Association of pharmacological treatments and real‐world outcomes in borderline personality disorder

Lieslehto, Johannes; Tiihonen, Jari; Lähteenvuo, Markku; Mittendorfer‐Rutz, Ellenor; Tanskanen, Antti O.; Taipale, Heidi

doi:10.1111/acps.13564

Cited by 10 publications

(2 citation statements)

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“…There were some differences in the results when stratified by age, which can be at least partially related to statistical power issues, mainly caused by less frequent use of amphetamine among adolescents and young adults. Our results showed consistently that lisdexamphetamine was associated with decreased risk of psychiatric hospitalization and suicidal behavior, which is well in line with the results from studies concerning individuals with borderline personality disorder, 23 , 24 as well as individuals with amphetamine use disorder. 25 …”

Section: Discussionsupporting

confidence: 91%

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Attention-Deficit/Hyperactivity Disorder Medications and Work Disability and Mental Health Outcomes

Taipale,

Bergström,

Gèmes

et al. 2024

JAMA Netw Open

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ImportanceIndividuals with attention-deficit/hyperactivity disorder (ADHD) often have comorbid psychiatric conditions. Relatively little is known about how specific ADHD medications are associated with overall treatment outcomes among these patients.ObjectiveTo investigate the association of the use of specific ADHD medications with hospitalization outcomes and work disability among adolescents and adults with ADHD.Design, Setting, and ParticipantsThis nationwide register-based cohort study identified individuals (aged 16-65 years) with ADHD from Swedish nationwide registers of inpatient health care, specialized outpatient health care, sickness absence, and disability pension during the years 2006 to 2021. Data analysis was performed from November 2022 to August 2023.ExposureUse of specific ADHD medications.Main Outcomes and MeasuresThe main outcome measure was psychiatric hospitalization, and secondary outcomes were suicide attempt and/or death by suicide, nonpsychiatric hospitalization, and work disability (ie, sickness absence or disability pension). The risk of outcomes between use vs nonuse periods of ADHD medications was compared in a within-individual design, where a person acts as their own control, and was analyzed with stratified Cox models.ResultsA total of 221 714 persons with ADHD were included in the study cohort (mean [SD] age, 25.0 [11.2] years; 120 968 male individuals [54.6%]). Methylphenidate was the most commonly used ADHD medication (151 837 individuals [68.5%]), followed by lisdexamphetamine (78 106 individuals [35.2%]) during the follow-up (mean [SD], 7.0 [4.7] years). The following medications were associated with a decreased risk of psychiatric hospitalization: amphetamine (adjusted hazard ratio [aHR], 0.74; 95% CI, 0.61-0.90), lisdexamphetamine (aHR, 0.80; 95% CI, 0.78-0.82), ADHD drug polytherapy (aHR, 0.85; 95% CI, 0.82-0.88), dexamphetamine (aHR, 0.88; 95% CI, 0.83-0.94), and methylphenidate (aHR, 0.93; 95% CI, 0.92-0.95). No associations were found for modafinil, atomoxetine, clonidine, and guanfacine. Decreased risk of suicidal behavior was associated with the use of dexamphetamine (aHR, 0.69; 95% CI, 0.53-0.89), lisdexamphetamine (aHR, 0.76; 95% CI, 0.68-0.84), and methylphenidate (aHR, 0.92; 95% CI, 0.86-0.98). None of the medications was associated with increased risk of nonpsychiatric hospitalization; instead, use of amphetamine, lisdexamphetamine, polytherapy, dexamphetamine, methylphenidate, and atomoxetine were associated with decreased risk of nonpsychiatric hospitalization. The results regarding work disability were significant only for the use of atomoxetine (aHR, 0.89; 95% CI, 0.82-0.97), especially among adolescents and young adults aged 16 to 29 years, (aHR, 0.82; 95% CI, 0.73-0.92).Conclusions and RelevanceIn this nationwide cohort study of adolescents and adults with ADHD, the use of ADHD medication was associated with fewer hospitalizations for both psychiatric and nonpsychiatric morbidity and lower suicidal behavior.

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Section: Discussionsupporting

confidence: 91%

“…with the results from studies concerning individuals with borderline personality disorder, 23,24 as well as individuals with amphetamine use disorder. 25 Methylphenidate was associated with decreased risk in adolescents and young adults (aHR, 0.91; 95% CI, 0.89-0.93) but less so among older individuals (aHR, 0.97; 95% CI, 0.94-0.99).…”

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confidence: 80%

Attention-Deficit/Hyperactivity Disorder Medications and Work Disability and Mental Health Outcomes

Taipale,

Bergström,

Gèmes

et al. 2024

JAMA Netw Open

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Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Solmi,

Monaco,

Højlund

et al. 2024

World Psychiatry

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Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta‐analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD‐defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all‐cause and ED‐related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow‐up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44‐49, n=283, mean follow‐up: 44.9±62.8 months, no significant ED‐group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23‐29, n=170, mean follow‐up: 59.3±71.2 months, no significant ED‐group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2‐0.7, n=214, mean follow‐up: 72.2±117.7 months, no significant ED‐group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person‐years (95% CI: 4.4‐6.1, n=167, mean follow‐up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18‐36, n=18, mean follow‐up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self‐injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio‐demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family‐based therapy, cognitive‐behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self‐help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.

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Medikamente zur Behandlung von Persönlichkeits- und Verhaltensstörungen

Müller,

Benkert

2023

Kompendium Der Psychiatrischen Pharmakotherapie

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Association of pharmacological treatments and real‐world outcomes in borderline personality disorder

Cited by 10 publications

References 53 publications

Attention-Deficit/Hyperactivity Disorder Medications and Work Disability and Mental Health Outcomes

Attention-Deficit/Hyperactivity Disorder Medications and Work Disability and Mental Health Outcomes

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Medikamente zur Behandlung von Persönlichkeits- und Verhaltensstörungen

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