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Association between the pharmacological treatment of bipolar disorder and risk of traumatic injuries: a self-controlled case series study

Published online by Cambridge University Press:  22 July 2022

Vanessa W. S. Ng
Affiliation:
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
Le Gao
Affiliation:
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
Esther W. Chan
Affiliation:
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
Ho Ming Edwin Lee
Affiliation:
Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
Joseph F. Hayes
Affiliation:
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
David P. J. Osborn
Affiliation:
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK Camden and Islington NHS Foundation Trust, London NW10PE, UK
Timothy H. Rainer
Affiliation:
Emergency Medicine Unit, The University of Hong Kong, Hong Kong, China
Kenneth K. C. Man*
Affiliation:
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
Ian C. K. Wong*
Affiliation:
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK
*
Authors for correspondence: Ian C. K. Wong, E-mail: wongick@hku.hk; Kenneth K. C. Man, E-mail: kenneth.man@ucl.ac.uk
Authors for correspondence: Ian C. K. Wong, E-mail: wongick@hku.hk; Kenneth K. C. Man, E-mail: kenneth.man@ucl.ac.uk

Abstract

Background

Patients with bipolar disorder (BPD) are prone to engage in risk-taking behaviours and self-harm, contributing to higher risk of traumatic injuries requiring medical attention at the emergency room (ER).We hypothesize that pharmacological treatment of BPD could reduce the risk of traumatic injuries by alleviating symptoms but evidence remains unclear. This study aimed to examine the association between pharmacological treatment and the risk of ER admissions due to traumatic injuries.

Methods

Individuals with BPD who received mood stabilizers and/or antipsychotics were identified using a population-based electronic healthcare records database in Hong Kong (2001–2019). A self-controlled case series design was applied to control for time-invariant confounders.

Results

A total of 5040 out of 14 021 adults with BPD who received pharmacological treatment and had incident ER admissions due to traumatic injuries from 2001 to 2019 were included. An increased risk of traumatic injuries was found 30 days before treatment [incidence rate ratio (IRR) 4.44 (3.71–5.31), p < 0.0001]. After treatment initiation, the risk remained increased with a smaller magnitude, before returning to baseline [IRR 0.97 (0.88–1.06), p = 0.50] during maintenance treatment. The direct comparison of the risk during treatment to that before and after treatment showed a significant decrease. After treatment cessation, the risk was increased [IRR 1.34 (1.09–1.66), p = 0.006].

Conclusions

This study supports the hypothesis that pharmacological treatment of BPD was associated with a lower risk of ER admissions due to traumatic injuries but an increased risk after treatment cessation. Close monitoring of symptoms relapse is recommended to clinicians and patients if treatment cessation is warranted.

Type
Original Article
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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References

American College of Surgeons Committee on Trauma. (2019). National trauma data standard data dictionary 2019 admissions. Retrieved from https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntds/data%20dictionaries/ntdb_data_dictionary_2019_revision.ashx.Google Scholar
Chen, V. C., Yang, Y. H., Lee, C. P., Wong, J., Ponton, L., Lee, Y., … Wu, S. I. (2018). Risks of road injuries in patients with bipolar disorder and associations with drug treatments: A population-based matched cohort study. Journal of Affective Disorders, 226, 124131. doi:10.1016/j.jad.2017.09.029.CrossRefGoogle ScholarPubMed
Cosci, F., & Chouinard, G. (2020). Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications. Psychotherapy and Psychosomatics, 89(5), 283306. doi:10.1159/000506868.CrossRefGoogle ScholarPubMed
Crump, C., Sundquist, K., Winkleby, M. A., & Sundquist, J. (2013). Comorbidities and mortality in bipolar disorder: A Swedish national cohort study. JAMA Psychiatry, 70(9), 931939. doi:10.1001/jamapsychiatry.2013.1394.CrossRefGoogle ScholarPubMed
Dean, B. B., Gerner, D., & Gerner, R. H. (2004). A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder. Current Medical Research and Opinion, 20(2), 139154. doi:10.1185/030079903125002801.CrossRefGoogle ScholarPubMed
Fazel, S., Zetterqvist, J., Larsson, H., Långström, N., & Lichtenstein, P. (2014). Antipsychotics, mood stabilisers, and risk of violent crime. Lancet, 384(9949), 12061214. doi:10.1016/S0140-6736(14)60379-2.CrossRefGoogle ScholarPubMed
Food and Health Bureau HKSAR (2017). Mental health review report. Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.Google Scholar
Gao, L., Man, K. K. C., Chan, E. W., Chui, C. S. L., Li, X., Coghill, D., … Wong, I. C. K. (2021). Treatment with methylphenidate for attention deficit hyperactivity disorder (ADHD) and the risk of all-cause poisoning in children and adolescents: A self-controlled case series study. CNS Drugs, 35(7), 769779. doi:10.1007/s40263-021-00824-x.CrossRefGoogle ScholarPubMed
Hayes, J. F., Miles, J., Walters, K., King, M., & Osborn, D. P. (2015). A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatrica Scandinavica, 131(6), 417425. doi:10.1111/acps.12408.CrossRefGoogle ScholarPubMed
Hayes, J. F., Pitman, A., Marston, L., Walters, K., Geddes, J. R., King, M., & Osborn, D. P. (2016). Self-harm, unintentional injury, and suicide in bipolar disorder during maintenance mood stabilizer treatment: A UK population-based electronic health records study. JAMA Psychiatry, 73(6), 630637. doi:10.1001/jamapsychiatry.2016.0432.CrossRefGoogle ScholarPubMed
Herrett, E., Thomas, S. L., Schoonen, W. M., Smeeth, L., & Hall, A. J. (2010). Validation and validity of diagnoses in the general practice research database: A systematic review. British Journal of Clinical Pharmacology, 69(1), 414. doi:10.1111/j.1365-2125.2009.03537.x.CrossRefGoogle ScholarPubMed
Kishi, T., Ikuta, T., Matsuda, Y., Sakuma, K., Okuya, M., Mishima, K., & Iwata, N. (2021). Mood stabilizers and/or antipsychotics for bipolar disorder in the maintenance phase: A systematic review and network meta-analysis of randomized controlled trials. Molecular Psychiatry, 26(8), 41464157. doi:10.1038/s41380-020-00946-6.CrossRefGoogle ScholarPubMed
Kishi, T., Matsuda, Y., Sakuma, K., Okuya, M., Mishima, K., & Iwata, N. (2020). Recurrence rates in stable bipolar disorder patients after drug discontinuation v. drug maintenance: A systematic review and meta-analysis. Psychological Medicine, 51(15), 19. doi:10.1017/s0033291720003505.Google ScholarPubMed
Lähteenvuo, M., Tanskanen, A., Taipale, H., Hoti, F., Vattulainen, P., Vieta, E., & Tiihonen, J. (2018). Real-world effectiveness of pharmacologic treatments for the prevention of rehospitalization in a Finnish nationwide cohort of patients with bipolar disorder. JAMA Psychiatry, 75(4), 347355. doi:10.1001/jamapsychiatry.2017.4711.CrossRefGoogle Scholar
Látalová, K. (2009). Bipolar disorder and aggression. International Journal of Clinical Practice, 63(6), 889899. doi:10.1111/j.1742-1241.2009.02001.x.CrossRefGoogle ScholarPubMed
Legislative Council Secretariat. (2020). Updated background brief prepared by the Legislative Council Secretariat for the meeting on 10 January 2020. Retrieved from https://www.legco.gov.hk/yr19-20/english/panels/hs/papers/hs20200110cb2-468-4-e.pdf.Google Scholar
Leung, G. M., Tin, K. Y., & O'Donnell, O. (2009). Redistribution or horizontal equity in Hong Kong's mixed public-private health system: A policy conundrum. Health Economics, 18(1), 3754. doi:10.1002/hec.1342.CrossRefGoogle ScholarPubMed
Liao, Y. T., Ku, Y. H., Chen, H. M., Lu, M. L., Chen, K. J., Yang, Y. H., … Chen, V. C. (2021). Effect of medication on risk of traumatic brain injury in patients with bipolar disorder: A nationwide population-based cohort study. Journal of Psychopharmacology, 35(8), 962970. doi:10.1177/02698811211013582.CrossRefGoogle ScholarPubMed
Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., … Murray, G. (2021). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian and New Zealand Journal of Psychiatry, 55(1), 7117. doi:10.1177/0004867420979353.CrossRefGoogle ScholarPubMed
Man, K. K., Chan, E. W., Coghill, D., Douglas, I., Ip, P., Leung, L. P., … Wong, I. C. (2015). Methylphenidate and the risk of trauma. Pediatrics, 135(1), 4048. doi:10.1542/peds.2014-1738.CrossRefGoogle ScholarPubMed
Man, K. K. C., Coghill, D., Chan, E. W., Lau, W. C. Y., Hollis, C., Liddle, E., … Wong, I. C. K. (2017). Association of risk of suicide attempts with methylphenidate treatment. JAMA Psychiatry, 74(10), 10481055. doi:10.1001/jamapsychiatry.2017.2183.CrossRefGoogle ScholarPubMed
Man, K. K. C., Lau, W. C. Y., Coghill, D., Besag, F. M. C., Cross, J. H., Ip, P., & Wong, I. C. K. (2020). Association between methylphenidate treatment and risk of seizure: A population-based, self-controlled case-series study. The Lancet Child and Adolescent Health, 4(6), 435443. doi:10.1016/s2352-4642(20)30100-0.CrossRefGoogle ScholarPubMed
McGinty, E. E., Baker, S. P., Steinwachs, D. M., & Daumit, G. (2013). Injury risk and severity in a sample of Maryland residents with serious mental illness. Injury Prevention, 19(1), 3237. doi:10.1136/injuryprev-2011-040309.CrossRefGoogle Scholar
Miura, T., Noma, H., Furukawa, T. A., Mitsuyasu, H., Tanaka, S., Stockton, S., … Kanba, S. (2014). Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: A systematic review and network meta-analysis. The Lancet. Psychiatry, 1(5), 351359. doi:10.1016/s2215-0366(14)70314-1.CrossRefGoogle ScholarPubMed
Najt, P., Perez, J., Sanches, M., Peluso, M. A., Glahn, D., & Soares, J. C. (2007). Impulsivity and bipolar disorder. European Neuropsychopharmacology, 17(5), 313320. doi:10.1016/j.euroneuro.2006.10.002.CrossRefGoogle ScholarPubMed
Ng, V. W. S., Man, K. K. C., Gao, L., Chan, E. W., Lee, E. H. M., Hayes, J. F., & Wong, I. C. K. (2021). Bipolar disorder prevalence and psychotropic medication utilisation in Hong Kong and the United Kingdom. Pharmacoepidemiology and Drug Safety, 30(11), 15881600. doi:10.1002/pds.5318.CrossRefGoogle Scholar
NICE. (2014). Bipolar disorder: assessment and management. Retrieved from https://www.nice.org.uk/guidance/cg185.Google Scholar
Petersen, I., Douglas, I., & Whitaker, H. (2016). Self controlled case series methods: An alternative to standard epidemiological study designs. British Medical Journal, 354, i4515. doi:10.1136/bmj.i4515.CrossRefGoogle ScholarPubMed
Singhal, A., Ross, J., Seminog, O., Hawton, K., & Goldacre, M. J. (2014). Risk of self-harm and suicide in people with specific psychiatric and physical disorders: Comparisons between disorders using English national record linkage. Journal of the Royal Society of Medicine, 107(5), 194204. doi:10.1177/0141076814522033.CrossRefGoogle ScholarPubMed
Slankamenac, K., Heidelberger, R., & Keller, D. I. (2020). Prediction of recurrent emergency department visits in patients with mental disorders. Frontiers in Psychiatry, 11, 48. doi:10.3389/fpsyt.2020.00048.CrossRefGoogle ScholarPubMed
Su, J. A., Cheng, B. H., Huang, Y. C., Lee, C. P., Yang, Y. H., Lu, M. L., … Chin-Hung Chen, V. (2017). Bipolar disorder and the risk of fracture: A nationwide population-based cohort study. Journal of Affective Disorders, 218, 246252. doi:10.1016/j.jad.2017.04.037.CrossRefGoogle ScholarPubMed
Tang, W. N. (1997). Previous private psychiatric treatment among public mental patients: A preliminary local survey. Hong Kong Medical Journal, 3(3), 321324.Google ScholarPubMed
Valtonen, H. M., Suominen, K., Haukka, J., Mantere, O., Leppämäki, S., Arvilommi, P., & Isometsä, E. T. (2008). Differences in incidence of suicide attempts during phases of bipolar I and II disorders. Bipolar Disorders, 10(5), 588596. doi:10.1111/j.1399-5618.2007.00553.x.CrossRefGoogle ScholarPubMed
VanderWeele, T. J., & Ding, P. (2017). Sensitivity analysis in observational research: Introducing the E-value. Annals of Internal Medicine, 167(4), 268274. doi:10.7326/m16-2607.CrossRefGoogle ScholarPubMed
Wang, Z., Chan, A. Y. L., Coghill, D., Ip, P., Lau, W. C. Y., Simonoff, E., … Man, K. K. C. (2021). Association between prenatal exposure to antipsychotics and attention-deficit/hyperactivity disorder, autism spectrum disorder, preterm birth, and small for gestational Age. JAMA Internal Medicine, 181(10), 13321340. doi:10.1001/jamainternmed.2021.4571.CrossRefGoogle ScholarPubMed
Weisler, R. H., Kalali, A. H., & Ketter, T. A. (2004). A multicenter, randomized, double-blind, placebo-controlled trial of extended-release carbamazepine capsules as monotherapy for bipolar disorder patients with manic or mixed episodes. The Journal of Clinical Psychiatry, 65(4), 478484. doi:10.4088/jcp.v65n0405.CrossRefGoogle ScholarPubMed
Whitaker, H. J., Hocine, M. N., & Farrington, C. P. (2009). The methodology of self-controlled case series studies. Statistical Methods in Medical Research, 18(1), 726. doi:10.1177/0962280208092342.CrossRefGoogle ScholarPubMed
Wong, A. Y., Wong, I. C., Chui, C. S., Lee, E. H., Chang, W. C., Chen, E. Y., … Chan, E. W. (2016). Association between acute neuropsychiatric events and helicobacter pylori therapy containing clarithromycin. JAMA Internal Medicine, 176(6), 828834. doi:10.1001/jamainternmed.2016.1586.CrossRefGoogle ScholarPubMed
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … Berk, M. (2018). Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97170. doi:10.1111/bdi.12609.CrossRefGoogle Scholar
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