Diego Antolín-Concha1, Markku Lähteenvuo2, Pia Vattulainen3, Antti Tanskanen4, Heidi Taipale5, Eduard Vieta6, Jari Tiihonen7. 1. University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen). 2. University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen). Electronic address: markku.lahteenvuo@niuva.fi. 3. EPID Research Oy, Espoo, Finland (Vattulainen). 4. University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Tanskanen, Taipale, Tiihonen); National Institute for Health and Welfare, Impact Assessment Unit, Helsinki, Finland (Tanskanen). 5. University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Tanskanen, Taipale, Tiihonen); School of Pharmacy, University of Eastern Finland, Kuopio, Finland (Taipale). 6. Institute of Neurosience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Vieta). 7. University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Tanskanen, Taipale, Tiihonen); Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen).
Abstract
BACKGROUND: Knowledge on the comparative effectiveness of pharmacological treatments to prevent suicide mortality in bipolar disorder is still lacking. METHODS: We studied the risk of suicide mortality during 1996-2012 among all patients who had been hospitalized due to bipolar disorder in Finland (n = 18,018; mean follow-up time 7.2 years) using nation-wide databases. We used a Cox proportional hazards model. Analyses were adjusted for the effects of time since diagnosis, order of treatments, current use of other treatments, polypharmacy, number of suicidal hospitalizations within 2 year (indicator of inherent risk of relapse), age at index date, sex, and calendar year of index date. In secondary analysis, the first 30 days were omitted from analysis after initiation of a psychopharmacological treatment to control for protopathic bias. RESULTS: In comparison between use and no use among specific agents, only lithium (HR 0.33, 95%CI 0.24-0.47, p<0.0001) and valproic acid (HR 0.61, 95%CI 0.48-0.79, p=0.0002) were associated with a significantly decreased risk of suicide in bipolar disorder. Lithium showed a 42% lower risk for suicide mortality compared to valproic acid (HR 0.58, 95% CI 0.39-0.86, p = 0.007). Hypnotics were associated with a significantly (HR 1.52, 95%CI 1.22-1.90, p=0.0002) higher risk of suicide. LIMITATIONS: Only hospitalized patients were included. CONCLUSIONS: Lithium should be considered as treatment of choice for patients with bipolar disorder who are at high risk for suicide. Hypnotic use among suicidal patients indicates need for close monitoring of these patients.
BACKGROUND: Knowledge on the comparative effectiveness of pharmacological treatments to prevent suicide mortality in bipolar disorder is still lacking. METHODS: We studied the risk of suicide mortality during 1996-2012 among all patients who had been hospitalized due to bipolar disorder in Finland (n = 18,018; mean follow-up time 7.2 years) using nation-wide databases. We used a Cox proportional hazards model. Analyses were adjusted for the effects of time since diagnosis, order of treatments, current use of other treatments, polypharmacy, number of suicidal hospitalizations within 2 year (indicator of inherent risk of relapse), age at index date, sex, and calendar year of index date. In secondary analysis, the first 30 days were omitted from analysis after initiation of a psychopharmacological treatment to control for protopathic bias. RESULTS: In comparison between use and no use among specific agents, only lithium (HR 0.33, 95%CI 0.24-0.47, p<0.0001) and valproic acid (HR 0.61, 95%CI 0.48-0.79, p=0.0002) were associated with a significantly decreased risk of suicide in bipolar disorder. Lithium showed a 42% lower risk for suicide mortality compared to valproic acid (HR 0.58, 95% CI 0.39-0.86, p = 0.007). Hypnotics were associated with a significantly (HR 1.52, 95%CI 1.22-1.90, p=0.0002) higher risk of suicide. LIMITATIONS: Only hospitalized patients were included. CONCLUSIONS:Lithium should be considered as treatment of choice for patients with bipolar disorder who are at high risk for suicide. Hypnotic use among suicidal patients indicates need for close monitoring of these patients.
Authors: Petra Truedson; Michael Ott; Krister Lindmark; Malin Ström; Martin Maripuu; Robert Lundqvist; Ursula Werneke Journal: J Clin Med Date: 2022-10-08 Impact factor: 4.964