Suicide Risk in Patients Treated With Lithium

IT University of Copenhagen, København, Capital Region, Denmark
Archives of General Psychiatry (Impact Factor: 14.48). 09/2005; 62(8):860-6. DOI: 10.1001/archpsyc.62.8.860
Source: PubMed


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.

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    • "Patients who had received lithium had a 1.5-to 3-fold reduced risk of suicide or suicide attempts compared to patients receiving valproate. Kessing et al. 2005 used data from a national register to analyze 13,186 patients who had received one or more prescriptions for lithium and compared these to patients who had never had a prescription for lithium. The authors found that patients with more than one lithiumprescription had a 0.44-fold reduced suicide rate compared to those who had only one lithium prescription. "
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    ABSTRACT: The management and treatment of patients with suicidal behavior is one of the most challenging tasks for health-care professionals. Patients with affective disorders are at high risk for suicidal behavior, therefore, should be a target for prevention. Numerous international studies of lithium use have documented anti-suicidal effects since the 1970s. Despite the unambiguous evidence of lithium's anti-suicidal effects and recommendations in national and international guidelines for its use in acute and maintenance therapy of affective disorders, the use of lithium is still underrepresented. The following article provides a comprehensive review of studies investigating the anti-suicidal effect of lithium in patients with affective disorders.
    Full-text · Article · Dec 2015
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    • "Many of these strategies have been discussed in a systematic review stemming from a 5-day conference of suicide experts from 15 countries who met in Austria in 2004 [19]. The emerging 'Best Practices' that all residents should be taught are: the best data for suicide prevention rests in early detection and optimizing treatment for the mental disorders that most often lead to suicide, including providing evidence-based pharmacological interventions such as lithium for mood disorders [28] or clozapine for schizophrenia [29], and targeted psychotherapies such as cognitive behavioral therapy [30] or interpersonal therapy [31] for depression or dialectical behavioral therapy for borderline personality disorder [32]. 2. Myths and Science of Assessing Suicide Risk (Maria Oquendo, MD): The initial section of this presentation covered terminology: first, terms residents should be taught NOT to use — deliberate self-harm, failed attempt or completion, manipulative act, nonfatal suicide or suicide attempt, parasuicide, and suicide victim, gesture or threat; and next, preferred terms that are descriptive and non-pejorative — suicidal ideation, attempts (including interrupted and aborted attempts and 'other preparatory suicidal behavior') and suicide completion. "
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    ABSTRACT: This report describes one in a series of National Institute of Health (NIH) supported conferences aimed at enhancing the ability of leaders of psychiatry residency training to teach research literacy and produce both clinician-scholars and physician-scientists in their home programs. Most psychiatry training directors would not consider themselves research scholars or even well-schooled in evidence based practice. Yet they are the front line educators to prepare tomorrow's psychiatrists to keep up with, critically evaluate, and in some cases actually participate in the discovery of new and emerging psychiatric knowledge. This annual conference is meant to help psychiatry training directors become more enthusiastic, knowledgeable and pedagogically prepared to create research-friendly environments at their home institutions, so that more trainees will, in turn, become research literate, practice evidence-based psychiatry, and enter research fellowships and careers. The overall design of each year's meeting is a series of plenary sessions introducing participants to new information pertaining to the core theme of that year's meeting, integrated with highly interactive small group teaching sessions designed to consolidate knowledge and provide pragmatic teaching tools appropriate for residents at various levels of training. The theme of each meeting, selected to be a compelling and contemporary clinical problem, serves as a vehicle to capture training directors' attention while teaching relevant brain science, research literacy and effective pedagogy. This report describes the content and assessment of the 2011 annual pre-meeting, "Evidence-based Approaches to Suicide Risk Assessment and Prevention: Insights from the Neurosciences and Behavioral Sciences for use in Psychiatry Residency Training."
    Full-text · Article · Sep 2012 · Comprehensive psychiatry
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    • "De los pacientes con depresión, un 11% había recibido un tratamiento antidepresivo sufi ciente. Kessing et al 28 (2005) llevaron a cabo un estudio de cohorte observacional en el que examinaron todos los casos de prescripción de litio y de suicidios registrados en Dinamarca durante un período de 5 años. Un total de 13.186 personas de edad ≥ 18 años adquirieron litio al menos en una ocasión durante el período de estudio. "
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    ABSTRACT: Bipolar disorder is associated with high risk for suicidal behavior. Lack of adherence to treatment is one factor that may be partly responsible for this common complication. We searched MEDLINE with the combination of the key words “compliance” or “adherence” with “suicide” and “bipolar”, limited to English language papers published between 1990 and July 2008.We evaluate the existent literature studying the influence of treatment adherence on suicidality among these patients. Our findings show a limited number of studies addressing this issue, mostly conducted with patients enrolled in lithium clinics. Results suggest an association between non-adherence and an increased risk of suicidal behavior among bipolar patients. Whether non-adherence leads to increase risk of suicidality due to specific properties of interventions such as lithium treatment or simply is secondary to mood stabilization is still an open question.
    Full-text · Article · Mar 2009 · Revista de Psiquiatría Biológica y Salud Mental
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