Suicide risk in patients treated with lithium.
ABSTRACT Prior observational studies suggest that treatment with lithium may be associated with reduced risk of suicide in bipolar disorder. However, these studies are biased toward patients with the most severe disorders, and the relation to sex and age has seldom been investigated.
To investigate whether treatment with lithium reduces the risk of suicide in a nationwide study.
An observational cohort study with linkage of registers of all prescribed lithium and recorded suicides in Denmark during a period from January 1, 1995, to December 31, 1999.
All patients treated with lithium in Denmark, ie, within community psychiatry, private specialist practice settings, and general practice.
A total of 13 186 patients who purchased at least 1 prescription of lithium and 1.2 million subjects from the general population.
All suicides identified on the basis of death certificates completed by doctors at the time of death.
Patients who purchased lithium had a higher rate of suicide than persons who did not purchase lithium. Purchasing lithium at least twice was associated with a 0.44 reduced rate of suicide (95% confidence interval, 0.28-0.70) compared with the rate when purchasing lithium only once. Further, the rate of suicide decreased with the number of prescriptions of lithium. There was no significant interaction between continued lithium treatment and sex and age regarding the suicide rate.
In a nationwide study including all patients treated with lithium, it was found that continued lithium treatment was associated with reduced suicide risk regardless of sex and age.
Article: Trastorno bipolar geriátrico07/2012; 19(3):76-83. DOI:10.1016/j.psiq.2012.06.004
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ABSTRACT: Objectives Suicide risk in psychiatric inpatients is known to be remarkably high after discharge. However, temporal patterns and risk factors among patients with bipolar disorder remain obscure. We investigated post-discharge temporal patterns of hazard and risk factors by type of illness phase among patients with bipolar disorder. Methods Based on national registers, all discharges of patients with bipolar disorder from a psychiatric ward in Finland in 1987-2003 (n=52,747) were identified, and each patient was followed up to post-index discharge or to suicide (n=466). For discharges occurring in 1995-2003 (n=35,946), factors modifying hazard of suicide during the first 120days (n=129) were investigated. ResultsThe temporal pattern of suicide risk depended on the type of illness phase, being highest but steeply declining after discharge with depression; less high and declining in mixed states; lower and relatively stable after mania. In Cox models, for post-discharge suicides (n=65) after hospitalizations for bipolar depression (n=9,635), the hazard ratio was 8.05 (p=0.001) after hospitalization with a suicide attempt and 3.63 (p<0.001) for male patients, but 0.186 (p=0.001) for patients taking lithium. Suicides after mania (n=28) or mixed episodes (n=20) were predicted by male sex and preceding suicide attempts, respectively. Conclusions Among inpatients with bipolar disorder, suicide risk is high and related strongly to the time elapsed from discharge after hospitalizations for depressive episodes, and less strongly after hospitalizations for mixed episodes. Intra-episodic suicide attempts and male sex powerfully predict suicide risk. Lower suicide rate after hospitalizations for depression among patients prescribed lithium is consistent with a preventive effect.Bipolar Disorders 07/2014; 16(8). DOI:10.1111/bdi.12237 · 4.89 Impact Factor
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ABSTRACT: Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder.Bipolar Disorders 10/2014; 17(1). DOI:10.1111/bdi.12271 · 4.89 Impact Factor