Ana Garcia Lopez

Mood-stabilizing pharmacological treatment in bipolar disorders and risk of suicide.

OBJECTIVES This study investigated the association between continued mood-stabilizing treatment (lithium and anticonvulsants) in bipolar disorder (BD) and the risk of suicide. METHODS Using linkage of national registers, the association between continued mood-stabilizing treatment and suicide was investigated among all patients discharged nationwide from hospital psychiatry as an in- or outpatient in a period from 1995 to 2000 in Denmark with a diagnosis of BD. RESULTS A total of 5,926 patients were included in the study and among these 51 patients committed suicide eventually during the study period. Although the rate of suicide was higher during periods when patients purchased anticonvulsants (293 suicides per 100,000 person-years) than during periods with lithium (136 suicides per 100,000 person-years), the suicide rate decreased with the number of prescriptions in a rather similar way for patients first treated with lithium and patients first treated with anticonvulsants: patients who continued treatment with mood-stabilizing drugs had a decreased rate of suicide compared to patients who purchased mood stabilizers once only [rate ratio for anticonvulsants = 0.28, 95% confidence interval (CI) = 0.19-0.41; rate ratio for lithium = 0.20, 95% CI = 0.10-0.38]. Further, the rate of suicide decreased consistently with the number of additional prescriptions. Switch to or augmentation with lithium to patients initiated on anticonvulsants was associated with a significantly reduced rate of suicide (rate ratio = 0.28, 95% CI = 0.20-0.40), whereas a switch to or augmentation with anticonvulsants to patients first started on lithium showed no additional effect on the suicide rate. CONCLUSIONS Although continued treatment with anticonvulsants and continued treatment with lithium was associated with a rather similar reduction in the rate of suicide, the results suggest that treatment with lithium may have some superiority in relation to prevention of suicide.

No increased risk of developing Alzheimer disease in patients with glaucoma.

PurposeTo investigate whether primary open-angle glaucoma (POAG) is associated with increased risk of developing Alzheimer disease (AD). MethodsIn a nationwide case register linkage study of patients with hospital admission or outpatient contact during the period from 1977 to 2001 in Denmark, the rate of subsequent AD for patients with a diagnosis of POAG was compared with the rate for patients with primary angle-closure glaucoma (PACG), cataract, and osteoarthritis (OA) and with the rate for the general population. ResultsA total of 11,721 patients with a diagnosis of POAG (including normal tension glaucoma), 5975 patients with PACG, 162,640 patients with cataract, and 230,208 patients with OA were identified in the registers. Patients with POAG did not have increased rate of subsequent AD compared to patients with PACG, cataract, or OA or compared with the general population. ConclusionsPOAG was not associated with increased risk of developing AD. It cannot be excluded that this negative finding is due to diagnostic misclassification as register data were used.

Late and very-late first-contact schizophrenia and the risk of dementia--a nationwide register based study.

To examine whether late and very‐late first‐contact schizophrenia carry a risk for later development of dementia.

Continued Antidepressant Treatment and Suicide in Patients with Depressive Disorder

Antidepressant use in Denmark, as in many developed countries, has substantially increased during recent years, coinciding with a decreasing suicide rate. In a nationwide observational cohort study with linkage of registers of all prescribed antidepressants and recorded suicides in Denmark from 1995 to 2000, we investigated the relation between continued treatment with antidepressants and suicide in a population of all patients discharged from hospital psychiatry with a diagnosis of depressive disorder. Patients discharged from hospital psychiatry with a diagnosis of depressive disorder had a highly increased rate of suicide. Those who continued treatment with antidepressants had a decreased rate of suicide compared with those who purchased antidepressants once (rate ratio: 0.31, 95% confidence interval: 0.26–0.36). Further, the rate of suicide decreased consistently with the number of prescriptions. On individualized data from a cohort of patients with a known history of depressive disorder, continued antidepressant treatment was associated with reduced risk of suicide.

Acute and transient psychosis in old age and the subsequent risk of dementia: a nationwide register-based study.

Aim:  Using the unique Danish psychiatric and somatic health registers, we investigated the rate of subsequent dementia in patients with late‐onset acute and transient psychosis.

Temporal changes in suicide rates for persons treated and not treated with antidepressants in Denmark during 1995-1999

Objective:  To compare the temporal changes in suicide rate among patients treated with antidepressants with the change in suicide rate among persons who have not been treated with antidepressants during 1995–1999.

Factors that affect the social well-being of children with cochlear implants

Abstract The aim of the study was to identify factors associated with the level of social well-being for cochlear implanted children and to estimate effect-related odds ratios for the childrens well-being. Another aim was to analyse associations between speech and language level and the level of social well-being. Data relate to 167 children with cochlear implants. In structural interviews, parents rated their childrens level of social well-being regarding the degree of their childs personal-social adjustment. Five different factors were considered. Logistic regression models and proportional odds models were used to analyse the relationship between the considered factors and the assessments. The analyses showed that the communication mode at home was the most highly associated factor. A statistically significant association was found between the level of social well-being and speech understanding, speech production and vocabulary. Children who were exposed to a spoken language had considerably better odds of having a high level of social well-being compared to children with a mixture of spoken language and sign support or sign language. Copyright

Functional implications of short- term retinal detachment in porcine eyes: study by multifocal electroretinography

Purpose:  The aim of the study was to determine the type and magnitude of detectable changes in pig multifocal electroretinography (mfERG) induced by the vitreoretinal surgical procedures necessary to gain access to the subretinal space.

Association between consistent purchase of anticonvulsants or lithium and suicide risk: a longitudinal cohort study from Denmark, 1995-2001

BACKGROUND Prior studies suggest anticonvulsants purchasers may be at greater risk of suicide than lithium purchasers. METHODS Longitudinal, retrospective cohort study of all individuals in Denmark purchasing anticonvulsants (valproic acid, carbamazepine, oxcarbazepine or lamotrigine) (n=9952) or lithium (n=6693) from 1995-2001 who also purchased antipsychotics at least once (to select out nonpsychiatric anticonvulsant use). Poisson regression of suicides by medication purchased (anticonvulsants or lithium) was conducted, controlling for age, sex, and calendar year. Confounding by indication was addressed by restricting the comparison to individuals prescribed the same medication: individuals with minimal medication exposure (e.g., who purchased only a single prescription of anticonvulsants) were compared to those individuals with more consistent medication exposure (i.e., purchasing > or = 6 prescriptions of anticonvulsants). RESULTS Demographics and frequency of anticonvulsant, lithium, or antipsychotic use were similar between lithium and anticonvulsant purchasers. Among patients who also purchased antipsychotic at least once during the study period, purchasing anticonvulsants more consistently (> or = 6 prescriptions) was associated with a substantial reduction in the risk of suicide (RR=0.22, 95% CI=0.11-0.42, p<0.0001), similar to patients consistently purchasing lithium (RR=0.27, 95% CI=0.12-0.62, p=0.006). Absolute suicide risks of consistent anticonvulsant and consistent lithium purchasers were similar. LIMITATIONS Lack of information about diagnoses and potential confounders, as well as other covariates that may differ between minimal and consistent medication purchasers, are limitations to this study. CONCLUSIONS In this longitudinal study of anticonvulsant purchasers likely to have psychiatric disorders, consistent anticonvulsant treatment was associated with decreased risk of completed suicide.

Delusional disorder in old age and the risk of developing dementia: a nationwide register-based study.

Objective: To examine whether very late first-contact delusional disorder carries a risk for later development of dementia. Methods: By linkage of the psychiatric and the somatic nationwide registers of all out- and in-patients with hospital contact in Denmark, we included all 60+ patients with first ever from 1 January 1994 to 31 December 2001 with the index main diagnosis: delusional disorder. First contact osteoarthritis patients as well as the general population were used as controls. A total of 1437 patients with persistent delusional disorder and 7302 patients with osteoarthritis were included. Median follow-up time until first diagnosis of dementia at discharge was 1.87 and 4.40 years, respectively. The probability of getting a dementia diagnosis was estimated using Poisson regression models with dementia as the outcome of interest. Results: Patients with very late first-contact delusional disorder had an 8.14 (95% CI, 6.51; 10.19) times increased rate of subsequently developing dementia compared with very late first contact osteoarthritis patients. Compared with the general population the rate ratio was 5.49 (95% CI, 4.81; 6.26). Conclusion: Very late first-contact delusional disorder increases the risk of subsequently getting a diagnosis of dementia 5–8 times compared with osteoarthritis patients and the general population.