Use of lithium and the risk of injurious motor vehicle crash in elderly adults: case-control study nested within a cohort
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《英国医生杂志》
1 Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, 687 Pine Ave, West Montreal, Quebec, Canada H3A 1A1, 2 Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Correspondence to: Samy Suissa Samy.suissa@clinepi.mcgill.ca
Introduction
Elderly people who use lithium may increase by twofold the risk of being involved in an injurious motor vehicle crash while driving. We had no information on diagnoses of bipolar disorder in this group (including severity of disease). Our sample size was too small to allow stratification by number of drugs used. There may, therefore, have been a small possibility in our study of confounding by indication due to disease severity.
A recent retrospective cohort study found lithium to be more efficacious than valproate semisodium (divalproex sodium) in preventing suicides.5 That finding may prompt clinicians to favour lithium over other mood stabilising agents. Patients who are prescribed lithium must be told about the increased risk of motor vehicle crashes.
This article was posted on bmj.com on 19 January 2004: http://bmj.com/cgi/doi/10.1136/bmj.38002.514838.94
Contributors: ME, JACD, BH, and SS designed and performed the study. JACD did the statistical analysis. SS is the guarantor.
Funding: Canadian Institute of Health Research and the Fonds de la Recherche en Santé du Québec.
Competing interests: None declared.
Ethical approval: Ethics committee of the Department of Epidemiology and Biostatistics, McGill University, Montreal.
References
Honig A, Arts BM, Ponds RW, Riedel WJ. Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for daily practice. Int Clin Psychopharmacol 1999;14: 167-71.
Verster JC, de Weert AM, Bijtjes SI, Aarab M, van Oosterwijck AW, Eijken EJ, et al. Driving ability after acute and sub-chronic administration of levocetirizine and diphenhydramine: a randomized, double-blind, placebo-controlled trial. Psychopharmacology (Berl) 2003:169: 84-90.
Hemmelgarn B, Suissa S, Huang A, Boivin JF, Pinard G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA 1997;278: 27-31.
Tamblyn R, Lavoie G, Petrella L, Monette J. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1995;48: 999-1009.
Goodwin FK, Fireman B, Simon GE, Hunkeler EM, Lee J, Revicki D. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA 2003;290: 1467-73.(Mahyar Etminan, pharmacoe)
Correspondence to: Samy Suissa Samy.suissa@clinepi.mcgill.ca
Introduction
Elderly people who use lithium may increase by twofold the risk of being involved in an injurious motor vehicle crash while driving. We had no information on diagnoses of bipolar disorder in this group (including severity of disease). Our sample size was too small to allow stratification by number of drugs used. There may, therefore, have been a small possibility in our study of confounding by indication due to disease severity.
A recent retrospective cohort study found lithium to be more efficacious than valproate semisodium (divalproex sodium) in preventing suicides.5 That finding may prompt clinicians to favour lithium over other mood stabilising agents. Patients who are prescribed lithium must be told about the increased risk of motor vehicle crashes.
This article was posted on bmj.com on 19 January 2004: http://bmj.com/cgi/doi/10.1136/bmj.38002.514838.94
Contributors: ME, JACD, BH, and SS designed and performed the study. JACD did the statistical analysis. SS is the guarantor.
Funding: Canadian Institute of Health Research and the Fonds de la Recherche en Santé du Québec.
Competing interests: None declared.
Ethical approval: Ethics committee of the Department of Epidemiology and Biostatistics, McGill University, Montreal.
References
Honig A, Arts BM, Ponds RW, Riedel WJ. Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for daily practice. Int Clin Psychopharmacol 1999;14: 167-71.
Verster JC, de Weert AM, Bijtjes SI, Aarab M, van Oosterwijck AW, Eijken EJ, et al. Driving ability after acute and sub-chronic administration of levocetirizine and diphenhydramine: a randomized, double-blind, placebo-controlled trial. Psychopharmacology (Berl) 2003:169: 84-90.
Hemmelgarn B, Suissa S, Huang A, Boivin JF, Pinard G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA 1997;278: 27-31.
Tamblyn R, Lavoie G, Petrella L, Monette J. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1995;48: 999-1009.
Goodwin FK, Fireman B, Simon GE, Hunkeler EM, Lee J, Revicki D. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA 2003;290: 1467-73.(Mahyar Etminan, pharmacoe)