Beta-Blocker Use and Decreased Incidence of Violence

overview: Beta-blockers, a class of drugs commonly used to treat high blood pressure and cardiovascular disorders, appear to be able to reduce aggressive and violent behavior and reduce suicidal behavior.

sauce: PLOS

A study published Jan. 31 found that individuals using beta-adrenergic blockers (beta-blockers) experienced a reduction in violence compared to periods off the medication.^st in open access journals PLOS Medicine.

If the findings are confirmed by other studies, beta blockers may be viewed as a way to manage aggression and hostility in individuals with mental illness.

Beta-blockers are used to treat symptoms of hypertension, angina and acute cardiovascular events, heart failure and arrhythmias, migraines, hyperthyroidism and glaucoma.

They are often used for anxiety and have been suggested for clinical depression and aggression, but the evidence is conflicting. increase.

Seena Fazel at the University of Oxford (UK) and colleagues at the Karolinska Institute in Sweden investigated psychiatric and behavioral outcomes. suicidal acts and deaths; and violent crime charges.

They compared 1.4 million Swedish beta-blocker users with themselves on and off the eight-year period from 2006 to 2013.

Beta-blocker treatment duration was associated with a 13% lower risk of being charged with a violent crime by the police, which was consistent across analyses. In addition, an 8% lower risk of hospitalization for mental disorders. and reported an 8% increase in association with receiving treatment for suicidal behavior.

However, these associations varied by psychiatric diagnosis, past psychiatric problems, and the severity and type of heart disease for which β-blockers were used to treat.

Previous studies have associated severe heart disease with an increased risk of depression and suicide, and these results were not associated with treatment with beta-blockers, but rather with the psychological distress and other effects associated with severe heart disease. impairment may suggest an increased risk of severe psychiatric events. In secondary analyses, the association with hospitalization was lower for major depression but lower for anxiety disorders.

Further research, including randomized controlled trials, is needed to understand the role of beta-blockers in the management of aggression and violence. If these support the findings of this study, beta blockers may be considered to manage aggression and violence in some individuals.

Fazel adds: Repurposing their use to manage aggression and violence may improve patient outcomes. “

Funding: This research was supported by the Wellcome Trust (No 202836/Z/16/Z). https://wellcome.org/grant-funding (SF), Swedish Research Council for Healthy Working Life and Welfare (2015-0028): https://forte.se/en/ (PL and HL), National Suicide Prevention Foundation (DIG-1-037-19): https://afsp.org/research-grant-information (BMD), and Karolinska Institutet Funds (2016fobi50581): https://staff.ki.se/ki-foundations-funds-list-of-grants (YM). Funders had no role in study design, data collection and analysis, publication decisions, or manuscript preparation.

About this psychopharmacology and violence research news

author: Claire Turner
sauce: PLOS
contact: Claire Turner – PLOS
image: image is public domain

Original research: open access.
“Association of β-Blockers with Psychiatric and Behavioral Outcomes: A Population-Based Cohort Study of 1.4 Million People in SwedenBy Seena Fazel et al. pros medicine

overview

Association of β-Blockers with Psychiatric and Behavioral Outcomes: A Population-Based Cohort Study of 1.4 Million People in Sweden

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Background

Beta-blockers are widely used in the treatment of heart disease and have been proposed for the treatment of anxiety and aggression, but studies are conflicting and limited by methodological problems. Drugs have been associated with other psychiatric disorders and the induction of suicidal behavior, although findings are mixed. intended to investigate.

Methods and Findings

We conducted a population-based longitudinal cohort study using Swedish national high-quality medical, mortality, and crime registries. We included 1,400,766 people aged 15 years and older who collected beta-blocker prescriptions and were followed for 8 years from 2006 to 2013. injury or attempted suicide), suicidal behavior (including death by suicide), and violent crime accusations.

Since this model essentially adjusts for all stable confounders (such as genetics and medical history), we apply a within-individual Cox proportional hazards regression to reduce the likelihood of confounding by indication. treatment duration and treatment off duration were compared.

We also adjusted for age as a time-varying covariate. Further analyzes were performed by the indicated indications, common users, cardiac severity, psychiatric and criminal history, individual beta-blockers, beta-blocker selectivity and solubility, and use of other drugs. adjusted. In the cohort, 86.8% (n = 1,215,247) are over 50 years old and 52.2% (n = 731,322) were female.

6.9% (n = 96,801) 0.7% of beta-blocker users (n = 9,960) exhibited suicidal behavior, and 0.7% (n = 9,405) were charged with violent crimes.

There was heterogeneity in the direction of the results. Intra-individual analysis showed that duration of beta-blocker treatment was associated with reduced risk of psychiatric hospitalization (hazard ratio) [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), suspected violent crime (HR: 0.87, 95% CI: 0.81–0.93, p < 0.001), increased risk of suicidal behavior (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratifying by diagnosis, the decreased association with psychiatric hospital admissions during beta-blocker treatment was primarily caused by a lower rate of hospital admissions for depression (HR: 0.92; 95% CI: 0.89 to 0.96; p < 0.001) and psychiatric disorders (HR: 0.89, 95% CI: 0.85–0.93, p < 0.001).

The association with psychiatric admissions and suicidal behavior was inconsistent, but the reduced association with violent accusations remained in most sensitivity analyses. Limitations include that within-person models do not account for confounding factors that may change during treatment unless measured and adjusted in the model.

Conclusion

This population-wide study did not find a consistent association between beta-blockers and psychiatric outcomes. However, β-blockers were associated with reduced violence and remained in sensitivity analyses. The use of beta-blockers to manage aggression and violence can be investigated further.