scholarly journals Comparative Effectiveness of Antipsychotics for Risk of Attempted or Completed Suicide Among Persons With Schizophrenia

2020 ◽  
Author(s):  
Heidi Taipale ◽  
Markku Lähteenvuo ◽  
Antti Tanskanen ◽  
Ellenor Mittendorfer-Rutz ◽  
Jari Tiihonen
Keyword(s):  
Comparative Effectiveness ◽  
Attempted Suicide ◽  
Sensitivity Analyses ◽  
First Line ◽  
Completed Suicide ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Risk Patients ◽  
Persons With Schizophrenia ◽  
Swedish Cohort

Abstract Objective The objective of our study was to investigate the comparative effectiveness of antipsychotics for the risk of attempted or completed suicide among all patients with schizophrenia in Finland and Sweden. Methods Two nationwide register-based cohort studies were conducted, including all individuals with schizophrenia in Finland (n = 61 889) and Sweden (n=29 823). The main exposure was 10 most commonly used antipsychotic monotherapies; also, adjunctive pharmacotherapies were investigated. The main outcome measure was attempted or completed suicide, which was analyzed with within-individual models by comparing use and nonuse periods in the same individual to minimize selection bias. Sensitivity analyses included attempted suicide (hospitalization only) as an outcome. Results Compared with no use of antipsychotics, clozapine use was the only antipsychotic consistently associated with a decreased risk of suicidal outcomes. Hazard ratios (HRs) and 95% CIs for attempted or completed suicide were 0.64 (0.49–0.84) in the Finnish cohort and 0.66 (0.43–0.99) in the Swedish cohort. No other antipsychotic was associated with a reduced risk of attempted and/or completed suicide. Benzodiazepines and Z-drugs were associated with an increased risk of attempted or completed suicide (HRs: 1.29–1.30 for benzodiazepines and 1.33–1.62 for Z-drugs). Conclusion Clozapine was the only antipsychotic associated with decreased risk of attempted or completed suicide among patients with schizophrenia, and it should be considered as first-line treatment for high-risk patients.

scholarly journals S210. COMPARATIVE EFFECTIVENESS OF ANTIPSYCHOTICS FOR RISK OF ATTEMPTED OR COMPLETED SUICIDE AMONG PERSONS WITH SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S118-S119
Author(s):  
Heidi Taipale ◽  
Markku Lähteenvuo ◽  
Antti Tanskanen ◽  
Ellenor Mittendorfer-Rutz ◽  
Jari Tiihonen
Keyword(s):  
Drug Use ◽  
Comparative Effectiveness ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Antipsychotic Therapy ◽  
Completed Suicide ◽  
Hazard Ratios ◽  
Persons With Schizophrenia ◽  
Swedish Cohort

Abstract Background Suicidal attempts and suicide are rather common phenomena in persons with schizophrenia whom are 6–14 times more likely to die due to suicide than the general population. Very little is known on effectiveness of antipsychotics in preventing suicide attempts and completed suicides among patients with schizophrenia. Whether all antipsychotics are effective in preventing attempted or completed suicides also remains unclear. The objective of our study was to investigate comparative effectiveness of antipsychotics for risk of attempted or completed suicide among all patients with schizophrenia in Finland and Sweden. Methods Two nationwide register-based cohort studies were conducted including all individuals with schizophrenia in Finland (N=61889) and Sweden (N=29823). The Finnish cohort included all persons treated for schizophrenia in inpatient care (1972–2014), with follow-up for drug use and outcomes during 1996–2017. The Swedish cohort included all persons with treatment contact due to schizophrenia in inpatient or specialized outpatient care, sickness absence, or disability pension (2006–2013), with follow-up for drug use and outcomes during 2006–2016. The main exposure included the ten most commonly used antipsychotic monotherapies, and also adjunctive pharmacotherapies (antidepressants, mood stabilizers, lithium, benzodiazepines and related drugs were investigated). The main outcome measure was attempted or completed suicide which was analyzed with within-individual models by comparing use and non-use periods in the same individual. Sensitivity analyses were conducted by between-individual models, with attempted suicide (hospitalization only) as an outcome, and by censoring first 30 days from each exposure. Results are reported as hazard ratios (HRs) with 95 % confidence intervals (95% CI). Results Compared with no use of antipsychotics, clozapine was the only antipsychotic therapy consistently associated with a decreased risk of suicidal outcomes. Hazard ratios (HRs) and 95% CI for attempted or completed suicide were 0.64 (95% CI 0.49–0.84) in the Finnish cohort, and 0.66 (0.43–0.99) in the Swedish cohort, and for attempted suicide 0.60 (0.46–0.79) in the Finnish cohort and 0.62 (0.40–0.95) in the Swedish cohort. No other antipsychotic was associated with a reduced risk of attempted and/or completed suicide than clozapine. Regarding adjunctive pharmacotherapies, benzodiazepines and Z-drugs were associated with an increased risk of suicide attempts or deaths (HRs for benzodiazepines 1.29–1.30 and 1.33–1.62 for Z-drugs, not reaching statistical significance in the Swedish cohort). Discussion The results from two large nationwide cohorts provide the first evidence on comparative real-world effectiveness of specific antipsychotics in the prevention of severe suicidal behavior. Clozapine was the only pharmacological treatment associated with a substantially decreased risk of attempted or completed suicide and should be considered as a first-line treatment for patients with suicidal ideation or behavior.

Abstract W P165: Acetaminophen Use and Risk of Stroke and Myocardial Infarction in a Hypertensive Population

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Rachael L Fulton ◽  
Matthew Walters ◽  
Anna Dominiczak ◽  
Gordon Mcinnes ◽  
Peter A Meredith ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prescription Data ◽  
Arterial Blood ◽  
Retrospective Data Analysis ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Risk Patients ◽  
Matched Design ◽  
Using Data ◽  
The Uk

Introduction: Recent data suggest self-reported acetaminophen use is associated with increased risk of cardiovascular events and that acetaminophen causes a modest rise in arterial blood pressure. There are no randomized studies, studies using verified prescription data or studies in high risk patients that investigate this relationship. Hypothesis: We aimed to assess the relationship between acetaminophen prescription data and risk of stroke and myocardial infarction in patients with hypertension. Methods: We performed a retrospective data analysis using data contained within the UK Clinical Research Practice Datalink. This includes verified prescription data. Multivariable Cox proportional hazard models were used to estimate hazard ratios for stroke or MI associated with acetaminophen use over a 10-year period. Acetaminophen exposure was a time dependent variable. A propensity matched design was also used to reduce potential for confounding. Results: We included 24496 hypertensive individuals aged 65-years or older. Of these, 10878 were acetaminophen exposed and 13618 were not. There was no relationship between risk of stroke, MI or any vascular event and acetaminophen exposure on adjusted analysis (OR 1.09, 95% CI 0.86 to 1.38; OR 0.98, 95% CI 0.76 to 1.27; OR 1.17, 95% CI 0.99 to 1.37 respectively). Results in the propensity matched sample (n=4000 per group) were similar and high frequency users (defined as receiving a prescription for >75% of months) were also not at increased risk. Conclusions: In summary, use of acetaminophen was not associated with an increased risk of stroke or myocardial infarction in a large cohort of hypertensive patients.

Risk Factors for Early Transformation of Follicular Lymphoma (FL): Report From the National LymphoCare Study (NLCS).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2698-2698 ◽  
Author(s):  
Nina D. Wagner-Johnston ◽  
Brian K Link ◽  
Michael Taylor ◽  
Nancy L. Bartlett
Keyword(s):  
Observational Study ◽  
Clin Oncol ◽  
Univariate Analysis ◽  
Sensitivity Analyses ◽  
Inverse Association ◽  
First Line ◽  
Extranodal Site ◽  
Initial Observation ◽  
Increased Risk

Abstract Abstract 2698 Poster Board II-674 Knowledge of how the disease characteristics and initial treatment (tx) patterns of FL affect the risk of transformation is limited to a few retrospective and single institution studies. Specifically, retrospective studies have shown an increased incidence of transformation in FL patients (pts) undergoing initial observation (J Clin Oncol 2007;25:2426), a decreased incidence in FL pts receiving aggressive, anthracycline based therapy (J Clin Oncol 2008;26:5165), and no difference in risk in FL pts receiving rituximab as first-line versus salvage therapy (Blood 2008;112:837 abstr). The NLCS, a multicenter, longitudinal observational study of 2734 pts with newly diagnosed FL, offers a unique opportunity to better characterize the risk of transformation. Pts who had evidence of transformation at initial diagnosis (n = 27) were excluded from this analysis. At a median follow-up of 37 months, 139 pts (5.1%; 95% CI 4.3% % 6.0%) developed a transformation; 47 pathologically confirmed and 92 clinically suspected. The overall survival curves for the confirmed and suspected transformation cases were not different, indicating similar outcomes for these patient groups. In univariate analysis, > 1 extranodal site (p < 0.001), LDH > normal (p < 0.001), FLIPI score ≥ 3 (p < 0.001), and advanced stage (p = 0.033) at diagnosis were associated with an increased risk of transformation. Age, histologic grade, ECOG performance status, B symptoms, number of nodal sites, hemoglobin, and IPI scores were not associated with transformation. Only > 1 extranodal site remained significant on multivariate analyses of all cases (OR = 1.30; 95% CI 1.06 – 1.61; p = 0.014). In univariate analysis, the risk of transformation was the same in 481 initially observed pts compared to 2253 treated pts (HR 0.99; 95% CI 0.64 – 1.54; p = 0.98). Of treated pts, the risk of transformation for the 944 pts who received first-line anthracyclines was not statistically different (although a trend exists) from the 1309 pts treated with a non-anthracycline regimen (HR 0.73; 95% CI 0.50 – 1.06; p = 0.096). Compared with 450 pts initially treated with non-rituximab containing regimens, the 1803 rituximab treated pts had a lower risk of transformation (6.9% vs. 4.7%), with a HR of 0.59 (95% CI 0.39 – 0.90; p = 0.012). The median follow-up was not significantly different in any of the arms for the subset analyses. Controlling for extranodal sites and FLIPI scores for the initially observed vs. treated, anthracycline vs. non-anthracycline and the rituximab vs. non-rituximab treated groups produced results nearly identical to the respective univariate comparisons. All results were similar in sensitivity analyses comparing confirmed vs. suspected cases, with the exception of a stronger inverse association of rituximab use in confirmed (HR 0.40; 95% CI 0.21 – 0.74; p = 0.003) vs. suspected cases (HR 0.78; 95% CI 0.45 – 1.36; p = 0.38). These findings demonstrate an incidence of FL transformation which is comparable to that reported historically. While most pts received early tx, these prospective data suggest that initial observation does not increase short term risk of transformation. These results also suggest that for initially treated pts, use of an anthracycline does not impact transformation, while use of rituximab may lower the risk of transformation. These results must be interpreted in the context of the limitations of a non-randomized observational study, and replication in other studies as well as longer follow-up will be needed to determine the overall influence of different therapeutic strategies on the risk of transformation. Disclosures: Link: Genentech: Membership on an entity's Board of Directors or advisory committees, Research Funding. Taylor:genentech: Employment.

Association of prostate-specific antigen (PSA) trajectories with risk for metastasis and mortality in non-metastatic castration-resistant prostate cancer (nmCRPC).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 27-27
Author(s):  
Sophia Li ◽  
Zhijie Ding ◽  
Jennifer H Lin ◽  
Ajay S. Behl ◽  
Chris Pericone ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Specific Antigen ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Risk Patients ◽  
Cox Proportional Hazard Regression ◽  
Group 1

27 Background: Currently there is insufficient guidance for the management of nmCRPC. This study assessed patient risk of developing metastases and death based on their PSA levels over time. Methods: This was a retrospective study using the Optum electronic health record database (1/1/2007 – 4/30/2016) in men ≥18 years. nmCRPC was defined as a PC diagnosis, 2 rising PSA levels ≥1 week apart, testosterone < 50 ng/dL (post-PC diagnosis), and no ICD-9/10 code or therapy indicating metastasis. Patients were required to have ≥1 PSA record per 3-month period for 9 months following nmCRPC diagnosis. Group Based Trajectory Modeling (GBTM) was used to group patients based on similar PSA trends over 9 months. The association of these PSA groups with metastasis/mortality risk was measured using multivariate Cox proportional hazard regression models. An overall trend for metastasis and mortality across the groups was also tested. Results: From a total of 729 patients included, 4 distinct groups were identified: Group 1 (49% of patients), 2 (32%), 3 (14%) and 4 (5%). Group 1 had the lowest PSA (7 ng/mL) at nmCRPC diagnosis and steady PSA during the 9-month follow-up. In contrast, Groups 2, 3 and 4 had higher PSA at nmCRPC diagnosis (17, 61, 513 ng/mL respectively) and rising PSA during follow-up. There was a trend of increasing metastasis and mortality risk (p < 0.001 for both trends) with the higher PSA groups. For metastasis, Hazard Ratios (HRs) and 95% confidence intervals (CIs) were 1.7 (1.3-2.2), 3.5 (2.5-5.0), 1.8 (0.7-4.7) in Groups 2, 3 and 4, respectively, vs. Group 1. For mortality, HRs (95% CIs) were 1.9 (1.4-2.5), 2.6 (1.8-3.7), 4.5 (2.4-8.4) in Groups 2, 3 and 4, respectively, vs. Group 1. Metastasis-free survival (MFS) independently predicted mortality risk. Patients developing metastasis within 1 year had 4.4-fold greater risk for mortality (95% CI = 2.2-8.8) than those who remained MFS at year 3. Conclusions: A large proportion of nmCRPC patients with PSA increases during the follow-up period had significantly increased risk for metastasis and mortality, with MFS predicting mortality risk. Periodic measurement of PSA may better inform management of nmCRPC.

scholarly journals Pre-eclampsia and risk of dementia later in life: nationwide cohort study

BMJ ◽  
2018 ◽  
pp. k4109 ◽  
Author(s):  
Saima Basit ◽  
Jan Wohlfahrt ◽  
Heather A Boyd
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Vascular Dementia ◽  
Cox Regression ◽  
Late Onset ◽  
Hazard Ratio ◽  
Sensitivity Analyses ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of

AbstractObjectiveTo explore associations between pre-eclampsia and later dementia, overall and by dementia subtype and timing of onset.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one live birth or stillbirth between 1978 and 2015.Main outcome measureHazard ratios comparing dementia rates among women with and without a history of pre-eclampsia, estimated using Cox regression.ResultsThe cohort consisted of 1 178 005 women with 20 352 695 person years of follow-up. Women with a history of pre-eclampsia had more than three times the risk of vascular dementia (hazard ratio 3.46, 95% confidence interval 1.97 to 6.10) later in life, compared with women with no history of pre-eclampsia. The association with vascular dementia seemed to be stronger for late onset disease (hazard ratio 6.53, 2.82 to 15.1) than for early onset disease (2.32, 1.06 to 5.06) (P=0.08). Adjustment for diabetes, hypertension, and cardiovascular disease attenuated the hazard ratios only moderately; sensitivity analyses suggested that body mass index was unlikely to explain the association with vascular dementia. In contrast, only modest associations were observed for Alzheimer’s disease (hazard ratio 1.45, 1.05 to 1.99) and other/unspecified dementia (1.40, 1.08 to 1.83).ConclusionsPre-eclampsia was associated with an increased risk of dementia, particularly vascular dementia. Cardiovascular disease, hypertension, and diabetes were unlikely to mediate the associations substantially, suggesting that pre-eclampsia and vascular dementia may share underlying mechanisms or susceptibility pathways. Asking about a history of pre-eclampsia could help physicians to identify women who might benefit from screening for early signs of disease, allowing for early clinical intervention.

scholarly journals Rurality as a Risk Factor for Attempted Suicide and Death by Suicide in Ontario, Canada

2021 ◽  
pp. 070674372110533
Author(s):  
Rebecca Barry ◽  
Jürgen Rehm ◽  
Claire de Oliveira ◽  
Peter Gozdyra ◽  
Simon Chen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Factor ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Emergency Department Visits ◽  
Sensitivity Analyses ◽  
Administrative Databases ◽  
Increased Risk ◽  
Urban Males ◽  
Males And Females

Objective This study aims to examine rural and urban differences in attempted suicide and death by suicide in Ontario, Canada. Method This is a population-based nested case-control study. Data were obtained from administrative databases held at ICES, which capture all hospital and emergency department visits across Ontario between 2007 and 2017. All adults living in Ontario who attempted suicide or died by suicide are included in the study, and controls were matched by sex and age. Suicides were captured using vital statistics. Suicide attempts were determined using emergency department service codes. Results Rurality is a risk factor for attempted suicide and death by suicide. Rural males are more likely to die by suicide compared with urban males (adjusted odds ratio(AOR) = 1.70, 95% confidence interval (CI), 1.49 to 1.95), and the odds of death by suicide increase with increasing levels of rurality. Rural males and females have an increased risk of attempted suicide compared with their urban counterparts (males: AOR = 1.37, 95% CI, 1.24 to 1.50) (females: AOR = 1.26, 95% CI,  1.14 to 1.39), with a pattern of increasing risk of suicide attempts with increasing rurality. Rural females are not at increased risk of suicide compared with urban females (AOR = 1.08, 95% CI, 0.80 to 1.45). Sensitivity analyses corroborated the results. Conclusions Rural males are almost two times more likely to die by suicide compared with urban males, and both rural males and females have an elevated risk of suicide attempts compared with urban residents. Future research should examine potential mediators of the relationship between rurality and suicide.

scholarly journals The Sabadell score is an independent predictor of five-year outcome after critical care discharge

2019 ◽  
Author(s):  
Ben Morton ◽  
Victoria Penston ◽  
Phillip McHale ◽  
Daniel Hungerford ◽  
Ged Dempsey
Keyword(s):  
Critical Care ◽  
Primary Outcome ◽  
Independent Predictor ◽  
University Hospital ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Critical Care Admission ◽  
Risk Patients ◽  
Observational Cohort ◽  
Parametric Survival

Abstract Background: Critical care survivors frequently suffer persistent morbidity and increased risk of mortality compared to the general population. However, there are no standardised tools to identify at-risk patients to target potential interventions. Our aim was to establish whether the “Sabadell score”, a simple tool applied upon critical care discharge, is an independent predictor of five-year mortality.Methods: Prospective observational cohort study of adults admitted to a mixed critical care unit at Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom. Sabadell score applied to all patients from September 2011 to December 2017. Primary outcome: five-year mortality assessed using a multivariable flexible parametric survival analysis adjusted for demographics, and clinically relevant covariates. Primary outcome: Adults discharged alive following critical care admission. Results: There were 5954 patients with a minimum of 18 months follow-up. Mean age was 59.5 (SD±17) and 57.1% were male. Patients were categorised into Sabadell scores, zero (38.4%), one (47.9%), two (10.5%) and three (3.1%). Adjusted hazard ratios for mortality were 2.09 (C.I. 1.85–2.36), 3.95 (C.I. 3.39–4.60) and 21.04 (C.I. 17.24–25.68) respectively. Sabadell score three predicted 99.9%, 99.5%, 98.5% and 87.4% mortality at five years for patients ³80 (aHR 3.37), 60-79 (aHR 2.52), 40-59 (aHR 2.03) and 16-39 respectively. A Sabadell score of two predicted 71.0%, 52.7%, 44.8% and 23.7% mortality at five years for these age categories.Conclusions : Sabadell score is an independent predictor of five-year survival after critical care discharge. These findings could be used to guide provision of increased support for patients after critical care discharge and/or informed discussions with patients and relatives about dying to ascertain their future wishes.

scholarly journals Methemoglobinemia – Two Uncommon Presentations

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Zuhal Gundogdu ◽  
Belkıs Ipekçi ◽  
Bengu Çınar
Keyword(s):  
High Risk ◽  
Hospital Admission ◽  
Oxygen Transport ◽  
Attempted Suicide ◽  
Gastric Lavage ◽  
Methemoglobin Level ◽  
First Case ◽  
Toxic Agents ◽  
Increased Risk ◽  
Risk Patients

Two rather different cases of methemoglobinemia are presented. The first case is an infant who had a circumcision procedure with prilocaine. The second case involves a 14-year-old girl who attempted suicide with an overdose of metoclopramide and butamirate citrate. The attention is drawn to differences in hospital admission and management especially with respect to methemoglobin level and age. If methemoglobin levels reach ≥ 10%, cyanosis would appear first. Symptoms of hypoxemia and diminished oxygen transport do not develop until levels reach 30 to 40%. Not only early intervention is crucial but also patients should not be discharged from the hospital too soon. Doctors should be able to identify high risk patients, paying a special attention to infants younger than three months old who might be at an increased risk of methemoglobinemia which is a potentially lethal complication of prilocaine. As for our second case, methemoglobin level has not increased, despite an overdose of metoclopramide. This may be due to age or timely elimination of toxic agents by gastric lavage, catharsis and administration of procyclidine.

scholarly journals Offspring psychopathology following preconception, prenatal and postnatal maternal bereavement stress

2013 ◽  
Vol 44 (1) ◽  
pp. 71-84 ◽  
Author(s):  
Q. A. Class ◽  
K. M. Abel ◽  
A. S. Khashan ◽  
M. E. Rickert ◽  
C. Dalman ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempt ◽  
Maternal Stress ◽  
Population Based ◽  
Autism Spectrum ◽  
Degree Relative ◽  
Early Stress ◽  
Completed Suicide ◽  
Hazard Ratios ◽  
Increased Risk

BackgroundPreconception, prenatal and postnatal maternal stress is associated with increased offspring psychopathology, but findings are inconsistent and need replication. We estimated associations between maternal bereavement stress and offspring autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, suicide attempt and completed suicide.MethodUsing Swedish registers, we conducted the largest population-based study to date examining associations between stress exposure in 738 144 offspring born 1992–2000 for childhood outcomes and 2 155 221 offspring born 1973–1997 for adult outcomes with follow-up to 2009. Maternal stress was defined as death of a first-degree relative during (a) the 6 months before conception, (b) pregnancy or (c) the first two postnatal years. Cox proportional survival analyses were used to obtain hazard ratios (HRs) in unadjusted and adjusted analyses.ResultsMarginal increased risk of bipolar disorder and schizophrenia following preconception bereavement stress was not significant. Third-trimester prenatal stress increased the risk of ASD [adjusted HR (aHR) 1.58, 95% confidence interval (CI) 1.15–2.17] and ADHD (aHR 1.31, 95% CI 1.04–1.66). First postnatal year stress increased the risk of offspring suicide attempt (aHR 1.13, 95% CI 1.02–1.25) and completed suicide (aHR 1.51, 95% CI 1.08–2.11). Bereavement stress during the second postnatal year increased the risk of ASD (aHR 1.30, 95% CI 1.09–1.55).ConclusionsFurther research is needed regarding associations between preconception stress and psychopathological outcomes. Prenatal bereavement stress increases the risk of offspring ASD and ADHD. Postnatal bereavement stress moderately increases the risk of offspring suicide attempt, completed suicide and ASD. Smaller previous studies may have overestimated associations between early stress and psychopathological outcomes.

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