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30-Day Mortality after Cardiovascular Events in Persons with or without Alzheimer's Disease.

https://arctichealth.org/en/permalink/ahliterature274270
Source
J Alzheimers Dis. 2015;48(1):241-9
Publication Type
Article
Date
2015
Author
Jari Heiskanen
Sirpa Hartikainen
Risto P Roine
Anna-Maija Tolppanen
Source
J Alzheimers Dis. 2015;48(1):241-9
Date
2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - epidemiology - mortality
Cardiovascular Diseases - epidemiology - mortality
Cohort Studies
Female
Finland - epidemiology
Hemorrhagic Disorders
Humans
Male
Morbidity
Myocardial Infarction
Outcome Assessment (Health Care)
Proportional Hazards Models
Residence Characteristics
Stroke
Abstract
Persons with Alzheimer's disease (AD) have been suggested to receive suboptimal treatment. We studied the 30-day mortality after ischemic stroke, hemorrhagic stroke, or myocardial infarction in individuals with or without AD.
An exposure matched cohort of all Finnish community-dwellers diagnosed with clinically verified AD in 2005-2012 (n?=?73,005) and 1-4 matched comparison persons/AD-affected person (n?=?215,449). Data on 30-day mortality after ischemic stroke (n?=?16,419; deaths: n?=?2,748), hemorrhagic stroke (n?=?3,570; deaths: n?=?1,224), and myocardial infarction (n?=?15,304; deaths: n?=?3,804) were obtained from the National Hospital Discharge register. The main analyses were restricted to first-ever events.
Persons with AD had slightly higher 30-day mortality after ischemic stroke (adjusted HR 1.36, 95% Confidence interval (CI) 1.24,1.49), hemorrhagic stroke (adjusted HR 1.11, 95% CI 0.98,1.25), or myocardial infarction (adjusted HR, 1.40, 9% CI 1.30,1.51). The associations were not affected by age, gender, or co-morbidities and remained similar when patients with previous ischemic strokes or infarctions were included. The absolute risk increase in 30-day mortality after ischemic or hemorrhagic stroke and myocardial infarction were 4.9% (95% CI 3.3,6.5), 3.3% (95% CI - 1.6,8.2), and 7.5% (95% CI 5.0,10.0), respectively.
Although the 30-day mortality was somewhat higher in the AD cohort, the absolute differences were small indicating that acute treatment was not notably inferior in AD patients. The slightly higher mortality was not explained by co-morbidities but may reflect the higher mortality of AD persons in general, or treatment practice of patients with severe cognitive impairment.
PubMed ID
26401944 View in PubMed
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Achievements and shortcomings of Finnish asthma care.

https://arctichealth.org/en/permalink/ahliterature15137
Source
Scand J Public Health. 2004;32(4):310-6
Publication Type
Article
Date
2004
Author
Pekka Ikäheimo
Tuili Tuuponen
Sirpa Hartikainen
Jorma Kiuttu
Timo Klaukka
Author Affiliation
Department of Public Health Science and General Practice, University of Oulu, Finland. pekka.ikaheimo@oulu.fi, pekka.ikaheimo@dnainternet.net
Source
Scand J Public Health. 2004;32(4):310-6
Date
2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Female
Finland
Humans
Male
Middle Aged
Practice Guidelines
Research Support, Non-U.S. Gov't
Abstract
BACKGROUND: The Finnish National Asthma Programme was launched in 1994. AIM: A postal self-completion questionnaire study was undertaken to evaluate how the guideline is working in the Finnish healthcare system. METHODS: A postal inquiry was sent to a random sample of 6,000 subjects aged 16+ years who were entitled to special reimbursement for anti-asthmatic medication and 4,657 subjects with self-reported asthma were included. RESULTS: The subjects comprised 38% men (n=1,781) and 62% women (n=2,876). In all, 62% of all the subjects and 78% of those with severe asthma had visited a doctor on account of asthma in the past 12 months. Some 83% of the respondents had a given physician who was responsible for treating their asthma, and 75% of these were under observation by a primary healthcare physician. Visits to asthma nurses were relatively rare. Inhaled glucocorticoids were used by 83% of the subjects, but short-acting beta-2-agonists were still the most commonly used asthma drug in monotherapy regardless of the severity of asthma. Inhaled glucocorticoids and a short-acting beta-2-agonist was the most frequent combination. Every tenth subject used this combination supplemented by a long-acting beta-2-agonist. CONCLUSION: Asthma care in Finland seems to be compatible with the national guidelines in terms of continuity and the common use of inhaled glucocorticoids. The primary care sector has adopted the main responsibility for the treatment of asthma. The common use of short-acting beta-2-agonists is an exception to an otherwise positive trend.
PubMed ID
15370772 View in PubMed
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Adverse drug effects in elderly people -- a disparity between clinical examination and adverse effects self-reported by the patient.

https://arctichealth.org/en/permalink/ahliterature164731
Source
Eur J Clin Pharmacol. 2007 May;63(5):509-15
Publication Type
Article
Date
May-2007
Author
Pasi Lampela
Sirpa Hartikainen
Raimo Sulkava
Risto Huupponen
Author Affiliation
Department of Pharmacology and Toxicology, University of Kuopio, P.O. Box 1627, 70211, Kuopio, Finland. Pasi.Lampela@uku.fi
Source
Eur J Clin Pharmacol. 2007 May;63(5):509-15
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems - statistics & numerical data
Aged
Aged, 80 and over
Data Collection - methods
Drug-Related Side Effects and Adverse Reactions
Female
Finland
Geriatric Assessment - methods
Humans
Male
Physicians - statistics & numerical data
Polypharmacy
Reproducibility of Results
Abstract
The trend towards polypharmacy is increasing among the elderly, and associated with this trend is an increased risk of adverse drug effects and drug-drug interactions. Our objective was to assess whether drug adverse effects reported by patients are in general agreement with those identified by a physician.
We evaluated the medication of 404 randomly selected individuals aged 75 years or older by means of interviews carried out by trained nurses and examinations conducted by a physician. The medication used by these patients was recorded prior to the physician's examination and modified thereafter if considered appropriate. Adverse effects noted by the physician were compared to those self-reported by the patients.
Almost all of the patients (98.8%) were using at least one drug, and the mean total number of drugs used was 6.5. Adverse effects were self-reported by 11.4% of the patients, whereas the physician observed apparent adverse drug effects in 24.0% of the patients. No adverse effects were reported in 53.2% of the patients. There were only seven patients that had adverse effects that were both self-reported and identified by the physician, and only four of these patients reported the same adverse effect that had been identified by the physician.
There was a great disparity between the adverse effects identified by the physician and those reported by the patients themselves. Based on our results, it would appear that elderly people tend to neglect adverse drug effects and may consider them to be an unavoidable part of normal ageing. Therefore, physicians should enquire about possible adverse effects even though elderly patients may not complain of any drug-related problems.
Notes
Comment In: Eur J Clin Pharmacol. 2007 Oct;63(10):979-80; author reply 98117618426
PubMed ID
17351768 View in PubMed
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Analgesics in postoperative care in hip fracture patients with dementia - reported by nurses.

https://arctichealth.org/en/permalink/ahliterature268599
Source
J Clin Nurs. 2014 Nov;23(21-22):3095-106
Publication Type
Article
Date
Nov-2014
Author
Maija Rantala
Sirpa Hartikainen
Tarja Kvist
Päivi Kankkunen
Source
J Clin Nurs. 2014 Nov;23(21-22):3095-106
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Acetaminophen - administration & dosage
Adult
Aged
Aged, 80 and over
Analgesics - administration & dosage
Analgesics, Opioid - administration & dosage
Attitude of Health Personnel
Cross-Sectional Studies
Dementia
Drug Administration Schedule
Female
Finland
Hip Fractures - surgery
Humans
Male
Middle Aged
Pain, Postoperative - drug therapy - nursing
Postoperative Care - nursing
Surveys and Questionnaires
Abstract
To describe the analgesic use in hip fracture patients with dementia during the first two postoperative days as reported by nurses.
Nurses play a pivotal role in treating postoperative pain in patients with dementia and monitoring the effects of administered analgesics.
Cross-sectional descriptive questionnaire study in seven university hospitals and 10 central hospitals in Finland.
The study was conducted from March until May in 2011 in Finland. For this analysis, the focus was on the sample of nurses (n = 269) who were working in orthopaedic units. Analgesics were classified according to the Anatomical Therapeutic Chemical Classification System. Nonparametric tests were applied to find out the significant differences between analgesic use and different hospitals.
Paracetamol and strong opioids administered orally or parenterally seemed to be the most typical of postoperatively used types of analgesics in patients with dementia. Nonsteroidal anti-inflammatory analgesics and weak opioids were also commonly reported to be in use. There were no statistically significant differences between hospitals in typical daily doses. The majority of the nurses reported that the primary aim of postoperative pain management in hip fracture patients with dementia was 'slight pain, which does not prevent normal functioning' (72%).
The pharmacological postoperative pain treatment in acute care was commonly based on the use of strong opioids and paracetamol in hip fracture patients with dementia. The reported use of transdermal opioids and codeine combination warrants further examination. Further studies are also needed to find out whether the pain is appropriately and adequately treated.
Transdermal opioids and codeine combination may not be relevant analgesics for acute pain management in older adults. It is important to create a balance between sufficient pain relief and adverse effects of analgesics to allow early mobilisation and functional recovery.
PubMed ID
24476197 View in PubMed
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Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study.

https://arctichealth.org/en/permalink/ahliterature142226
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Publication Type
Article
Date
Jun-2010
Author
Niina Pokela
J Simon Bell
Katri Lihavainen
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Analgesics - therapeutic use
Analgesics, Opioid - therapeutic use
Cross-Sectional Studies
Data Collection
Depression - complications
Female
Finland
Health status
Humans
Male
Multivariate Analysis
Pain - drug therapy
Polypharmacy
Residence Characteristics - statistics & numerical data
Sex Factors
Abstract
Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics.
The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged >or=75 years, and to investigate factors associated with daily and as-needed analgesic use.
A random sample of people aged >or=75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good).
Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of >or=1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95 degrees % CI, 1.17-2.71]), living alone (OR, 1.46 [95 degrees % CI, 1.02-2.11]), poor self-rated health (OR, 2.6 [95% CI, 1.22-3.84]), and use of >or=10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26-3.87]). Among users of >or=1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.175.14]) and poor (OR, 2.57 [95% CI, 1.03-6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04-0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics.
Analgesics were used by approximately 50% of community-dwelling people aged >or=75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of >or=10 nonanalgesic drugs.
PubMed ID
20624613 View in PubMed
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Anticholinergic burden and dry mouth among Finnish, community-dwelling older adults.

https://arctichealth.org/en/permalink/ahliterature294919
Source
Gerodontology. 2018 Mar; 35(1):3-10
Publication Type
Journal Article
Date
Mar-2018
Author
Antti Tiisanoja
Anna-Maija Syrjälä
Kaija Komulainen
Pasi Lampela
Sirpa Hartikainen
Heidi Taipale
Matti Knuuttila
Pekka Ylöstalo
Author Affiliation
Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.
Source
Gerodontology. 2018 Mar; 35(1):3-10
Date
Mar-2018
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Cholinergic Antagonists - adverse effects - therapeutic use
Finland - epidemiology
Humans
Independent living
Male
Poisson Distribution
Saliva - secretion
Xerostomia - chemically induced - epidemiology
Abstract
The aim was to study whether the anticholinergic burden of drugs is related to xerostomia and salivary secretion among community-dwelling elderly people.
Anticholinergic drugs have been shown to be a risk factor for dry mouth, but little is known about the effects of cumulative exposure to anticholinergic drugs measured by anticholinergic burden on salivary secretion or xerostomia.
The study population consisted of 152 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS). A Poisson regression model with robust error variance was used to estimate relative risks (RR) with 95% confidence intervals (CI 95%).
Participants with a high-anticholinergic burden (ADS = 3) were more likely to have xerostomia (RR: 3.17; CI: 1.44-6.96), low-unstimulated salivary flow (
PubMed ID
28940566 View in PubMed
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Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study.

https://arctichealth.org/en/permalink/ahliterature115704
Source
Drugs Aging. 2013 May;30(5):321-30
Publication Type
Article
Date
May-2013
Author
Pasi Lampela
Piia Lavikainen
J Arturo Garcia-Horsman
J Simon Bell
Risto Huupponen
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, 70211 Kuopio, Finland. Pasi.Lampela@uef.fi
Source
Drugs Aging. 2013 May;30(5):321-30
Date
May-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Animals
Cerebral Cortex - metabolism
Cholinergic Antagonists - adverse effects - blood - therapeutic use
Depression - prevention & control
Female
Finland
Geriatric Assessment
Humans
Male
Mental Status Schedule
Pulmonary Disease, Chronic Obstructive - drug therapy
Rats
Rats, Wistar
Urinary Bladder, Overactive - drug therapy
Abstract
The serum anticholinergic activity (SAA) assay has been used to quantify patients' anticholinergic load. In addition, several ranked lists of anticholinergic drugs have been developed to assess anticholinergic drug burden.
This study investigated whether SAA assay results and scores from three ranked lists of anticholinergic drugs (Carnahan's Anticholinergic Drug Scale, Rudolph's Anticholinergic Risk Scale, and Chew's list) are associated with anticholinergic adverse drug events (ADEs) in older people.
We analyzed data from participants in the population-based Geriatric Multidisciplinary Good Care of the Elderly Study in Kuopio, Finland (n = 621). Demographic, diagnostic, and drug use data were collected during standardized interviews and verified from medical records. Vision, functional capacity, cognition, and mood were assessed using validated techniques. The SAA was measured from blood samples.
The SAA was not associated with anticholinergic ADEs. Anticholinergic drug burden computed using each of the three lists was inversely associated with short-distance vision (p 
Notes
Comment In: J Urol. 2014 Aug;192(2):49025035017
PubMed ID
23475596 View in PubMed
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Antidementia drug use among community-dwelling individuals with Alzheimer's disease in Finland: a nationwide register-based study.

https://arctichealth.org/en/permalink/ahliterature260126
Source
Int Clin Psychopharmacol. 2014 Jul;29(4):216-23
Publication Type
Article
Date
Jul-2014
Author
Heidi Taipale
Antti Tanskanen
Marjaana Koponen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
Int Clin Psychopharmacol. 2014 Jul;29(4):216-23
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy
Cholinesterase Inhibitors - adverse effects - therapeutic use
Cohort Studies
Diagnostic and Statistical Manual of Mental Disorders
Drug Monitoring
Drug Prescriptions
Drug Therapy, Combination - adverse effects
Excitatory Amino Acid Antagonists - adverse effects - therapeutic use
Female
Finland
Follow-Up Studies
Galantamine - adverse effects - therapeutic use
Guideline Adherence
Humans
Indans - adverse effects - therapeutic use
Male
Memantine - adverse effects - therapeutic use
Nootropic Agents - adverse effects - therapeutic use
Phenylcarbamates - adverse effects - therapeutic use
Piperidines - adverse effects - therapeutic use
Practice Guidelines as Topic
Proportional Hazards Models
Registries
Abstract
The objective of this study was to investigate the prevalence of acetylcholinesterase inhibitor (AChEI) and memantine use, duration of treatment, concomitant use of these drugs, and factors associated with the discontinuation of AChEI therapy during 2006-2009. We utilized data from a nationwide sample of community-dwelling individuals with a clinically verified Alzheimer's disease diagnosed during the year 2005 (n=6858) as a part of the MEDALZ-2005 study. During the 4-year follow-up, 84% used AChEI and 47% used memantine. Altogether, 22% of the sample used both drugs concomitantly. The median duration of the first AChEI use period was 860 (interquartile range 295-1458) days and 1103 (interquartile range 489-1487) days for the total duration of AChEI use. Although 20% of the AChEI users discontinued the use during the first year, over half of them restarted later. The risk of discontinuation was higher for rivastigmine [hazard ratio 1.34 (confidence interval 1.22-1.48)] and galantamine users [hazard ratio 1.23 (confidence interval 1.15-1.37)] compared with donepezil users in the adjusted model. In conclusion, median time for AChEI use was over 3 years and every fifth Alzheimer's disease patient used AChEI and memantine concomitantly during the follow-up. The low rate of discontinuation is consistent with the Finnish Care Guideline but in contrast to the results reported from many other countries.
Notes
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PubMed ID
24608822 View in PubMed
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Antidepressant use and risk of hip fractures among community-dwelling persons with and without Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature292637
Source
Int J Geriatr Psychiatry. 2017 12; 32(12):e107-e115
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-2017
Author
Sanna Torvinen-Kiiskinen
Anna-Maija Tolppanen
Marjaana Koponen
Antti Tanskanen
Jari Tiihonen
Sirpa Hartikainen
Heidi Taipale
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Int J Geriatr Psychiatry. 2017 12; 32(12):e107-e115
Date
12-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - complications
Antidepressive Agents - therapeutic use
Female
Finland - epidemiology
Hip Fractures - epidemiology
Hospitalization - statistics & numerical data
Humans
Male
Proportional Hazards Models
Retrospective Studies
Risk factors
Abstract
To study whether antidepressant use is associated with an increased risk of hip fracture among community-dwelling persons with and without Alzheimer's disease (AD), and to compare the risk according to duration of use and between antidepressant groups.
Retrospective cohort study, including 50,491 persons with AD (mean age 80) and 100,982 comparison persons without AD from Finnish register-based MEDALZ cohort. Antidepressant use was compared with nonuse with Cox proportional hazard models. Incident users were identified with a one year washout period from Prescription register data. Main outcome was hospitalization due to hip fracture.
During antidepressant use, the age-adjusted rate of hip fractures per 100 person-years was 3.01 (95% CI 2.75-3.34) among persons with and 2.28 (1.94-2.61) among persons without AD. Antidepressant use was associated with an increased risk of hip fracture among persons with and without AD (adjusted HR 1.61, 95% CI 1.45-1.80 and 2.71, 2.35-3.14, respectively) compared with nonuse. The risk was most prominent in the beginning of use and was elevated even up to 4 years. The risk was increased with all of the most frequently used antidepressants.
Antidepressant use is associated with an increased risk of hip fracture among older persons. Copyright © 2017 John Wiley & Sons, Ltd.
Notes
CommentIn: Evid Based Nurs. 2017 Jul;20(3):94 PMID 28601807
PubMed ID
28055139 View in PubMed
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Antipsychotic doses among community-dwelling persons with Alzheimer disease in Finland.

https://arctichealth.org/en/permalink/ahliterature266764
Source
J Clin Psychopharmacol. 2014 Aug;34(4):435-40
Publication Type
Article
Date
Aug-2014
Author
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
J Clin Psychopharmacol. 2014 Aug;34(4):435-40
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology - psychology
Antipsychotic Agents - administration & dosage
Cohort Studies
Dose-Response Relationship, Drug
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Residence Characteristics
Abstract
Use of antipsychotics for treatment of behavioral and psychological symptoms of dementia is frequent among persons with Alzheimer disease (AD). Doses used in long-term therapy have not been previously reported. We describe antipsychotic doses used among community-dwelling persons with AD and investigate factors associated with high-dose use. The MEDALZ-2005 (Medication use and Alzheimer disease) cohort is a nationwide sample including all persons with clinically diagnosed AD at the end of year 2005 in Finland (n = 28,093). Data including prescriptions, comorbidities, and hospital discharge diagnoses were collected from nationwide registers. Antipsychotic doses in monotherapy were investigated during 2006 to 2009. Among 8920 antipsychotic users, 4% (n = 336) used antipsychotics with high dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics. High-dose use was associated with younger age (
PubMed ID
24875073 View in PubMed
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116 records – page 1 of 12.