Acta Psychiatrica Scandinavica最新文献

{"title":"Healthcare Occupations, Suicides, and Suicide Attempts: A Cohort Study Based on the Working Population in Sweden","authors":"Alicia Nevriana,&nbsp;Emma Brulin,&nbsp;Tomas Hemmingsson,&nbsp;Melody Almroth,&nbsp;Kuan-Yu Pan,&nbsp;Theo Bodin,&nbsp;Katarina Kjellberg,&nbsp;Daniel Falkstedt","doi":"10.1111/acps.70018","DOIUrl":"10.1111/acps.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Many studies have examined physicians' risk of suicide, but studies of other healthcare occupations have been fewer. Suicide attempts have also rarely been studied. We aimed to determine the risks of suicide and suicide attempts among healthcare workers in comparison with non-healthcare workers, according to occupational qualification level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This population-based cohort study linking Swedish national registers included 243,183 healthcare workers in high-qualified occupations (e.g., physicians); 1,789,076 workers in other high-qualified occupations; 514,726 healthcare workers in low-qualified occupations (e.g., assistant nurses); and 2,026,890 workers in low-qualified occupations residing in Sweden in 2005 and followed them until the latest December 31, 2020. We estimated adjusted hazard ratios (aHR) for suicide and first suicide attempt.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to non-healthcare workers, higher risks for suicide were observed for several healthcare occupations, primarily those working with patient care (e.g., aHR physicians 1.57, 95% CI: 1.23–2.00, registered nurses 1.61, 95% CI: 1.37–1.88, assistant nurses 1.25, 95% CI: 1.17–1.34), rather than those in administrative roles (aHR high-qualified healthcare administrators 1.01 95% CI: 0.76–1.35). Among physicians, the risk was most apparent for psychiatrists (aHR 2.70, 95% CI: 1.21–6.03). For suicide attempts, the risks were primarily observed among registered nurses (aHR 1.22, 95% CI: 1.15–1.29) and assistant nurses (aHR 1.15, 95% CI: 1.12–1.18). Among healthcare workers, assistant nurses had the highest incidence rates for suicide (18.7/100,000 person-years) and suicide attempts (175.1/100,000 person-years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Workers in several healthcare occupations showed a higher risk of suicide relative to non-healthcare workers with a similar occupational qualification level. Interventions may need to be developed to reduce the risk of suicidal behavior in these groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"360-371"},"PeriodicalIF":5.0,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bipolar Disorder and Poisoning due to Medicines or Illegal Substances","authors":"Mikko Niskanen,&nbsp;Olli Kärkkäinen,&nbsp;Heidi Taipale,&nbsp;Johannes Lieslehto,&nbsp;Jari Tiihonen,&nbsp;Aleksi Hamina","doi":"10.1111/acps.70017","DOIUrl":"10.1111/acps.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individuals with bipolar disorder face an elevated risk of premature death, often due to external causes such as accidental injuries, self-harm, and substance-related deaths. This study aimed to investigate the incidence of severe poisonings among individuals with bipolar disorder and to examine associated demographic and clinical factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cohort study using data from national registers in Finland, measuring hospitalizations and deaths due to poisoning by medicines or illegal substances in 1996–2018. Cox proportional hazards regression models were used to assess associations between predictor variables and poisoning outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study population comprised 60,045 individuals aged 15–65 diagnosed with bipolar disorder in 1987–2018. During the study period, 13.1% (<i>N</i> = 7872) of the population experienced at least one poisoning resulting in hospitalization or death. The age-standardized rate of hospitalizations was 50.6 (95% CI, 49.5–51.7) per 1000 person-years and of deaths 1.8 (95% CI, 1.6–2.0) per 1000 person-years. The majority of poisonings leading to hospitalization (59.1%) or death (56.6%) were intentional and caused by pharmaceuticals (hospitalizations, 76.9%; deaths, 63.6%). Additionally, psychoactive narcotics and stimulants were the cause of 26.8% of the poisoning deaths. The strongest risk factors for hospitalization were substance use disorder (adjusted hazard ratio, aHR, 2.75, 95% CI, 2.61–2.90) and a history of suicide attempt (2.70, 2.52–2.88). The risk of poisoning death was most strongly associated with substance use disorder (3.02, 2.60–3.52) and a history of suicide attempt (2.38, 1.94–2.91). Female sex was associated with a higher risk of hospitalization (1.19, 1.14–1.25), but a lower risk of death (0.72, 0.62–0.82).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Individuals with bipolar disorder face a substantial risk of poisoning by medicines or illegal substances, with notable sex differences in hospitalization and death rates. Key risk factors include substance use disorder and a history of suicide attempt.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"299-307"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life Expectancy, Loss of Life Expectancy, and Lifetime Costs in Bipolar Disorder: A Nationwide Population-Based Study","authors":"Ikbal Andrian Malau,&nbsp;Ying-Ming Chiu,&nbsp;Hui-Chih Chang,&nbsp;Ya-Chu Yang,&nbsp;Jane Pei-Chen Chang,&nbsp;Christoph U. Correll,&nbsp;Vieta Eduard,&nbsp;Kuan-Pin Su","doi":"10.1111/acps.70013","DOIUrl":"10.1111/acps.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD) significantly affects life expectancy (LE), results in substantial loss of LE, and contributes to high medical costs, with these impacts varying by age at onset and gender. Previous studies have often overlooked the significance of age at the onset when estimating LE in individuals with BD. This study aimed to address this limitation and assess the impacts of BD on LE, loss of LE, and medical costs for BD patients categorized by age and gender in Taiwan using a new semiparametric extrapolation method over an 11-year duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A rolling-over algorithm estimated the survival function, with lifetime risk extrapolated. LE and loss of LE were calculated by comparing BD patients to matched non-BD referents by sex, age, and diagnosis year. Lifetime medical costs were determined by multiplying average monthly expenses by survival rates. Data from Taiwan's National Health Insurance (2009–2019) identified BD patients aged 5–84 with ≥ 2 outpatient or ≥ 1 inpatient BD diagnosis. The semiparametric survival extrapolation method was validated by comparing it with the Kaplan–Meier analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results indicate that following a BD diagnosis, patients have an LE of 26.79 years, reflecting a loss of 15.08 years compared to matched referents. On average, patients with BD incurred annual medical expenses of around $2516, with costs rising with age for both sexes. The mean estimated lifetime cost for the study population was about $55,015. The extrapolation method demonstrated high accuracy, with a less than 5% relative bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Semiparametric extrapolation is an effective method for estimating LE, loss of LE, and lifetime costs in BD. Future work could refine semiparametric extrapolation and assess factors influencing LE loss and lifetime costs in BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"350-359"},"PeriodicalIF":5.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic and Clinical Characteristics of Lithium-Treated Older Adults With Bipolar Disorder: A Replication Study From the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project","authors":"Orestes V. Forlenza,&nbsp;Ni Xu,&nbsp;Peijun Chen,&nbsp;Soham Rej,&nbsp;Ariel G. Gildengers,&nbsp;Tomas Hajek,&nbsp;Martha Sajatovic,&nbsp;the GAGE-BD initiative","doi":"10.1111/acps.70016","DOIUrl":"https://doi.org/10.1111/acps.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To replicate a previous study addressing differences and similarities of older adults with bipolar disorder (OABD) treated with lithium as compared to those treated with other drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional analysis of a harmonized dataset of the GAGE-BD Project, with over 2 thousand participants enrolled from two recruitment waves, with worldwide representation. Participants were allocated in two treatment groups according to the availability of information about current lithium use (Lithium, n = 754; Non-lithium, n = 1,161). We used linear regression, linear mixed and generalized linear mixed models to examine the associations between treatment groups and other variables, with emphasis on the distribution of socio-demographical and clinical variables, controlling for age, gender, and study site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found statistical associations between lithium use and higher education level, as well as with bipolar-1 subtype, and a negative association with comorbid anxiety disorder. OABD patients treated with lithium had lower scores on depression rating scales, and better overall global cognitive and functional state. Lithium users also reported having fewer cardiovascular comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found several potentially relevant differences in the clinical profile of OABD treated with lithium; nonetheless, the interpretation of the present results must take into account the methodological limitations inherent to the cross-sectional approach and data harmonization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"393-396"},"PeriodicalIF":5.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145196697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosis and Dementia—Disorders of Disadvantage","authors":"Lucy Gibson,&nbsp;Christoph Mueller,&nbsp;Robert Stewart","doi":"10.1111/acps.70012","DOIUrl":"10.1111/acps.70012","url":null,"abstract":"&lt;p&gt;As any Old Age Psychiatrist will tell you, late-life affective and psychotic disorders are some of the least understood mental health conditions, particularly considering their impact and the large number of people affected. This lack of attention partly lies in the common mundane situation of overshadowing research interests. Mental health research in older adults focuses almost entirely on dementia, while research into affective and psychotic disorders focuses almost entirely on young adults. Unfortunately, lack of research translates into an impoverished evidence base, which in turn filters through to underrepresentation in healthcare policy, and this compounds the problem by reducing the likelihood of interest from research funders, impeding capacity building and perpetuating a vicious cycle of inattention which does no favours for patients or health services. Even within the field, there are inequalities in research evidence, with considerably more attention paid to late-onset syndromes than to those who may have been living with their earlier-onset condition for decades by the time they reach older age ranges.&lt;/p&gt;&lt;p&gt;However, considering late-life psychosis, overshadowing research priorities are only part of the problem, as the conditions themselves present sizeable intrinsic challenges. The social withdrawal that characterises late-onset psychosis limits the likelihood of people affected being represented in conventional recruited research samples or retained in any study involving follow-up [&lt;span&gt;1&lt;/span&gt;]. Furthermore, people with earlier-onset diagnoses are frequently out of contact with mental health services by the time they reach ‘older adult’ age ranges, so that it is difficult to identify potential participants for approaching in the first place. Conventional case control, cohort and intervention studies are therefore logistically formidable, if not wholly impractical and/or fundamentally limited by participation and/or attrition bias.&lt;/p&gt;&lt;p&gt;The growing availability of routine healthcare data for research provides important opportunities for improving the evidence base. Most national data governance frameworks permit the use of effectively anonymised healthcare information to be used for research which enables the better representation of populations who would previously have been considered ‘hard to reach’ in conventional recruited samples. This advantage is exemplified in the approach taken by Normark et al. [&lt;span&gt;2&lt;/span&gt;], described in this issue, using national data from Denmark to investigate dementia incidence in people with schizophrenia and related disorders (ICD-10 F2x) according to their age at first psychosis diagnosis or treatment. There are reasonable considerations about the required reliance on recorded diagnoses (given that both conditions may be under-diagnosed, particularly dementia, and that under-diagnosis is unlikely to be at random); however, it is difficult to see how the question could be addressed in a","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"153-155"},"PeriodicalIF":5.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcriptomic and Neurotransmitter Insights Into Gray Matter Volume Changes From 1 Hz rTMS in Treating Schizophrenia With Auditory Verbal Hallucinations","authors":"Yuanjun Xie,&nbsp;Chenxi Li,&nbsp;Muzhen Guan,&nbsp;Tian Zhang,&nbsp;Chaozong Ma,&nbsp;Lingling Wang,&nbsp;Xinxin Li,&nbsp;Yijun Li,&nbsp;Zhongheng Wang,&nbsp;Huaning Wang,&nbsp;Peng Fang","doi":"10.1111/acps.70014","DOIUrl":"10.1111/acps.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Auditory verbal hallucinations (AVH) are prominent positive symptoms of schizophrenia that frequently prove resistant to conventional antipsychotic treatments. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising intervention for AVH; however, the underlying neurobiological mechanisms mediating its efficacy remain incompletely understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, schizophrenia patients with AVH were randomly assigned to either an active stimulation group or a sham control group. The active stimulation group received 1 Hz rTMS targeting the left temporoparietal junction (TPJ), while the sham group underwent an identical procedure without actual stimulation. Structural MRI scans were conducted before and after treatment to evaluate changes in gray matter volume (GMV). Further analyses examined associations between GMV changes and both gene expression profiles and neurotransmitter receptor densities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Active rTMS stimulation resulted in a significant reduction in AVH symptoms and was associated with increased GMV in specific cortical regions related to sensory and cognitive processing. These structural changes correlated with gene sets enriched in neuroplasticity-related pathways, such as cell morphogenesis, chromatin remodeling, and vesicle cytoskeletal trafficking. Notable changes were also observed in neurotransmitter receptor densities, particularly for serotonin (5HT1a), dopamine (D1), and glutamate (mGluR5) receptors. Multiple linear regression analysis identified specific hub gene expressions, such as ANK1, and patterns of neurotransmitter density, especially mGluR5, as significant predictors of GMV changes following rTMS stimulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Low-frequency rTMS induced GMV changes, coupled with alterations in gene expression and neurotransmitter receptor densities, contribute to symptom alleviation in schizophrenia patients with AVH. These findings support rTMS as a promising intervention for targeting the neurobiological substrates underlying AVH in schizophrenia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"372-392"},"PeriodicalIF":5.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Lithium Lower the Risk of Glaucoma—A Danish Nationwide Study","authors":"Tomas Hajek,&nbsp;Orestes Forlenza,&nbsp;Marcelo Nicolela,&nbsp;Ann-Eva Christensen,&nbsp;Henrik Vorum,&nbsp;René Ernst Nielsen","doi":"10.1111/acps.70010","DOIUrl":"10.1111/acps.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Glaucoma is an optic neuropathy caused by neurodegenerative loss of retinal ganglion cells (RGC). Mechanisms that contribute to RGC death include some of the same mechanisms involved in bipolar disorders (BD) and are the same mechanisms which are targeted by lithium (Li). We conducted a pharmacoepidemiological, population study in Denmark testing the links between Li prescriptions and risk of glaucoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>A nationwide, register-based historical, prospective cohort study of participants who were alive and over the age of 18 between January 1, 1996 and December 31, 2019. Participants were followed from the start of study until censoring or glaucoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Results</h3>\u0000 \u0000 <p>A total of 7,683,398 individuals (51.3% females) contributing 121,366,461 person-years were included in the study. In the general population, Li exposure was associated with developing glaucoma (HR = 1.10, 95% CI = 1.02–1.19, <i>p</i> = 0.01), but this association was not present in the population with BD (HR = 1.07, 95% CI = 0.93–1.22, <i>p</i> = 0.34). In the cumulative dosage analyses of the entire population, people with no Li prescription (HR = 0.78 95% CI = 0.66–0.93, <i>p</i> = 0.01) and between 365 defined daily doses (DDDs) and 5 × 365 DDDs of Li showed significantly reduced risk of glaucoma, relative to at least one prescription (HR = 0.79, 95% CI = 0.64–0.99, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>BDs as indexed by Li prescription are associated with a greater risk of glaucoma. This is in keeping with generally increased rates of medical comorbidities in BD. While there was no clear dose–response relationship, some of the higher cumulative exposures to Li might be protective relative to a single prescription.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"308-315"},"PeriodicalIF":5.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Episodes and Suicidal Risks in Bipolar and Major Depressive Disorder Patients During Versus Before Long-Term Treatment With Lithium","authors":"Maurizio Pompili,&nbsp;Isabella Berardelli,&nbsp;Salvatore Sarubbi,&nbsp;Elena Rogante,&nbsp;Mariarosaria Cifrodelli,&nbsp;Denise Erbuto,&nbsp;Dorian A. Lamis,&nbsp;Ross J. Baldessarini","doi":"10.1111/acps.70002","DOIUrl":"https://doi.org/10.1111/acps.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Lithium treatment reduces the risk of recurring episodes in bipolar disorder (BD) and probably also in major depressive disorder (MDD) and has evidence of antisuicidal effects. Study objectives were to test for effects of adding lithium treatment for one year to a year of other treatments on risks of illness recurrence, suicidal ideation, and suicide attempts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compared 296 major mood disorder outpatients for 12 months with treatment that did not include lithium versus 12 months with lithium included. We considered differences in the recurrence of new episodes of illness, new suicidal ideation and suicide attempts, and estimated time to these outcomes with survival analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>With lithium treatment included, there were marked reductions in episode recurrences (3.12-fold), suicidal ideation (4.78-fold), and suicide attempts (6.54-fold) in both BD and MDD patients, with corresponding delays to these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adding lithium treatment was strongly associated with reduced risk and delay of clinical recurrence, suicidal ideation and suicide attempts in both BD and MDD outpatients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"290-298"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Three Distinct Pathways to First Episode Mania and Psychosis: Latent Class Analysis of Antecedent Psychopathology”","authors":"Rachana Mehta,&nbsp;Ranjana Sah","doi":"10.1111/acps.70008","DOIUrl":"https://doi.org/10.1111/acps.70008","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"316-317"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Antidepressants Decreased After Initiation of ADHD Treatment in Adults—A Finnish Nationwide Register Study Describing Use of ADHD and Non-ADHD Medication in People With and Without ADHD","authors":"Elisa Westman,&nbsp;Tuire Prami,&nbsp;Alvar Kallio,&nbsp;Ilona Iso-Mustajärvi,&nbsp;Joel Jukka,&nbsp;Paavo Raittinen,&nbsp;Maarit J. Korhonen,&nbsp;Anita Puustjärvi,&nbsp;Sami Leppämäki","doi":"10.1111/acps.70007","DOIUrl":"https://doi.org/10.1111/acps.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>ADHD is often associated with comorbid psychiatric conditions. Differential diagnosis between other conditions and ADHD is not always clear, and patients are sometimes initially treated for another disorder instead. ADHD diagnosis and appropriate ADHD treatment potentially reduce the need for medication of the other disorder. Reaching high adherence to and persistence with ADHD medication is challenging. This nationwide cohort study aimed to describe not only ADHD medication use but also the use of other drugs in ADHD patients compared to controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Nationwide care and prescription registers were used to identify incident ADHD patients of any age between 2015 and 2020. Four controls were matched to each ADHD patient by age, gender, and residence. Analyses included data from 1.1.2010 to 31.12.2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Study cohort included 66,146 ADHD patients and 256,270 controls, with a total follow-up of 1,123,412 years. Sustained and extended-release methylphenidate were the two most commonly used first-line ADHD drugs across all age groups. Simultaneous use of different ADHD drugs was rare. Primary adherence was very high, with 95% of the patients purchasing their prescribed medication in general and 80% doing so within 10 days. Persistence with medication was the highest among the youngest patients. A decrease in purchases was observed during the summer holidays in school-age children and adolescents. In adults, antidepressant use often preceded ADHD diagnosis and decreased after ADHD treatment initiation, unlike in controls at the same time. In young children, antibiotics and anti-inflammatory drug use was higher in ADHD patients than in controls, especially before ADHD identification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>As far as we know, this is the first study to describe changes in the use of non-ADHD medications in relation to ADHD identification. In adults, antidepressant use decreased after ADHD treatment initiation, and in children, antibiotic and anti-inflammatory use showed more prominent decrease compared to controls of the same age. The data indicated high primary adherence to ADHD medication, and the youngest children remained on continuous ADHD medication the longest. The effect of summer holidays was visible in the purchase data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"203-215"},"PeriodicalIF":5.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}