HIGH RISK OF NEW PSYCHIATRIC DISORDERS AND SUICIDAL BEHAVIOR IN DEMENTIA

Abstract Occurrence of new mental health (MH) disorders in patients with dementia is neglected, with next to nothing known. We examined association between dementia diagnosis and risk of new psychiatric disorders and suicide, and MH services use. We merged four national databases from US Department of Veterans Affairs. Sample included 2,529,181 patients (≥50 years) in fiscal years (FY) 2012-2013 with no MH disorders. Dementia, psychiatric disorders (mood, anxiety, substance), suicidal behavior (ideation, plan, attempt, death by suicide) were identified by ICD-9/10 codes and national suicide databases. Hazard ratios (HR) were estimated using Cox proportional hazard models, with time-to-event defined as age at first diagnosis of MH disorder during FY 2014-2016. Analyses adjusted for medical/sociodemographic factors. Compared to those without dementia, dementia patients showed roughly 2-fold increased risk of new mood (HR: 2.19, 95% Wald CI: 2.15-2.24, p<.001) or anxiety (HR: 1.56, 95% CI: 1.50-1.63, p<.001) disorders. Recent dementia diagnosis was associated with highest risk of these disorders than prior or no diagnosis; for example, patients with recent diagnosis showed 72% greater risk of anxiety disorders (HR: 1.72, 95% CI: 1.63-1.81, p<.001). Although patients with prior dementia diagnosis had lower risk of suicidal behavior, risk increased with recent dementia diagnosis. However, dementia patients with new MH disorders showed little MH services use (< 20%). Patients with dementia have increased risk of new MH disorders, especially recent dementia diagnosis. Furthermore, MH services are underutilized, highlighting critical need for integration of such services in caring for dementia patients.

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Cholesterol and Egg Intakes, and Risk of Hypertension in a Large Prospective Cohort of French Women

Nutrients ◽

10.3390/nu12051350 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1350

Author(s):

Conor-James MacDonald ◽

Anne-Laure Madika ◽

Fabrice Bonnet ◽

Guy Fagherazzi ◽

Martin Lajous ◽

...

Keyword(s):

Cardiovascular Disease ◽

Population Based ◽

Dietary History ◽

Egg Consumption ◽

Hazard Ratios ◽

Increased Risk ◽

Cholesterol Intake ◽

Cox Proportional Hazard Models ◽

Diet History Questionnaire ◽

Meta Analyses

Purpose: The relationship between egg and cholesterol intakes, and cardiovascular disease is controversial. Meta-analyses indicate that egg consumption is associated with increased cardiovascular disease and mortality, but reduced incidence of hypertension, a major risk factor for cardiovascular disease. This study aims to investigate the associations between consumption of egg and cholesterol, and hypertension risk in a cohort of French women. Methods: We used data from the E3N cohort study, a French prospective population-based study initiated in 1990. From the women in the study, we included those who completed a detailed diet history questionnaire, and who did not have prevalent hypertension or cardiovascular disease at baseline, resulting in 46,424 women. Hypertension cases were self-reported. Egg and cholesterol intake was estimated from dietary history questionnaires. Cox proportional hazard models with time-updated exposures were used to calculate hazard ratios. Spline regression was used to determine any dose–respondent relationship. Results: During 885,321 person years, 13,161 cases of incident hypertension were identified. Higher cholesterol consumption was associated with an increased risk of hypertension: HRQ1–Q5 = 1.22 [1.14:1.30], with associations similar regarding egg consumption up to seven eggs per week: HR4–7 eggs = 1.14 [1.06:1.18]. Evidence for a non-linear relationship between hypertension and cholesterol intake was observed. Conclusions: Egg and cholesterol intakes were associated with a higher risk of hypertension in French women. These results merit further investigation in other populations.

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Psychiatric comorbidity in individuals with bullous pemphigoid and all bullous disorders in the Danish national registers

BMC Psychiatry ◽

10.1186/s12888-020-02810-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Marianna Rania ◽

Liselotte Vogdrup Petersen ◽

Michael Eriksen Benros ◽

Zhi Liu ◽

Luis Diaz ◽

...

Keyword(s):

Psychiatric Disorders ◽

Bullous Pemphigoid ◽

Psychiatric Comorbidity ◽

Psychiatric Symptoms ◽

Integrated Approach ◽

Hazard Ratios ◽

Increased Risk ◽

Bidirectional Association ◽

Broad Array ◽

Subsequent Onset

Abstract Background Bullous pemphigoid (BP) is an autoimmune blistering skin disease that takes a profound physical and mental toll on those affected. The aim of the study was to investigate the bidirectional association between BP and all bullous disorders (ABD) with a broad array of psychiatric disorders, exploring the influence of prescribed medications. Methods This nationwide, register-based cohort study encompassed 6,470,450 individuals born in Denmark and alive from 1994 to 2016. The hazard ratios (HRs) of a subsequent psychiatric disorder in patients with BP/ABD and the reverse exposure and outcome were evaluated. Results Several psychiatric disorders were associated with increased risk of subsequent BP (4.18-fold for intellectual disorders, 2.32-fold for substance use disorders, 2.01-fold for schizophrenia and personality disorders, 1.92–1.85-1.49-fold increased risk for organic disorders, neurotic and mood disorders), independent of psychiatric medications. The association between BP and subsequent psychiatric disorders was not significant after adjusting for BP medications, except for organic disorders (HR 1.27, CI 1.04–1.54). Similar results emerged with ABD. Conclusion Psychiatric disorders increase the risk of a subsequent diagnosis of BP/ABD independent of medications, whereas medications used for the treatment of BP/ABD appear to account for the subsequent onset of psychiatric disorders. Clinically, an integrated approach attending to both dermatological and psychiatric symptoms is recommended, and dermatologists should remain vigilant for early symptoms of psychiatric disorders to decrease mental health comorbidity.

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Cardiovascular risk factors among patients with schizophrenia, bipolar, depressive, anxiety, and personality disorders

European Psychiatry ◽

10.1016/j.eurpsy.2016.02.004 ◽

2016 ◽

Vol 35 ◽

pp. 8-15 ◽

Cited By ~ 40

Author(s):

M. Pérez-Piñar ◽

R. Mathur ◽

Q. Foguet ◽

S. Ayis ◽

J. Robson ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Psychiatric Disorders ◽

Physical Inactivity ◽

Social Deprivation ◽

Tobacco Consumption ◽

Hazard Ratios ◽

Increased Risk ◽

Primary Care Practices

AbstractBackgroundThe evidence informing the management of cardiovascular risk in patients with psychiatric disorders is weak.MethodsThis cohort study used data from all patients, aged ≥ 30, registered in 140 primary care practices (n = 524,952) in London to estimate the risk of developing diabetes, hypertension, hyperlipidemia, tobacco consumption, obesity, and physical inactivity, between 2005 and 2015, for patients with a previous diagnosis of schizophrenia, depression, anxiety, bipolar or personality disorder. The role of antidepressants, antipsychotics and social deprivation in these associations was also investigated. The age at detection of cardiovascular risk factor was compared between patients with and without psychiatric disorders. Variables, for exposures and outcomes, defined from general practitioners records, were analysed using multivariate regression.ResultsPatients with psychiatric disorders had an increased risk for cardiovascular risk factors, especially diabetes, with hazard ratios: 2.42 (2.20–2.67) to 1.31 (1.25–1.37), hyperlipidemia, with hazard ratios: 1.78 (1.60–1.97) to 1.25 (1.23–1.28), and obesity. Antidepressants, antipsychotics and social deprivation did not change these associations, except for smoking and physical inactivity. Antidepressants were associated with higher risk of diabetes, hypertension and hyperlipidemia. Antipsychotics were associated with a higher risk of diabetes. Antidepressants and antipsychotics were associated with lower risk of other risk factors. Patients with psychiatric conditions have later detection of cardiovascular risk factors. The interpretation of these results should acknowledge the lower rates of detection of risk factors in mentally ill patients.ConclusionsCardiovascular risk factors require special clinical attention among patients with psychiatric disorders. Further research could study the effect of antidepressants and antipsychotics on cardiovascular risk factors.

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Incidence of ischaemic heart disease and stroke among people with psychiatric disorders: retrospective cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.2019.250 ◽

2019 ◽

Vol 217 (2) ◽

pp. 442-449 ◽

Cited By ~ 4

Author(s):

Caroline A. Jackson ◽

Joannes Kerssens ◽

Kelly Fleetwood ◽

Daniel J. Smith ◽

Stewart W. Mercer ◽

...

Keyword(s):

Bipolar Disorder ◽

Heart Disease ◽

Psychiatric Disorder ◽

Psychiatric Disorders ◽

Ischaemic Heart Disease ◽

Sociodemographic Factors ◽

Deprivation Level ◽

Relative Risks ◽

Increased Risk ◽

Over Time

BackgroundPsychiatric disorders are associated with increased risk of ischaemic heart disease (IHD) and stroke, but it is not known whether the associations or the role of sociodemographic factors have changed over time.AimsTo investigate the association between psychiatric disorders and IHD and stroke, by time period and sociodemographic factors.MethodWe used Scottish population-based records from 1991 to 2015 to create retrospective cohorts with a hospital record for psychiatric disorders of interest (schizophrenia, bipolar disorder or depression) or no record of hospital admission for mental illness. We estimated incidence and relative risks of IHD and stroke in people with versus without psychiatric disorders by calendar year, age, gender and area-based deprivation level.ResultsIn all cohorts, incidence of IHD (645 393 events) and stroke (276 073 events) decreased over time, but relative risks decreased for depression only. In 2015, at the mean age at event onset, relative risks were 2- to 2.5-fold higher in people with versus without a psychiatric disorder. Age at incidence of outcome differed by cohort, gender and socioeconomic status. Relative but not absolute risks were generally higher in women than men. Increasing deprivation conveys a greater absolute risk of IHD for people with bipolar disorder or depression.ConclusionsDespite declines in absolute rates of IHD and stroke, relative risks remain high in those with versus without psychiatric disorders. Cardiovascular disease monitoring and prevention approaches may need to be tailored by psychiatric disorder and cardiovascular outcome, and be targeted, for example, by age and deprivation level.

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Begleiterkrankungen oder Folgeerkrankungen – das Phänomen der Komorbidität bei autoimmun blasenbildenden Dermatosen

Karger Kompass Autoimmun ◽

10.1159/000519651 ◽

2021 ◽

pp. 1-3

Author(s):

Michael Sticherling

Keyword(s):

Mental Health ◽

Cohort Study ◽

Psychiatric Disorders ◽

Psychiatric Symptoms ◽

Integrated Approach ◽

Hazard Ratios ◽

Increased Risk ◽

Bidirectional Association ◽

Broad Array ◽

Subsequent Onset

Background: Bullous pemphigoid (BP) is an autoimmune blistering skin disease that takes a profound physical and mental toll on those affected. The aim of the study was to investigate the bidirectional association between BP and all bullous disorders (ABD) with a broad array of psychiatric disorders, exploring the influence of prescribed medications. Methods: This nationwide, register-based cohort study encompassed 6,470,450 individuals born in Denmark and alive from 1994 to 2016. The hazard ratios (HRs) of a subsequent psychiatric disorder in patients with BP/ABD and the reverse exposure and outcome were evaluated. Results: Several psychiatric disorders were associated with increased risk of subsequent BP (4.18-fold for intellectual disorders, 2.32-fold for substance use disorders, 2.01-fold for schizophrenia and personality disorders, 1.92–1.85–1.49-fold increased risk for organic disorders, neurotic and mood disorders), independent of psychiatric medications. The association between BP and subsequent psychiatric disorders was not significant after adjusting for BP medications, except for organic disorders (HR 1.27, CI 1.04–1.54). Similar results emerged with ABD. Summary: Psychiatric disorders increase the risk of a subsequent diagnosis of BP/ABD independent of medications, whereas medications used for the treatment of BP/ABD appear to account for the subsequent onset of psychiatric disorders. Clinically, an integrated approach attending to both dermatological and psychiatric symptoms is recommended, and dermatologists should remain vigilant for early symptoms of psychiatric disorders to decrease mental health comorbidity.

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P09.06 Risk factors associated with Meningioma in a Cohort of 2 Million Israeli Adolescents

Neuro-Oncology ◽

10.1093/neuonc/noz126.138 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii39-iii40

Author(s):

S Yust-Katz ◽

E Derzane ◽

L Keinan ◽

A Amiel ◽

A Honig ◽

...

Keyword(s):

Risk Factors ◽

Autoimmune Diseases ◽

Cancer Registry ◽

Large Population ◽

Univariate Analysis ◽

Hazard Ratios ◽

Increased Risk ◽

Potential Risk Factors ◽

History Of ◽

Cox Proportional Hazard Models

Abstract Background: Meningiomas are the most common primary central nervous system tumors. Risk factors including- obesity, height, history of allergy/atopy or autoimmune diseases, have been assessed with conflicting results. In this study, we reviewed the database of a large cohort of Israeli adolescents in order to assess potential risk factors for the development of meningiomas. Methods: This study analyzed a cohort of 2,035,915 Jewish men and women who underwent compulsory physical examination as part of screening for army drafting between the age of 16 to 19 from 1948 to 1991. Meningioma incidence was identified by linkage to the national cancer registry. Cox proportional hazard models were used to estimate the hazard ratios for meningioma according the several risk factors including sex, BMI, height, history of allergic and autoimmune disease. Results: Linkage of the adolescent military database with the Israeli cancer registry revealed 480 cases of meningioma. The median age at diagnosis of meningioma was 42.1 ± 9.4 (range 17.4–62.6). On univariate analysis, only gender (female) and height were significantly associated with the risk of meningioma for the whole study population (p<0.01 for both variables). When analyzed separately for gender- height was significant only for men. Spline analysis in the men group showed the minimum risk at a height of 1.62 meters and a statistically significant increase in the risk for meningioma at heights taller than 1.85 meters. BMI was not associated with an elevated risk of meningioma even when analyzed separately for gender. Past medical history including asthma, diabetes, and other atopic and autoimmune diseases were not found to be associated with the risk of meningioma. Conclusion: In this large population study, we found that sex and taller height in adolescent males was associated with an increased risk of meningioma.

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Effect of comorbidity on the risk of death associated with antipsychotic use among community-dwelling older adults

International Psychogeriatrics ◽

10.1017/s1041610212000117 ◽

2012 ◽

Vol 24 (7) ◽

pp. 1058-1064 ◽

Cited By ~ 7

Author(s):

Natasa Gisev ◽

Sirpa Hartikainen ◽

Timothy F. Chen ◽

Mikko Korhonen ◽

J. Simon Bell

Keyword(s):

Older Adults ◽

Respiratory Disease ◽

Population Based ◽

Community Dwelling ◽

Risk Of Death ◽

Hazard Ratios ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Antidepressant Use ◽

Community Dwelling Older Adults

ABSTRACTBackground: Antipsychotics are associated with adverse events and mortality among older adults with dementia. The objective of this study was to evaluate the risk of death associated with antipsychotic use among community-dwelling older adults with a range of comorbidities.Methods: This was a population-based cohort study of all 2,224 residents of Leppävirta, Finland, aged ≥65 years on 1 January 2000. Records of all reimbursed drug purchases were extracted from the Finnish National Prescription Register and diagnostic data were obtained from the Special Reimbursement Register. All-cause mortality was evaluated over a nine-year follow-up period. Time-dependent Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality of antipsychotic use compared to non-use.Results: In total, 332 residents used antipsychotics between 2000 and 2008. The unadjusted HR for risk of death associated with antipsychotic use was 2.71 (95% CI = 2.3–3.2). After adjusting for baseline age, sex, antidepressant use, and diagnostic confounders, the HR was 2.07 (95% CI = 1.73–2.47). The adjusted HR was the highest among antipsychotic users with baseline respiratory disease (HR = 2.21, 95% CI = 1.30–3.76).Conclusions: The increased risk of death associated with antipsychotic use was similar across diagnostic categories, the highest being among those with baseline respiratory disease. However, the results should be interpreted with caution, as the overall sample size of antipsychotic users was small. As in other observational studies, residual confounding may account for the higher mortality observed among antipsychotic users. Further research is needed to confirm these findings.

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Abstract MP60: Coronary Artery Calcium and Dementia Risk in the Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.133.suppl_1.mp60 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Akira Fujiyoshi ◽

David R Jacobs ◽

Annette L Fitzpatrick ◽

Alvaro Alonso ◽

Daniel A Duprez ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Calcium ◽

Agatston Score ◽

Dementia Diagnosis ◽

Cox Models ◽

Ethnic Study ◽

Risk Of Death ◽

Hazard Ratios ◽

Incident Dementia ◽

Increased Risk

Introduction: Vascular risk factors (VRFs) predict incident dementia. Coronary artery calcium (CAC), capturing cumulative VRFs exposure, may predict dementia beyond VRFs. Hypothesis: In a community-based sample, baseline CAC is associated with incident dementia independent of VRFs assessed at baseline and APOE -ε 4 genotype. Methods: Among 6,814 participants of the Multi-Ethnic Study of Atherosclerosis (MESA), aged 45-84 years at baseline (2000-2002), we first identified candidate cases for incident all-cause dementia using hospital and death certificate ICD codes. For the analyses, we limited to cases whose diagnosis was validated using following criteria: 1) verifiable medical records available, 2) unlikely alternative diagnosis (e.g. delirium), and 3) written dementia diagnosis. Baseline CAC was categorized according to Agatston score (0, > 0 to <50, 50 to <100, 100 to <400, and ≥400). Cox models were used to obtain hazard ratios (HRs) adjusted for demographics, VRFs, APOE -ε 4, and incident stroke prior to dementia diagnosis. Results: We had complete data on 6,295 individuals for analysis with a mean follow-up of 11.1 years (208 validated cases). Crude rates of dementia were greater with higher baseline CAC categories. Adjusted HR of dementia per one higher CAC category was 1.14 (95%CI 1.03, 1.26) (see Table). The associations were similar when excluding interim incident coronary heart disease, or cardiovascular diseases, or using a model that accounted for competing risk of death with no dementia diagnosis. Conclusion: Higher CAC score measured at baseline was independently and significantly associated with increased risk of dementia. This finding is consistent with an important role for vascular injury in development of dementia.

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Abstract MP073: Combining Multiple Kidney Markers to Predict Future Risk of Clinical Outcomes: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.125.suppl_10.amp073 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Salman Waheed ◽

Kunihiro Matsushita ◽

Brad C Astor ◽

Josef Coresh

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cystatin C ◽

Kidney Injury ◽

Atherosclerosis Risk In Communities ◽

Hazard Ratios ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Future Risk ◽

Aric Study

Background There is substantial interest in investigating how multiple chronic kidney disease (CKD) markers combine to predict risk, in particular using eGFR by cystatin C (eGFR cys ) as a supplement to traditional CKD markers, eGFR by creatinine (eGFR cr ) and albumin: creatinine ratio (ACR). Methods We followed 10,268 participants for a median of 11.2 years. Participants were classified into 8 categories: (1) no CKD by any marker (reference); CKD by either (2) eGFR cr or (3) eGFR cys (<60 ml/min/1.73 m 2 ) or (4) ACR (≥30 mg/g) only; CKD by both (5) eGFR cys and eGFR cr or (6) eGFR cys and ACR or (7) eGFR cr and ACR; and (8) CKD by all 3 markers. Cox proportional hazard models were used to estimate hazard ratios. Results Risk increased with the number of markers indicating CKD. eGFR cr <60 alone (ACR and eGFR cys normal) was associated with increased risk of ESRD but not other outcomes [mortality: 0.95 (0.7, 1.2); coronary heart disease: 0.9 (0.6, 1.2); heart failure: 0.9 (0.6, 1.2); acute kidney injury: 1.3 (0.9, 2.0)] compared to individuals without CKD by any marker. In contrast, eGFR cys <60 alone was associated with increased risk of all outcomes except coronary heart disease. When all three markers were abnormal, risk was higher compared to when combination of eGFR cr and ACR were abnormal, particularly for ESRD [ESRD: 109.2 (66.3, 179.9) vs. 12.2 (4.6, 32.2)]. More markers indicating CKD were associated with higher risk for each of the five outcomes examined after adjustment for covariates (Table). Conclusions Cystatin C is a useful confirmatory marker in those with eGFR cr <60 to predict future risk of mortality, cardiovascular and kidney outcomes, particularly in the absence of albuminuria (i.e., when creatinine is the only criterion used to define CKD). Cystatin C may be used as a supplement to traditional CKD markers when more precise information about risk is needed.

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Abstract 3114: Antiplatelet Therapy Use and the Risk of Venous Thromboembolic Events in the Double-Blind Raloxifene Use in The Heart (RUTH) Trial

Circulation ◽

10.1161/circ.116.suppl_16.ii_698-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Claire S Duvernoy ◽

Adeline A Yeo ◽

Mayme Wong ◽

David A Cox ◽

Hyungin M Kim

Keyword(s):

Clinical Symptoms ◽

Proportional Hazard ◽

Thromboembolic Events ◽

Double Blind ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Cox Proportional Hazard Models

Background: Raloxifene (RLX) use in postmenopausal women (PMW) with osteoporosis increases risk of venous thromboembolic events (VTE) 2-fold, compared to placebo (PL). Platelet activation is involved in the pathophysiology of arterial thromboses more than venous thromboses, but some data suggest that aspirin may reduce VTE risk associated with estrogen use. This analysis examines the effects of concomitant antiplatelet (AP) therapy on VTE risk in RLX-treated women. Methods: In RUTH, 10,101 PMW with coronary heart disease (CHD) or increased risk of CHD were randomized to either PL or RLX 60 mg/d and followed for a median 5.6 yr. Reports of clinical symptoms of VTE were supported by relevant diagnostic data and adjudicated. Concomitant use of AP agents (aspirin, clopidogrel, ticlopidine, dipyridamole) was allowed. Cox proportional hazard models, with use of warfarin, presence of fracture, and/or hospitalization as covariates, were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results: Overall, RLX 60 mg/d use was associated with an increased VTE risk [HR 1.44 (95% CI 1.06 –1.95)] from PL. Most women (71%) reported using aspirin, and 14.2% reported using non-aspirin AP agents. VTE risk was similar (HR = 1.04, Table ) for women who used RLX alone versus those who used RLX with AP agents. The increase in VTE risk with RLX compared to PL was similar between women who used any AP prior to VTE and those who did not (interaction P=0.29). Women who used aspirin prior to VTE had a similar increased VTE risk with RLX from PL [HR 1.57(95% CI 1.00 –2.47)], compared to women who did not use aspirin [HR 1.34 (95% CI 0.89 –2.01)] (interaction P=0.62). Conclusion: In RUTH, PMW with CHD or at high risk of CHD treated with RLX had an increased risk of VTE compared to PL. Concomitant use of aspirin or non-aspirin AP agents with RLX therapy did not lower VTE risk from RLX alone.

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