38 research outputs found
Mortality risk and mood stabilizers in bipolar disorder: a propensity-score weighted population-based cohort study in 2002-2018
No full textHealthcare resource utilization of people with depressive disorder and co-occurring incident diabetes mellitus: A 20-year population-based propensity score-matched cohort study
No full textBackground: Depression with co-occurring diabetes is associated with elevated risk of diabetes complications, driving substantial healthcare expenditure. However, previous research investigating healthcare utilization associated with depression in patients with diabetes is hampered by important limitations. We examined whether pre-existing depression increased healthcare utilization and costs in patients with incident diabetes. Method: This population-based propensity score (PS)-matched (1:10) cohort study identified 12,165 patients with pre-existing depression and incident-diabetes (depression-diabetes group) and 116,853 patients with incident-diabetes only (diabetes-only group) between 2002 and 2021 in Hong Kong, using territory-wide medical-record database of public healthcare services. A comprehensive array of covariates was included in PS-matching, comprising age, sex, calendar-year period, catchment-area, physical and psychiatric comorbidities, and medication prescriptions. Service-specific utilization per patient-year was compared by negative binomial regression between groups, with stratified analyses by service types, sex, and age groups. Results: Depression-diabetes group was significantly associated with 38 % elevated healthcare utilization relative to diabetes-only group across emergency (Odds ratio 1.16, 95 %CI[1.12–1.20]; HK243] versus HK210]), inpatient (1.47[1.27–1.72]; HK2208] versus HK1574]), and outpatient services (1.29[1.27–1.31]; HK1526] versus HK1105]), leading to additional HK$8540 annual healthcare costs per-patient. Additional analyses demonstrated that increased healthcare utilization was observed in both men and women with depression and co-occurring diabetes relative to their diabetes-only counterparts, across three age-groups, and in both psychiatric and non-psychiatric resources. Conclusion: Patients with pre-existing depression and co-occurring incident-diabetes are at heightened risk for increased healthcare resource utilization and cost compared to diabetes-only patients. Further research on effective interventions is warranted to alleviate the burden associated with both conditions.</p
Pre-existing chronic physical morbidity and excess mortality in people with bipolar disorder: a population-based cohort study in 2008-2018
No full textPre-existing chronic physical morbidity and excess mortality in people with bipolar disorder: A population-based cohort study in 2008-2018
No full textPre-existing chronic physical morbidity and excess mortality in people with bipolar disorder: a population-based cohort study in 2008-2018
No full textMortality risk and mood stabilizers in bipolar disorder: a propensity-score weighted population-based cohort study in 2002-2018
No full textAnatomical, behavioral, and cognitive teratogenicity associated with valproic acid: a systematic review
No full textBackground. Recent guidance from UK health authorities strongly cautions against the use of valproic acid (VPA) in persons under 55 because of reevaluated risk of teratogenicity. Objective. To summarize the extant literature documenting VPA-associated anatomical, behavioral, and cognitive teratogenicity. Method. Pubmed, Medline, Cochrane Library, PsychInfo, Embase, Scopus, Web of Science, and Google Scholar were searched in accordance with PRISMA guidelines. Collected data covered study design, participant characteristics, anatomical, behavioral, or cognitive effects, and folic acid outcomes. Results. 122 studies were identified meeting inclusion comprised of studies evaluating anatomical (n = 67), behavioral (n = 28), and cognitive (n = 47) teratogenicity. Twenty studies were identified reporting on the risk mitigation effects of folic acid supplementation. Prenatal VPA exposure is associated with anatomical teratogenicity including major congenital malformations (odds ratio [OR] 2.47-9.30; p < 0.005). Behavioral teratogenicity including autism (OR 1.70-4.38), impaired motor development (OR 7.0), and ADHD (OR 1.39) are also significantly associated with VPA exposure. VPA was associated with intellectual disability and low IQ (hazard ratio [HR] 2.4-4.48, verbal intelligence: Spearman's ρ = -0.436, respectively). Teratogenic effects were dose-dependent across all domains and were significant when compared with controls and other antiepileptic drugs (eg, carbamazepine, lamotrigine, and levetiracetam). Folic acid supplementation does not significantly reduce the hazard associated with VPA. Conclusions. VPA is significantly associated with anatomical, behavioral, and cognitive teratogenicity. Folic acid supplementation does not abrogate the risk of teratogenicity associated with VPA exposure. Available evidence supports recommendations to reduce VPA exposure in women of reproductive age
All-cause and cause-specific mortality in people with depression: a large-scale systematic review and meta-analysis of relative risk and aggravating or attenuating factors, including antidepressant treatment.
No full textDepression has been reported to be associated with premature mortality. However, no meta-analysis has comprehensively examined all-cause and cause-specific mortality risk in people with this condition, focusing also on possible aggravating and attenuating factors, including antidepressant treatment. We conducted a systematic review and meta-analysis of cohort studies to synthesize mortality risk estimates associated with depression (major depressive disorder and dysthymia) due to any and specific causes, and when depression is accompanied by comorbid conditions. Effects of antidepressant medication and electroconvulsive therapy (ECT), and other potential moderators of mortality risk, were evaluated. We searched EMBASE, Medline and PsycINFO databases up to January 26, 2025, pooling mortality estimates using random-effect models. Publication bias, subgroup and meta-regression analyses, and quality assessment (Newcastle-Ottawa Scale) were performed. Across 268 studies, 10,842,094 individuals with depression and 2,837,933,536 control subjects were included. All-cause mortality was doubled in people with depression versus no depression/general population controls (relative risk, RR=2.10, 95% CI: 1.87-2.35, I2=99.9%), being especially high for suicide (RR=9.89, 95% CI: 7.59-12.88, I2=99.6%), but also elevated for natural causes (RR=1.63, 95% CI: 1.51-1.75, I2=99.6%). Among individuals with versus without depression matched for comorbid conditions, the depression-associated mortality risk was also significantly elevated (RR=1.29, 95% CI: 1.21-1.37, I2=99.9%). Depression with versus without psychotic symptoms (RR=1.61, 95% CI: 1.45-1.78, I2=6.3%), and treatment-resistant versus non-treatment-resistant depression (RR=1.27, 95% CI: 1.16-1.39, I2=85.3%), conferred an incremental mortality risk. Antidepressant use (versus no antidepressant use) was associated with significantly lower all-cause mortality in people with depression (RR=0.79, 95% CI: 0.68-0.93, I2=99.2%). ECT use (versus no ECT use) was associated with reduced all-cause mortality (RR=0.73, 95% CI: 0.66-0.82, I2=0%), natural-cause mortality (RR=0.76, 95% CI: 0.59-0.97, I2=12.0%), and suicide (RR=0.67, 95% CI: 0.53-0.85, I2=32.3%). Our results affirm heightened mortality risk in depression, identify clinically relevant patient subgroups with increased mortality risk, and highlight mortality-reducing effects of antidepressant treatment and ECT. Multipronged intervention approaches targeting physical health improvement and suicide risk alleviation, optimizing antidepressant treatment, and pursuing early identification and effective interventions for psychotic and treatment-resistant depression, could help reduce this mortality gap, which is still growing.published_or_final_versio
Biased Agonism in Psychopharmacology: An Opportunity to Improve Efficacy and Safety of Treatments
No full textThe prevalence, clinical impact, and therapeutic considerations of trauma in adults with bipolar disorder: A systematic review
No full textBACKGROUND\nMETHODS\nRESULTS\nCONCLUSIONS\nExposure to severe stressful life events (e.g., physical, sexual, emotional abuse and/or physical or emotional neglect) is common among adults with bipolar disorder (BD) and is associated with poor prognosis and clinical outcomes. This systematic review aims to evaluate the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD.\nA systematic review of primary research was conducted using Embase, PsycInfo, MEDLINE, and PubMed databases from inception to January 2025, following PRISMA criteria. Sixteen human studies evaluating the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD were included.\nPrevalence rates of trauma range from approximately 40-60 % of adults with BD. Childhood physical maltreatment is highly associated with comorbidities and symptom severity in adults with BD. Childhood emotional maltreatment is associated with an earlier age of onset, greater illness severity, comorbidity and suicidality in BD. The moderating effects of trauma in BD treatment response across disparate modalities of treatment are not adequately characterized.\nTrauma, particularly childhood trauma, is prevalent and has a severe negative clinical impact on the presentation, progression, treatment, and outcomes of adults with BD. The research strategic priority is to characterize the biosignature of trauma in BD, the impact of trauma on treatment outcomes, and to empirically evaluate integrated models of care in persons with BD with a history of trauma.published_or_final_versio
