| 11. |
- Ragazan, Dragos C., et al.
(författare)
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Gender influence on the bipolar disorder inpatient length of stay in Sweden, 2005–2014 : A register-based study
- 2019
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 256, s. 183-191
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Tidskriftsartikel (refereegranskat)abstract
- Background: The influence of gender on bipolar disorder is controversial and it is unclear if inpatient care differs between men and women. Here, we investigate for gender differences in the inpatient length of stay for Swedes admitted for bipolar disorder and explore other factors that could explain any observed association. Methods: Admission data were extracted from the Swedish National Patient Register and included all patients first admitted to a psychiatric inpatient unit with a bipolar disorder diagnosis, circa 2005–2014. Patients were then retrospectively followed for subsequent hospitalizations. Diagnostic subtypes were categorized by ICD-10 clusters: depressive, depressive with psychotic features, manic, manic with psychotic features, mixed, and other. Psychotropic therapies preceding the corresponding admissions were attained from the Prescribed Drug Register. Mixed-effects zero-truncated negative binomial regressions were employed to model the length of stay per admission. Results: Analysis included 39,653 admissions by 16,271 inpatients (60.0% women). Overall, when compared to men, women spent 7.5% (95% CI: 4.2–11.0%, p < 0.001) extra days hospitalized per admission. However, upon adjusting for candidate confounders, including the bipolar subtype, and selected comorbidities and psychotropics, the association weakened wherein women then spent 3.7% (95% CI: 0.1–6.9%, p = 0.028) extra days hospitalized per admission. Limitations: The integrity of register data can be variable and the adherence to outpatient dispensed psychotropics could not be validated. Conclusion: Although the influence of gender on the bipolar disorder inpatient length of stay is evident, other factors attenuate and better explain this crude observation.
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| 12. |
- Reutfors, Johan, et al.
(författare)
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Medication and suicide risk in schizophrenia : A nested case-control study
- 2013
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 150:2-3, s. 416-420
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of pharmacotherapy in relation to suicide risk is limited.AIM: To explore suicide risk in schizophrenia in relation to medication with antipsychotics, antidepressants, and lithium.METHODS: Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n=4000), patients who died by suicide within five years from diagnosis were defined as cases (n=84; 54% male). Individually matched controls were identified from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Adjusted odds ratios [OR] of the association between medication and suicide were calculated by conditional logistic regression.RESULTS: Lower suicide risk was found in patients who had been prescribed a second generation antipsychotic (clozapine, olanzapine, risperidone, or ziprasidone; 12 cases and 20 controls): OR 0.29 (95% confidence interval [CI], 0.09-0.97). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.23 (95% CI 0.06-0.89). No significant association was observed between suicide and prescription of any antipsychotic, depot injection antipsychotics, antidepressants, SSRI, or lithium.CONCLUSIONS: Lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these drugs, to differences in adherence, or to differences in other patient characteristics associated with lower suicide risk.
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| 13. |
- Reutfors, J., et al.
(författare)
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Seasonality of suicide in Sweden : relationship with psychiatric disorder
- 2009
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 119:1-3, s. 59-65
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little is known as to whether suicide seasonality is related to psychiatric disorders affecting suicide risk/incidence. The present study aims to assess suicide seasonality patterns with regard to the history of psychiatric morbidity among suicide victims. Methods: The history of psychiatric inpatient diagnoses in the five years prior to suicide was identified among all suicides in Sweden from 1992 to 2003. Suicide seasonality was estimated as the relative risk of suicide during the month of highest to that in the month of lowest suicide incidence. Analyses were performed with respect to sex, suicide method and history of inpatient treatment of psychiatric disorder. Results: Among both male (n = 9,902) and female (n = 4,128) suicide victims, there were peaks in suicide incidence in the spring/early summer. This seasonal variation was more evident in suicide victims with a psychiatric inpatient diagnosis than in those without such a diagnosis. A seasonal variation was found in most diagnostic groups, with significant peaks in males with a history of depression and in females with a history of a neurotic, stress-related, or somatoform disorder. Overall, suicide seasonality was more evident in violent than in non-violent suicide methods. Limitation: Only psychiatric disorders severe enough to require hospital admission were studied. Conclusion: A history of inpatient-treated psychiatric disorder appears to be associated with an increase in suicide seasonality, especially in violent suicide methods. This increase is found in several psychiatric disorders.
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| 14. |
- Reutfors, Johan, et al.
(författare)
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Suicide risk and antipsychotic side effects in schizophrenia : nested case-control study.
- 2016
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Ingår i: Human Psychopharmacology. - : Wiley. - 0885-6222 .- 1099-1077. ; 31:4, s. 341-345
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study explores suicide risk in schizophrenia in relation to side effects from antipsychotic medication.METHODS: Among patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4000), those who died by suicide within 5 years from diagnosis were defined as cases (n = 84; 54% male). For each case, one individually matched control was identified from the same population. Information on antipsychotic side effects, including extrapyramidal symptoms (EPS) and akathisia, as well as prescriptions of anticholinergic medication, was retrieved from clinical records in a blinded fashion. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of the association between suicide and side effects as well as anticholinergic medication were estimated using conditional logistic regression.RESULTS: A lower suicide risk was found in patients with a history of EPS (aOR 0.33, 95% CI 0.12-0.94). There was no statistically significant association between akathisia or anticholinergic medication use and the suicide risk.CONCLUSIONS: A lower suicide risk identified among patients with EPS could potentially reflect higher antipsychotic adherence, exposure to higher dosage, or polypharmacy among these patients.
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| 15. |
- Westman, Jeanette, et al.
(författare)
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Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT)
- 2019
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 208, s. 138-144
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Tidskriftsartikel (refereegranskat)abstract
- Background: Life expectancy is reduced by 19 years in men and 17 in women with psychosis in Sweden, largely due to cardiovascular disease. Aim: Assess whether a psychosocial health promotion intervention improves cardiometabolic risk factors, quality of life, and severity of illness in patients with psychotic disorders more than treatment as usual. Methods: A pragmatic intervention trial testing a manual-based multi-component health promotion intervention targeting patients with psychosis. The Swedish intervention was adapted from IMPaCT therapy, a health-promotion program based on motivational interviewing and cognitive behavioral therapy, designed to be incorporated into routine care. The intervention group consisted of 119 patients and the control group of 570 patients from specialized psychosis departments. Outcome variables were assessed 6 months before intervention during the run-in period, again at the start of intervention, and 12 months after the intervention began. The control group received treatment as usual. Results: The intervention had no significant effect on any of the outcome variables. However, BMI, waist circumference, systolic BP, heart rate, HbA1c, general health, and Clinical Global Impressions Scale score improved significantly during the run-in period before the start of the active intervention (observer effect). The multi-component design meant that treatment effects could only be calculated for the intervention as a whole. Conclusion: The results of the intervention are similar to those of the U.K. IMPaCT study, in which the modular health-promotion intervention had little effect on cardiovascular risk indicators. However, in the current study, the run-in period had a positive effect on cardiometabolic risk factors.
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| 16. |
- Ösby, Urban
(författare)
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Mortality in schizophrenia and affective disorder
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with psychiatric disorders such as schizophrenia, bipolar disorder and unipolar disorder have a considerably increased mortality compared to the population. To reduce this increased mortality is a major task for clinical psychiatry, and the aim of this study is to improve the knowledge about the increased mortality in order to reduce its effects for the patients. The studies in this thesis are based upon register linkages. Information about diagnosis and time of admission and discharge from the Patient register has been linked with information about cause and time of death from the Cause-of-death register, and information about first-degree relatives from the Second-generation register. First admissions with schizophrenia in Stockholm County during 1978 to 1994 were reduced by 1.3% yearly for males and 1.9% for females, while first admissions with either schizophrenia or paranoid psychosis were unchanged for both sexes, indicating that the reduction of first schizophrenia admissions may be an effect of diagnostic changes during the study period. For schizophrenics in Stockholm County followed-up from the first diagnosis, standardized mortality ratios (SMR:s) for all causes of death were increased to 2.8 for males and 2.4 for females. SMR was most increased in suicide, with 15.7 for males and 19.7 for females, and in unspecified violence, with 11.7 for males and 9.9 for females. SMR:s for suicide were particularly increased for young patients during the first year after the first admission. More excess deaths were caused by natural (somatic) than by unnatural causes of death, although the specific causes of death that caused most extra deaths were suicide in males and cardiovascular disease in females. Time trends in SMR for all causes of death during 1976 to 1995, for patients in Stockholm County diagnosed with schizophrenia for the first time, increased 1.7 times for males and 1.3 times for females. Cardiovascular death increased 4.7 times for males and 2.7 times for females, while all unnatural causes of death increased 1.8 times for males and suicide increased 1.9 times for females. The increase in mortality may be an effect of the concomitant reduction with 64% of days in hospital for schizophrenia. SMR:s for all patients with a hospital diagnosis of bipolar or unipolar disorder in Sweden for all causes of death were 2.5 for males and 2.7 for females in bipolar disorder, and 2.0 for both sexes in unipolar disorder. SMR:s for suicide in bipolar disorder were 15.0 for males and 22.4 for females, and in unipolar disorder 20.9 and 27.0 respectively. In bipolar disorder, most extra deaths were caused by natural causes, while in unipolar disorder, unnatural causes caused most extra deaths. Time trends for suicide mortality increased, both for bipolar and unipolar disorder. SMR:s for suicide for siblings to patients with schizophrenia, bipolar or unipolar disorder were not increased, unless the siblings had a psychiatric diagnosis of their own. Siblings with psychiatric diagnoses had as high suicide mortality as the probands. However, previous suicide in the family increased the suicide risk for patients with schizophrenia and bipolar disorder, but not unipolar disorder.
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