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Kappes JR, Huber DA, Kirchebner J, Sonnweber M, Günther MP, Lau S. Self-Harm Among Forensic Psychiatric Inpatients With Schizophrenia Spectrum Disorders: An Explorative Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:352-372. [PMID: 34861802 DOI: 10.1177/0306624x211062139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The burden of self-injury among offenders undergoing inpatient treatment in forensic psychiatry is substantial. This exploratory study aims to add to the previously sparse literature on the correlates of self-injury in inpatient forensic patients with schizophrenia spectrum disorders (SSD). Employing a sample of 356 inpatients with SSD treated in a Swiss forensic psychiatry hospital, patient data on 512 potential predictor variables were retrospectively collected via file analysis. The dataset was examined using supervised machine learning to distinguish between patients who had engaged in self-injurious behavior during forensic hospitalization and those who had not. Based on a combination of ten variables, including psychiatric history, criminal history, psychopathology, and pharmacotherapy, the final machine learning model was able to discriminate between self-injury and no self-injury with a balanced accuracy of 68% and a predictive power of AUC = 71%. Results suggest that forensic psychiatric patients with SSD who self-injured were younger both at the time of onset and at the time of first entry into the federal criminal record. They exhibited more severe psychopathological symptoms at the time of admission, including higher levels of depression and anxiety and greater difficulty with abstract reasoning. Of all the predictors identified, symptoms of depression and anxiety may be the most promising treatment targets for the prevention of self-injury in inpatient forensic patients with SSD due to their modifiability and should be further substantiated in future studies.
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Affiliation(s)
| | | | | | | | | | - Steffen Lau
- Psychiatric University Hospital Zurich, Switzerland
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Tcherni-Buzzeo M. Increased Prescribing of Psychotropic Drugs or School-Based Services for Children with Disabilities? Associations of These Self-control-Boosting Strategies with Juvenile Violence at the State Level. JOURNAL OF DEVELOPMENTAL AND LIFE-COURSE CRIMINOLOGY 2023; 9:1-35. [PMID: 36789240 PMCID: PMC9910267 DOI: 10.1007/s40865-023-00223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The increasing rates at which psychotropic drugs have been prescribed to children and adolescents in the USA in the last three decades (since the early 1990s) have prompted questions about whether this trend is associated with the "great American crime decline." Medicalization can be considered one of the strategies to remedy children's neuropsychological deficits and improve their self-control. Another possible remedy is school-based services for children with learning disabilities, mandated by the Individuals with Disabilities Education Improvement Act (IDEA) of 2004. Using state-level panel data analyses for years 1990-2014 (with the main focus on 2000-2014 outcomes), the current study estimates associations between these two developmental self-control remedies-medicalization and school-based services-and minor, moderate, and severe types of juvenile violence, while controlling for relevant covariates (both time-varying and time-invariant). The results of mixed-effects linear regression analyses accounting for powerful time trends show a strong association between increases in school-based services for children with learning disabilities and declines in all types of juvenile violence. Another strong and consistent finding that emerges in the analyses is the link between reductions in child poverty at the state level and decreases in juvenile violence, both contemporaneously and over time. Psychotropic drug prescribing to children (measured using Supplemental Security Income rolls of children with mental health conditions) exhibits inconsistent or insignificant effects. The findings of this study have substantial theoretical and policy implications and indicate the importance of strengthening school-based services for children with disabilities and reducing child poverty as essential violence prevention tools.
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Molero Y, Kaddoura S, Kuja-Halkola R, Larsson H, Lichtenstein P, D’Onofrio BM, Fazel S. Associations between β-blockers and psychiatric and behavioural outcomes: A population-based cohort study of 1.4 million individuals in Sweden. PLoS Med 2023; 20:e1004164. [PMID: 36719888 PMCID: PMC9888684 DOI: 10.1371/journal.pmed.1004164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/28/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND β-blockers are widely used for treating cardiac conditions and are suggested for the treatment of anxiety and aggression, although research is conflicting and limited by methodological problems. In addition, β-blockers have been associated with precipitating other psychiatric disorders and suicidal behaviour, but findings are mixed. We aimed to examine associations between β-blockers and psychiatric and behavioural outcomes in a large population-based cohort in Sweden. METHODS AND FINDINGS We conducted a population-based longitudinal cohort study using Swedish nationwide high-quality healthcare, mortality, and crime registers. We included 1,400,766 individuals aged 15 years or older who had collected β-blocker prescriptions and followed them for 8 years between 2006 and 2013. We linked register data on dispensed β-blocker prescriptions with main outcomes, hospitalisations for psychiatric disorders (not including self-injurious behaviour or suicide attempts), suicidal behaviour (including deaths from suicide), and charges of violent crime. We applied within-individual Cox proportional hazards regression to compare periods on treatment with periods off treatment within each individual in order to reduce possible confounding by indication, as this model inherently adjusts for all stable confounders (e.g., genetics and health history). We also adjusted for age as a time-varying covariate. In further analyses, we adjusted by stated indications, prevalent users, cardiac severity, psychiatric and crime history, individual β-blockers, β-blocker selectivity and solubility, and use of other medications. In the cohort, 86.8% (n = 1,215,247) were 50 years and over, and 52.2% (n = 731,322) were women. During the study period, 6.9% (n = 96,801) of the β-blocker users were hospitalised for a psychiatric disorder, 0.7% (n = 9,960) presented with suicidal behaviour, and 0.7% (n = 9,405) were charged with a violent crime. There was heterogeneity in the direction of results; within-individual analyses showed that periods of β-blocker treatment were associated with reduced hazards of psychiatric hospitalisations (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), charges of violent crime (HR: 0.87, 95% CI: 0.81 to 0.93, p < 0.001), and increased hazards of suicidal behaviour (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratifying by diagnosis, reduced associations with psychiatric hospitalisations during β-blocker treatment were mainly driven by lower hospitalisation rates due to depressive (HR: 0.92, 95% CI: 0.89 to 0.96, p < 0.001) and psychotic disorders (HR: 0.89, 95% CI: 0.85 to 0.93, p < 0.001). Reduced associations with violent charges remained in most sensitivity analyses, while associations with psychiatric hospitalisations and suicidal behaviour were inconsistent. Limitations include that the within-individual model does not account for confounders that could change during treatment, unless measured and adjusted for in the model. CONCLUSIONS In this population-wide study, we found no consistent links between β-blockers and psychiatric outcomes. However, β-blockers were associated with reductions in violence, which remained in sensitivity analyses. The use of β-blockers to manage aggression and violence could be investigated further.
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Affiliation(s)
- Yasmina Molero
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sam Kaddoura
- School of Medicine, Imperial College, London, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, United States of America
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- * E-mail:
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O'Donnell C, Demler TL, Trigoboff E. Selective Serotonin Reuptake Inhibitors (SSRIs) and Their Effect on Patient Aggression in Adult Patients in a State Psychiatric Facility: A Retrospective Analysis. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:33-38. [PMID: 35382065 PMCID: PMC8970236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The utility of selective serotonin reuptake inhibitors (SSRIs) has been overshadowed by the box warning they received when the United States (US) Food and Drug Administration (FDA) identified an increased risk of suicidality in patients 24 years of age or younger. Newer studies have identified suicidality as self-aggression and hypothesized whether this might also apply to aggression toward others. The controversy surrounding SSRIs has led to a decrease in prescriptions from healthcare clinicians and number of patients seeking the necessary treatment. The objective of this study was to determine if there is a relationship between SSRI use and aggressive behavior in an inpatient state psychiatric facility. DESIGN Using a retrospective analysis, patients (N=64) admitted to an inpatient state psychiatric facility between January 1, 2013, and December 31, 2020, who were taking SSRIs were assessed to determine if they had an increased risk of aggression, whether toward themselves or others. Patients served as their own comparators and were required to have a period without an SSRI and an equivalent period taking an SSRI. Patients were assessed through markers of aggression, including psychiatric emergencies; restraints; seclusions; as needed (PRN) medication use or STAT medication use for agitation, aggression, violence, poor impulse control, or psychosis; and PRN nicotine use. RESULTS There was no statistical significance in any of the analyses demonstrating that SSRI use led to an increased risk of aggression in this sample of inpatients. CONCLUSION The FDA warning of increased risk of suicidality and case reports of aggression potentially associated with the use of certain antidepressants should not prevent prescribers from treating adult patients with SSRI medications.
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Affiliation(s)
- Carolyn O'Donnell
- Drs. O'Donnell, Demler, and Trigoboff are with the State University of New York at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice in Buffalo, New York
- Drs. O'Donnell and Demler are with the New York State Office of Mental Health at Buffalo Psychiatric Center in Buffalo, New York
- Drs. Demler and Trigoboff are with the State University of New York at Buffalo School of Medicine, Department of Psychiatry in Buffalo, New York
| | - Tammie Lee Demler
- Drs. O'Donnell, Demler, and Trigoboff are with the State University of New York at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice in Buffalo, New York
- Drs. O'Donnell and Demler are with the New York State Office of Mental Health at Buffalo Psychiatric Center in Buffalo, New York
- Drs. Demler and Trigoboff are with the State University of New York at Buffalo School of Medicine, Department of Psychiatry in Buffalo, New York
| | - Eileen Trigoboff
- Drs. O'Donnell, Demler, and Trigoboff are with the State University of New York at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice in Buffalo, New York
- Drs. O'Donnell and Demler are with the New York State Office of Mental Health at Buffalo Psychiatric Center in Buffalo, New York
- Drs. Demler and Trigoboff are with the State University of New York at Buffalo School of Medicine, Department of Psychiatry in Buffalo, New York
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Göhler AC, Haas JW, Sperl MFJ, Hermann C, Winkler A. Placebo nasal spray protects female participants from experimentally induced sadness and concomitant changes in autonomic arousal. J Affect Disord 2021; 295:131-138. [PMID: 34438321 DOI: 10.1016/j.jad.2021.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To investigate the powerful placebo effects in antidepressant drug trials and their mechanisms, recent pioneering experimental studies showed that expectation manipulation combined with an active placebo attenuated induced sadness. In the present study, we aimed at extending these findings by assessing the psychophysiological response in addition to mere self-report. METHODS One hundred and thirteen healthy female students were randomly assigned to a drug expectation group (active placebo, positive treatment expectation), placebo expectation group (active placebo, no treatment expectation), or a no-treatment group (no placebo, no treatment expectation). After placebo intake, sadness was induced by self-deprecating statements using the Velten method combined with sad music, including a rumination phase. Sadness was measured using the Positive and Negative Affect Schedule Expanded Form (PANAS-X). Heart rate and skin conductance were assessed continuously. RESULTS After mood induction and after rumination, self-reported sadness was significantly lower, and skin conductance level was significantly higher, in the drug expectation group than in the no-treatment group. The mood induction was further accompanied by a heart rate deceleration within all groups. LIMITATIONS Generalizability is limited by sample selectivity and focusing on sadness as a symptom of depression, exclusively. CONCLUSION Expectation-induced placebo effects significantly influenced sadness-correlated changes in autonomic arousal, and not only subjectively reported sadness, indicating that placebo effects in the context of affect are not merely due to subjective response bias. The systematic modification of treatment expectation could be utilized in clinical practice to optimize current therapeutic approaches to improve mood regulation.
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Affiliation(s)
- Annelie C Göhler
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Julia W Haas
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany
| | - Matthias F J Sperl
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Christiane Hermann
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Alexander Winkler
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany.
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Kuramoto LK, Sobolev BG, Rosner J, Brasher PMA, Azoulay L, Cragg JJ. A systematic, concept-based method of developing the exposure measure for drug safety and effectiveness studies. Pharmacoepidemiol Drug Saf 2021; 31:13-21. [PMID: 34657356 DOI: 10.1002/pds.5372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/12/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE In drug safety and effectiveness studies based on secondary data, the choice of an appropriate exposure measure for a given outcome can be challenging. Different measures of exposure can yield different estimates of treatment effect and safety. There is a knowledge gap with respect to developing and refining measures of drug exposure, to ensure that the exposure measure addresses the study question and is suitable for statistical analysis. METHODS We present a transparent, step-by-step approach to the development of drug exposure measures involving secondary data. This approach would be of interest to students and investigators with initial training in pharmacoepidemiology. We illustrate the approach using a study about Parkinson's disease. RESULTS We described the exposure specifications according to the study question. Next, we refined the exposure measure by linking it to knowledge about four major concepts in drug safety and effectiveness studies: drug use patterns, duration, timing, and dose. We then used this knowledge to guide the ultimate choice of exposure measure: time-varying, cumulative 6-month exposure to tamsulosin (a drug used to treat prostate hyperplasia). CONCLUSIONS The proposed approach links exposure specifications to four major concepts in drug safety and effectiveness studies. Formulating subject-matter knowledge about these major concepts provides an avenue to develop the rationale and specifications for the exposure measure.
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Affiliation(s)
- Lisa K Kuramoto
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris G Sobolev
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jan Rosner
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, and Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Jacquelyn J Cragg
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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7
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Landén M, Larsson H, Lichtenstein P, Westin J, Song J. Respiratory infections during lithium and valproate medication: a within-individual prospective study of 50,000 patients with bipolar disorder. Int J Bipolar Disord 2021; 9:4. [PMID: 33521836 PMCID: PMC7847747 DOI: 10.1186/s40345-020-00208-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In vitro studies have demonstrated that lithium has antiviral properties, but evidence from human studies is scarce. Lithium is used as a mood stabilizer to treat patients with bipolar disorder. Here, the aim was to investigate the association between lithium use and the risk of respiratory infections in patients with bipolar disorder. To rule out the possibility that a potential association could be due to lithium's effect on psychiatric symptoms, we also studied the effect of valproate, which is an alternative to lithium used to prevent mood episodes in bipolar disorder. METHOD We followed 51,509 individuals diagnosed with bipolar disorder in the Swedish Patient register 2005-2013. We applied a within-individual design using stratified Cox regression to estimate the hazard ratios (HRs) of respiratory infections during treated periods compared with untreated periods. RESULTS During follow-up, 5,760 respiratory infections were documented in the Swedish Patient Register. The incidence rate was 28% lower during lithium treatment (HR 0.73, 95% CI 0.61-0.86) and 35% higher during valproate treatment (HR 1.35, 95% CI 1.06-1.73) compared with periods off treatment. CONCLUSIONS This study provides real-world evidence that lithium is associated with decreased risk for respiratory infections and suggests that the repurposing potential of lithium for potential antiviral or antibacterial effects is worthy of investigation.
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Affiliation(s)
- Mikael Landén
- Section of Psychiatry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå Stråket 15, 413 45, Gothenburg, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Westin
- Department of Infectious Diseases, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jie Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Keen C, Foulds JA, Willoughby M, Newton-Howes G, Knight J, Fazel S, Borschmann R, Kinner SA, Young JT. Antidepressant use and interpersonal violence perpetration: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e043306. [PMID: 33441364 PMCID: PMC7812107 DOI: 10.1136/bmjopen-2020-043306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/08/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There are conflicting perspectives as to whether antidepressant medication increases, decreases or has no effect on violence perpetration, impulsivity and aggressive behaviour. This is an important question given the widespread use of antidepressant medication and the significant medical, social, legal and health consequences of violence. We aim to: (1) systematically identify observational studies and randomised controlled trials that quantify the relationship between antidepressant use and interpersonal violence; (2) assess the quality of studies that quantify the relationship between antidepressant use and interpersonal violence and (3) estimate the pooled prevalence and measure of effect for the relationship between antidepressant use and interpersonal violence. METHODS AND ANALYSIS We will search MEDLINE, EMBASE, CINAHL, PsycINFO, PubMed and the Cochrane Library for relevant peer-reviewed literature. Our primary outcome is the perpetration of violent acts directed at others. Our secondary outcome is physical, interpersonal aggression measured through validated surveys. We will include randomised controlled trials, cohort studies and case-control studies that examine the association between the use of antidepressants and violence perpetration and/or physical aggression. No restrictions will be placed on the population. We will use the Methodological Standard for Epidemiological Research scale to assess the quality of included studies. We will provide an overview of the included studies and assess heterogeneity and publication bias. If there are sufficient studies, we will conduct meta-analyses to examine the possible association between antidepressants and violence, and undertake meta-regression to examine the effect of antidepressant class, length of follow-up, age of participants and population subgroups on the association between antidepressants and violence. ETHICS AND DISSEMINATION No ethics approval is required. Our findings will be disseminated through a peer-reviewed journal article and conference presentations. PROSPERO REGISTRATION DETAILS CRD42020175474.
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Affiliation(s)
- Claire Keen
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - James A Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Melissa Willoughby
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Josh Knight
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Seena Fazel
- Psychiatry, University of Oxford, Oxford, UK
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stuart A Kinner
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Mater Research Institute-UQ, University of Queensland, Brisbane, Queensland, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jesse T Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
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9
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Montoya ZT, Uhernik AL, Smith JP. Comparison of cannabidiol to citalopram in targeting fear memory in female mice. J Cannabis Res 2020; 2:48. [PMID: 33526146 PMCID: PMC7819293 DOI: 10.1186/s42238-020-00055-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Abstract
Background Cannabidiol (CBD) and selective serotonin reuptake inhibitors (SSRIs) are currently used to treat post-traumatic stress disorder (PTSD). However, these drugs are commonly studied after dosing just prior to extinction training, and there are gaps in our understanding of how they affect fear memory formation, their comparative effects on various types of memory, and of sexual dimorphisms in effects. Also, more studies involving female subjects are needed to balance the gender-inequality in the literature. Therefore, the purpose of this study was to directly compare the effects of CBD to citalopram in affecting the formation of auditory cued, contextual, and generalized fear memory, and to evaluate how extinction of these different memories was altered by pre-acquisition treatment in female mice. We also evaluated the impact of the estrous cycle on each of these. Methods Auditory-cued trace fear conditioning was conducted shortly after dosing female C57BL/6 mice, with either CBD or citalopram (10 mg/kg each), by pairing auditory tones with mild foot shocks. Auditory-cued, contextual, and generalized fear memory was assessed by measuring freezing responses, with an automated fear conditioning system, 24 h after conditioning. Each memory type was then evaluated every 24 h, over a 4-day period in total, to create an extinction profile. Freezing outcomes were statistically compared by ANOVA with Tukey HSD post hoc analysis, N = 12 mice per experimental group. Evaluation of sexual dimorphism was by comparison to historical data from male mice. Results Auditory cue-associated fear memory was not affected with CBD or citalopram; however, contextual memory was reduced with CBD by 11%, p < 0.05, but not citalopram, and generalized fear memory was reduced with CBD and citalopram, 20% and 22%, respectively, p < 0.05. Extinction learning was enhanced with CBD and citalopram, but, there was considerable memory-type variability between drug effects, with freezing levels reduced at the end of training by 9 to 17% for CBD, and 10 to 12% with citalopram. The estrous cycle did not affect any outcomes. Conclusions Both drugs are potent modifiers of fear memory formation; however, there is considerable divergence in their targeting of different memory types which, overall, could support the use of CBD as an alternative to SSRIs for treating PTSD in females, but not males. A limitation of the study was that it compared data from experiments done at different times to evaluate sexual dimorphism. Overall, this suggests that more research is necessary to guide any therapeutic approach involving CBD.
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Affiliation(s)
- Zackary T Montoya
- Colorado State University-Pueblo, 2200 Bonforte Blvd, Pueblo, CO, 81001, USA
| | - Amy L Uhernik
- Colorado State University-Pueblo, 2200 Bonforte Blvd, Pueblo, CO, 81001, USA
| | - Jeffrey P Smith
- Colorado State University-Pueblo, 2200 Bonforte Blvd, Pueblo, CO, 81001, USA.
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10
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Lengvenyte A, Vieta E. Association between selective serotonin reuptake inhibitors and violent crime - could underlying psychopathology be the cause? Eur Neuropsychopharmacol 2020; 36:151-153. [PMID: 32475743 DOI: 10.1016/j.euroneuro.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aiste Lengvenyte
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
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11
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Lagerberg T, Fazel S, Molero Y, Franko MA, Chen Q, Hellner C, Lichtenstein P, Chang Z. Associations between selective serotonin reuptake inhibitors and violent crime in adolescents, young, and older adults - a Swedish register-based study. Eur Neuropsychopharmacol 2020; 36:1-9. [PMID: 32475742 PMCID: PMC7347007 DOI: 10.1016/j.euroneuro.2020.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 01/07/2023]
Abstract
This study identified individuals ever dispensed a selective serotonin reuptake inhibitor (SSRI) aged 15-60 years during 2006-2013, using Swedish national registers. The outcome was violent crime conviction. The main statistical analyses assessed risks of violent crime during periods on compared to off SSRI treatment within individuals. Further analyses investigated risk over time in relation to treatment initiation and discontinuation. The study identified 785,337 individuals (64.2% female), experiencing 32,203 violent crimes in 5,707,293 person-years. Between-individual analyses found statistically significantly elevated Hazard Ratios (HRs) overall (HR = 1.10), and in 15-24 and 25-34 year-olds (HR = 1.19 and 1.16), but non-significant HRs in 35-44 and 45-60-year-olds (HR = 1.02 and 1.04). In within-individual analyses, where 2.6% of SSRI users were informative, hazards were elevated overall (HR = 1.26, 95% CI = 1.19, 1.34), and across age groups (HR of 1.35 [95% CI = 1.19, 1.54] in 25-34-year-olds to 1.15 [95% CI = 0.99, 1.33] in 35-44-year-olds). In the overall cohort, the within-individual HRs were significantly elevated throughout treatment (HRs of 1.24 to 1.35) and for up to 12 weeks post-discontinuation (HRs of 1.37 and 1.20). While questions on causality remain, these results indicate that there may be an increased risk of violent crime during SSRI treatment in a small group of individuals. It may persist throughout medicated periods, across age groups, and after treatment discontinuation. Further confirmation is needed from studies with different designs, and clinical focus should be on high-risk individuals, as a majority of SSRI-users (around 97% in our cohort) will not commit violent crimes.
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Affiliation(s)
- Tyra Lagerberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden.
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Yasmina Molero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden
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Foulds J, Young JT. Pharmacotherapy for incarcerated people with a history of violence: Response to commentary by Schofield et al. Aust N Z J Psychiatry 2020; 54:106-107. [PMID: 31691572 DOI: 10.1177/0004867419885175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Jesse T Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,The Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,National Drug Research Institute, Curtin University, Perth, WA, Australia
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13
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Osler M, Wium-Andersen MK, Wium-Andersen IK, Gronemann FH, Jørgensen MB, Rozing MP. Incidence of suicidal behaviour and violent crime following antidepressant medication: a Danish cohort study. Acta Psychiatr Scand 2019; 140:522-531. [PMID: 31487044 DOI: 10.1111/acps.13097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine the incidence of suicidal and violent behaviour following initiation of antidepressant medication. METHOD Cohorts of 997 911 conscripts and 95 794 patients with a first-time affective disorder were followed for purchase of antidepressant medication, suicide, suicide attempts and conviction for violent crime in Danish registries between 1997 through 2015. Incidence of outcomes was estimated for the first 28 days, 28-365 days or later after initiation of antidepressants or study entry. RESULTS Of 16.5% of conscripts and 73.7% of patients with affective disorders initiated antidepressant medication. Incidence of suicide was 3-4 times higher during the first 28 days after initiation compared to the rates in the following year in both cohorts. A similar trend was seen among the untreated patients with affective disorders, whereas suicide incidence was stable at a low level among conscripts not treated with antidepressants. Incidence of attempted suicide was highest during the 28 days before and after initiation of antidepressants, while rates of violent crime were similar before and after initiation. These trends in incidence were independent of class of antidepressant. CONCLUSION Higher rates of suicidal behaviour in the weeks following initiation of antidepressant medication probably reflect disease severity and a delay in mood response.
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Affiliation(s)
- M Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark.,Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M K Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - I K Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark.,Psychiatric Centre Copenhagen Dept O, Rigshospitalet, Copenhagen, Denmark
| | - F H Gronemann
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - M B Jørgensen
- Psychiatric Centre Copenhagen Dept O, Rigshospitalet, Copenhagen, Denmark
| | - M P Rozing
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Centre Copenhagen Dept O, Rigshospitalet, Copenhagen, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Hall RCW, Friedman SH, Sorrentino R, Lapchenko M, Marcus A, Ellis R. The myth of school shooters and psychotropic medications. BEHAVIORAL SCIENCES & THE LAW 2019; 37:540-558. [PMID: 31513302 DOI: 10.1002/bsl.2429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/15/2019] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Abstract
There has been an assertion in certain parts of the media, especially social media, that the majority of individuals who have engaged in a school shooting were prescribed psychotropic medications prior to the event. To determine if there is any validity to this assertion, the authors of this article reviewed publicly available information regarding individuals involved in "educational shootings" per FBI publications for active shooters from 2000 to 2017. Sources of information included news reports with official citations, official reports regarding events, available court records, and FBI Freedom of Information Act requests. Secondary data-points were also collected, such as location, number of weapons used, number of victims, legal outcome, and whether the shooter committed suicide. From the information obtained, it appears that most school shooters were not previously treated with psychotropic medications - and even when they were, no direct or causal association was found.
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15
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Penagos-Corzo JC, Antonio AA, Dorantes-Argandar G, Alcázar-Olán RJ. Psychometric Properties and Development of a Scale Designed to Evaluate the Potential of Predatory Violent Behavior. Front Psychol 2019; 10:1648. [PMID: 31417446 PMCID: PMC6646734 DOI: 10.3389/fpsyg.2019.01648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/01/2019] [Indexed: 01/10/2023] Open
Abstract
The objective of this study was to develop and determine the psychometric properties of an instrument designed to detect traits and behavior that are associated with predatory violent behavior, which is defined as a determined, planned, controlled, and proactive aggression. The sample was comprised of 564 students, mostly in their last year of high school, or in their first year of college. The initial instrument had 78 items, ultimately resulting in 13 with good internal consistency (α = 0.825). Factor analysis showed four factors: anger-in, appeal for weapons, suicidal ideation, and the tendency to take justice into one’s own hands. Said factors showed significant correlations of convergent validity. Data shown here allows inferring that the instrument is a novel and concise tool that evaluates and detects the potential of predatory violent behavior.
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Affiliation(s)
| | - Alejandra A Antonio
- Department of Psychology, Universidad de las Américas Puebla, Puebla, Mexico
| | - Gabriel Dorantes-Argandar
- Centro de Investigación Transdiciplinar en Psicología (CITPsi), Universidad Autónoma del Estado de Morelos, Cuernavaca, Mexico
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Molero Y, Larsson H, D'Onofrio BM, Sharp DJ, Fazel S. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden. BMJ 2019; 365:l2147. [PMID: 31189556 PMCID: PMC6559335 DOI: 10.1136/bmj.l2147] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine associations between gabapentinoids and adverse outcomes related to coordination disturbances (head or body injuries, or both and road traffic incidents or offences), mental health (suicidal behaviour, unintentional overdoses), and criminality. DESIGN Population based cohort study. SETTING High quality prescription, patient, death, and crime registers, Sweden. PARTICIPANTS 191 973 people from the Swedish Prescribed Drug Register who collected prescriptions for gabapentinoids (pregabalin or gabapentin) during 2006 to 2013. MAIN OUTCOME MEASURES Primary outcomes were suicidal behaviour, unintentional overdoses, head/body injuries, road traffic incidents and offences, and arrests for violent crime. Stratified Cox proportional hazards regression was conducted comparing treatment periods with non-treatment periods within an individual. Participants served as their own control, thus accounting for time invariant factors (eg, genetic and historical factors), and reducing confounding by indication. Additional adjustments were made by age, sex, comorbidities, substance use, and use of other antiepileptics. RESULTS During the study period, 10 026 (5.2%) participants were treated for suicidal behaviour or died from suicide, 17 144 (8.9%) experienced an unintentional overdose, 12 070 (6.3%) had a road traffic incident or offence, 70 522 (36.7%) presented with head/body injuries, and 7984 (4.1%) were arrested for a violent crime. In within-individual analyses, gabapentinoid treatment was associated with increased hazards of suicidal behaviour and deaths from suicide (age adjusted hazard ratio 1.26, 95% confidence interval 1.20 to 1.32), unintentional overdoses (1.24, 1.19 to 1.28), head/body injuries (1.22, 1.19 to 1.25), and road traffic incidents and offences (1.13, 1.06 to 1.20). Associations with arrests for violent crime were less clear (1.04, 0.98 to 1.11). When the drugs were examined separately, pregabalin was associated with increased hazards of all outcomes, whereas gabapentin was associated with decreased or no statistically significant hazards. When stratifying on age, increased hazards of all outcomes were associated with participants aged 15 to 24 years. CONCLUSIONS This study suggests that gabapentinoids are associated with an increased risk of suicidal behaviour, unintentional overdoses, head/body injuries, and road traffic incidents and offences. Pregabalin was associated with higher hazards of these outcomes than gabapentin.
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Affiliation(s)
- Yasmina Molero
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - David J Sharp
- Division of Brain Sciences, Imperial College London, London, UK
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
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Is Sertraline a Good Pharmacological Strategy to Control Anger? Results of a Systematic Review. Behav Sci (Basel) 2019; 9:bs9050057. [PMID: 31126061 PMCID: PMC6562745 DOI: 10.3390/bs9050057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/10/2019] [Accepted: 05/21/2019] [Indexed: 01/02/2023] Open
Abstract
Introduction: Extensive research has made it possible to conclude that dysfunctions in serotoninergic transmission are associated with a tendency toward violence and behavioral dysregulations in humans. In this regard, it has been suggested that selective serotonin reuptake inhibitors (SSRIs), such as sertraline, which regulate the serotonin system, might reduce proneness to violence. Aims: This review aims to explore changes in feelings of anger-state (e.g., irritability and hostility) and anger expression as primary outcomes after sertraline treatment. Methods: Based on PRISMA quality criteria for reviews, a literature search was carried out through PubMed, PsycINFO, Dialnet, Psicodoc, Web of Knowledge, and the Cochrane Library. Results: Initially, 605 publications were identified, removing 219 duplicate manuscripts and screening the titles and abstracts of the remaining 386 records. This process left 248 articles for full-text reading, finally including 15 entries. Thus, several empirical studies were included that employed different research designs. In this regard, we considered 3 case reports, 5 open clinical trials, and 7 randomized placebo-controlled trials. The majority of the studies were unanimous in concluding that a large percentage of patients with high irritability levels responded satisfactorily to sertraline treatment. In fact, their mood improved, and they experienced a reduction in irritability and anger expression after a few weeks of treatment (approximately two weeks). However, it was necessary to increase the sertraline dose after months of treatment to avoid exhaustion effects. Moreover, not all the patients responded to the treatment and it is particularly interesting that a small percentage of patients were refractory to treatment or even showed an increase in irritability after a few weeks of treatment. In those cases, it was necessary to discontinue the treatment or reduce the dose to the initial levels. Discussion: Although it is necessary to be cautious about the benefits of sertraline as a way to control anger and irritability, it is relevant to consider pharmacological strategies to reduce anger-state as coadjutant treatments to psychotherapy in order to promote lasting changes in violent populations.
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Hayes JF, Lundin A, Wicks S, Lewis G, Wong ICK, Osborn DPJ, Dalman C. Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type Calcium Channel Antagonists, and Biguanides With Rates of Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness. JAMA Psychiatry 2019; 76:382-390. [PMID: 30624557 PMCID: PMC6450278 DOI: 10.1001/jamapsychiatry.2018.3907] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Drug repurposing is potentially cost-effective, low risk, and necessary in psychiatric drug development. The availability of large, routine data sets provides the opportunity to evaluate the potential for currently used medication to benefit people with serious mental illness (SMI). OBJECTIVE To determine whether hydroxylmethyl glutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), L-type calcium channel (LTCC) antagonists, and biguanides are associated with reduced psychiatric hospitalization and self-harm in individuals with SMI. DESIGN, SETTING, AND PARTICIPANTS These within-individual cohort studies of patients with SMI compared rates of psychiatric hospitalization and self-harm during periods of exposure and nonexposure to the study drugs, with adjusting for a number of time-varying covariates. Participants included 142 691 individuals from the entire population of Sweden with a diagnosis of bipolar disorder (BPD), schizophrenia, or nonaffective psychosis (NAP) who were 15 years or older and who were treated with psychiatric medication from October 1, 2005, through December 31, 2016. Data were analyzed from April 1 through August 31, 2018. INTERVENTIONS Treatment with HMG-CoA RIs, LTCC antagonists, or biguanides. MAIN OUTCOMES AND MEASURES Psychiatric hospitalizations and self-harm admissions. RESULTS Among the 142 691 eligible participants, the HMG-CoA RI exposure periods were associated with reduced rates of psychiatric hospitalization in BPD (adjusted hazard ratio [aHR], 0.86; 95% CI, 0.83-0.89; P < .001), schizophrenia (aHR, 0.75; 95% CI, 0.71-0.79; P < .001), and NAP (aHR, 0.80; 95% CI, 0.75-0.85; P < .001) and reduced self-harm rates in BPD (aHR, 0.76; 95% CI, 0.66-0.86; P < .001) and schizophrenia (aHR, 0.58; 95% CI, 0.45-0.74; P < .001). Exposure to LTCC antagonists was associated with reduced rates of psychiatric hospitalization and self-harm in subgroups with BPD (aHRs, 0.92 [95% CI, 0.88-0.96; P < .001] and 0.81 [95% CI, 0.68-0.95; P = .01], respectively), schizophrenia (aHRs, 0.80 [95% CI, 0.74-0.85; P < .001] and 0.30 [95% CI, 0.18-0.48; P < .001], respectively), and NAP (aHRs, 0.89 [95% CI, 0.83-0.96; P = .002] and 0.56 [95% CI, 0.42-0.74; P < .001], respectively). During biguanide exposure, psychiatric hospitalization rates were reduced in subgroups with BPD (aHR, 0.80; 95% CI, 0.77-0.84; P < .001), schizophrenia (aHR, 0.73; 95% CI, 0.69-0.77; P < .001), and NAP (aHR, 0.85; 95% CI, 0.79-0.92; P < .001), and self-harm was reduced in BPD (aHR, 0.73; 95% CI, 0.62-0.84; P < .001) and schizophrenia (aHR, 0.64; 95% CI, 0.48-0.85; P < .001). CONCLUSIONS AND RELEVANCE This study provides additional evidence that exposure to HMG-CoA RIs, LTCC antagonists, and biguanides might lead to improved outcomes for individuals with SMI. Given the well-known adverse event profiles of these agents, they should be further investigated as repurposed agents for psychiatric symptoms.
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Affiliation(s)
- Joseph F. Hayes
- Division of Psychiatry, University College London, London, United Kingdom
| | - Andreas Lundin
- Department of Public Health Sciences, Epidemiology of Psychiatric Conditions, Substance Use, and Social Environment, Karolinska Institute, Stockholm, Sweden
| | - Susanne Wicks
- Department of Public Health Sciences, Epidemiology of Psychiatric Conditions, Substance Use, and Social Environment, Karolinska Institute, Stockholm, Sweden
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Ian C. K. Wong
- Centre for Medicines Optimisation Research and Education, Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom,Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong
| | - David P. J. Osborn
- Division of Psychiatry, University College London, London, United Kingdom
| | - Christina Dalman
- Department of Public Health Sciences, Epidemiology of Psychiatric Conditions, Substance Use, and Social Environment, Karolinska Institute, Stockholm, Sweden
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Lagerberg T, Molero Y, D’Onofrio BM, Fernández de la Cruz L, Lichtenstein P, Mataix-Cols D, Rück C, Hellner C, Chang Z. Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden. Eur Child Adolesc Psychiatry 2019; 28:1137-1145. [PMID: 30659386 PMCID: PMC6675912 DOI: 10.1007/s00787-018-01269-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022]
Abstract
This study examines trends in antidepressant drug dispensations among young people aged 0-24 years in Sweden during the period 2006-2013, as well as prescription patterns and central nervous system (CNS) polypharmacy with antidepressants. Using linkage of Swedish national registers, we identified all Swedish residents aged 0-24 years that collected at least one antidepressant prescription (here defined as antidepressant users) between 1 January 2006 and 31 December 2013 (n = 174,237), and categorized them as children (0-11 years), adolescents (12-17 years), and young adults (18-24 years). Prevalence of antidepressant dispensation rose from 1.4 to 2.1% between 2006 and 2013, with the greatest relative increase in adolescents [by 97.8% in males (from 0.6 to 1.3%) and by 86.3% in females (from 1.1 to 2.1%)]. Most individuals across age categories were prescribed selective serotonin reuptake inhibitors, received their prescriptions from psychiatric specialist care, and had treatment periods of over 12 months. Prevalence of CNS polypharmacy (dispensation of other CNS drug classes in addition to antidepressants) increased across age categories, with an overall increase in prevalence from 52.4% in 2006 to 62.1% in 2013. Children experienced the largest increase in polypharmacy of three or more psychotropic drug classes (4.4-10.1%). Anxiolytics, hypnotics, and sedatives comprised the most common additional CNS drug class among persons who were prescribed antidepressants. These findings show that the dispensation of antidepressants among the young is prevalent and growing in Sweden. The substantial degree of CNS polypharmacy in young patients receiving antidepressants requires careful monitoring and further research into potential benefits and harms.
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Affiliation(s)
- Tyra Lagerberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden.
| | - Y. Molero
- 0000 0004 1937 0626grid.4714.6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK ,0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Karolinska Institutet, Solna, 171 65 Stockholm, Sweden
| | - B. M. D’Onofrio
- 0000 0004 1937 0626grid.4714.6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden ,0000 0001 0790 959Xgrid.411377.7Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN USA
| | - L. Fernández de la Cruz
- 0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Karolinska Institutet, Solna, 171 65 Stockholm, Sweden
| | - P. Lichtenstein
- 0000 0004 1937 0626grid.4714.6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden
| | - D. Mataix-Cols
- 0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Karolinska Institutet, Solna, 171 65 Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - C. Rück
- 0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Karolinska Institutet, Solna, 171 65 Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - C. Hellner
- 0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Karolinska Institutet, Solna, 171 65 Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Z. Chang
- 0000 0004 1937 0626grid.4714.6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden
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Chick J. Unhelpful Prescribing in Alcohol Use Disorder: Risk and Averting Risk. Alcohol Alcohol 2019; 54:1-4. [PMID: 30624639 DOI: 10.1093/alcalc/agy090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 02/04/2023] Open
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Abstract
The aim of this review is to evaluate the placebo effect in the treatment of anxiety and depression. Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin or norepinephrine in the brain. However, analyses of the published and the unpublished clinical trial data are consistent in showing that most (if not all) of the benefits of antidepressants in the treatment of depression and anxiety are due to the placebo response, and the difference in improvement between drug and placebo is not clinically meaningful and may be due to breaking blind by both patients and clinicians. Although this conclusion has been the subject of intense controversy, the current article indicates that the data from all of the published meta-analyses report the same results. This is also true of recent meta-analysis of all of the antidepressant data submitted to the Food and Drug Administration (FDA) in the process of seeking drug approval. Also, contrary to previously published results, the new FDA analysis reveals that the placebo response has not increased over time. Other treatments (e.g., psychotherapy and physical exercise) produce the same benefits as antidepressants and do so without the side effects and health risks of the active drugs. Psychotherapy and placebo treatments also show a lower relapse rate than that reported for antidepressant medication.
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Sex Differences in Reported Adverse Drug Reactions of Selective Serotonin Reuptake Inhibitors. Drug Saf 2018; 41:677-683. [PMID: 29484612 DOI: 10.1007/s40264-018-0646-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Several studies have investigated sex as a risk factor for the occurrence of adverse drug reactions (ADRs) and found that women are more likely to experience ADRs than men. OBJECTIVE The aim of this explorative study was to investigate whether differences exist in reported ADRs of selective serotonin reuptake inhibitors (SSRIs) for men and women in the database of the Netherlands Pharmacovigilance Centre Lareb. METHODS A ratio of reports concerning women and men, corrected for the number of users, was calculated for all the ADRs reported on SSRIs. RESULTS We found that 16 ADRs were statistically significantly more reported in women than men, and four ADRS were reported more in men than women. CONCLUSION ADRs more reported in women than men when using SSRIs were usually dose-related ADRs or commonly occurring ADRs. Differences in the pharmacokinetics of SSRIs between men and women may explain why these reports of dose-related ADRs when using SSRIs concern women more than men.
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Selective serotonin re-uptake inhibitors and the risk of violent suicide: a nationwide postmortem study. Eur J Clin Pharmacol 2018; 75:393-400. [DOI: 10.1007/s00228-018-2586-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022]
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Joas E, Karanti A, Song J, Goodwin GM, Lichtenstein P, Landén M. Pharmacological treatment and risk of psychiatric hospital admission in bipolar disorder. Br J Psychiatry 2017; 210:197-202. [PMID: 28104736 DOI: 10.1192/bjp.bp.116.187989] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/23/2022]
Abstract
BackgroundClinical trials have examined the efficacy of drugs to prevent relapse in patients with bipolar disorder, however, their design often limits generalisation to routine clinical practice.AimsTo estimate the effectiveness of drugs used for maintenance treatment in bipolar disorder.MethodWe used national registers to identify 35 022 individuals diagnosed with bipolar disorder and information on lithium, valproate, carbamazepine, lamotrigine, quetiapine and olanzapine treatment from 2006 to 2009. The main outcome was psychiatric hospital admissions. We used stratified cox regression to compare periods on and off medication within the same individual.ResultsMedication with lithium, valproate, lamotrigine, olanzapine and quetiapine was associated with reduced rates of admission to hospital. Lithium was more effective than quetiapine and olanzapine. The effects of specific drugs depended on the polarity of the mood episode.ConclusionsOur findings complement results from randomised controlled trails, but suggest that lithium is more effective than both quetiapine and olanzapine in routine clinical practice.
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Affiliation(s)
- Erik Joas
- Erik Joas, MSc, Alina Karanti, MD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Jie Song, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Mikael Landén MD, PhD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alina Karanti
- Erik Joas, MSc, Alina Karanti, MD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Jie Song, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Mikael Landén MD, PhD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jie Song
- Erik Joas, MSc, Alina Karanti, MD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Jie Song, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Mikael Landén MD, PhD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Guy M Goodwin
- Erik Joas, MSc, Alina Karanti, MD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Jie Song, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Mikael Landén MD, PhD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Erik Joas, MSc, Alina Karanti, MD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Jie Song, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Mikael Landén MD, PhD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Erik Joas, MSc, Alina Karanti, MD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Jie Song, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Mikael Landén MD, PhD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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de Vries YA, Roest AM, Beijers L, Turner EH, de Jonge P. Bias in the reporting of harms in clinical trials of second-generation antidepressants for depression and anxiety: A meta-analysis. Eur Neuropsychopharmacol 2016; 26:1752-1759. [PMID: 27659240 DOI: 10.1016/j.euroneuro.2016.09.370] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/02/2016] [Accepted: 09/08/2016] [Indexed: 11/15/2022]
Abstract
Previous research has shown that reporting bias has inflated the apparent efficacy of antidepressants. We investigated whether apparent safety was also affected. We included 133 trials, involving 31,296 patients, of second-generation antidepressants for the treatment of major depressive disorder (MDD) or anxiety disorders, obtained from Food and Drug Administration (FDA) reviews. We extracted data on overall discontinuation, discontinuation due to adverse events, and serious adverse events (SAEs). Meta-analysis was used to compare discontinuation rates between FDA reviews and matching journal articles, while SAEs were compared qualitatively. The odds ratio for overall discontinuation, comparing drug to placebo, was 1.0 for both sources, while that for discontinuation due to adverse events was 2.4 for both sources. Seventy-seven of 97 (79%) journal articles provided incomplete information on SAEs; sixty-one (63%) articles made no mention of SAEs at all. Of 21 articles which could be compared to the FDA, only 6 (29%) had full reporting without discrepancies. Nine (43%) articles reported a discrepant number of SAEs. Descriptions were absent or discrepant in 6 (29%) additional articles, even for important SAEs such as suicide attempts. In conclusion, reporting bias has not affected average discontinuation rates over trials. However, SAE reporting is not only very poor, with over half of articles failing to discuss SAEs altogether, but discrepancies between the FDA and articles were common and often led to a more favorable drug-placebo comparison. These findings suggest that journal articles are an unreliable source of data on SAEs in antidepressant trials.
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Affiliation(s)
- Ymkje Anna de Vries
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Annelieke M Roest
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lian Beijers
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erick H Turner
- Behavioral Health and Neurosciences Division, Portland Veterans Affairs Medical Center, Portland, OR, USA; Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Developmental Psychology, Department of Psychology, University of Groningen, Groningen, The Netherlands
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Hemminki E, Merikukka M, Gissler M, Wahlbeck K, Savolainen J, Ristikari T, Aaltonen M. Antidepressant use and violent crimes among young people: a longitudinal examination of the Finnish 1987 birth cohort. J Epidemiol Community Health 2016; 71:12-18. [PMID: 27354489 DOI: 10.1136/jech-2016-207265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/04/2016] [Accepted: 06/05/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), has been questioned due to poor efficacy and safety. We examined whether young violent offenders were more likely antidepressant users prior to their first violent offence than other young persons. METHODS The study is a follow-up of children born in Finland in 1987 (n=59 120), linking national registers to each other using personal identity codes. Data on psychotropic drug use came from a register of reimbursed drugs and data on crimes from a register on court convictions (after the age of 14 years). Participants were followed until the age of 18 years, and for some analyses until the end of the follow-up (mean 21 years). To adjust for differences in background characteristics, regression analyses for antidepressant use were made, using the no-conviction group as the reference. RESULTS Proportions of young people convicted by the age of 18 years were: 5% of boys (1.7% for violent crimes) and 1% (0.5%) of girls. Antidepressant use (both overall and for SSRIs) prior to violent crime was more common among those convicted than among those without convictions. Among boys with repeated violent crimes, it was also more common than among boys with non-violent crimes. Adjustment for differences in background characteristics decreased the associations between antidepressant use and violent crime, but did not eliminate them. CONCLUSIONS The results add further evidence for caution in prescribing antidepressants among young persons. It also calls for a reanalysis of violence measures in the original trial data.
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Affiliation(s)
| | | | | | | | - Jukka Savolainen
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki Finland
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The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide. J Forensic Leg Med 2016; 41:65-71. [PMID: 27138119 DOI: 10.1016/j.jflm.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/04/2016] [Accepted: 04/01/2016] [Indexed: 11/22/2022]
Abstract
Adverse drug reactions and interactions are among the major causes of death in the United States. Antidepressants have been reported as causing suicide and homicide and share the class attribute of frequently producing akathisia, a state of severe restlessness associated with thoughts of death and violence. Medical examiners can now identify some pharmacogenetic interactions that cause drugs, deemed safe for most, to be lethal to others. Such deaths do not yet include medication-induced, akathisia-related suicides and homicides. An extrapyramidal side effect, akathisia is a manifestation of drug toxicity whose causes lie, inter alia, in drugs, doses, and co-prescribed medications that inhibit and compete for metabolizing enzymes, which may themselves be defective. In this paper, we report our investigation into adverse drug reactions/interactions in three persons who committed homicide, two also intending suicide, while on antidepressants prescribed for stressful life events. Their histories of medication use, adverse reactions and reasons for changes in medications are presented. DNA samples were screened for variants in the cytochrome P450 gene family; that produce drug metabolizing enzymes. All three cases exhibit genotype-based diminished metabolic capability that, in combination with their enzyme inhibiting/competing medications, decreased metabolism further and are the likely cause of these catastrophic events.
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Henje Blom E, Ho TC, Connolly CG, LeWinn KZ, Sacchet MD, Tymofiyeva O, Weng HY, Yang TT. The neuroscience and context of adolescent depression. Acta Paediatr 2016; 105:358-65. [PMID: 26663379 PMCID: PMC4779656 DOI: 10.1111/apa.13299] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/24/2015] [Accepted: 12/03/2015] [Indexed: 01/19/2023]
Abstract
Adolescent depression is a growing public health concern with an increased risk of negative health outcomes, including suicide. The use of antidepressants and psychotherapy has not halted its increasing prevalence, and there is a critical need for effective prevention and treatment. We reviewed the neuroscience of adolescent depression, with a focus on the neurocircuitry of sustained threat and summarised contextual factors that have an impact on brain development and the pathophysiology of depression. We also reviewed novel treatment models. Conclusion Attention to the relevant neurocircuitry and contextual factors implicated in adolescent depression is necessary to advance prevention and treatment development.
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Affiliation(s)
- Eva Henje Blom
- Department of Psychiatry Division of Child and Adolescent Psychiatry University of California, San Francisco (UCSF) San Francisco CA USA
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Tiffany C. Ho
- Department of Psychiatry Division of Child and Adolescent Psychiatry University of California, San Francisco (UCSF) San Francisco CA USA
| | - Colm G. Connolly
- Department of Psychiatry Division of Child and Adolescent Psychiatry University of California, San Francisco (UCSF) San Francisco CA USA
| | - Kaja Z. LeWinn
- Department of Psychiatry Division of Child and Adolescent Psychiatry University of California, San Francisco (UCSF) San Francisco CA USA
| | - Matthew D. Sacchet
- Department of Psychiatry Division of Child and Adolescent Psychiatry University of California, San Francisco (UCSF) San Francisco CA USA
- Neurosciences Program and Department of Psychology Stanford University Stanford, CA USA
| | - Olga Tymofiyeva
- Department of Radiology University of California, San Francisco (UCSF) San Francisco CA USA
| | - Helen Y. Weng
- The Osher Center for Integrative Medicine University of California, San Francisco (UCSF) San Francisco CA USA
| | - Tony T. Yang
- Department of Psychiatry Division of Child and Adolescent Psychiatry University of California, San Francisco (UCSF) San Francisco CA USA
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Kirsch I. Der Placeboeffekt in der antidepressiven Behandlung. VERHALTENSTHERAPIE 2016. [DOI: 10.1159/000443542] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Szmulewicz A, Samamé C, Caravotta P, Martino DJ, Igoa A, Hidalgo-Mazzei D, Colom F, Strejilevich SA. Behavioral and emotional adverse events of drugs frequently used in the treatment of bipolar disorders: clinical and theoretical implications. Int J Bipolar Disord 2016; 4:6. [PMID: 26879750 PMCID: PMC4754238 DOI: 10.1186/s40345-016-0047-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/04/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Behavioral and emotional adverse events induced by drugs commonly prescribed to patients with bipolar disorders are of paramount importance to clinical practice and research. However, no reviews on the topic have been published so far. METHODS An extensive search was performed. Reports were reviewed if they described behavioral side effects related to pharmacological treatments for bipolar disorders in healthy subjects or patients with different neuropsychiatric disorders. For this review, lithium, antipsychotics, anticonvulsants and selective serotonin reuptake inhibitors were included. RESULTS Apathy or emotional blunting, diminished sexual desire, and inability to cry were reported to be associated with exposure to selective serotonin reuptake inhibitors. Neuroleptic-induced deficit syndrome/emotional detachment and obsessive-compulsive symptomatology and decision-making modifications. A lithium-related amotivational syndrome was also reported in the literature. Furthermore, hypersexuality and obsessive-compulsive symptoms have been noted in subjects treated with lamotrigine. LIMITATIONS Primary studies on drug-related adverse events are scant so far and most of the data currently available derive from case reports. Moreover, most of the evidence reviewed is based on studies performed on healthy subjects and patients with neuropsychiatric conditions other than bipolar disorders. DISCUSSION There is a remarkable dearth of data on behavioral adverse events of pharmacological treatment for bipolar disorders. However, the pieces of evidence available at present, though scant and scattered, suggest that different behavioral adverse events may be related to pharmacological treatment for these disorders. The implications of these findings for research and management of patients with mood disorders are discussed.
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Affiliation(s)
- Alejandro Szmulewicz
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,Hospital de Emergencias Psiquiátricas Torcuato de Alvear (HEPTA), Buenos Aires, Argentina.
| | - Cecilia Samamé
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | - Pablo Caravotta
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | - Diego J Martino
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | - Ana Igoa
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina.
| | | | - Francesc Colom
- Bipolar Disorders Program, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,, Congreso 2477 Dto. D (1428), Buenos Aires, Argentina.
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Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016; 352:i65. [PMID: 26819231 PMCID: PMC4729837 DOI: 10.1136/bmj.i65] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To study serious harms associated with selective serotonin and serotonin-norepinephrine reuptake inhibitors.Design Systematic review and meta-analysis. MAIN OUTCOME MEASURES Mortality and suicidality. Secondary outcomes were aggressive behaviour and akathisia. DATA SOURCES Clinical study reports for duloxetine, fluoxetine, paroxetine, sertraline, and venlafaxine obtained from the European and UK drug regulators, and summary trial reports for duloxetine and fluoxetine from Eli Lilly's website. ELIGIBILITY CRITERIA FOR STUDY SELECTION Double blind placebo controlled trials that contained any patient narratives or individual patient listings of harms. DATA EXTRACTION AND ANALYSIS Two researchers extracted data independently; the outcomes were meta-analysed by Peto's exact method (fixed effect model). RESULTS We included 70 trials (64,381 pages of clinical study reports) with 18,526 patients. These trials had limitations in the study design and discrepancies in reporting, which may have led to serious under-reporting of harms. For example, some outcomes appeared only in individual patient listings in appendices, which we had for only 32 trials, and we did not have case report forms for any of the trials. Differences in mortality (all deaths were in adults, odds ratio 1.28, 95% confidence interval 0.40 to 4.06), suicidality (1.21, 0.84 to 1.74), and akathisia (2.04, 0.93 to 4.48) were not significant, whereas patients taking antidepressants displayed more aggressive behaviour (1.93, 1.26 to 2.95). For adults, the odds ratios were 0.81 (0.51 to 1.28) for suicidality, 1.09 (0.55 to 2.14) for aggression, and 2.00 (0.79 to 5.04) for akathisia. The corresponding values for children and adolescents were 2.39 (1.31 to 4.33), 2.79 (1.62 to 4.81), and 2.15 (0.48 to 9.65). In the summary trial reports on Eli Lilly's website, almost all deaths were noted, but all suicidal ideation events were missing, and the information on the remaining outcomes was incomplete. CONCLUSIONS Because of the shortcomings identified and having only partial access to appendices with no access to case report forms, the harms could not be estimated accurately. In adults there was no significant increase in all four outcomes, but in children and adolescents the risk of suicidality and aggression doubled. To elucidate the harms reliably, access to anonymised individual patient data is needed.
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Affiliation(s)
- Tarang Sharma
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Faculty of Health and Medical Sciences, Denmark
| | - Louise Schow Guski
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Faculty of Health and Medical Sciences, Denmark
| | - Nanna Freund
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Faculty of Health and Medical Sciences, Denmark
| | - Peter C Gøtzsche
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Faculty of Health and Medical Sciences, Denmark
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Abstract
The PLOS Medicine Editors take stock of changes in the reporting of observational studies following our new transparency guidelines from August 2014.
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