Truedson Petra, Ott Michael, Wahlström Lisa, Lundqvist Robert, Maripuu Martin, Lindmark Krister, Lieber Ingrid, Werneke Ursula
Department of Clinical Sciences, Psychiatry, Sunderby Research Unit, Umeå University, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden.
Front Psychiatry. 2024 Apr 3;15:1358461. doi: 10.3389/fpsyt.2024.1358461. eCollection 2024.
Mood stabilisers and other psychotropic drugs can lead to serious adverse drug events (ADEs). However, the incidence remains unknown. We aimed to (a) determine the incidence of serious ADEs in patients with bipolar or schizoaffective disorders, (b) explore the role of lithium exposure, and (c) describe the aetiology.
This study is part of the LiSIE (Lithium-Study into Effects and Side Effects) retrospective cohort study. Between 2001 and 2017, patients in the Swedish region of Norrbotten, with a diagnosis of bipolar or schizoaffective disorder, were screened for serious ADEs to psychotropic drugs, having resulted in critical, post-anaesthesia, or intensive care. We determined the incidence rate of serious ADEs/1,000 person-years (PY).
In 1,521 patients, we identified 41 serious ADEs, yielding an incidence rate of 1.9 events per 1,000 PY. The incidence rate ratio (IRR) between ADEs with lithium present and causally implicated and ADEs without lithium exposure was significant at 2.59 (95% CI 1.20-5.51; p = 0.0094). The IRR of ADEs in patients <65 and ≥65 years was significant at 3.36 (95% CI 1.63-6.63; p = 0.0007). The most common ADEs were chronic lithium intoxication, oversedation, and cardiac/blood pressure-related events.
Serious ADEs related to treatment of bipolar (BD) or schizoaffective disorder (SZD) were uncommon but not rare. Older individuals were particularly at risk. The risk was higher in individuals exposed to lithium. Serum lithium concentration should always be checked when patients present with new or unclear somatic symptoms. However, severe ADEs also occurred with other mood stabilisers and other psychotropic drugs.
心境稳定剂和其他精神药物可导致严重药物不良事件（ADEs）。然而，其发生率尚不清楚。我们旨在（a）确定双相情感障碍或分裂情感性障碍患者中严重ADEs的发生率，（b）探讨锂暴露的作用，以及（c）描述病因。
本研究是LiSIE（锂的效应和副作用研究）回顾性队列研究的一部分。2001年至2017年期间，对瑞典北博滕地区诊断为双相情感障碍或分裂情感性障碍的患者进行筛查，以确定因精神药物导致的严重ADEs，这些事件导致了危急情况、麻醉后或重症监护情况。我们确定了严重ADEs/每1000人年（PY）的发生率。
在1521名患者中，我们识别出41例严重ADEs，发生率为每1000 PY 1.9起事件。存在锂且有因果关联的ADEs与未暴露于锂的ADEs之间的发生率比（IRR）为2.59，具有显著性（95% CI 1.20 - 5.51；p = 0.0094）。年龄＜65岁和≥65岁患者中ADEs的IRR为3.36，具有显著性（95% CI 1.63 - 6.63；p = 0.0007）。最常见的ADEs是慢性锂中毒、过度镇静以及心脏/血压相关事件。
与双相情感障碍（BD）或分裂情感性障碍（SZD）治疗相关的严重ADEs并不常见但也并非罕见。老年个体尤其危险。暴露于锂的个体风险更高。当患者出现新的或不明原因的躯体症状时，应始终检查血清锂浓度。然而，使用其他心境稳定剂和其他精神药物时也会发生严重ADEs。
