1
|
Rodríguez-Cano R, Lotre K, von Soest T, Rognli EB, Bramness JG. Loneliness in adolescence and prescription of psychotropic drugs in adulthood: 23-year longitudinal population-based and registry study. BJPsych Open 2024; 10:e61. [PMID: 38465662 PMCID: PMC10951847 DOI: 10.1192/bjo.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The role of adolescent loneliness in adult mental health and prescriptions of psychotropic drugs remains underexplored. AIMS We aim to determine whether (a) experiencing loneliness in adolescence and (b) changes in loneliness from adolescence to adulthood are prospectively associated with prescriptions for a variety of psychotropic drugs in adulthood. METHOD We used data from a Norwegian population-based sample with 2602 participants, collected across four waves between 1992 and 2006. Loneliness was assessed at each wave, with survey data linked to medicinal drug prescription records from the Norwegian Prescription Database. We identified prescription histories of antipsychotics, mood stabilisers, antidepressants and benzodiazepines from 2007 to 2015, for each participant. We use latent growth curve analyses to model the relationship of adolescent loneliness and loneliness change from adolescence to adulthood, with subsequent psychotropic drugs prescription. RESULTS Adolescents with heightened loneliness, and adolescents whose loneliness increased into young adulthood, had a greater likelihood of being prescribed antipsychotics, mood stabilisers and antidepressants in adulthood. These associations remained significant after adjustment for confounders such as sociodemographic characteristics, conduct problems, substance use and mental health problems. CONCLUSIONS Loneliness in adolescence and its adverse development over a span of 15 years was linked to higher risk of receiving prescriptions for antipsychotics, mood stabilisers and antidepressants later in life. The findings may indicate that loneliness increases the risk for developing psychotic disorders, bipolar disorders and major depression.
Collapse
Affiliation(s)
- Rubén Rodríguez-Cano
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Norway; and PROMENTA Research Center, Department of Psychology, University of Oslo, Norway
| | - Karianne Lotre
- Institute for Clinical Medicine, UiT – The Arctic University of Norway, Norway
| | - Tilmann von Soest
- PROMENTA Research Center, Department of Psychology, University of Oslo, Norway; and Norwegian Social Research (NOVA), OsloMet – Oslo Metropolitan University, Norway
| | - Eline Borger Rognli
- Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Jørgen Gustav Bramness
- Institute for Clinical Medicine, UiT – The Arctic University of Norway, Norway; Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Trondheim, Norway; and Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
| |
Collapse
|
2
|
Rognli EB, Bramness JG, von Soest T. Smoking in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, antidepressants and anxiolytics. Psychol Med 2022; 52:3241-3250. [PMID: 33583454 PMCID: PMC9693672 DOI: 10.1017/s0033291720005401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Whether smoking should be regarded as a risk factor for mental disorders remains unresolved. Prescribed psychotropic drugs can be used as indications for mental disorders. We investigated how smoking was prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. METHODS Information about smoking, including the Fagerström Test for Nicotine Dependence, and relevant confounders, were obtained from the population-based Young in Norway Study (N = 2602), with four data collection waves between 1992 and 2006. These survey data were linked with information on prescriptions for psychotropic drugs from the comprehensive, nationwide Norwegian Prescription Database from 2007 to 2015. RESULTS Daily smoking with high dependence in 2006 at age 28.5 (s.d. = 2.0) was associated with filling prescriptions of antipsychotics (OR, 6.57, 95% CI 2.19-19.70, p = 0.001), mood stabilizers (OR, 7.11, 95% CI 2.51-20.15, p < 0.001) and antidepressants (OR, 1.91, 95% CI 1.13-3.23, p = 0.016) 1-9 years later. Associations remained significant after adjustment for a variety of potential confounders measured before the assessment of smoking, including sociodemographic background, conduct problems, cannabis use, mental distress, and previous prescriptions for psychotropic medications. The association between smoking and prescription of anxiolytics was weaker and more unstable. CONCLUSIONS In this study of young adults, daily smoking with high dependence was associated with later prescriptions of antipsychotics, mood stabilizers and antidepressants, indicating smoking as a risk factor for mental disorders treated with these drugs.
Collapse
Affiliation(s)
- Eline Borger Rognli
- Section for Clinical Addiction Research, Department on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Jørgen Gustav Bramness
- Norwegian Institute of Public Health, Oslo, Norway
- Institute for Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
| | - Tilmann von Soest
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway
- Norwegian Social Research (NOVA), OsloMet – Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
3
|
Moe JS, Bolstad I, Mørland JG, Bramness JG. GABA A subunit single nucleotide polymorphisms show sex-specific association to alcohol consumption and mental distress in a Norwegian population-based sample. Psychiatry Res 2022; 307:114257. [PMID: 34852975 DOI: 10.1016/j.psychres.2021.114257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
Little is known about genetic influences on the relationship between alcohol consumption and mental distress in the general population, where the majority report consumption and distress far below diagnostic thresholds. This study investigated single nucleotide polymorphisms (SNPs) from candidate gene studies on alcohol use disorder and depressive disorders, for association with alcohol consumption and with mental distress in a population-based sample from the Cohort of Norway (n = 1978, 49% women). The relationship between alcohol consumption and mental distress was further examined for genotype modification. There was a positive correlation between mental distress and alcohol consumption in men, as well as an association between SNPs and mental distress in men (GABRG1, GABRA2, DRD2, ANKK1, MTHFR) and women (CHRM2, MTHFR) and between SNPs and alcohol consumption in women (GABRA2, MTHFR). No modification by SNP genotype was found on the relationship between alcohol consumption and mental distress. The association between mental distress and GABRG1 in men remained significant after correcting for multiple comparisons. The results indicate that alcohol consumption and mental distress are associated in the general population even at levels below clinical thresholds and point to SNPs in genes related to GABAergic signalling for level of mental distress in men.
Collapse
Affiliation(s)
- Jenny Skumsnes Moe
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Disorders, Innlandet Hospital Trust, Brumunddal, Norway; Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Ingeborg Bolstad
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Disorders, Innlandet Hospital Trust, Brumunddal, Norway; Blue Cross East, Norway
| | - Jørg Gustav Mørland
- Division of Health Data and Organization, Norwegian Institute of Public Health, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Jørgen Gustav Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Disorders, Innlandet Hospital Trust, Brumunddal, Norway; Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
4
|
Abebe DS, Lien L, Bramness JG. Effects of age and gender on the relationship between alcohol use disorder and somatic diseases: a national register study in Norway. BMJ Open 2021; 11:e050608. [PMID: 34758993 PMCID: PMC8587343 DOI: 10.1136/bmjopen-2021-050608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to examine how age and gender moderate the associations between alcohol use disorders (AUD) and several somatic diseases. DESIGN AND SETTING We performed a retrospective, register-based cohort study with 6-year follow-up of patients with AUD and the general population. Data were acquired from the Norwegian Patient Registry. Cox regressions were used to estimate HRs of somatic diseases. PARTICIPANTS Patients with AUD (17 023; 0.4%) were compared with the population without AUD (4 271 559; 99.6%), with adults aged 18 years or older who were registered residents of Norway on 1 January 2008. MAIN OUTCOMES Dichotomous variables of 12 specific somatic diseases (cardiovascular diseases, endocrine, nutritional, and metabolic diseases, cancer, and infectious diseases) were assessed. Diagnoses were set in specialist healthcare services. RESULTS Patients with AUD, compared with a population without AUD, experienced a significantly greater burden of all studied somatic diseases. Middle-aged adults with AUD had increased risks (p<0.05) for hypertension; ischaemic diseases; pulmonary diseases; cerebrovascular diseases; malnutrition; metabolic disorders; cancer; and influenza and pneumonia than younger and older adults with AUD. For most somatic diseases, we found no differences between younger versus older adults with AUD, and between females versus males with AUD (p>0.05). Males with AUD had significantly higher risks for pulmonary heart diseases (HR=3.9, 95% CI 3.3 to 4.6) and metabolic disorders (HR 4.7, 95% CI 4.5 to 5.0), while females with AUD had a significantly higher risk for viral hepatitis (HR=4.4, 95% CI 3.8 to 5.1). CONCLUSIONS Age moderated the associations between AUD and most somatic diseases, with middle-aged adults with AUD having a greater increased risk of somatic diseases compared with younger and older adults with AUD. Gender only moderated associations between AUD and pulmonary heart diseases, metabolic disorders and viral hepatitis. This has implications for the prioritisation of somatic resources among patients with AUD.
Collapse
Affiliation(s)
- Dawit Shawel Abebe
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Jørgen Gustav Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Drug and Tobacco Research, Norwegian Institute of Public Health, Oslo, Norway
- Insitute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
5
|
Mørland J, Bramness JG. Δ9-tetrahydrocannabinol (THC) is present in the body between smoking sessions in occasional non-daily cannabis users. Forensic Sci Int 2020; 309:110188. [PMID: 32120192 DOI: 10.1016/j.forsciint.2020.110188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/04/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND THC can be measured in blood up to a month after last intake in heavy cannabis users. The cognitive deficits during abstinence have been hypothesized to be at least in part due to residual THC in brain. To which extent THC accumulation will occur after occasional cannabis use has gained limited attention. We aimed to predict THC-levels between smoking sessions in non-daily as well as daily cannabis users and to compare these predictions with published THC levels. METHODS Predictions were based on pharmacokinetic principles on drug accumulation after repeated dosing, applied to different cannabis smoking patterns, using data from a three-compartment model for THC pharmacokinetics and results on the terminal elimination half-life of THC in humans. We searched the literature for THC measurements which could be compared with these predictions. We found no such results from controlled studies of long-term repeated cannabis consumption of known THC amounts. Thirteen published studies contained, however, enough information on cannabis use and results from THC-measurements to make tentative comparisons with the predictions. RESULTS The predictions of THC-plasma levels present after different cannabis smoking patterns assuming terminal elimination half-lives of THC of 21.5 h or longer, had some support in published THC levels measured in individuals self-reporting their cannabis consumption. We found no consistent discrepancies between the predictions and reported THC plasma levels after non-daily or daily cannabis use. The predictions indicate that THC might be present in plasma between smoking sessions above usual analytical limits when smoking every third and second day, and at lower levels after once weekly smoking. CONCLUSIONS The study indicates that THC might be present continuously even in non-daily smokers at low levels, even if the smoking occasions are separated by a week. This is different from alcohol, where ethanol has disappeared after a day. From a toxicological point of view the persistance of THC in the brain, raises questions whether this should be given more attention as with other toxicological thinking where long-term presence of bioactive substances gives rise to concern. There are some uncertainties in this analysis, and controlled studies on THC-accumulation accompanying different use patterns seem warranted.
Collapse
Affiliation(s)
- J Mørland
- Norwegian Institute of Public Health, PO Box 222 Skøyen 0213, N-0403 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1072, Blindern, N-0316 Oslo, Norway.
| | - J G Bramness
- Norwegian Institute of Public Health, PO Box 222 Skøyen 0213, N-0403 Oslo, Norway; Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
6
|
Rognli EB, Bramness JG, von Soest T. Cannabis use in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, and antidepressants. Acta Psychiatr Scand 2020; 141:149-156. [PMID: 31560790 DOI: 10.1111/acps.13104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Cannabis is an acknowledged risk factor for some mental disorders, but for others the evidence is inconclusive. Prescribed medicinal drugs can be used as proxies for mental disorders. In this study, we investigate how use of cannabis is prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. METHODS Data on cannabis exposure and relevant confounders were obtained from 2,602 individuals in the longitudinal Young in Norway Study, providing survey data from four data collection waves between 1992 and 2006. Data were coupled with information about prescriptions for psychotropic drugs from the Norwegian Prescription Database between 2007 and 2015. RESULTS Past year cannabis use increased the risk of prescription of antipsychotics (OR = 5.56, 95 % CI 1.64 - 18.87), mood stabilizers (OR = 5.36, 95 % CI 1.99 - 14.44) and antidepressants (OR = 2.10, 95 % CI 1.36 - 3.25), after accounting for sociodemographic variables, conduct problems, additional drug use, mental distress, and prescriptions the year before cannabis use was measured. CONCLUSIONS In this study of young adults from the general population, past year cannabis use was associated with later prescriptions of antipsychotics, mood stabilizers, and antidepressants.
Collapse
Affiliation(s)
- Eline Borger Rognli
- Section for Clinical Addiction Research, Department on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Jørgen Gustav Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Institute for Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Tilmann von Soest
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway.,Norwegian Social Research (NOVA), OsloMet - Oslo Metropolitan University, Norway
| |
Collapse
|
7
|
Hjemsæter AJ, Bramness JG, Drake R, Skeie I, Monsbakken B, Thoresen M, Landheim AS. Predictors of problematic substance use 18 years after treatment: a longitudinal cohort study of persons with substance use disorders. Cogent Psychology 2019. [DOI: 10.1080/23311908.2019.1634325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Arne Jan Hjemsæter
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
- SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Jørgen Gustav Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Robert Drake
- Rockville Institute, IPS Employment Center, Lebanon, USA
| | - Ivar Skeie
- SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Department of Mental Health, Innlandet Hospital Trust, Gjøvik, Norway
| | - Bent Monsbakken
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
- SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Magne Thoresen
- Department Of Biostatistics, University of Oslo, Institute of Basic Medical Sciences, Oslo, Norway
| | - Anne Signe Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
- Department of Public Health, Inland Norway University Of Applied Sciences, Elverum, Norway
| |
Collapse
|
8
|
Skurtveit S, Bramness JG, Hjellvik V, Hartz I, Nesvåg R, Hauge LJ, Handal M. Increase in diagnosis of depressive disorders contributes to the increase in antidepressant use in adolescents. Acta Psychiatr Scand 2018; 137:413-421. [PMID: 29623693 DOI: 10.1111/acps.12877] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study if the observed increase in use of antidepressants (AD) among adolescents may be explained by higher incidence of depressive disorder diagnosis, increasing treatment of other mental disorders or more liberal prescribing practice. METHODS We used three different study populations of girls and boys aged 13-17 years in Norway: 1) individuals who were diagnosed with depressive disorders in primary health care, 2) individuals who were diagnosed with depressive disorders in secondary health care; 3) individuals who were dispensed ADs as recorded in the prescription database. Dataset 2) and 3) were linked. RESULTS Incidence of depressive disorders increased from 2010 to 2015 both in primary and secondary health care, especially in girls. One in four girls with incident depressive disorders was prescribed ADs and this proportion was stable over time. Among girls treated with ADs the proportion with a diagnosis where AD treatment is indicated increased from 61.1% to 66.0%. Furthermore, the proportion with moderate or severe episodes of major depressive disorders was stable and high, 72.9% in 2014. CONCLUSION The only issue studied that could explain increasing AD use in girls was increasing incidence of depressive disorders. Most adolescents with incident diagnosis of depressive disorders were not treated with ADs.
Collapse
Affiliation(s)
- S Skurtveit
- Norwegian Institute of Public Health, Oslo.,Norwegian Centre for Addiction Research, University of Oslo, Oslo
| | - J G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar
| | - V Hjellvik
- Norwegian Institute of Public Health, Oslo
| | - I Hartz
- Norwegian Institute of Public Health, Oslo.,Section for Research and Development, Innlandet Hospital Trust, Brumunddal
| | - R Nesvåg
- The Norwegian Medical Association, Oslo, Norway
| | - L J Hauge
- Norwegian Institute of Public Health, Oslo
| | - M Handal
- Norwegian Institute of Public Health, Oslo
| |
Collapse
|
9
|
Salvatore S, Bramness JG, Reid MJ, Thomas KV, Harman C, Røislien J. Wastewater-Based Epidemiology of Stimulant Drugs: Functional Data Analysis Compared to Traditional Statistical Methods. PLoS One 2015; 10:e0138669. [PMID: 26394227 PMCID: PMC4578919 DOI: 10.1371/journal.pone.0138669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Wastewater-based epidemiology (WBE) is a new methodology for estimating the drug load in a population. Simple summary statistics and specification tests have typically been used to analyze WBE data, comparing differences between weekday and weekend loads. Such standard statistical methods may, however, overlook important nuanced information in the data. In this study, we apply functional data analysis (FDA) to WBE data and compare the results to those obtained from more traditional summary measures. Methods We analysed temporal WBE data from 42 European cities, using sewage samples collected daily for one week in March 2013. For each city, the main temporal features of two selected drugs were extracted using functional principal component (FPC) analysis, along with simpler measures such as the area under the curve (AUC). The individual cities’ scores on each of the temporal FPCs were then used as outcome variables in multiple linear regression analysis with various city and country characteristics as predictors. The results were compared to those of functional analysis of variance (FANOVA). Results The three first FPCs explained more than 99% of the temporal variation. The first component (FPC1) represented the level of the drug load, while the second and third temporal components represented the level and the timing of a weekend peak. AUC was highly correlated with FPC1, but other temporal characteristic were not captured by the simple summary measures. FANOVA was less flexible than the FPCA-based regression, and even showed concordance results. Geographical location was the main predictor for the general level of the drug load. Conclusion FDA of WBE data extracts more detailed information about drug load patterns during the week which are not identified by more traditional statistical methods. Results also suggest that regression based on FPC results is a valuable addition to FANOVA for estimating associations between temporal patterns and covariate information.
Collapse
Affiliation(s)
- Stefania Salvatore
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- * E-mail:
| | | | | | | | | | - Jo Røislien
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, Oslo, Norway
| |
Collapse
|
10
|
Tveito M, Lorentzen B, Engedal K, Tanum L, Bramness JG, Refsum H, Høiseth G. Changes in cognitive function during psychogeriatric treatment in relation to benzodiazepine cessation. Pharmacopsychiatry 2014; 47:145-50. [PMID: 24936805 DOI: 10.1055/s-0034-1381982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study was to investigate cognitive functions after admission to a geriatric psychiatric hospital, and to study the short-term effects of cessation of benzodiazepine use on cognitive functions. METHODS Details of benzodiazepine use and serum concentration measurements were recorded on admission. The Hopkins verbal learning test, the Stroop test, Digit Vigilance Test and the Mini Mental Status Examination were performed on admission, and after 4 weeks of hospitalization. Test results were compared for the total group of patients, as well as for benzodiazepine "continuers" and the "quitters". RESULTS For all patients (n=224), improved performances were observed in 10 out of 12 cognitive tests. Significant improvements were seen in 4 out of 12 tests. Benzodiazepine "quitters" improved significantly more than the "continuers" (p=0.027) only on the Hopkins verbal learning test, delayed recall performance. DISCUSSION Among elderly psychiatric patients, cognitive function improved slightly during the 4 weeks of hospital treatment, but only for one of the memory tests, the improvement was related to the cessation of benzodiazepine treatment.
Collapse
Affiliation(s)
- M Tveito
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - B Lorentzen
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - K Engedal
- Norwegian Centre for Aging and Health, Vestfold Hospital Trust, Norway
| | - L Tanum
- Norwegian Centre for Addiction Research, University of Oslo, Norway
| | - J G Bramness
- Norwegian Centre for Addiction Research, University of Oslo, Norway
| | - H Refsum
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - G Høiseth
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
11
|
Skurtveit S, Strøm H, Skrivarhaug T, Mørland J, Bramness JG, Engeland A. Road traffic accident risk in patients with diabetes mellitus receiving blood glucose-lowering drugs. Prospective follow-up study. Diabet Med 2009; 26:404-8. [PMID: 19388971 DOI: 10.1111/j.1464-5491.2009.02699.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To investigate, at a national level, whether patients using insulin or oral glucose-lowering agents had an increased risk of road traffic accidents compared with non-users. METHODS All Norwegians aged 18-69 years (3.1 million) were followed from April 2004 until September 2006. Information on drug prescriptions, road traffic accidents and emigration/death was obtained from the following population-based registries: the Prescription Database, the Road Accident Registry and the Central Population Registry. The exposure period was the time from the first prescription of insulin or oral glucose-lowering agent during the study period. The incidence of accidents in the exposed person-time was compared with the incidence of accidents in the unexposed person-time by standardized incidence ratio (SIR). RESULTS During the study period, 20 494 road traffic accidents with personal injuries were registered in Norway. One hundred and eighty-three accidents were registered for insulin users not taking oral glucose-lowering agents and 219 for users of oral blood glucose-lowering drugs without insulin. The SIR (95% confidence interval) for all ages and both genders combined were: insulin 1.4 (1.2-1.6), oral glucose-lowering agents 1.2 (1.0-1.3) and users of drugs for peptic ulcer and gastro-oesophageal reflux disease (negative comparators) 1.3 (1.2-1.4). The highest SIRs were found among the youngest insulin users (18-34 years old). CONCLUSIONS A slightly increased risk of being involved in a road traffic accident was observed for drivers prescribed insulin, while no increased risk was observed for drivers prescribed oral glucose-lowering agents. The increased risk observed for insulin users was similar to that observed for users of drugs for peptic ulcer and gastro-oesophageal reflux disease.
Collapse
Affiliation(s)
- S Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | | | | |
Collapse
|
12
|
Bramness JG, Arnestad M, Karinen R, Hilberg T. Fatal overdose of zopiclone in an elderly woman with bronchogenic carcinoma. J Forensic Sci 2001; 46:1247-9. [PMID: 11569575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The death of a 72-year-old woman with respiratory debilitation due to bronchogenic carcinoma is described. She overdosed herself with probably 200 to 350 mg of zopiclone. Zopiclone, quantitated by HPLC in femoral postmortem blood, was found to be 1.9 mg/L (4.8 micromol/L). This level is higher than many other zopiclone fatalities reported. We report a case where only zopiclone was detected.
Collapse
Affiliation(s)
- J G Bramness
- National Institute of Forensic Toxicology, Oslo, Norway
| | | | | | | |
Collapse
|
13
|
Bramness JG. [Lou Andreas-Salome (1861-1937)--psychoanalytical and feministic contribution to understanding her biography]. Tidsskr Nor Laegeforen 2001; 121:2032-6. [PMID: 11875901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Lou (Louise) Andreas-Salomé's life and work has preoccupied many biographers. The interest may have be sparked by her liaisons with many of the greatest men of her time. She had an intimate relationship with Friedrich Nietzsche in a period of great change for him. She was Rainer Marie Rilke's mistress for several years. And she pursued a close friendship and working relationship with Sigmund Freud in the latter part of her life. But her significance goes beyond these associations. She was a celebrated novelist and essayist in her own right, with ten novels and more than 50 essays, also on psychoanalytical subjects. She has been viewed as femme fatale, opportunist, feminist, radical, liberal, but also as a significant contributor to psychoanalytical thought. There have been two biographical approaches: a psychoanalytical approach focusing on her loss of father-figures and later difficult relationships with famous men, and a feministic approach accusing psychoanalysts of not contributing to insight, but belittling Salomé's legitimate position. A fuller understanding may be obtained by integrating these two views.
Collapse
Affiliation(s)
- J G Bramness
- Statens Rettstoksikologiske Institutt Postboks 495 Sentrum 0105 Oslo
| |
Collapse
|
14
|
Bramness JG, Skurtveit S, Grung M, Mørland J. [Centrally acting muscle relaxants and traffic hazards]. Tidsskr Nor Laegeforen 2000; 120:1966-9. [PMID: 11008526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND An increasing number of the centrally acting muscle relaxants were withdrawn from the Norwegian market during the 1988-98 period. The only drug in this group now marketed in Norway is carisoprodol. The National Institute of Forensic Toxicology in Norway analyses all blood samples from suspected drugged drivers. In later years there has been a marked increase in the number of blood samples testing positive for carisoprodol or meprobamate (the major metabolite). MATERIAL AND METHODS 480 cases testing positive for central muscle relaxants in the years 1984-1998 were further studied. RESULTS Compared with blood samples positive primarily for benzodiazepines, there were more women in the group (39% vs. 15%), and fewer drugs and less alcohol were detected. INTERPRETATION The positive samples may indicate misuse or abuse due to the fact that high drug concentrations and concomitant use of benzodiazepines were frequent. This knowledge should have implications for doctors prescribing centrally acting muscle relaxants.
Collapse
|
15
|
Bramness JG, Skurtveit S, Mørland J. [Detection of zopiclone in many drivers--a sign of misuse or abuse]. Tidsskr Nor Laegeforen 1999; 119:2820-1. [PMID: 10494203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
In 1998 zopiclone had a 42% share of the prescribed hypnotic drug market in Norway. The National Institute of Forensic Toxicology analyses all blood samples from suspected drugged drivers. The rise in zopiclone prescription was partly reflected in an increase in the number of drivers with zopiclone detected in the blood. We looked closer at the test results from 101 drivers with zopiclone detected in their blood in the January 1994 to April 1999 period. 60% had blood concentrations of zopiclone above the concentration observed after intake of therapeutic doses; 80% had higher blood concentrations than those expected 8 hours after intake of therapeutic doses. The majority of the drivers also tested positive for illegal drugs, prescription drugs with abuse potential, or alcohol. This indicates that zopiclone is misused or abused. Therefore the same caution should be applied when prescribing zopiclone as is applied when prescribing e.g. benzodiazepines.
Collapse
|
16
|
Bramness JG. [The bell tolls for Ernest Hemingway. Somatic, psychiatric and psychoanalytical aspects of his life and work]. Tidsskr Nor Laegeforen 1999; 119:2477-81. [PMID: 10425900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
This year, the centennial of Ernest Miller Hemingway's (1899-1961) birth is being celebrated. He committed suicide on July 2 1961, thus ending a crowded and turbulent life. He published seven novels and a number of short stories during his lifetime; four novels were published after his death. Millions of copies of his works have been sold and he is still one of the world most read authors. His simple, matter-of-fact and compressed style has had great influence on other authors. There has been enormous interest in the life and works of Hemingway. This paper addresses this interest and various aspects of Hemingway's life and tries to offer some explanations by looking at Hemingway's medical history, using some psychoanalytical approaches to his life and work.
Collapse
Affiliation(s)
- J G Bramness
- Psykiatrisk poliklinikk Vinderen distriktspsykiatriske senter, Oslo
| |
Collapse
|
17
|
Bramness JG, Olsen H. [Adverse effects of zopiclone]. Tidsskr Nor Laegeforen 1998; 118:2029-32. [PMID: 9656789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In 1994 zopiclone (Imovane), a cyclopyrrolon, was introduced in Norway as a new kind of hypnotic. In 1996 zopiclone had a 26% share of the hypnotic market. This review of relevant literature has revealed a lack of documentation on the adverse effects of zopiclone. The similarities between zopiclone and benzodiazepine hypnotics are more striking than the differences. The bulk of comparative research has been carried out with triazolam, a drug taken off the Norwegian market in 1991. With zopiclone there is less inhibition of psychomotor function the day after intake than with flunitrazepam. Zopiclone causes less subjective "hangover" than nitrazepam, but there is a similar inhibition of psychomotor function the day after intake, and in some cases greater addictive potential.
Collapse
|
18
|
Bramness JG. [Save us from idiocy]. Tidsskr Nor Laegeforen 1996; 116:2083. [PMID: 8779151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
19
|
Bramness JG. [Interruptions of physicians' work at hospitals]. Tidsskr Nor Laegeforen 1996; 116:1719. [PMID: 8658445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
20
|
Bramness JG. [Admission criteria for medical studies]. Tidsskr Nor Laegeforen 1992; 112:2390. [PMID: 1412249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
21
|
Bramness JG, Vaglum P. [Socialization of physician's role during the clinical part of medical education. 2: Students' identification with physician's role]. Tidsskr Nor Laegeforen 1992; 112:2211-3. [PMID: 1523660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Young doctors find it difficult to cope with the doctor's role. Socialization to the doctors role starts at medical school. In this survey 225 students at the University of Oslo were asked to assess the extent of their identification with the role of doctor when working in the emergency ward and in ordinary hospital wards. The process of identification progressed while the students worked in the emergency ward, but not when they worked in the ordinary wards. To promote adherence to the doctor's role it is necessary to define the roles, responsibilities and duties of the students in ordinary wards, and there should be a progression in what is expected of the students from an early stage to a later stage of the clinical curriculum. The role of the students must become well-defined in the ordinary hospital wards.
Collapse
|
22
|
Bramness JG, Fixdal TC, Vaglum P. [Socialization of physician's role during the clinical part of medical education. 1: Students' assessment of own skills]. Tidsskr Nor Laegeforen 1992; 112:2207-10. [PMID: 1523659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The learning of clinical skills may be the most important factor in the socialization of medical students to the doctor's role. In this survey 225 students from early and late stages of the clinical curriculum at the University of Oslo were asked to assess their clinical skills. The results show that many students lack sufficient practice, and there is little development of clinical skills from early to late stages of the clinical curriculum. This can promote an uncertainty amongst the students about the doctor's role. These results should lead to changes in the clinical teaching. Each department should set clearer objectives for what the students should be taught, and should verify that this takes place. Training in communication skills should be emphasized. Students should be given greater responsibility for clinical work throughout the clinical phase of their training.
Collapse
|
23
|
Abstract
Earlier research has shown that medical students in the United Kingdom and the United States report a higher level of nervous symptoms than the general population. To better understand how medical students in Norway compare with these findings, 299 male and female students in the clinical curriculum at the University of Oslo were asked to complete a questionnaire about themselves and their mental health. Medical students in Norway do not differ from the general population in mental health. However, the students report a lower level of general self-esteem than the general population. The male students had more nervous symptoms and a less general self-esteem than the female students compared with the general population. This research also shows that medical school stress is a good predictor of nervous symptoms even when psychosocial variables such as marital or cohabitation status, confident other and general self-esteem are taken into consideration.
Collapse
Affiliation(s)
- J G Bramness
- Department of Behavioural Sciences in Medicine, University of Oslo, Norway
| | | | | |
Collapse
|