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Pettersson, E., Larsson, H., D'Onofrio, B., Almqvist, C. & Lichtenstein, P. (2019). Association of Fetal Growth With General and Specific Mental Health Conditions. JAMA psychiatry
Open this publication in new window or tab >>Association of Fetal Growth With General and Specific Mental Health Conditions
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2019 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Importance: It is unclear if the associations between fetal growth and later mental health conditions remain after controlling for familial factors and psychiatric comorbidity.

Objective: To examine the associations between fetal growth and general and specific mental health conditions, controlling for familial factors.

Design, Setting, and Participants: This register-based study conducted in Sweden analyzed 546 894 pairs of full siblings born between January 1, 1973, and December 31, 1998. Sibling pairs were followed up through December 31, 2013. First, population-based and within-sibling pair associations (which controlled for time-invariant familial confounders) between fetal growth and the outcomes were estimated. Second, exploratory factor analysis was applied to the outcomes to derive 1 general factor and 4 specific and independent factors. Third, the general and specific factors were regressed on fetal growth. Statistical analysis was performed from March 27, 2017, to October 27, 2018.

Main Outcome and Measures: The outcomes were 11 psychiatric diagnoses (depression, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar disorder, alcohol abuse, drug use, attention-deficit/hyperactivity disorder, autism, schizophrenia, and schizoaffective disorder) and court convictions of violent crimes. Birth weight (in kilograms) statistically adjusted for gestational age was the exposure.

Results: The mean (SD) age of the 1 093 788 participants was 27.2 (6.8) years (range, 15.1-40.9 years) and 51.5% were male. Nine outcomes were significantly associated with birth weight in the population at large: depression (odds ratio [OR], 0.96; 95% CI, 0.95-0.98), anxiety (OR, 0.94; 95% CI, 0.92-0.95), posttraumatic stress disorder (OR, 0.91; 95% CI, 0.89-0.93), bipolar disorder (OR, 0.94; 95% CI, 0.89-1.00), alcohol abuse (OR, 0.89; 95% CI, 0.87-0.91), drug use (OR, 0.83; 95% CI, 0.80-0.85), violent crimes (OR, 0.85; 95% CI, 0.83-0.86), attention-deficit/hyperactivity disorder (OR, 0.88; 95% CI, 0.86-0.90), and autism (OR, 0.95; 95% CI, 0.92-0.97). Only depression (OR, 0.95; 95% CI 0.92-0.98), obsessive-compulsive disorder (OR, 0.93; 95% CI, 0.87-0.99), attention-deficit/hyperactivity disorder (OR, 0.86; 95% CI, 0.82-0.89), and autism (OR, 0.72; 95% CI, 0.69-0.76) remained significantly associated within sibling pairs. An exploratory factor analysis indicated that 1 general and 4 specific factors (capturing anxiety, externalizing, neurodevelopmental, and psychotic conditions) fit the outcomes well. Across almost all sensitivity analyses, an increase in birth weight by 1 kg significantly reduced the general (β, -0.047; 95% CI, -0.071 to -0.023) and the specific neurodevelopmental factors (β, -0.159; 95% CI, -0.190 to -0.128) within sibling pairs.

Conclusions and Relevance: Controlling for familial confounders, reduced fetal growth was associated with a small but significant increase in the general factor of psychopathology and a moderate increase in a specific neurodevelopmental factor.

Place, publisher, year, edition, pages
American Medical Association, 2019
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-72370 (URN)10.1001/jamapsychiatry.2018.4342 (DOI)30725083 (PubMedID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-02-12Bibliographically approved
Taylor, M. J., Martin, J., Lu, Y., Brikell, I., Lundström, S., Larsson, H. & Lichtenstein, P. (2019). Association of Genetic Risk Factors for Psychiatric Disorders and Traits of These Disorders in a Swedish Population Twin Sample. JAMA psychiatry, 76(3), 280-289
Open this publication in new window or tab >>Association of Genetic Risk Factors for Psychiatric Disorders and Traits of These Disorders in a Swedish Population Twin Sample
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2019 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 76, no 3, p. 280-289Article in journal (Refereed) Published
Abstract [en]

Importance: Psychiatric traits associated with categorically defined psychiatric disorders are heritable and present to varying degrees in the general population. It is commonly assumed that diagnoses represent the extreme end of continuously distributed traits in the population, but this assumption has yet to be robustly tested for many psychiatric phenotypes.

Objective: To assess whether genetic risk factors associated with psychiatric disorders are also associated with continuous variation in milder population traits.

Design, Setting, and Participants: This study combined a novel twin analytic approach with polygenic risk score (PRS) analyses in a large population-based twin sample. Phenotypic and genetic data were available from the Child and Adolescent Twin Study in Sweden. Inpatient data were available for January 1, 1987, to December 31, 2014, and outpatient data for January 1, 2001, to December 31, 2013. The last day of follow-up was December 31, 2014. Data analysis was performed from January 1, 2017, to September 30, 2017.

Main Outcomes and Measures: Questionnaires that assessed traits of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), learning difficulties, tic disorders (TDs), obsessive-compulsive disorder (OCD), anxiety, major depressive disorder (MDD), mania, and psychotic experiences were administered to a large Swedish twin sample. Individuals with clinical psychiatric diagnoses were identified using the Swedish National Patient Register. Joint categorical/continuous twin modeling was used to estimate genetic correlations between psychiatric diagnoses and continuous traits. The PRSs for psychiatric disorders were calculated based on independent discovery genetic data. The association between PRSs for each disorder and associated continuous traits was tested.

Results: Phenotype data were available for 13 923 twin pairs (35.1% opposite sex and 31.7% same-sex females) at 9 years of age, 5165 pairs (36.9% opposite sex and 34.0% same-sex females) at 15 years of age, and 4273 pairs (36.5% opposite sex and 34.4% same-sex females) at 18 years of age. Genetic data were available for 13 412 individuals (50.2% females). Twin genetic correlations between numerous psychiatric diagnoses and corresponding traits ranged from 0.31 to 0.69. Disorder PRSs were associated with related population traits for ASD (β [SE] = 0.04 [0.01] at 9 years of age), ADHD (β [SE] = 0.27 [0.03] at 9 years of age), TDs (β [SE] = 0.02 [0.004] at 9 years of age), OCD (β [SE] = 0.13 [0.05] at 18 years of age), anxiety (β [SE] = 0.18 [0.08] at 9 years of age; β [SE] = 0.07 [0.02] at 15 years of age; and β [SE] = 0.40 [0.17] at 18 years of age), MDD (β [SE] = 0.10 [0.03] at 9 years of age; β [SE] = 0.11 [0.02] at 15 years of age; and β [SE] = 0.41 [0.10] at 18 years of age), and schizophrenia (β [SE] = 0.02 [0.01] at 18 years of age). Polygenic risk scores for depressive symptoms were associated with MDD diagnoses (odds ratio, 1.16; 95% CI, 1.02-1.32).

Conclusions and Relevance: These results suggest that genetic factors associated with psychiatric disorders are also associated with milder variation in characteristic traits throughout the general population for many psychiatric phenotypes. This study suggests that many psychiatric disorders are likely to be continuous phenotypes rather than the categorical entities currently defined in diagnostic manuals, which has strong implications for genetic research in particular.

Place, publisher, year, edition, pages
American Medical Association, 2019
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-71751 (URN)10.1001/jamapsychiatry.2018.3652 (DOI)000460506700011 ()30566181 (PubMedID)2-s2.0-85059175163 (Scopus ID)
Funder
Wellcome trust, 106047Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-1678 2014-0834 2014-0322Swedish Research Council, 340-2013-5867 2014-3831
Note

Funding Agencies:

Judah Foundation  

Tourette Association of America  

National Institutes of Health  NS40024  NS016648  MH079489  MH073250 

American Recovery and Re-investment Act  MH079489  NS040024-0751  NSw040024-09S1  MH092289  MH092290  MH092291  MH092292  RO1MH092293  MH092513  MH092516  MH092520  NS40024-07S1  NS16648-29S1  MH071507  MH079487  MH079488  MH079494 

New Jersey Center for Tourette Syndrome and Associated Disorders 

Available from: 2019-01-23 Created: 2019-01-23 Last updated: 2019-03-19Bibliographically approved
Brander, G., Isomura, K., Chang, Z., Kuja-Halkola, R., Almqvist, C., Larsson, H., . . . Fernández de la Cruz, L. (2019). Association of Tourette Syndrome and Chronic Tic Disorder With Metabolic and Cardiovascular Disorders. JAMA Neurology
Open this publication in new window or tab >>Association of Tourette Syndrome and Chronic Tic Disorder With Metabolic and Cardiovascular Disorders
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2019 (English)In: JAMA Neurology, ISSN 2168-6149, E-ISSN 2168-6157Article in journal (Refereed) Epub ahead of print
Abstract [en]

Importance: There are limited data concerning the risk of metabolic and cardiovascular disorders among individuals with Tourette syndrome (TS) or chronic tic disorder (CTD).

Objective: To investigate the risk of metabolic and cardiovascular disorders among individuals with TS or CTD over a period of 40 years.

Design, Settings, and Participants: This longitudinal population-based cohort study included all individuals living in Sweden between January 1, 1973, and December 31, 2013. Families with clusters of full siblings discordant for TS or CTD were further identified. Data analyses were conducted from August 1, 2017, to October 11, 2018.

Exposures: Previously validated International Classification of Diseases diagnoses of TS or CTD in the Swedish National Patient Register.

Main Outcomes and Measures: Registered diagnoses of obesity, dyslipidemia, hypertension, type 2 diabetes, and cardiovascular diseases (including ischemic heart diseases, arrhythmia, cerebrovascular diseases and transient ischemic attack, and arteriosclerosis).

Results: Of the 14 045 026 individuals in the cohort, 7804 individuals (5964 males [76.4%]; median age at first diagnosis, 13.3 years [interquartile range, 9.9-21.3 years]) had a registered diagnosis of TS or CTD in specialist care. Of 2 675 482 families with at least 2 singleton full siblings, 5141 families included siblings who were discordant for these disorders. Individuals with TS or CTD had a higher risk of any metabolic or cardiovascular disorders compared with the general population (hazard ratio adjusted by sex and birth year [aHR], 1.99; 95% CI, 1.90-2.09) and sibling controls (aHR for any disorder, 1.37; 95% CI, 1.24-1.51). Specifically, individuals with TS or CTD had higher risks for obesity (aHR, 2.76; 95% CI, 2.47-3.09), type 2 diabetes (aHR, 1.67; 95% CI, 1.42-1.96), and circulatory system diseases (aHR, 1.76; 95% CI, 1.67-1.86). The risk of any cardiometabolic disorder was significantly greater in males than in females (aHR, 2.13; 95% CI, 2.01-2.26 vs aHR, 1.79; 95% CI, 1.64-1.96), as was the risk of obesity (aHR, 3.24; 95% CI, 2.83-3.70 vs aHR, 1.97; 95% CI, 1.59-2.44). The risks were already evident from childhood (the groups were significantly different by age 8 years) and were significantly reduced with the exclusion of individuals with comorbid attention-deficit/hyperactivity disorder (aHR, 1.52; 95% CI, 1.42-1.62), while excluding other comorbidities did not significantly affect the results. Compared with patients with TS or CTD who were not taking antipsychotics, patients with a longer duration of antipsychotic treatment (>1 year) had significantly lower risks of metabolic and cardiovascular disorders.

Conclusions and Relevance: The findings of this study suggest that TS and CTD are associated with a substantial risk of metabolic and cardiovascular disorders. The results highlight the importance of carefully monitoring cardiometabolic health in patients with TS or CTD across the lifespan, particularly in those with comorbid attention-deficit/hyperactivity disorder.

Place, publisher, year, edition, pages
American Medical Association, 2019
National Category
Psychiatry Neurology
Identifiers
urn:nbn:se:oru:diva-71659 (URN)10.1001/jamaneurol.2018.4279 (DOI)30640363 (PubMedID)
Available from: 2019-01-22 Created: 2019-01-22 Last updated: 2019-01-22Bibliographically approved
Pettersson, E., Lichtenstein, P., Larsson, H., Song, J., Agrawal, A., Børglum, A. D., . . . Polderman, T. J. (2019). Genetic influences on eight psychiatric disorders based on family data of 4 408 646 full and half-siblings, and genetic data of 333 748 cases and controls (vol 49, pg 351, 2019). Psychological Medicine, 49(2), 351-351
Open this publication in new window or tab >>Genetic influences on eight psychiatric disorders based on family data of 4 408 646 full and half-siblings, and genetic data of 333 748 cases and controls (vol 49, pg 351, 2019)
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2019 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 49, no 2, p. 351-351Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Cambridge University Press, 2019
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-72090 (URN)10.1017/S0033291718002945 (DOI)000456278500022 ()30334498 (PubMedID)
Note

Funding Agency:

NIMH NIH HHS  U01 MH109532

Available from: 2019-02-05 Created: 2019-02-05 Last updated: 2019-02-05Bibliographically approved
Taylor, M. J., Larsson, H., Gillberg, C., Lichtenstein, P. & Lundström, S. (2019). Investigating the childhood symptom profile of community-based individuals diagnosed with attention-deficit/hyperactivity disorder as adults. Journal of Child Psychology and Psychiatry and Allied Disciplines, 60(3), 259-266
Open this publication in new window or tab >>Investigating the childhood symptom profile of community-based individuals diagnosed with attention-deficit/hyperactivity disorder as adults
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2019 (English)In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 60, no 3, p. 259-266Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is currently defined as a disorder with onset during childhood. Although ADHD occurs in adults as well as children, recent debate has focused on whether adult ADHD represents a continuation of a child-onset disorder or if ADHD may, in at least some cases, have an adult onset. We therefore aimed to test the hypothesis of adult-onset ADHD using a sample born relatively recently (1992-1999) in order to minimize confounding by secular changes in diagnostic practices.

METHODS: We identified 74 individuals with a community diagnosis of ADHD first assigned during adulthood. We also identified individuals with childhood (N = 194) and adolescent (N = 394) community diagnoses of ADHD. These groups were compared with a comparison group (N = 14,474) on their childhood ADHD and neuropsychiatric symptoms, and rate of other psychiatric diagnoses during childhood.

RESULTS: Having an adulthood community diagnosis of ADHD was associated with a mean increase in childhood ADHD symptoms of approximately three times that of the comparison group. Individuals with an adult community diagnosis of ADHD also displayed more autistic traits, motor problems, learning difficulties, tics, and oppositional behavior. Forty two percent of these individuals, compared with 1% of comparison cases, had a psychiatric diagnosis other than ADHD as children. In post-hoc analyses of 21 ADHD cases showing few or no ADHD symptoms in childhood, we were unable to detect any other childhood symptomatology in only nine cases, of whom six were female.

CONCLUSIONS: Our results indicate that alternative explanations for data that appear to show adult onset ADHD, such as sex biases in diagnostic practices, need rigorous testing before adult onset ADHD can be accepted as a valid clinical construct.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019
Keywords
Attention-deficit/hyperactivity disorder, adulthood, age of onset, twin study
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-69904 (URN)10.1111/jcpp.12988 (DOI)000459224900004 ()30338854 (PubMedID)2-s2.0-85055273325 (Scopus ID)
Funder
Fredrik och Ingrid Thurings StiftelseForte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council, 340‐2013‐5867
Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2019-03-07Bibliographically approved
Kennedy, B., Ruoqing, C., Fang, F., Valdimarsdottir, U., Montgomery, S., Larsson, H. & Fall, K. (2019). Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life. Journal of Epidemiology and Community Health, Article ID jech-2018-211815.
Open this publication in new window or tab >>Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life
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2019 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, article id jech-2018-211815Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: While compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited.

METHODS: In this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0±7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression.

RESULTS: We found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates.

CONCLUSION: Low stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
alcohol, epidemiology, health behaviour, psychological stress, smoking
National Category
Substance Abuse
Identifiers
urn:nbn:se:oru:diva-72375 (URN)10.1136/jech-2018-211815 (DOI)30718261 (PubMedID)
Available from: 2019-02-11 Created: 2019-02-11 Last updated: 2019-02-11Bibliographically approved
Ginsberg, Y., D'Onofrio, B. M., Rickert, M. E., Class, Q. A., Rosenqvist, M. A., Almqvist, C., . . . Larsson, H. (2019). Maternal infection requiring hospitalization during pregnancy and attention-deficit hyperactivity disorder in offspring: a quasi-experimental family-based study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 60(2), 160-168
Open this publication in new window or tab >>Maternal infection requiring hospitalization during pregnancy and attention-deficit hyperactivity disorder in offspring: a quasi-experimental family-based study
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2019 (English)In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 60, no 2, p. 160-168Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Maternal infection during pregnancy (IDP) has been associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. However, infection is associated with social adversity, poor living conditions and other background familial factors. As such, there is a need to rule out whether the observed association between maternal IDP and ADHD might be attributed to such confounding.

METHODS: This nationwide population-based cohort study using a family-based, quasi-experimental design included 1,066,956 individuals born in Sweden between 1992 and 2002. Data on maternal IDP (bacterial or viral) requiring hospitalization and ADHD diagnosis in offspring were gathered from Swedish National Registers, with individuals followed up through the end of 2009. Ordinary and stratified Cox regression models were used for estimation of hazard ratios (HRs) and several measured covariates were considered. Cousin- and sibling-comparisons accounted for unmeasured genetic and environmental factors shared by cousins and siblings.

RESULTS: In the entire population, maternal IDP was associated with ADHD in offspring (HR = 2.31, 95% CI = 2.04-2.61). This association was attenuated when accounting for measured covariates (HR = 1.86, 95% CI = 1.65-2.10). The association was further attenuated when adjusting for unmeasured factors shared between cousins (HR = 1.52, 95% CI = 1.12-2.07). Finally, the association was fully attenuated in sibling comparisons (HR = 1.03, 95% CI = 0.76-1.41).

CONCLUSIONS: This study suggests that the association between maternal IDP and offspring ADHD is largely due to unmeasured familial confounding. Our results underscore the importance of adjusting for unobserved familial risk factors when exploring risk factors for ADHD.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019
Keywords
Maternal infection during pregnancy, attention-deficit/hyperactivity disorder, cousin comparisons, familial confounding, quasi-experimental, sibling comparisons
National Category
Psychiatry Obstetrics, Gynecology and Reproductive Medicine Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-68597 (URN)10.1111/jcpp.12959 (DOI)000456605900005 ()30136726 (PubMedID)2-s2.0-85052396814 (Scopus ID)
Funder
Stockholm County CouncilThe Karolinska Institutet's Research FoundationSwedish Research Council
Note

Funding Agency:

Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM)  340-2013-5867

Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2019-02-07Bibliographically approved
Brikell, I., Chen, Q., Kuja-Halkola, R., D'Onofrio, B. M., Wiggs, K. K., Lichtenstein, P., . . . Larsson, H. (2019). Medication treatment for attention-deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy. Epilepsia, 60(2), 284-293
Open this publication in new window or tab >>Medication treatment for attention-deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy
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2019 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 60, no 2, p. 284-293Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) affects 10%-30% of individuals with epilepsy, yet concerns remain regarding the safety of ADHD medication in this group. The objective of this study was to examine the risk of acute seizures associated with ADHD medication in individuals with epilepsy.

METHODS: A total of 21 557 individuals with a seizure history born between 1987 and 2003 were identified from Swedish population registers. Within this study population, we also identified 6773 youth (<19 years of age) who meet criteria for epilepsy, and 1605 youth with continuous antiepileptic drug (AED) treatment. ADHD medication initiation and repeated medication periods were identified from the Swedish Prescribed Drug Register between January 1, 2006 and December 31, 2013. Acute seizures were identified via unplanned visits to hospital or specialist care with a primary seizure discharge diagnosis in the Swedish National Patient Register during the same period. Conditional Poisson regression was used to compare the seizure rate during the 24 weeks before and after initiation of ADHD medication with the rate during the same 48 weeks in the previous year. Cox regression was used to compare the seizure rate during ADHD medication periods with the rate during nonmedication periods. Comparisons were made within-individual to adjust for unmeasured, time?constant confounding.

RESULTS: Among 995 individuals who initiated ADHD medication during follow-up, within-individual analyses showed no statistically significant difference in the rate of seizures during the 24 weeks before and after medication initiation, compared to the same period in the previous year. In the full study population 11 754 seizure events occurred during 136 846 person-years and 1855 individuals had at least one ADHD medication period. ADHD medication periods were associated with a reduced rate of acute seizures (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.57-0.94), compared to nonmedication periods within the same individual. Similar associations were found in youth with epilepsy and continuous AED treatment, when adjusting for AEDs, and across sex, age, and comorbid neurodevelopmental disorders.

SIGNIFICANCE: We found no evidence for an overall increased rate of acute seizures associated with ADHD medication treatment among individuals with epilepsy. These results suggest that epilepsy should not automatically preclude patients from receiving ADHD medications.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
ADHD, epilepsy, methylphenidate, neurodevelopmental disorders, pharmacoepidemiology, seizures, treatment
National Category
Psychiatry Neurology
Identifiers
urn:nbn:se:oru:diva-71848 (URN)10.1111/epi.14640 (DOI)000458863500011 ()30682219 (PubMedID)2-s2.0-85060658495 (Scopus ID)
Funder
Swedish Research Council, 340-2013-5867
Note

Funding Agencies:

Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM)  340-2013-5867 

National Institute on Drug Abuse  K99DA040727 

National Institute of Mental Health  1R01MH102221 

Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-03-07Bibliographically approved
Gong, T., Lundholm, C., Rejnö, G., Bölte, S., Larsson, H., D'Onofrio, B. M., . . . Almqvist, C. (2019). Parental asthma and risk of autism spectrum disorder in offspring: a population and family based case-control study. Clinical and Experimental Allergy
Open this publication in new window or tab >>Parental asthma and risk of autism spectrum disorder in offspring: a population and family based case-control study
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Associations between parental asthma and prenatal exposure to asthma medications with offspring autism spectrum disorder (ASD) have been reported. However, the associations might be confounded by unmeasured (genetic and shared environmental) familial factors.

OBJECTIVE: We investigated the association between (a) maternal/paternal asthma and offspring ASD, and (b) prenatal exposures to β2-agonists, other asthma medications and offspring ASD using cases and controls selected from the population as well as biological relatives with different degrees of relatedness.

METHODS: We included all children (N=1,579,263) born in Sweden 1992-2007. A nested case-control design was used to compare 22,894 ASD cases identified from the National Patient Register to (i) 228,940 age-, county- and sex-matched controls randomly selected from the population, (ii) their eligible full-siblings (n=1,267), (iii) half-siblings (n=1,323), (iv) full-cousins (n=11,477), and (v) half-cousins (n=3,337). Conditional logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for ASD in children differentially exposed to parental asthma or prenatal asthma medications.

RESULTS: Maternal asthma was associated with increased risk of offspring ASD (OR 1.43, 95% CI 1.38-1.49); there was a weaker association for paternal asthma (OR 1.17, 95% CI 1.11-1.23). The risk of offspring ASD in mothers with asthma showed similar estimates when adjusting for shared familial factors among paternal half-siblings (OR 1.20, 95% CI 0.80-1.81), full-cousins (OR 1.28, 95% CI 1.16-1.41), and half-cousins (OR 1.30, 95% CI 1.10-1.54), albeit with wider confidence intervals. Prenatal exposure to asthma medications among subjects whose mothers had asthma was not associated with subsequent ASD.

CONCLUSIONS AND CLINICAL RELEVANCE: In this large observational study, parental asthma was associated with slightly elevated risk of ASD in offspring. More specifically, the increased risk by maternal asthma did not seem to be confounded by familial factors. There was no evidence of an association between asthma medications during pregnancy and offspring ASD.

Place, publisher, year, edition, pages
Blackwell Science Ltd., 2019
Keywords
Asthma, autism spectrum disorder, confounding, medications during pregnancy, nested case-control
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-72475 (URN)10.1111/cea.13353 (DOI)30742718 (PubMedID)
Available from: 2019-02-14 Created: 2019-02-14 Last updated: 2019-02-14Bibliographically approved
Haglund, A., Lysell, H., Larsson, H., Lichtenstein, P. & Runeson, B. (2019). Suicide Immediately After Discharge From Psychiatric Inpatient Care: A Cohort Study of Nearly 2.9 Million Discharges. Journal of Clinical Psychiatry, 80(2), Article ID 18m12172.
Open this publication in new window or tab >>Suicide Immediately After Discharge From Psychiatric Inpatient Care: A Cohort Study of Nearly 2.9 Million Discharges
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2019 (English)In: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 80, no 2, article id 18m12172Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The risk of suicide is elevated after discharge from a psychiatric hospital. This study aimed to investigate how recent suicidal behavior affects the risk of suicide in patients with different psychiatric diagnoses immediately after discharge.

METHODS: Registers with national coverage were linked to create a study cohort including all individuals discharged from psychiatric hospitals in Sweden from 1973 through 2009. Hazard ratios for discharge diagnoses were calculated. The risk of suicide within 30 days after discharge in each diagnostic category when suicidal behavior had been registered within 30 days before admission was estimated.

RESULTS: A total of 3,695 suicides occurred after 2,883,088 discharges. If recent suicidal behavior was registered, the risk of completed suicide increased prominently in all diagnostic categories, but particularly for schizophrenia (hazard ratio [HR] = 8.9; 95% CI, 6.4-12.4) and other nonorganic psychosis (HR = 6.8; 95% CI, 5.1-9.0). Patients suffering from depression had the highest overall risk of suicide postdischarge (HR = 3.0; 95% CI, 2.7-3.3). This finding applied especially to male patients with depression (HR = 4.5; 95% CI, 4.0-5.0) or with reaction to crisis (HR = 3.6; 95% CI 3.0-4.4).

CONCLUSIONS: A distinct elevation of the risk of suicide was seen in all diagnostic groups if a recent self-harm event had occurred, particularly among patients with psychotic disorders. Overall, the immediate risk of suicide after discharge was high regardless of recent suicidal behavior. The findings in this study have relevance for clinical decisions about immediate after-care and treatment in connection with discharge from psychiatric inpatient care.

Place, publisher, year, edition, pages
Physicians Postgraduate Press, 2019
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-72474 (URN)10.4088/JCP.18m12172 (DOI)30758922 (PubMedID)
Available from: 2019-02-14 Created: 2019-02-14 Last updated: 2019-02-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6851-3297

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