University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen).
University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen).
J Affect Disord. 2020 Dec 1;277:885-892. doi: 10.1016/j.jad.2020.09.016. Epub 2020 Sep 6.
Knowledge on the comparative effectiveness of pharmacological treatments to prevent suicide mortality in bipolar disorder is still lacking.
We studied the risk of suicide mortality during 1996-2012 among all patients who had been hospitalized due to bipolar disorder in Finland (n = 18,018; mean follow-up time 7.2 years) using nation-wide databases. We used a Cox proportional hazards model. Analyses were adjusted for the effects of time since diagnosis, order of treatments, current use of other treatments, polypharmacy, number of suicidal hospitalizations within 2 year (indicator of inherent risk of relapse), age at index date, sex, and calendar year of index date. In secondary analysis, the first 30 days were omitted from analysis after initiation of a psychopharmacological treatment to control for protopathic bias.
In comparison between use and no use among specific agents, only lithium (HR 0.33, 95%CI 0.24-0.47, p<0.0001) and valproic acid (HR 0.61, 95%CI 0.48-0.79, p=0.0002) were associated with a significantly decreased risk of suicide in bipolar disorder. Lithium showed a 42% lower risk for suicide mortality compared to valproic acid (HR 0.58, 95% CI 0.39-0.86, p = 0.007). Hypnotics were associated with a significantly (HR 1.52, 95%CI 1.22-1.90, p=0.0002) higher risk of suicide.
Only hospitalized patients were included.
Lithium should be considered as treatment of choice for patients with bipolar disorder who are at high risk for suicide. Hypnotic use among suicidal patients indicates need for close monitoring of these patients.
关于预防双相情感障碍自杀死亡率的药物治疗比较效果的知识仍然缺乏。
我们使用全国性数据库研究了 1996 年至 2012 年间因双相情感障碍在芬兰住院的所有患者（n=18018；平均随访时间 7.2 年）的自杀死亡率风险。我们使用 Cox 比例风险模型。分析调整了诊断后时间、治疗顺序、当前使用其他治疗方法、联合用药、2 年内自杀住院次数（复发固有风险指标）、索引日期年龄、性别和索引日期的日历年份的影响。在二次分析中，在开始精神药理学治疗后，前 30 天被从分析中排除，以控制逆行偏倚。
与特定药物的使用与不使用相比，只有锂（HR 0.33，95%CI 0.24-0.47，p<0.0001）和丙戊酸（HR 0.61，95%CI 0.48-0.79，p=0.0002）与双相情感障碍自杀风险显著降低相关。与丙戊酸相比，锂的自杀死亡率风险降低了 42%（HR 0.58，95%CI 0.39-0.86，p=0.007）。催眠药与自杀风险显著相关（HR 1.52，95%CI 1.22-1.90，p=0.0002）。
仅包括住院患者。
对于自杀风险高的双相情感障碍患者，应考虑将锂作为首选治疗方法。自杀患者使用催眠药表明需要密切监测这些患者。
