Association between quetiapine use and self-harm outcomes among people with recorded personality disorder in UK primary care: A self-controlled case series analysis. (November 2022)

• Record Type: Journal Article
• Authors: Hayes, Joseph F; Hardoon, Sarah; Deighton, Jessica; Viding, Essi; Osborn, David PJ
• Is Part Of: Journal of psychopharmacology. Volume 36:Number 11(2022)
• Page Start: 1218
• Page End: 1225
• Publication Date: 2022-11
• Subjects: Personality disorder -- quetiapine -- self-harm; Psychopharmacology -- Periodicals; 615.78
• DOI: 10.1177/02698811221131990
• Languages: English
• ISSNs: 0269-8811

Abstract

Background: Quetiapine is frequently prescribed to people with personality disorder diagnoses, but this is not supported by evidence or treatment guidelines. Aims: To examine associations between periods of quetiapine prescribing and self-harm events in people with personality disorder. Method: Self-controlled case series using linked primary care and hospital records covering the period 2007–2017. We calculated incidence rates and incidence rate ratios (IRRs) for self-harm events during periods when people were prescribed (exposed to) quetiapine, as well as periods when they were unexposed or pre-exposed to quetiapine. Results: We analysed data from 1, 082 individuals with established personality disorder diagnoses, all of whom had at least one period of quetiapine prescribing and at least one self-harm episode. Their baseline rate of self-harm (greater than 12 months before quetiapine treatment) was 0.52 episodes per year. Self-harm rates were elevated compared to the baseline rate in the month after quetiapine treatment was commenced (IRR 1.85; 95% confidence interval (CI) 1.46–2.34) and remained raised throughout the year after quetiapine treatment was started. However, self-harm rates were highest in the month prior to quetiapine initiation (IRR 3.59; 95% CI 2.83–4.55) and were elevated from 4 months before quetiapine initiation, compared to baseline. Conclusion: Self-harm rates were elevated throughout the first year of quetiapine prescribing, compared to the baseline rate. However, rates of self-harm reduced in the month after patients commenced quetiapine, compared to the month before quetiapine was initiated. Self-harm rates gradually dropped over a year of quetiapine treatment. Quetiapine may acutely reduce self-harm. Longer-term use and any potential benefits need to be balanced with the risk of adverse events.