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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 Open the ORCID record for Vanessa W. S. Ng [Opens in a new window] ,
Le Gao Open the ORCID record for Le Gao [Opens in a new window] ,
Esther W. Chan Open the ORCID record for Esther W. Chan [Opens in a new window] ,
Ho Ming Edwin Lee Open the ORCID record for Ho Ming Edwin Lee [Opens in a new window] ,
Joseph F. Hayes Open the ORCID record for Joseph F. Hayes [Opens in a new window] ,
David P. J. Osborn Open the ORCID record for David P. J. Osborn [Opens in a new window] ,
Timothy H. Rainer Open the ORCID record for Timothy H. Rainer [Opens in a new window] ,
Kenneth K. C. Man Open the ORCID record for Kenneth K. C. Man [Opens in a new window]  and
Ian C. K. Wong Open the ORCID record for Ian C. K. Wong [Opens in a new window]
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
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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.

Keywords

Bipolar disorderinjurymood stabilizerspharmacological treatmentself-controlled case seriestrauma
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 11 , August 2023 , pp. 5185 - 5193
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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