| アブストラクト | OBJECTIVE: To estimate the risk of self-harm in people with epilepsy and identify factors which influence this risk. METHODS: We identified people with incident epilepsy in the Clinical Practice Research Datalink, linked to hospitalization and mortality data, in England (01/01/1998-03/31/2014). In Phase 1, we estimated risk of self-harm among people with epilepsy, versus those without, in a matched cohort study using a stratified Cox proportional hazards model. In Phase 2, we delineated a nested case-control study from the incident epilepsy cohort. People who had self-harmed (cases) were matched with up to 20 controls. From conditional logistic regression models, we estimated relative risk of self-harm associated with mental and physical illness comorbidity, contact with healthcare services and antiepileptic drug (AED) use. RESULTS: Phase 1 included 11,690 people with epilepsy and 215,569 individuals without. We observed an adjusted hazard ratio of 5.31 (95% CI 4.08-6.89) for self-harm in the first year following epilepsy diagnosis and 3.31 (95% CI 2.85-3.84) in subsequent years. In Phase 2, there were 273 cases and 3790 controls. Elevated self-harm risk was associated with mental illness (OR 4.08, 95% CI 3.06-5.42), multiple general practitioner consultations, treatment with two AEDs versus monotherapy (OR 1.84, 95% CI 1.33-2.55) and AED treatment augmentation (OR 2.12, 95% CI 1.38-3.26). CONCLUSION: People with epilepsy have elevated self-harm risk, especially in the first year following diagnosis. Clinicians should adequately monitor these individuals and be especially vigilant to self-harm risk in people with epilepsy and comorbid mental illness, frequent healthcare service contact, those taking multiple AEDs and during treatment augmentation. |
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| ジャーナル名 | Journal of neurology |
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| 投稿日 | 2018/10/26 |
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| 投稿者 | Gorton, Hayley C; Webb, Roger T; Pickrell, W Owen; Carr, Matthew J; Ashcroft, Darren M |
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| 組織名 | Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and;Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health,;University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),;1.134 Stopford Building, Oxford Road, Manchester, M13 3PT, UK.;hayley.gorton@manchester.ac.uk.;NIHR Greater Manchester Patient Safety Translational Research Centre, University;of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester,;UK. hayley.gorton@manchester.ac.uk.;UK.;Centre for Mental Health and Safety, Division of Psychology and Mental Health,;School of Health Sciences, Faculty of Biology, Medicine and Health, University of;Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.;Neurology and Molecular Neuroscience Research Group, Swansea University Medical;School, Swansea University, Swansea, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30357466/ |
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