[New national guidelines for the treatment of schizophrenia in Sweden]. / Nya nationella riktlinjer för vård och stöd vid schizofreni - Lyfter fram ¼återhämtningsperspektivet«: Rehabilitering i kombination med läkemedel kan ge bättre livskvalitet.

Schizophrenia affects about 0.7 % of the population and is characterized by hallucinations, delusions and reduced functioning affecting the ability to study, work and socialize. Life expectancy for patients with schizophrenia is approximately 15-20 years shorter mostly due to cardiovascular disease. Stigmatization is  common despite the fact that it is a treatable disorder with a combination of medication and psychosocial interventions. Case management, psycho-education and supported employment are proven strategies, but less than half of individuals with schizophrenia are adequately treated. The National Board of Health and Welfare is currently launching updated National Guidelines (2018). The aim is to provide an overview of evidence-based interventions enabling patients with schizophrenia to live a fairly normal life. An evaluation has revealed that previous guidelines for antipsychotic medications have been satisfactorily implemented, but not those for psychosocial interventions. These will now be emphasized as ¼central recommendations« and will be followed up with specific indicators based on data from national registers.

An association between initiation of selective serotonin reuptake inhibitors and suicide - a nationwide register-based case-crossover study.

BACKGROUND: Treatment with selective serotonin reuptake inhibitors (SSRI) is one of the most common treatments for depression. It is however not clear whether or not there is an increased short-term suicide risk during initiation with SSRI. METHODS: A register-based nationwide case-crossover study including 5,866 suicides, 1,698 women and 4,168 men, from the Death Register 2007-2010 in Sweden. SSRI initiation was defined as a dispensed prescription of SSRI within 28 days prior to the date of suicide with no previous dispensed prescription of SSRI within 4 months prior that prescription. The control period took place one year earlier. Odds ratio (OR) was estimated using conditional logistic regression. RESULT: During the 28 day period prior to suicide 48 women and 138 men were exposed to SSRI initiation (while not being exposed in the control period) and 22 women and 43 men were exposed in the control period (while not being exposed in the case period). The OR for suicide after initiation with SSRI was 2.7 (95% CI: 1.6-44) for women, and 4.3 (95% CI: 3.0-6.1) for men. The highest OR was found 8-11 days after initiation with SSRI 9.7 (95% CI: 3.0-31.7) for women and men combined. CONCLUSION: The main limitation in this study is confounding by indication, but the descriptive question is however not confounded by indication. Together with plausible biological mechanisms and previous clinical and epidemiological observations our findings, linking initiation of SSRI to increased short-term suicide risk, deserve further attention specifically in the clinical setting.