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- Clapham, Eric, et al.
(författare)
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Exposure to risperidone versus other antipsychotics and risk of osteoporosis-related fractures : a population-based study
- 2020
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Ingår i: Acta Psychiatrica Scandinavica. - : WILEY. - 0001-690X .- 1600-0447. ; 141:1, s. 74-83
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Tidskriftsartikel (refereegranskat)abstract
- Objective Antipsychotics may increase serum prolactin, which has particularly been observed with risperidone. Further, hyperprolactinemia has been linked to osteoporosis-related fractures. Therefore, we investigated fracture risk in a nationwide cohort exposed to antipsychotics. Methods Swedish registers were used to identify adults with two consecutive dispensations of risperidone (n = 38 211), other atypical antipsychotics not including paliperidone (n = 60 691), or typical antipsychotics (n = 17 445) within three months between 2006 and 2013. An osteoporosis-related fracture was defined as a non-open hip/femur fracture in primary analyses. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Risperidone users were on average older (mean age of 68, 44, and 63 years for risperidone, other atypical antipsychotics, and typical antipsychotics respectively). Compared with other atypical antipsychotics, there was no association between risperidone and osteoporosis-related fractures in the overall (HR = 1.04, CI: 0.91-1.19) or age-stratified analyses. A significantly increased risk of typical antipsychotics (HR = 1.24, CI: 1.07-1.45) compared with other atypical antipsychotics remained for ages >45 years. Conclusion Risperidone does not appear to be associated with an increased risk of osteoporosis-related fracture compared with other atypical antipsychotic agents as a group. For typical antipsychotics, a moderately elevated risk of hip fractures was noted compared with other atypical antipsychotics, possibly because of residual confounding.
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| 5. |
- Kouppis, Efthymios, et al.
(författare)
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Validity of the personality disorder diagnosis in the Swedish National Patient Register
- 2020
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 141:5, s. 432-438
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Tidskriftsartikel (refereegranskat)abstract
- Aims The Swedish National Patient Register (NPR) is an exceptional source of information in clinical epidemiological research. The register is, however, not validated for the diagnosis of personality disorder (PD). We therefore assessed its validity in this patient group, and the group with emotionally unstable PD (EUPD)/borderline personality disorder (BPD).Methods Records from 100 random adult patients (aged 15-65 years) diagnosed with any PD in the NPR between 1987 and 2015 were analysed using a protocol based on general diagnostic criteria for PD, as well as specific criteria for EUPD/BPD in both ICD and DSM classification systems.Results Of the 100 patients, 27 had been given a diagnosis of EUPD, 23 another specific PD and 50 an unspecified PD. Using ICD criteria, 88 of 95 evaluable patients could be confirmed to have a PD, that is an agreement rate of 93%. Using DSM criteria, the agreement was lower (77 patients or 81%). Of 26 evaluable patients with a diagnosis of EUPD/BPD, the diagnosis was confirmed in all cases when using the ICD criteria, but in only 20 when using the DSM criteria.Conclusions The NPR is a valid source of data for the diagnosis of PD per se and also of EUPD in women.
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- Smedler, Erik, et al.
(författare)
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Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis.
- 2020
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Ingår i: Acta psychiatrica Scandinavica. - : Wiley. - 1600-0447 .- 0001-690X. ; 141:6, s. 534-540
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Tidskriftsartikel (refereegranskat)abstract
- To investigate external factors that trigger manic and hypomanic relapses and how this is associated with personality and clinical outcome measured as number of affective episodes over a seven-year period.This is a prospective cohort study of 204 meticulously characterized Swedish bipolar disorder patients. Personality was evaluated at baseline using the Swedish universities Scales of Personality in 170 patients, and 90 patients were followed up after approximately seven years in order to evaluate clinical outcomes.We found that 44% of the patients reported trigger factors, including sleep disturbance, work or family related issues, medication, and illicit drug use. There were no significant differences in any of the personality traits when comparing the 74 patients that reported triggers with the 90 patients that did not. At seven-year follow-up, there was no difference between the groups in number of affective episodes (depressive, hypomanic, manic or mixed), involuntary commitments, suicide attempts, or self-harm incidents since baseline.Around 40% of the patients reported external triggers for manic and hypomanic episodes. However, this was neither associated with personality traits nor number of affective episodes at seven-year follow-up.Around 40% of all bipolar disorder patients reported trigger factors for manic or hypomanic episodes. Reporting trigger factors was not associated with personality Reporting trigger factors was not associated with outcomes over a seven-year period. Limitations Patients had on average long duration of illness and may be less sensitive to external stressors than persons with recent onset. Trigger factors were identified retrospectively, and may thus be prone to recall bias. The number of affective episodes might be a too crude outcome measure as most subjects had not suffered any affective episodes at follow-up.
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