Beta-Blockers for Exams Identify Students at High Risk of Psychiatric Morbidity
Beta-Blockers for Exams Identify Students at High Risk of Psychiatric Morbidity
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DOI：
10.1089/cap.2016.0079
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发表时间：
2017-04-01
影响因子：
1.9
通讯作者：
Fosbol, Emil L.
中科院分区：
文献类型：
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作者：
Butt, Jawad H.;Dalsgaard, Soren;Fosbol, Emil L.
目的：β受体阻滞剂可以缓解考试相关焦虑的自主神经症状，并且可能对考试相关焦虑和表现焦虑有益，但对相关精神病学结果的了解尚不清楚。我们假设，β受体阻滞剂治疗考试相关的焦虑识别年轻学生的风险，以后的精神事件。方法：使用丹麦全国性的行政登记处，我们研究了健康的学生，年龄在14-30岁（1996-2012年），第一次声称处方β受体阻滞剂在考试期间（5月至6月）;学生谁被规定β受体阻滞剂的医疗原因被排除在外。我们将这些学生的年龄，性别和一年中的时间与健康和不使用β受体阻滞剂的积极对照组相匹配。通过未调整相关性的累积发生率曲线和调整后风险比（HR）的多变量原因特异性考克斯比例风险分析，检查了意外使用抗抑郁药、意外使用其他精神药物和自杀企图的风险。结果：我们确定了12,147名健康学生与考试相关的β受体阻滞剂使用和12，147名匹配的健康学生，目前或以前没有使用β受体阻滞剂（中位年龄，19岁; 80.3%女性）。在所有健康学生中，0.14%的人在考试期间首次服用β-受体阻滞剂，其中19岁学生的比例最高（0.39%）。在随访期间，81%的学生只服用了β-受体阻滞剂的单一处方。随访期间，2225例（18.3%）β受体阻滞剂使用者和1400（11.5%）非β受体阻滞剂使用者被处方抗抑郁药（p < 0.0001）; 1225（10.1%）β受体阻滞剂使用者和658（5.4%）非β受体阻滞剂使用者被开了精神药物（p < 0.0001）; 16名（0.13%）β受体阻滞剂使用者和6名（0.05%）非β受体阻滞剂使用者企图自杀（p = 0.03）。考试相关β受体阻滞剂的使用与抗抑郁药使用风险增加相关（校正HR，1.68 [95%置信区间（CI），1.57-1.79]，p < 0.0001），其他精神药物使用（HR，1.93 [95% CI，1.76-2.12] p < 0.0001），自杀未遂（HR，2.67 [95% CI，1.04-6.82] p = 0.04）。在健康的学生中，使用beta-在考试期间使用阻断剂与精神疾病后果的风险增加有关，并可能识别出心理脆弱的学生，特别注意。
Objectives: Beta-blockers relieve the autonomic symptoms of exam-related anxiety and may be beneficial in exam-related and performance anxiety, but knowledge on related psychiatric outcomes is unknown. We hypothesized that beta-blocker therapy for exam-related anxiety identifies young students at risk of later psychiatric events.Methods: Using Danish nationwide administrative registries, we studied healthy students aged 14-30 years (1996-2012) with a first-time claimed prescription for a beta-blocker during the exam period (May-June); students who were prescribed a beta-blocker for medical reasons were excluded. We matched these students on age, sex, and time of year to healthy and study active controls with no use of beta-blockers. Risk of incident use of antidepressants, incident use of other psychotropic medications, and suicide attempts was examined by cumulative incidence curves for unadjusted associations and multivariable cause-specific Cox proportional hazard analyses for adjusted hazard ratios (HRs).Results: We identified 12,147 healthy students with exam-related beta-blocker use and 12,147 matched healthy students with no current or prior use of beta-blockers (median age, 19 years; 80.3% women). Among all healthy students, 0.14% had a first-time prescription for a beta-blocker during the exam period with the highest proportion among students aged 19 years (0.39%). Eighty-one percent of the students filled only that single prescription for a beta-blocker during follow-up. During follow-up, 2225 (18.3%) beta-blocker users and 1400 (11.5%) nonbeta-blocker users were prescribed an antidepressant (p < 0.0001); 1225 (10.1%) beta-blocker users and 658 (5.4%) nonbeta-blocker users were prescribed a psychotropic drug (p < 0.0001); and 16 (0.13%) beta-blocker users and 6 (0.05%) nonbeta-blocker users attempted suicide (p = 0.03). Exam-related beta-blocker use was associated with an increased risk of antidepressant use (adjusted HRs, 1.68 [95% confidence intervals (CIs), 1.57-1.79], p < 0.0001), other psychotropic medication use (HR, 1.93 [95% CI, 1.76-2.12] p < 0.0001), and suicide attempts (HR, 2.67 [95% CI, 1.04-6.82] p = 0.04).Conclusion: In healthy students, use of beta-blockers during the exam period was associated with an increased risk of psychiatric outcomes and might identify psychologically vulnerable students who need special attention.