.55%) of all individuals developed dementia. Patients with psychosis had a higher risk of dementia at all ages of follow-up, with the highest risk estimate at follow-up before age 70 (hazard ratio (HR) adjusted 4.44 CI (4.01–4.91)). However, the risk also varied with age at psychosis onset, being highest at late-onset (adjusted hazard ratio: 5.16 (95% confidence interval: 4.59–5.81)).
Conclusion
Patients with psychosis had a higher risk of developing dementia than individuals without psychosis. The risk varied with age at psychosis onset and age at follow-up.
{"title":"Risk of Dementia in Patients Suffering From Psychosis—A Danish Register-Based Cohort Study","authors":"Simone Normark, Marie Kim Wium-Andersen, Merete Osler, Ida Kim Wium-Andersen","doi":"10.1111/acps.13828","DOIUrl":"https://doi.org/10.1111/acps.13828","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the association of psychosis with subsequent risk of dementia and to explore any impact of age at psychosis onset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Danish National health registries, a total of 39,022 patients with a diagnosis of psychosis and a matched sample of 195,109 individuals without psychosis were included in the study. All individuals were born between 1910 and 1959 and were a minimum of 18 years of age in 1969. The risk of being diagnosed with dementia was analyzed using Cox proportional hazard regression with adjustment for sociodemographic variables and alcohol use disorder. Analyses were stratified by age of psychosis onset (< 45/45+ years) and age at follow-up in three categories (60–70, 70–80, and 80 or above).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During mean 16.8 years of follow-up, 18,653 (12.55%) of all individuals developed dementia. Patients with psychosis had a higher risk of dementia at all ages of follow-up, with the highest risk estimate at follow-up before age 70 (hazard ratio (HR) adjusted 4.44 CI (4.01–4.91)). However, the risk also varied with age at psychosis onset, being highest at late-onset (adjusted hazard ratio: 5.16 (95% confidence interval: 4.59–5.81)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with psychosis had a higher risk of developing dementia than individuals without psychosis. The risk varied with age at psychosis onset and age at follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"180-186"},"PeriodicalIF":5.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13828","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768077","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}
George Kirov, Emily Simmonds, Tyler Kaster, Valentina Escott-Price
Background
Electroconvulsive therapy (ECT) is the most effective therapy for severe or treatment-resistant depression. A common short-term side effect is memory problems, and it is important to know whether ECT increases the risk for dementia later in life. Major psychiatric disorders are associated with an increased risk for developing dementia, making the analysis of dementia risk challenging. A small number of previous studies indicate that ECT does not increase this risk. We wanted to examine the association between ECT and subsequent risk of dementia in the population of Wales, UK.
Methods
We analysed the electronic health records of the Welsh population. We selected 110,774 people aged between 35 and 65 on 1.1.1995 who had no prior diagnosis of dementia and had been hospitalised with diagnoses of affective disorders. Of those, 1010 received at least one course of ECT between 1995 and 2024 before a diagnosis of dementia.
Results
The 110,774 persons were followed up until the end of the study period in 2024, or the date of dementia diagnosis, or the date of death, for a mean of 24.5 (SD = 6.3) years. 15.4% of the ECT group developed dementia, compared to 13.1% for the non-ECT-treated individuals. After controlling for age, sex, social deprivation status, physical comorbidities, history of alcohol abuse, the number of psychiatric hospitalisations and the age when they first occurred, the hazard ratio for dementia was not increased in the ECT group: HR = 0.888, 95% CI: 0.757–1.044, p = 0.15.
Conclusions
Though crude analyses found a greater risk of dementia among those receiving ECT, once confounders were accounted for, we failed to find a statistically significant risk for dementia among those who received ECT. Our findings strengthen the conclusions of previous reports and provide further reassurance for people considering this treatment.
{"title":"Risk of Dementia After Electroconvulsive Therapy: A Cohort Study on the Population of Wales","authors":"George Kirov, Emily Simmonds, Tyler Kaster, Valentina Escott-Price","doi":"10.1111/acps.70005","DOIUrl":"https://doi.org/10.1111/acps.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Electroconvulsive therapy (ECT) is the most effective therapy for severe or treatment-resistant depression. A common short-term side effect is memory problems, and it is important to know whether ECT increases the risk for dementia later in life. Major psychiatric disorders are associated with an increased risk for developing dementia, making the analysis of dementia risk challenging. A small number of previous studies indicate that ECT does not increase this risk. We wanted to examine the association between ECT and subsequent risk of dementia in the population of Wales, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed the electronic health records of the Welsh population. We selected 110,774 people aged between 35 and 65 on 1.1.1995 who had no prior diagnosis of dementia and had been hospitalised with diagnoses of affective disorders. Of those, 1010 received at least one course of ECT between 1995 and 2024 before a diagnosis of dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 110,774 persons were followed up until the end of the study period in 2024, or the date of dementia diagnosis, or the date of death, for a mean of 24.5 (SD = 6.3) years. 15.4% of the ECT group developed dementia, compared to 13.1% for the non-ECT-treated individuals. After controlling for age, sex, social deprivation status, physical comorbidities, history of alcohol abuse, the number of psychiatric hospitalisations and the age when they first occurred, the hazard ratio for dementia was not increased in the ECT group: HR = 0.888, 95% CI: 0.757–1.044, <i>p</i> = 0.15.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Though crude analyses found a greater risk of dementia among those receiving ECT, once confounders were accounted for, we failed to find a statistically significant risk for dementia among those who received ECT. Our findings strengthen the conclusions of previous reports and provide further reassurance for people considering this treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"270-277"},"PeriodicalIF":5.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930077","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}
Jasmien Obbels, Kristof Vansteelandt, Esmée Verwijk, Kaat Hebbrecht, Shauni Verspecht, Nathalie Denayer, Liese Van den Eynde, Pascal Sienaert
Objective
There is ongoing concern about the possible negative impact of ECT on neuropsychological functioning, especially on autobiographical memory. In this study we aimed to identify the short- and long-term neuropsychological effects of ECT in the domain of memory.
Methods
Twenty-eight patients aged 18 years and older with a unipolar or bipolar depression, referred for ECT, were eventually included. The neuropsychological test battery assessed verbal memory, verbal fluency, and autobiographical memory. The battery was administered prior to ECT, 1 week, and 3 months after the last ECT session. We compared the neuropsychological performances of our sample with normative data from a healthy population.
Results
After adjusting for covariates, performance on tasks assessing verbal memory, verbal fluency, and autobiographical memory showed a significant decline during ECT. However, test scores significantly improved following the completion of ECT. Additionally, patients with higher QIDS-CR scores consistently demonstrated lower performance on the verbal fluency task across all time points. No significant association was found between the total number of ECT sessions and changes in test scores during or after treatment. 3 months after ending ECT, cognitive functioning returned to pretreatment levels of performance. We found that patients with a depressive episode performed significantly worse on task measuring verbal memory and fluency at every time point as compared to a healthy population.
Conclusion
Our results show that a course of ECT in patients with a depressive episode influences verbal memory, autobiographical memory and verbal fluency. Neuropsychological performances significantly declined during ECT. Following ECT, neuropsychological performances, as compared to during ECT, were significantly improved and were equivalent to baseline. However, neuropsychological performance remains poor as compared to a healthy population.
{"title":"Exploring Neuropsychological Functioning After Electroconvulsive Therapy in the Domain of Memory: A Prospective Study","authors":"Jasmien Obbels, Kristof Vansteelandt, Esmée Verwijk, Kaat Hebbrecht, Shauni Verspecht, Nathalie Denayer, Liese Van den Eynde, Pascal Sienaert","doi":"10.1111/acps.70001","DOIUrl":"https://doi.org/10.1111/acps.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There is ongoing concern about the possible negative impact of ECT on neuropsychological functioning, especially on autobiographical memory. In this study we aimed to identify the short- and long-term neuropsychological effects of ECT in the domain of memory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-eight patients aged 18 years and older with a unipolar or bipolar depression, referred for ECT, were eventually included. The neuropsychological test battery assessed verbal memory, verbal fluency, and autobiographical memory. The battery was administered prior to ECT, 1 week, and 3 months after the last ECT session. We compared the neuropsychological performances of our sample with normative data from a healthy population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After adjusting for covariates, performance on tasks assessing verbal memory, verbal fluency, and autobiographical memory showed a significant decline during ECT. However, test scores significantly improved following the completion of ECT. Additionally, patients with higher QIDS-CR scores consistently demonstrated lower performance on the verbal fluency task across all time points. No significant association was found between the total number of ECT sessions and changes in test scores during or after treatment. 3 months after ending ECT, cognitive functioning returned to pretreatment levels of performance. We found that patients with a depressive episode performed significantly worse on task measuring verbal memory and fluency at every time point as compared to a healthy population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results show that a course of ECT in patients with a depressive episode influences verbal memory, autobiographical memory and verbal fluency. Neuropsychological performances significantly declined during ECT. Following ECT, neuropsychological performances, as compared to during ECT, were significantly improved and were equivalent to baseline. However, neuropsychological performance remains poor as compared to a healthy population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"260-269"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929995","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}
Mete Ercis, Alessandro Miola, Javier Ortiz-Orendain, Vanessa K. Pazdernik, Tamahara Gonzalez-Campos, Manuel Gardea-Resendez, Peggy M. Gruhlke, Ian M. Michel, Jennifer L. Vande Voort, Alastair J. McKean, Aysegul Ozerdem, Mark A. Frye
Background
Despite the classic Kraepelinian dichotomy between bipolar disorder (BD) and schizophrenia (SZ), contemporary evidence suggests shared antecedent risk factors and similarities in the early course. This study aimed to identify distinct trajectories leading to first-episode mania (FEM) and first-episode psychosis (FEP) by examining antecedent psychopathology, including psychiatric diagnoses, symptoms, substance use, and psychotropic medication exposure.
Methods
Individuals born after 1985 who resided in Olmsted County, Minnesota, USA, and had FEM/FEP were identified through the Rochester Epidemiology Project. Latent class analysis (LCA) was used to identify subgroups based on antecedent psychopathology incorporating 57 dichotomous antecedent measures before FEM/FEP.
Results
A total of 202 individuals (BD n = 73, SZ n = 129; 26.7% female, mean age 20.8 ± 3.7 years) were included. A 3-class LCA model optimally fits the data. Class 1 (Neurodevelopmental, 29.7%) had a high prevalence of neurodevelopmental disorders, behavioral symptoms, and ADHD medication use. Class 2 (Depressive-Anxious, 31.2%) included depressive and anxiety disorders, mood-related symptoms, and SSRI/SNRI use. Class 3 (Minimal Psychiatric Morbidity, 39.1%) had a low prevalence of antecedent diagnoses and symptoms, with comparable substance use to other classes. There were significant diagnostic differences, with SZ being more common in the Neurodevelopmental (71.7%) and Minimal Psychiatric Morbidity (70.9%) classes, while BD was more common in the Depressive-Anxious class (p = 0.007). Neurodevelopmental and Minimal Psychiatric Morbidity classes had higher proportions of males (85.0% and 82.3%, respectively) compared to the Depressive-Anxious class (50.8%, p < 0.001). The Neurodevelopmental class showed an earlier age at first mental health visit (9.5 ± 5.5 years) and a longer antecedent illness duration (10.8 ± 6.1 years) than the other classes (p < 0.001).
Conclusion
This study identified three distinct pathways to FEM and FEP, offering a transdiagnostic perspective on the antecedent illness trajectories of BD and SZ. Future research should validate these categories that are more inclusive than the classic BD versus SZ dichotomy and explore their potential for predicting illness course and guiding personalized early interventions.
{"title":"Three Distinct Pathways to First Episode Mania and Psychosis: Latent Class Analysis of Antecedent Psychopathology","authors":"Mete Ercis, Alessandro Miola, Javier Ortiz-Orendain, Vanessa K. Pazdernik, Tamahara Gonzalez-Campos, Manuel Gardea-Resendez, Peggy M. Gruhlke, Ian M. Michel, Jennifer L. Vande Voort, Alastair J. McKean, Aysegul Ozerdem, Mark A. Frye","doi":"10.1111/acps.13826","DOIUrl":"https://doi.org/10.1111/acps.13826","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the classic Kraepelinian dichotomy between bipolar disorder (BD) and schizophrenia (SZ), contemporary evidence suggests shared antecedent risk factors and similarities in the early course. This study aimed to identify distinct trajectories leading to first-episode mania (FEM) and first-episode psychosis (FEP) by examining antecedent psychopathology, including psychiatric diagnoses, symptoms, substance use, and psychotropic medication exposure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individuals born after 1985 who resided in Olmsted County, Minnesota, USA, and had FEM/FEP were identified through the Rochester Epidemiology Project. Latent class analysis (LCA) was used to identify subgroups based on antecedent psychopathology incorporating 57 dichotomous antecedent measures before FEM/FEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 202 individuals (BD <i>n</i> = 73, SZ <i>n</i> = 129; 26.7% female, mean age 20.8 ± 3.7 years) were included. A 3-class LCA model optimally fits the data. Class 1 (Neurodevelopmental, 29.7%) had a high prevalence of neurodevelopmental disorders, behavioral symptoms, and ADHD medication use. Class 2 (Depressive-Anxious, 31.2%) included depressive and anxiety disorders, mood-related symptoms, and SSRI/SNRI use. Class 3 (Minimal Psychiatric Morbidity, 39.1%) had a low prevalence of antecedent diagnoses and symptoms, with comparable substance use to other classes. There were significant diagnostic differences, with SZ being more common in the Neurodevelopmental (71.7%) and Minimal Psychiatric Morbidity (70.9%) classes, while BD was more common in the Depressive-Anxious class (<i>p</i> = 0.007). Neurodevelopmental and Minimal Psychiatric Morbidity classes had higher proportions of males (85.0% and 82.3%, respectively) compared to the Depressive-Anxious class (50.8%, <i>p</i> < 0.001). The Neurodevelopmental class showed an earlier age at first mental health visit (9.5 ± 5.5 years) and a longer antecedent illness duration (10.8 ± 6.1 years) than the other classes (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified three distinct pathways to FEM and FEP, offering a transdiagnostic perspective on the antecedent illness trajectories of BD and SZ. Future research should validate these categories that are more inclusive than the classic BD versus SZ dichotomy and explore their potential for predicting illness course and guiding personalized early interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"278-289"},"PeriodicalIF":5.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929838","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}
David R A Coelho, Jennifer Nicoloro Santabarbara, Marzieh Majd, Willians Fernando Vieira, Maura De Laney, Melis Lydston, Olindo Assis Martins-Filho, Lilian Maria Garcia Bahia-Oliveira, Joshua D Salvi, Paolo Cassano, Katherine E Burdick
Introduction: Bipolar disorder (BD) is frequently associated with cognitive dysfunction, which can significantly impact the quality of life and functional recovery of affected individuals. Growing evidence suggests that inflammation may contribute to the cognitive dysfunction observed in BD.
Methods: We conducted a systematic review following PRISMA guidelines, searching six databases on March 23, 2023 (PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, and ClinicalTrials.gov), with the aim of identifying studies that examined the relationship between peripheral or central inflammatory markers and cognitive function in adults with BD. Studies involving animals, abstracts, protocols, reviews, and non-English publications were excluded. The quality of included studies was assessed using the Risk of Bias in Non-Randomized Studies-of Exposure (ROBINS-E). A narrative synthesis was completed, stratifying results based on the associations between inflammatory markers and cognitive domains in BD. The review protocol was pre-registered in PROSPERO (CRD42023415437).
Results: Out of 2680 identified records, 25 studies involving 3567 adults with BD (mean age: 43.6 years; 1839 females and 1728 males) met the inclusion criteria. Seventeen studies were classified as low risk of bias, seven as having some concerns, and one as high risk. Elevated levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 receptor antagonist (IL-1Ra) were most commonly associated with cognitive dysfunction in domains such as executive function, processing speed, and memory. Findings for other inflammatory markers were less consistent. Most studies relied on cross-sectional designs, which limit causal interpretations.
Conclusion: This review found a consistent association between inflammation and cognitive dysfunction in BD, particularly involving CRP, TNF-α, IL-6, and IL-1RA in areas such as executive function, processing speed, and memory. Targeting inflammation may offer a promising approach to mitigating these cognitive challenges. Future studies should prioritize longitudinal designs, standardized cognitive assessments, and the exploration of central inflammatory markers to better understand the neurobiological processes underlying cognitive dysfunction in BD. These findings may help inform the development of adjunctive anti-inflammatory strategies to support cognitive health in individuals with BD.
双相情感障碍（BD）常与认知功能障碍相关，认知功能障碍可显著影响患者的生活质量和功能恢复。越来越多的证据表明，炎症可能导致认知功能障碍。我们按照PRISMA指南，于2023年3月23日检索了6个数据库（PubMed、Embase、Cochrane Library、Web of Science、PsycINFO和ClinicalTrials.gov），进行了系统综述，目的是确定外周或中枢炎症标志物与成年双相障碍患者认知功能之间关系的研究。排除了涉及动物、摘要、方案、综述和非英文出版物的研究。纳入研究的质量采用非随机暴露研究的偏倚风险（ROBINS-E）进行评估。基于炎症标志物和BD认知领域之间的关联，我们完成了一项叙述性综合研究，并对结果进行了分层。该综述方案在PROSPERO （CRD42023415437）中进行了预注册。结果：在2680份已确定的记录中，25项研究涉及3567名成年双相障碍患者(平均年龄：43.6岁；1839名女性和1728名男性)符合纳入标准。17项研究被归类为低风险偏倚，7项研究存在一些问题，1项研究被归类为高风险。c反应蛋白（CRP）、肿瘤坏死因子-α (TNF-α)、白细胞介素-6 （IL-6）和白细胞介素-1受体拮抗剂（IL-1Ra）水平升高与执行功能、处理速度和记忆等领域的认知功能障碍最常相关。其他炎症标志物的结果不太一致。大多数研究依赖于横截面设计，这限制了因果解释。结论：本综述发现炎症与双相障碍患者认知功能障碍之间存在一致的关联，特别是涉及CRP、TNF-α、IL-6和IL-1RA等领域的执行功能、处理速度和记忆。靶向炎症可能为减轻这些认知挑战提供了一种有希望的方法。未来的研究应优先考虑纵向设计，标准化的认知评估，并探索中枢炎症标志物，以更好地了解双相障碍认知功能障碍的神经生物学过程。这些发现可能有助于制定辅助抗炎策略，以支持双相障碍患者的认知健康。
{"title":"Association Between Inflammatory Markers and Cognitive Function in Adults With Bipolar Disorder: A Systematic Review.","authors":"David R A Coelho, Jennifer Nicoloro Santabarbara, Marzieh Majd, Willians Fernando Vieira, Maura De Laney, Melis Lydston, Olindo Assis Martins-Filho, Lilian Maria Garcia Bahia-Oliveira, Joshua D Salvi, Paolo Cassano, Katherine E Burdick","doi":"10.1111/acps.13824","DOIUrl":"https://doi.org/10.1111/acps.13824","url":null,"abstract":"<p><strong>Introduction: </strong>Bipolar disorder (BD) is frequently associated with cognitive dysfunction, which can significantly impact the quality of life and functional recovery of affected individuals. Growing evidence suggests that inflammation may contribute to the cognitive dysfunction observed in BD.</p><p><strong>Methods: </strong>We conducted a systematic review following PRISMA guidelines, searching six databases on March 23, 2023 (PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, and ClinicalTrials.gov), with the aim of identifying studies that examined the relationship between peripheral or central inflammatory markers and cognitive function in adults with BD. Studies involving animals, abstracts, protocols, reviews, and non-English publications were excluded. The quality of included studies was assessed using the Risk of Bias in Non-Randomized Studies-of Exposure (ROBINS-E). A narrative synthesis was completed, stratifying results based on the associations between inflammatory markers and cognitive domains in BD. The review protocol was pre-registered in PROSPERO (CRD42023415437).</p><p><strong>Results: </strong>Out of 2680 identified records, 25 studies involving 3567 adults with BD (mean age: 43.6 years; 1839 females and 1728 males) met the inclusion criteria. Seventeen studies were classified as low risk of bias, seven as having some concerns, and one as high risk. Elevated levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 receptor antagonist (IL-1Ra) were most commonly associated with cognitive dysfunction in domains such as executive function, processing speed, and memory. Findings for other inflammatory markers were less consistent. Most studies relied on cross-sectional designs, which limit causal interpretations.</p><p><strong>Conclusion: </strong>This review found a consistent association between inflammation and cognitive dysfunction in BD, particularly involving CRP, TNF-α, IL-6, and IL-1RA in areas such as executive function, processing speed, and memory. Targeting inflammation may offer a promising approach to mitigating these cognitive challenges. Future studies should prioritize longitudinal designs, standardized cognitive assessments, and the exploration of central inflammatory markers to better understand the neurobiological processes underlying cognitive dysfunction in BD. These findings may help inform the development of adjunctive anti-inflammatory strategies to support cognitive health in individuals with BD.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688430","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}
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