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Research on the risk of stroke following the use of mood stabilisers specific to patients with bipolar disorder is limited.
In this study, we investigated the risk of stroke following the exposure to mood stabilisers in patients with bipolar disorder.
Data for this nationwide population-based study were derived from the Taiwan National Health Insurance Research Database. Among a retrospective cohort of patients with bipolar disorder (n = 19 433), 609 new-onset cases of stroke were identified from 1999 to 2012. A case–crossover study design utilising 14-day windows was applied to assess the acute exposure effect of individual mood stabilisers on the risk of ischaemic, haemorrhagic and other types of stroke in patients with bipolar disorder.
Mood stabilisers as a group were significantly associated with the increased risk of stroke in patients with bipolar disorder (adjusted risk ratio, 1.26; P = 0.041). Among individual mood stabilisers, acute exposure to carbamazepine had the highest risk of stroke (adjusted risk ratio, 1.68; P = 0.018), particularly the ischaemic type (adjusted risk ratio, 1.81; P = 0.037). In addition, acute exposure to valproic acid elevated the risk of haemorrhagic stroke (adjusted risk ratio, 1.76; P = 0.022). In contrast, acute exposure to lithium and lamotrigine did not significantly increase the risk of any type of stroke.
Use of carbamazepine and valproic acid, but not lithium and lamotrigine, is associated with increased risk of stroke in patients with bipolar disorder.
Most previous studies of long-term mortality risk following self-harm
have been conducted in Western countries with few studies from Asia.
To investigate suicide and non-suicide mortality after non-fatal
self-harm in Taipei City, Taiwan.
Prospective cohort study (median follow-up 3.3 years) of 7601 individuals
presenting to hospital with self-harm (January 2004 to December 2006).
Standardised mortality ratios (SMRs) for suicide and non-suicide
mortality were calculated.
Suicide risk in the year following self-harm was over 100 times higher
than in the general population (SMR = 119.6, 95% CI 99.6–142.5). Males
and middle-aged and older adults had the highest subsequent risk of
suicide. Compared with people who took an overdose, individuals who used
hanging or charcoal burning in their index episode had the highest risk
of suicide. For non-suicide mortality the SMRs were 6.7 (95% CI 5.7–7.8)
in the first year and 4.4 (95% CI 3.9–4.9) during the whole follow-up
Patterns of increased all-cause and suicide mortality following an
episode of self-harm are similar in Taipei City to those seen in Western
countries. Designing better aftercare following non-fatal self-harm,
particularly for those with underlying physical disorders or who have
used lethal self-harm methods, should be a priority for suicide
prevention programmes in Asia.
Previous population association studies have indicated that certain alleles of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) may reduce the risk of alcoholism in Asian populations. The association of ALDH2 and ADH2 with the development of alcoholism was found to be independent of each other and has been replicated in different Asian populations, while the effect of ADH3 is less studied.
We genotyped the alcohol metabolism genes among Han men with alcohol dependence (n=46) and their ethnically matched normal controls (n=63) in Taiwan. Multiple logistic regression was then applied to assess the contribution of ADH3 to alcoholism by controlling the effect of ALDH2 and ADH2.
The results of multivariate analyses demonstrated that the odds ratios for an increment of one allele of ADH2∗1, ADH3∗2 and ALDH2∗1 in the development of alcoholism were 4.18, 3.82, and 6.89, respectively.
These findings clearly indicate that all three alcohol-metabolising genes contribute to susceptibility to alcoholism.
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