| 1. |
- Bauer, M., et al.
(författare)
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Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder
- 2021
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Ingår i: International Journal of Bipolar Disorders. - : Springer Science and Business Media LLC. - 2194-7511. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun's electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.
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| 2. |
- Karanti, Alina (Aikaterini), et al.
(författare)
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Patient educational level and management of bipolar disorder
- 2021
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Ingår i: Bjpsych Open. - : Royal College of Psychiatrists. - 2056-4724. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Socioeconomic factors can affect healthcare management. Aims The aim was to investigate if patient educational attainment is associated with management of bipolar disorder. Method We included patients with bipolar disorder type 1 (n = 4289), type 2 (n = 4020) and not otherwise specified (n = 1756), from the Swedish National Quality Register for Bipolar Disorder (BipolaR). The association between patients' educational level and pharmacological and psychological interventions was analysed by binary logistic regression. We calculated odds ratios after adjusting for demographic and clinical variables. Results Higher education was associated with increased likelihood of receiving psychotherapy (adjusted odds ratio 1.34, 95% CI 91.22-1.46) and psychoeducation (adjusted odds ratio 1.18, 95% CI 1.07-1.46), but with lower likelihood of receiving first-generation antipsychotics (adjusted odds ratio 0.76, 95% CI 0.62-0.94) and tricyclic antidepressants (adjusted odds ratio 0.76, 95% CI 0.59-0.97). Higher education was also associated with lower risk for compulsory in-patient care (adjusted odds ratio 0.79, 95% CI 0.67-0.93). Conclusions Pharmacological and psychological treatment of bipolar disorder differ depending on patients' educational attainment. The reasons for these disparities remain to be explained.
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| 3. |
- Larsson, F., et al.
(författare)
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Bipolar disorder type 1 was the most stable bipolar subdiagnosis
- 2021
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Ingår i: Lakartidningen. - 1652-7518. ; 118
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Tidskriftsartikel (refereegranskat)abstract
- DSM-IV subcategorises bipolar disorders into type 1, type 2, and a third not otherwise specified (NOS) category. Although previous works suggest that these subtypes remain reasonably stable over time, it is unclear if subdiagnoses endure over time or if patients are commonly recategorized within the spectrum in a real-world clinical setting. We assessed subdiagnostic stability in 6,374 individuals with bipolar disorder using data from the Swedish national quality assurance register for bipolar disorders (BipoläR). Diagnoses at baseline registration - that could occur at any time point during the course of illness - were compared with diagnoses at follow-up registration 3 years later. Changes in subdiagnoses were analysed in relation to clinical setting, diagnostic procedure, and patient features. We found that 74 %, 67 %, and 47 % of patients diagnosed with bipolar disorder type 1, type 2, and NOS, respectively, retained the same subdiagnosis at the 3-year follow-up. The following factors were associated with higher rate of subdiagnostic transitions: previous suicide attempts, unemployment or low psychosocial function, treatment with antidepressants, and comorbid anxiety, neuropsychiatric, or personality disorder. Conversely, use and duration of mood stabilizer treatment, the use of structured diagnostic instruments, and treatment at an outpatient unit specialized in managing affective disorders were associated with lower likelihood of subdiagnostic transitions. Our findings confirm that bipolar disorder type 1 is the most stable subdiagnostic group, but findings also indicate a significant degree of subdiagnostic instability, particularly in the NOS group.
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| 4. |
- Sköld, Martin, et al.
(författare)
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Regional lithium prescription rates and recurrence in bipolar disorder
- 2021
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Ingår i: International Journal of Bipolar Disorders. - : Springer Science and Business Media LLC. - 2194-7511. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background Lithium is the best documented maintenance treatment in bipolar disorder, but its use varies considerably across and within countries. It is not known whether regional differences in lithium prescription rates translate to differing regional outcomes. Aims To estimate associations between county specific lithium prescription rates and county specific recurrence odds of bipolar disorder in Sweden. Method Data from 14,616 patients with bipolar I disorder, bipolar II disorder, or bipolar disorder not otherwise specified were extracted from the Swedish national quality assurance register for bipolar disorders (BipolaR). Lithium prescription frequencies were calculated for 21 counties. Logistic regression analyses were run adjusted for confounders, with any type of recurrence as primary outcome, and incident elated and depressive episodes as secondary outcomes. Subsets of patients with bipolar I, II and not otherwise specified disorder were also analysed separately. Results Lithium prescription rates for populations with all bipolar subtypes ranged across counties from 37.7 to 84.9% (mean 52.4%). Higher regional prescription rates were significantly associated with lower rate of any type of recurrence. The association was stronger when bipolar I disorder was analysed separately. Conclusions The advantages for lithium use long acknowledged for bipolar I disorder are also seen for the rest of the bipolar spectrum. Results suggest that population level outcomes of bipolar disorder could be improved by increasing the number of patients using lithium.
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