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It is not known whether regional differences in lithium prescription rates translate to differing regional outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To estimate associations between county specific lithium prescription rates and county specific recurrence odds of bipolar disorder in Sweden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Data from 14,616 patients with bipolar I disorder, bipolar II disorder, or bipolar disorder not otherwise specified were extracted from the Swedish national quality assurance register for bipolar disorders (Bipol\u00e4R). Lithium prescription frequencies were calculated for 21 counties. Logistic regression analyses were run adjusted for confounders, with any type of recurrence as primary outcome, and incident elated and depressive episodes as secondary outcomes. Subsets of patients with bipolar I, II and not otherwise specified disorder were also analysed separately.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Lithium prescription rates for populations with all bipolar subtypes ranged across counties from 37.7 to 84.9% (mean 52.4%). Higher regional prescription rates were significantly associated with lower rate of any type of recurrence. The association was stronger when bipolar I disorder was analysed separately.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The advantages for lithium use long acknowledged for bipolar I disorder are also seen for the rest of the bipolar spectrum. Results suggest that population level outcomes of bipolar disorder could be improved by increasing the number of patients using lithium.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s40345-021-00223-7","type":"journal-article","created":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T04:03:23Z","timestamp":1622520203000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Regional lithium prescription rates and recurrence in bipolar disorder"],"prefix":"10.1186","volume":"9","author":[{"given":"Martin","family":"Sk\u00f6ld","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindre","family":"Rolstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Joas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Kardell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"P\u00e5lsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy M.","family":"Goodwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4496-6451","authenticated-orcid":false,"given":"Mikael","family":"Land\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,1]]},"reference":[{"key":"223_CR1","unstructured":"Adler M (ed), H\u00e4ggstr\u00f6m L, Jarbin H, Land\u00e9n M, Liberg B, Math\u00e9 A, Ryd\u00e9n E, Svanborg C. 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The current study was approved by the Regional Ethics Committee in Gothenburg, Sweden (Dnr 294\u201311). According to Swedish law, inclusion in Swedish quality registers follows an opt\u2010out procedure where patients are informed and may decline to participate, in which case data cannot be recorded. The requirement for informed consent is waived in register studies where analyses are conducted on an anonymized dataset.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: MS has nothing to disclose. SR has nothing to disclose. EJ has nothing to disclose. MK has nothing to disclose. EP has nothing to disclose. GG reports personal fees from Servier, personal fees from Lundbeck, personal fees from Medscape, personal fees from P1Vital, personal fees from Compass pathways, personal fees from Johnson&Johnson\/Janssen, personal fees from Sage Therapeutics, personal fees from Novartis, outside the submitted work. ML reports grants from The Swedish Foundation for Strategic Research, grants from The Swedish Medical Research council, grants from The Swedish Federal Government under the LUA\/ALF agreement, during the conduct of the study; personal fees from Lundbeck pharmaceuticals, outside the submitted work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"18"}}