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Affective disorders and completed suicide by self-poisoning, trend of using antidepressants as a method of self-poisoning.

https://arctichealth.org/en/permalink/ahliterature290994
Source
Psychiatry Res. 2017 09; 255:360-366
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
09-2017
Author
Sanna Löfman
Helinä Hakko
Arja Mainio
Pirkko Riipinen
Author Affiliation
University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O.Box 5000, 90014 Oulu, Finland; Oulu University Hospital, Department of Psychiatry, PL 26, 90029 OYS, Oulu, Finland. Electronic address: sanna.lofman@student.oulu.fi.
Source
Psychiatry Res. 2017 09; 255:360-366
Date
09-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Antidepressive Agents - poisoning
Bipolar Disorder - drug therapy - psychology
Depressive Disorder, Major - drug therapy - psychology
Female
Finland
Humans
Middle Aged
Mood Disorders - drug therapy - psychology
Poisoning - psychology
Suicide - psychology - trends
Abstract
The aim of this research was to study the role and trend of antidepressant use as a method of suicide in completed self-poisoning suicides in patients with affective disorders during a 23-year follow up period. The data consisted of 483 completed self-poisoning suicides from 1988 to 2011 in the province of Oulu in Northern Finland (286 men and 197 women). Of the self-poisoning victims, 26.9% (n=130) had hospital-treated unipolar depression and 3.1% (n=15) hospital-treated bipolar disorder. Further, 53.8% (n=70) of those with unipolar depression and 53.3% (n=8) of those with bipolar depression died by suicide using antidepressants. During the 23-year follow-up period, the proportion of those using antidepressants doubled among all self-poisoning victims of suicide. A significant decline was observed in the use of tricyclic antidepressants in self- poisoning suicides while a linear increase was found in the use of SSRIs (selective serotonin reuptake inhibitors) and other antidepressants. During recent years one in five self-poisoning suicides involved the use of antiepileptics. A limitation of our study was that the psychiatric diagnoses only include hospital inpatient episodes. In conclusion, the use of new antidepressants has increased rapidly, but the risk of their use in self-poisoning suicide has perhaps been underestimated.
PubMed ID
28628870 View in PubMed
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Beliefs about medications: measurement and relationship to adherence in patients with severe mental disorders.

https://arctichealth.org/en/permalink/ahliterature154404
Source
Acta Psychiatr Scand. 2009 Jan;119(1):78-84
Publication Type
Article
Date
Jan-2009
Author
H. Jónsdóttir
S. Friis
R. Horne
K I Pettersen
A. Reikvam
O A Andreassen
Author Affiliation
Division of Psychiatry, Ulleval University Hospital & Institute of Psychiatry, University of Oslo, Oslo, Norway. halldora.jonsdottir@medisin.uio.no
Source
Acta Psychiatr Scand. 2009 Jan;119(1):78-84
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adult
Anticonvulsants - adverse effects - therapeutic use
Antidepressive Agents - adverse effects - therapeutic use
Antipsychotic Agents - adverse effects - therapeutic use
Bipolar Disorder - drug therapy - psychology
Cross-Sectional Studies
Culture
Female
Humans
Lithium Carbonate - adverse effects - therapeutic use
Male
Norway
Patient Compliance - psychology
Psychometrics
Psychotic Disorders - drug therapy - psychology
Psychotropic Drugs - adverse effects - therapeutic use
Questionnaires
Schizophrenia - drug therapy
Schizophrenic Psychology
Abstract
To determine if the Beliefs about Medicines Questionnaire (BMQ) has satisfactory psychometric properties in patients with severe mental disorders and if their scores differ from those of patients with severe medical disorders. To investigate if the scores are related to medication adherence.
Two hundred and eighty psychiatric patients completed the BMQ and reported how much of their medication they had taken the past week. Serum concentrations of medications were analyzed. BMQ scores were compared with those of patients with chronic medical disorders.
Cronbach's alpha was satisfactory for all subscales. The psychiatric group scored lower on the necessity of taking medication than the medical group. Non-adherent patients felt medication to be less necessary and were more concerned about it than adherent patients. The necessity subscale predicted adherence fairly well.
The BMQ has satisfactory psychometric properties for use in patients with severe mental disorders. The constructs measured by the BMQ are related to adherence in these patients.
PubMed ID
18983630 View in PubMed
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Depressive and bipolar disorders: patients' attitudes and beliefs towards depression and antidepressants.

https://arctichealth.org/en/permalink/ahliterature45660
Source
Psychol Med. 2005 Aug;35(8):1205-13
Publication Type
Article
Date
Aug-2005
Author
Lars Vedel Kessing
Hanne Vibe Hansen
Koen Demyttenaere
Per Bech
Author Affiliation
Department of Psychiatry, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark. lars.kessing@rh.dk
Source
Psychol Med. 2005 Aug;35(8):1205-13
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adult
Antidepressive Agents - therapeutic use
Attitude to Health
Bipolar Disorder - drug therapy - psychology
Culture
Depressive Disorder - drug therapy - psychology
Female
Humans
Male
Questionnaires
Research Support, Non-U.S. Gov't
Abstract
BACKGROUND: There is increasing evidence that attitudes and beliefs are important in predicting adherence to treatment and medication in depressive and bipolar disorders. However, these attitudes have received little study in patients whose disorders were sufficiently severe to require hospitalization. METHOD: The Antidepressant Compliance Questionnaire (ADCQ) was mailed to a large population of patients with depressive or bipolar disorder, representative of patients treated in hospital settings in Denmark. RESULTS: Of the 1005 recipients, 49.9% responded to the letter. A large proportion of the patients (40-80%) had erroneous views as to the effect of antidepressants. Older patients (over 40 years of age) consistently had a more negative view of the doctor-patient relationship, more erroneous ideas concerning the effect of antidepressants and a more negative view of antidepressants in general. Moreover, their partners agreed on these negative views. Women had a more negative view of the doctor-patient relationship than men, and patients with a depressive disorder had a more negative view of antidepressants than patients with bipolar disorder. The number of psychiatric hospitalizations or the type of treating physician (general practitioner, psychiatrist in private practice, community psychiatrist, hospital psychiatrist, other doctor) did not affect attitudes and beliefs. CONCLUSION: Lack of knowledge about affective disorder and its treatment and a critical attitude, especially among older patients, may add to an adverse prognosis of depressive and bipolar disorders.
PubMed ID
16116946 View in PubMed
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Incidence of and risk factors for delirium among psychiatric inpatients.

https://arctichealth.org/en/permalink/ahliterature211595
Source
Psychiatr Serv. 1996 Jul;47(7):727-30
Publication Type
Article
Date
Jul-1996
Author
J. Ritchie
W. Steiner
M. Abrahamowicz
Author Affiliation
Department of Psychiatry, McGill University, Montreal General Hospital, Quebec, Canada.
Source
Psychiatr Serv. 1996 Jul;47(7):727-30
Date
Jul-1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antiparkinson Agents - adverse effects - therapeutic use
Bipolar Disorder - drug therapy - psychology
Cross-Sectional Studies
Delirium - chemically induced - diagnosis - epidemiology
Female
Humans
Male
Mental Disorders - drug therapy - psychology
Middle Aged
Patient Admission
Psychotropic Drugs - adverse effects - therapeutic use
Quebec - epidemiology
Retrospective Studies
Risk factors
Schizophrenia - drug therapy
Schizophrenic Psychology
Abstract
The presence and effects of delirium among psychiatric patients are not well understood. This study investigated incidence rates and risk factors for delirium among hospitalized psychiatric patients.
The charts of 199 patients admitted over a one-year period to a tertiary care teaching hospital were retrospectively reviewed. Demographic and medication variables were analyzed using multiple logistic regression. Delirium was diagnosed retrospectively using DSM-III-R criteria.
The overall incidence of delirium in the study sample was 14.6 percent. Delirium was most common among patients with schizophrenia and bipolar disorder; patients with bipolar disorder had the highest incidence (35.5 percent). Only 48 percent of delirious patients were actually recognized as having delirium at the time it occurred. Antiparkinsonian medications were the only medications significantly associated with delirium; lithium was not an independent risk factor. Older age was the only significant demographic risk variable. The hospital stays of patients with delirium were 62.1 percent longer than those of patients without delirium.
Patients with bipolar disorder appeared to be at higher risk for developing delirium, whether or not lithium was used in treatment. This finding may reflect an inherent predisposition to delirium among these patients. Alternatively, the combination of medications used in treating patients with bipolar disorder may be a risk factor.
PubMed ID
8807686 View in PubMed
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Predictors of adherence to psychopharmacological and psychosocial treatment in bipolar I or II disorders - an 18-month prospective study.

https://arctichealth.org/en/permalink/ahliterature256381
Source
J Affect Disord. 2014 Feb;155:110-7
Publication Type
Article
Date
Feb-2014
Author
Petri Arvilommi
Kirsi Suominen
Outi Mantere
Sami Leppämäki
Hanna Valtonen
Erkki Isometsä
Author Affiliation
Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Psychiatric and substance abuse services, Helsinki City Department of Social Services and Health Care, Helsinki, Finland.
Source
J Affect Disord. 2014 Feb;155:110-7
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - therapeutic use
Bipolar Disorder - drug therapy - psychology - therapy
Depression - psychology
Diagnostic and Statistical Manual of Mental Disorders
Female
Finland
Follow-Up Studies
Humans
Male
Middle Aged
Patient Compliance - psychology - statistics & numerical data
Prospective Studies
Psychotherapy
Abstract
Poor treatment adherence among patients with bipolar disorder (BD) is a common clinical problem. However, whether adherence is mostly determined by patient characteristics or attitudes, type of treatment or treatment side-effects remains poorly known.
The Jorvi Bipolar Study (JoBS) is a naturalistic prospective 18-month study representing psychiatric in- and outpatients with DSM-IV BD I and II in three Finnish cities. During the 18-month follow-up we investigated the continuity of, attitudes towards and adherence to various types of psychopharmacological and psychosocial treatments among 168 psychiatric in- and outpatients with BD I or II.
One-quarter of the patients using mood stabilizers or atypical antipsychotics discontinued medication during at least one treatment phase of the follow-up autonomously, mostly during depression. When pharmacotherapy continued, adherence was compromised in one-third. Rates of non-adherence to mood stabilizers or antipsychotics did not differ, but the predictors did. One-quarter of the patients receiving psychosocial treatments were non-adherent to them.
Serum concentrations were not estimated.
More than one-half of BD patients either discontinue pharmacotherapy or use it irregularly. Autonomous discontinuation takes place mostly in depression. Although rates of non-adherence do not necessarily differ between mood-stabilizing medications, the predictors for nonadherence do. Moreover, adherence to one medication does not guarantee adherence to another, nor does adherence at one time-point ensure later adherence. Attitudes towards treatments affect adherence to medications as well as to psychosocial treatments and should be repeatedly monitored. Non-adherence to psychosocial treatment should be given more attention.
PubMed ID
24262639 View in PubMed
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[Psychosocial determinants of lithium compliance in patients with bipolar disorder].

https://arctichealth.org/en/permalink/ahliterature199332
Source
Can J Nurs Res. 1999 Sep;31(2):25-40
Publication Type
Article
Date
Sep-1999
Author
J P Bonin
Author Affiliation
l'Université de Montréal en sciences infirmières.
Source
Can J Nurs Res. 1999 Sep;31(2):25-40
Date
Sep-1999
Language
French
Publication Type
Article
Keywords
Adult
Antimanic Agents - therapeutic use
Bipolar Disorder - drug therapy - psychology
Female
Health Knowledge, Attitudes, Practice
Hospitals, Psychiatric
Humans
Lithium Chloride - therapeutic use
Logistic Models
Male
Models, Psychological
Outpatients - psychology
Patient Compliance - psychology - statistics & numerical data
Quebec
Questionnaires
Risk factors
Socioeconomic Factors
Abstract
Physical, cognitive, and social factors play a central role in the lithium compliance of people with bipolar disorder. However, studies provide only a partial understanding of this phenomenon and there is currently no nursing model that takes into consideration a combination of factors. This study, based on Pender's preventive health beliefs model, was intended to identify the psychosocial determinants of lithium compliance. A random sample (n = 149) of outpatients at a large Montreal psychiatric hospital was used to measure lithium compliance on the basis of 5 criteria: compliance according to the nurse and according to the patient, appointment compliance, and compliance according to two criteria related to hyperuricemia. Polytomous logistic regression analyses were computed by regressing a composite of these criteria on sociodemographic variables and on the variables of the Pender model: susceptibility, seriousness, control over health, motivation to be healthy, perceived benefits and obstacles, and triggering factors. It appears that being female, being elderly, living with a partner, and perceived treatment benefits and obstacles are determining factors in lithium compliance. These results are all the more important in light of Quebec's newly implemented drug insurance plan, which could increase the obstacles to medication. Nurses will have to be increasingly vigilant with respect to these new obstacles and will have to adjust their interventions accordingly.
PubMed ID
10696158 View in PubMed
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Suicidal Behavior During Lithium and Valproate Treatment: A Within-Individual 8-Year Prospective Study of 50,000 Patients With Bipolar Disorder.

https://arctichealth.org/en/permalink/ahliterature285048
Source
Am J Psychiatry. 2017 Aug 01;174(8):795-802
Publication Type
Article
Date
Aug-01-2017
Author
Jie Song
Arvid Sjölander
Erik Joas
Sarah E Bergen
Bo Runeson
Henrik Larsson
Mikael Landén
Paul Lichtenstein
Source
Am J Psychiatry. 2017 Aug 01;174(8):795-802
Date
Aug-01-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antimanic Agents - adverse effects - therapeutic use
Bipolar Disorder - drug therapy - psychology
Female
Humans
Information Storage and Retrieval - statistics & numerical data
Lithium Compounds - adverse effects - therapeutic use
Longitudinal Studies
Male
Middle Aged
Proportional Hazards Models
Registries - statistics & numerical data
Risk
Suicide - prevention & control - psychology - statistics & numerical data
Suicide, Attempted - prevention & control - psychology - statistics & numerical data
Sulfates - adverse effects - therapeutic use
Sweden
Valproic Acid - adverse effects - therapeutic use
Young Adult
Abstract
Conclusions regarding lithium's antisuicidal effect for bipolar disorder have been limited due to nonrepresentative subjects and potential confounding factors, including varying severity of illness. Findings regarding the effect of valproate, the most common alternative to lithium, are inconsistent for suicidal behavior. This study investigated the associations of these two drugs with the risk of suicide-related events, and possible differences between drugs, by using within-individual designs in a register-based longitudinal cohort.
Through linkage of multiple Swedish national registers, 51,535 individuals with bipolar disorder were followed from 2005 to 2013 for treatment with lithium and valproate. Stratified Cox regression was used to estimate the hazard ratios of suicide-related events during treated periods compared with untreated periods. For significant associations between medication and suicide-related events, the population attributable fraction was estimated to assess the public health impact for patients with bipolar disorder.
During follow-up, 10,648 suicide-related events occurred. The incidence rate was significantly decreased by 14% during lithium treatment (hazard ratio 0.86, 95% confidence interval [CI] 0.78-0.95) but not during valproate treatment (hazard ratio 1.02, 95% CI 0.89-1.15). The difference in hazard ratios of suicide-related events between lithium and valproate was statistically significant. Estimates of the population attributable fraction suggested that 12% (95% CI 4%-20%) of suicide-related events could have been avoided if patients had taken lithium during the entire follow-up.
The results suggest that lithium should be considered for patients with bipolar disorder with suspected suicidal intentions, although risk for suicide is only one of the considerations when providing clinical care.
PubMed ID
28595491 View in PubMed
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Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study.

https://arctichealth.org/en/permalink/ahliterature278552
Source
Acta Neuropsychiatr. 2016 Apr;28(2):75-84
Publication Type
Article
Date
Apr-2016
Author
Louise Bjørklund
Henriette Thisted Horsdal
Ole Mors
Søren Dinesen Østergaard
Christiane Gasse
Source
Acta Neuropsychiatr. 2016 Apr;28(2):75-84
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antidepressive Agents - therapeutic use
Bipolar Disorder - drug therapy - psychology
Child
Denmark
Drug Therapy - trends
Female
Humans
Male
Middle Aged
Registries
Retrospective Studies
Young Adult
Abstract
In bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy.
Cohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest.
We identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants.
The results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.
PubMed ID
26357986 View in PubMed
Less detail

Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study.

https://arctichealth.org/en/permalink/ahliterature134379
Source
Br J Psychiatry. 2011 Jul;199(1):57-63
Publication Type
Article
Date
Jul-2011
Author
Lars Vedel Kessing
Gunnar Hellmund
John R Geddes
Guy M Goodwin
Per Kragh Andersen
Author Affiliation
Psychiatric Center Copenhagen, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. lars.vedel.kessing@regionh.dk
Source
Br J Psychiatry. 2011 Jul;199(1):57-63
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antimanic Agents - therapeutic use
Antipsychotic Agents - therapeutic use
Bipolar Disorder - drug therapy - psychology
Denmark - epidemiology
Drug Substitution
Epidemiologic Methods
Female
Hospitalization - statistics & numerical data
Hospitals, Psychiatric - statistics & numerical data
Humans
Lithium Compounds - therapeutic use
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Valproic Acid - therapeutic use
Young Adult
Abstract
Valproate is one of the most used mood stabilisers for bipolar disorder, although the evidence for the effectiveness of valproate is sparse.
To compare the effect of valproate v. lithium for treatment of bipolar disorder in clinical practice.
An observational cohort study with linkage of nationwide registers of all people with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed valproate or lithium in Denmark during a period from 1995 to 2006.
A total of 4268 participants were included among whom 719 received valproate and 3549 received lithium subsequent to the diagnosis of bipolar disorder. The rate of switch/add on to the opposite drug (lithium or valproate), antidepressants, antipsychotics or anticonvulsants (other than valproate) was increased for valproate compared with lithium (hazard ratio (HR) = 1.86, 95% CI 1.59-2.16). The rate of psychiatric hospital admissions was increased for valproate v. lithium (HR = 1.33, 95% CI 1.18-1.48) and regardless of the type of episode leading to a hospital admission (depressive or manic/mixed). Similarly, for participants with a depressive index episode (HR = 1.87, 95% CI 1.40-2.48), a manic index episode (HR = 1.24, 95% CI 1.01-1.51) and a mixed index episode (HR = 1.44, 95% CI 1.04-2.01), the overall rate of hospital admissions was significantly increased for valproate compared with lithium.
In daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate.
Notes
Comment In: Br J Psychiatry. 2011 Oct;199(4):341-221965836
PubMed ID
21593515 View in PubMed
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