Mortality and Lithium-Protective Effects after First-Episode Mania Diagnosis in Bipolar Disorder: A Nationwide Retrospective Cohort Study in Taiwan.

IF 16.3 1区医学 Q1 PSYCHIATRY

Psychotherapy and Psychosomatics Pub Date : 2024-01-01 Epub Date: 2024-01-09 DOI:10.1159/000535777

Andre F Carvalho, Chih-Wei Hsu, Eduard Vieta, Marco Solmi, Wolfgang Marx, Michael Berk, Chih-Sung Liang, Ping-Tao Tseng, Liang-Jen Wang

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引用次数: 0

Abstract

Introduction: This study aimed to estimate all-cause mortality in patients after a first-episode mania (FEM) and examine whether six guideline-recommended medications can reduce mortality.

Methods: The cohort included population-based FEM samples and matched controls from Taiwan, spanning 2007 to 2018. The primary outcomes assessed were all-cause/suicide-related mortality, while the secondary outcome focused on mortality associated with pharmacological treatments. We compared mortality in post-FEM patients and age-/sex-matched controls without any diagnosed bipolar disorders and patients with and without psychopharmacological treatment using Cox regression analysis, respectively. Statistics were presented with time-to-event adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs).

Results: The study included 54,092 post-FEM patients and 270,460 controls, totaling 2,467,417 person-years of follow-up. Post-FEM patients had higher risks of all-cause mortality (AHR 2.38, 95% CI: 2.31-2.45) and suicide death (10.80, 5.88-19.84) than controls. Lithium (0.62, 0.55-0.70), divalproex (0.89, 0.83-0.95), and aripiprazole (0.81, 0.66-1.00) were associated with reduced all-cause mortality compared to non-users. There were no significant all-cause mortality differences for quetiapine (0.95, 0.89-1.01), risperidone (0.92, 0.82-1.02), and paliperidone (1.24, 0.88-1.76) users. When accounting for drug action onset times in sensitivity analyses, only lithium significantly reduced all-cause mortality (AHR range 0.65-0.72). There were 35 and 16 suicide deaths in post-FEM patients and controls, respectively. No drug had a significant effect on suicide deaths (lithium: 6; divalproex: 7; aripiprazole: 0; quetiapine: 10; risperidone: 4; paliperidone: 1).

Conclusion: Post-FEM patients had a higher risk of all-cause/suicide-related mortality, and lithium treatment might reduce all-cause mortality.

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双相情感障碍首次发作躁狂诊断后的死亡率和锂的保护作用：台湾全国性回顾性队列研究》。

简介：本研究旨在估算首次发病躁狂症（FEM）患者的全因死亡率，并研究指南推荐的六种药物是否能降低死亡率：本研究旨在估算首发躁狂症（FEM）患者的全因死亡率，并探讨指南推荐的六种药物是否能降低死亡率：研究队列包括来自台湾的基于人口的躁狂症样本和匹配对照，时间跨度为2007年至2018年。评估的主要结果是全因/自杀相关死亡率，次要结果侧重于与药物治疗相关的死亡率。我们采用 Cox 回归分析法，分别比较了未确诊双相情感障碍的 FEM 后患者和年龄/性别匹配的对照组的死亡率，以及接受和未接受精神药物治疗的患者的死亡率。统计数据以时间到事件调整后危险比（AHRs）和95%置信区间（CIs）表示：研究共纳入 54,092 名 FEM 后患者和 270,460 名对照者，随访时间共计 2,467,417 人年。FEM后患者的全因死亡风险（AHR 2.38，95% CI：2.31-2.45）和自杀死亡风险（10.80，5.88-19.84）高于对照组。与非使用者相比，锂（0.62，0.55-0.70）、二丙戊酸钠（0.89，0.83-0.95）和阿立哌唑（0.81，0.66-1.00）可降低全因死亡率。喹硫平（0.95，0.89-1.01）、利培酮（0.92，0.82-1.02）和帕利培酮（1.24，0.88-1.76）使用者的全因死亡率没有明显差异。在敏感性分析中考虑到药物起效时间时，只有锂能显著降低全因死亡率（AHR 范围为 0.65-0.72）。FEM后患者和对照组分别有35例和16例自杀死亡。没有一种药物对自杀死亡有明显影响（锂：6；二丙戊酸钠：7；阿立哌唑：0；喹硫平：0）：0; quetiapine: 10; risperidone：4；帕利哌酮：1）：结论结论：FEM 后患者全因/自杀相关死亡风险较高，锂治疗可降低全因死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.