Vertebral fracture as a risk factor for self-harm: a retrospective cohort study.

BACKGROUND: The prevention of self-harm is an international public health priority. It is vital to identify at-risk populations, particularly as self-harm is a risk factor for suicide. This study aims to examine the risk of self-harm in people with vertebral fractures. METHODS: Retrospective cohort study. Patients with vertebral fracture were identified within the Clinical Practice Research Datalink and matched to patients without fracture by sex and age. Incident self-harm was defined by primary care record codes following vertebral fracture. Overall incidence rates (per 10,000 person-years (PY)) were reported. Cox regression analysis determined risk (hazard ratios (HR), 95 % confidence interval (CI)) of self-harm compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by median age and sex. RESULTS: The number of cases of vertebral fracture was 16,293, with a matched unexposed cohort of the same size. Patients were predominantly female (70.1 %), median age was 76.3 years. Overall incidence of self-harm in the cohort with vertebral fracture was 12.2 (10.1, 14.8) /10,000 PY. There was an initial crude association between vertebral fracture and self-harm, which remained after adjustment (HR 2.4 (95 %CI 1.5, 3.6). Greatest risk of self-harm was found in those with vertebral fractures who were aged below 76.3 years (3.2(1.8, 5.7)) and male (3.9(1.8, 8.5)). CONCLUSIONS: Primary care patients with vertebral fracture are at increased risk of self-harm compared to people without these fractures. Male patients aged below 76 years of age appear to be at greatest risk of self-harm. Clinicians need to be aware of the potential for self-harm in this patient group.

Rheumatic Conditions as Risk Factors for Self-Harm: A Retrospective Cohort Study.

OBJECTIVE: To examine the risk of self-harm in rheumatic conditions. METHODS: We conducted a retrospective cohort study using data from the Clinical Practice Research Datalink. Patients with ankylosing spondylitis, fibromyalgia, osteoarthritis, or rheumatoid arthritis were identified from 1990 to 2016 and matched to patients without these conditions. Incident self-harm was defined by medical record codes following a rheumatic diagnosis. Incidence rates (per 10,000 person-years) were reported for each condition, both overall and year-on-year (2000-2016). Cox regression analysis determined risk (hazard ratio [HR] and 95% confidence interval [95% CI]) of self-harm for each rheumatic cohort compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by age and sex. Due to nonproportionality over time, osteoarthritis was also stratified by disease duration (<1 year, ≥1 to <5 years, ≥5 to <10 years, and ≥10 years). RESULTS: The incidence of self-harm was highest in patients with fibromyalgia (HR 25.12 [95% CI 22.45-28.11] per 10,000 person-years) and lowest for osteoarthritis (HR 6.48 [95% CI 6.20-6.76]). There was a crude association with each rheumatic condition and self-harm, except for ankylosing spondylitis. Although attenuated, these associations remained after adjustment for fibromyalgia (HR 2.06 [95% CI 1.60-2.65]), rheumatoid arthritis (HR 1.59 [95% CI 1.20-2.11]), and osteoarthritis (1 to <5 years HR 1.12 [95% CI 1.01-1.24]; ≥5 to <10 years HR 1.35 [95% CI 1.18-1.54]). Age and sex were weak effect modifiers for these associations. CONCLUSION: Primary care patients with fibromyalgia, osteoarthritis, or rheumatoid arthritis (but not ankylosing spondylitis) are at increased risk of self-harm compared to people without these rheumatic conditions. Clinicians need to be aware of the potential for self-harm in patients with rheumatic conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.

Effect of disease severity and dopaminergic medication on recollection and familiarity in patients with idiopathic nondementing Parkinson's.

The effect of disease severity and dopaminergic medication on the assessment of familiarity and the recollection of episodic details during recognition in nondementing idiopathic Parkinson's is uncertain. Some studies have reported familiarity as deficient in mild Parkinson's yet others have found it intact even in moderate Parkinson's. Recollection has been found to be both preserved and deficient in mild and moderate Parkinson's. The extent to which these conflicting findings are explained by disease severity or dopaminergic medication or a combination of the two is uncertain, as all studies assessed patients in a medicated state, and disease severity has not always been consistently reported. Twelve patients with mild Parkinson's and 11 with moderate Parkinson's (medicated Hoehn and Yahr mean: 2.1 and 3.2, respectively), completed matched versions of a yes/no recognition memory test in a medicated and unmedicated condition (termed ON and OFF, respectively). Twenty-one matched healthy volunteers also completed both memory tasks in 2 separate sessions (termed Blue and Green, respectively). In the ON/Green condition, the moderate Parkinson's recollection performance was significantly poorer than the healthy volunteers and mild Parkinson's. By contrast, recognition memory and familiarity measures in both Parkinson's group were relatively spared. In the OFF/Blue condition, the moderate Parkinson's recollection was impaired, but only in relation to the healthy volunteer set. There were no significant differences in recollection performance between the mild and moderate Parkinson's groups. Again, recognition memory and familiarity measures in both Parkinson's group were relatively spared. Further analyses showed the moderate patients' recollection rates to be significantly poorer ON-medication compared to OFF. These findings are discussed in relation to the staging of disease progression on medial temporal areas which separately support recollection and familiarity, and the putative effects the different classes of dopaminergic drugs may have on these areas.