Acta Psychiatrica Scandinavica最新文献

Introduction: Network meta-analyses suggest dexamphetamines (dAMP) may yield more favourable short-term outcomes than methylphenidate (MPH) in adults with ADHD, yet evidence on long-term comparative persistence remains scarce. This study compared 12-month treatment persistence between MPH and dAMP in a large multicentre cohort and explored associations with ADHD clinical presentations and objectively measured core symptoms.

Methods: Stimulant persistence was defined by the primary outcome, 'time-to-transition', the interval from initiation to switching stimulant classes, transitioning to non-stimulants or complete discontinuation. Patients were censored at 12 months or at last clinical contact. A multivariable mixed-effects Cox proportional hazard model with a random intercept for clinicians was used to estimate hazard ratios (HR) and assess the relative impact of stimulant class on persistence, including its interactions with DSM-based clinical presentations and objective indices.

Results: Among 12,995 participants (49% female), 62% initiated dAMP and 38% MPH. Median time-to-transition was 33.1 weeks for dAMP versus 15.0 weeks for MPH. MPH was associated with a 45% increased hazard for non-persistence compared to dAMP (HR = 1.45, 95% CI [1.36-1.55]). Regarding clinical and objective factors, hyperactive/impulsive presentation (HR = 1.14, p = 0.025) and objective impulsivity (HR = 1.05, p = 0.002) were independently associated with non-persistence. A significant interaction was observed between stimulant class and objective hyperactivity (p = 0.003), indicating that dAMP's persistence advantage became more pronounced with increasing motor activity (HR = 1.09). Nevertheless, these associations were secondary to the overarching effect of the stimulant class itself.

Conclusion: Treatment with dAMP demonstrates significantly superior 12-month persistence compared to MPH in adults with ADHD. While clinical and objective measures of impulsivity and hyperactivity identify patients at higher risk for treatment non-persistence, dAMP's advantage remains consistent across all presentations. These findings suggest that prioritizing dAMP may enhance long-term treatment persistence in adult ADHD clinical practice.

Background: Suicide risk is elevated after prison release, but population-level evidence on temporal risk patterns and associated factors remains limited. We aimed to describe characteristics of individuals who die by suicide after release from Norwegian prisons, compare their suicide mortality with the general population, and examine risk factors over time.

Material and methods: Data from the Norwegian Prison Release Study (nPRIS), including all people in prison in Norway (2000-2022), were linked to the Norwegian Cause of Death Registry, the Norwegian Prison Registry, the Norwegian Patient Registry, and Statistics Norway. We calculated crude mortality rates (CMR) per 100,000 person-years, standardized mortality ratios (SMR), annual age-standardized years of life lost rate (ASYR), and Cox proportional hazards models.

Results: From 2000 to 2022, 1183 suicides (9.1% of all deaths; CMR 81; 95% CI 76-85) occurred after release (90% male). The SMR was higher in women (SMR 8.64; 95% CI 7.17-10.34) than men (SMR 3.98; 95% CI 3.76-4.22). In multivariable models (2009-2022; n = 57,034; 516 suicides), strong independent associations with suicide 6 months post-release included self-harm (adjusted HR [aHR] 4.76; 95% CI 2.60-8.72), severe mental illness (aHR 1.95; 95% CI 1.16-3.27), release from high-security prisons (aHR 1.93; 95% CI 1.12-3.33), and pretrial detention (aHR 1.82; 95% CI 1.06-3.13).

Conclusions: Suicide risk is substantially and persistently elevated relative to the general population, peaks immediately after release, and is concentrated among people with prior self-harm, severe mental illness, and those released from high-security settings.

Introduction: Antipsychotic-associated heart rate-corrected QT (QTc) prolongation and sudden cardiac death are uncommon in young people, but risk is concentrated in patients with identifiable clinical vulnerability and during selected drug- or exposure-related situations. We mapped the evidence and developed a risk-stratified framework for clinical monitoring.

Methods: This structured narrative review searched PubMed in August 2026 using one comprehensive query and 41 targeted subqueries. After PMID-based deduplication, 934 unique records underwent title screening, 382 abstract review, and 158 full-text relevance assessment; 104 database-derived sources met broad relevance criteria. Backward citation checking and author-identified sources added 58 articles. Overall, 162 sources were considered and 100 providing direct, non-redundant support were cited from the original search; three further sources were incorporated during peer review to address reviewer comments, for a final total of 103 cited references. Two authors independently assessed full-text relevance. Youth evidence was prioritized; adult evidence was used for adult-only agents or when youth-specific data were unavailable. Findings were synthesized narratively without formal risk-of-bias or certainty assessment.

Results: Patient-level factors, particularly electrolyte disturbance, bradycardia, restrictive eating disorder or medical instability, thyroid dysfunction, inherited channelopathy, structural disease, and interacting drugs, were more consistently associated with QTc risk than drug identity for many commonly used agents. Ziprasidone and pimozide had the strongest youth-specific drug-related signals. Adult evidence supported heightened caution with sertindole and iloperidone; high-dose phenothiazines and amisulpride in overdose or renal impairment represented exposure- or context-dependent risks. Clozapine required separate myocarditis-focused surveillance. The evidence supports structured baseline risk assessment and targeted ECG and electrolyte testing, with repeat monitoring driven by risk factors, treatment changes, and agent-specific warnings.

Conclusion: Monitoring should be tiered rather than uniformly scheduled for all patients. The proposed framework distinguishes core clinical risk assessment from targeted cardiac testing and identifies precautionary intervals that require prospective validation.