Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

Author:

Öhlund Louise1ORCID,Ott Michael2ORCID,Lundqvist Robert3,Sandlund Mikael4,Salander Renberg Ellinor4,Werneke Ursula5

Affiliation:

1. Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Umeå, 901 87, Sweden

2. Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden

3. Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Luleå, Sweden

4. Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden

5. Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Luleå, Sweden

Abstract

Background: Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events. Methods: A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers. Results: Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events ( p = 0.013) and numbers of events experienced ( p = 0.004). These effects were preserved 2 years after CS initiation. Conclusions: CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.

Funder

Department of Psychiatry, Sunderby Hospital, Region Norrbotten, Sweden.

Research & Development Fund of Research and Innovation Unit, Region Norrbotten, Sweden.

Publisher

SAGE Publications

Subject

Pharmacology, Toxicology and Pharmaceutics (miscellaneous),Psychology (miscellaneous)

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