Introduction
There have been rising concerns regarding the risk of suicide attempt upon use of attention-deficit/ hyperactivity disorder (ADHD) pharmacological treatments.

Aims
To examine the risk of suicide attempt among individuals treated with ADHD medication across five countries/region.

Methods
This multi! national self-controlled case series study examined the risk of suicide attempt among individuals treated with ADHD medication using electronic health records from population-based databases across Hong Kong, New Zealand, South Korea, Taiwan, and the United Kingdom. We included individuals who initiated ADHD medication and had a recorded suicide attempt during the study period (2001-2020). We calculated incidence rates for suicide attempt events in each predetermined exposure risk periods. Incidence rate ratios (IRR) in periods of exposure to ADHD medication compared with unexposed periods were calculated with conditional Poisson regression. The IRRs and their 95% confidence intervals (CIs) were estimated for each exposure risk periods.

Results
We identified 452, 4841, 313, 222, and 1058 patients from Hong Kong, New Zealand, South Korea, Taiwan, and ! the United Kingdom, respectively. Risk of suicide attempt was the highest during the pre-exposure period in all populations: Hong Kong, 90-days-pre-exposure (IRR 4.10, 95%CI 2.61-6.46), first-90-days-exposure (3.21, 1.95-5.28), post-90-days-exposure (1.24, 0.93-1.67); New Zealand, 90-days-pre-exposure (2.40, 2.10-2.75), first-90-days-exposure (1.54,1.28-1.85), post-90-days-exposure (1.06, 0.94-1.19); South Korea, 90-days-pre-exposure (2.67, 1.61-4.44), first-90-days-exposure (1.35, 0.70-2.62), post-90-days-exposure (2.22, 1.30-3.79); Taiwan, 90-days-pre-exposure (2.66,1.49-4.74), first-90-days-exposure (no events were observed), post-90-days-exposure (0.87,0.46-1.66); and United Kingdom, 90-days-pre-exposure (2.07, 1.41-3.03), first-90-days-exposure (1.47, 0.80-2.69), post-90-days-exposure (1.45, 1.08-1.94).

Conclusions
Although initiation of ADHD medication was associated with suicide attempt, the risk was the highest ! in the period immediately before ADHD medication initiation. Thus, the results of this multinational study do not support a causal association between ADHD medication use and suicide attempt.

Introduction
Psychotropic medications are a common therapy for depression. Whereas, these drugs are frequently off-label used, especially in adolescents. Off-label drug use is associated with indeterminate effectiveness and increased risks of side effects, so requires evidence to support its clinical implementation.

Aims
The study aims to investigate extent of evidence for off-label use of psychotropic medications in treatment of adolescence depression.

Methods
A cohort study (2020-2022) was carried out in adolescents with the diagnosis of depression in a tertiary hospital in China. Label-adherence of psychotropic medications was determined with the reference of drug labels approved by China National Medical Products Administration. The Formulary of Off-label Use of Drugs, and The Formulary of Off-label Use of Drugs for Paediatrics were applied to examine the evidence on particular scenarios. Logistic regression models were applied to detect the association between participant characteristics and off-label use of psychotropic medications.

Results
Among 4097 adolescents using psychotropic medications, off-label use accounted for 73.6%. Common off-label use scenarios included using eszopiclone, quetiapine, aripiprazole, olanzapine, idebenone and citicoline for treating depression; and generalizing the use of fluvoxamine, trazodone, agomelatine, and escitalopram from adults to adolescents. Use of olanzapine, agomelatine and escitalopram in treatment of adolescence depression was supported with evidence, depositing bare evidence for others. Senior psychiatrists (adjusted odds ratio =1.8, 95% confidence interval =1.4-2.3) were more likely to extrapolate psychotropic drug use from adults to adolescents. But, the senior title of psychiatrists (AOR=0.7, 95% CI=0.6-0.9) was inversely associated with off-label-indication use.

Discussion
Prevalence of off-label use of psychotropic medications was high in adolescents with depression. Generally, evidence on common off-label scenarios is sparse. More high-quality studies are expected. Feasible evidence for off-label drug use should be incorporated into clinical decision support system in China. Extra cautions are required when generalizing adult use of psychotropic medications to adolescents.

Introduction: Prevalence of antidepressant use in children and adolescents is growing in the last decade. Vortioxetine is a new multimodal antidepressant approved by the FDA for the treatment of Major Depressive Disorder and recently introduced in Europe. Whether antidepressants would increase the suicidal ideation and behavior in children and adolescents remain controversial.
Aims: We aim to investigate the association between vortioxetine use in children, adolescents and young adults and risk of suicidality using spontaneous reporting system
Methods: We conducted a case/non-case study with disproportionality analysis based on the FDA Adverse Event Reporting System (FAERS). We analyzed individual case safety reports of suicide, suicidal behavior or overdose related to vortioxetine in children, adolescents and young adults compared to all other medications in FAERS (1988-2023). We first compare the characteristics of cases and non-cases. Then, we calculated reporting odds ratio (ROR) with 95% confidence intervals (CI%), in overall and by age groups and limited to major depression.
Results: A total of 85 reports describing suicidality associated with vortioxetine use in pediatric patients and young adults were identified, mostly from US and Canada and in female. We detected several strong disproportionate reporting signals for vortioxetine use in patients aged 0-24 and several suicidality events. The strongest signals were intentional overdose (ROR=7.45, 95%CI: 4.62-11.44), suicide attempt (ROR=7.34, 95%CI: 4.31-11.75) and suicidal ideation (ROR= 6.41, 95% CI: 4.21-9.40). These signals were mainly driven by those observed in young adults (18-24 years old). Only "suicidal ideation" signal was found in adolescents (12-17 years old). All the above-mentioned signals were no longer triggered if we limited to vortioxetine use for major depression.
Discussion: Better knowledge of vortioxetine-related suicidality risk is needed to increase clinicians' awareness leading to safer prescribing of vortioxetine in pediatric patients and young adults.

Introduction
Leukotriene receptor antagonists (LTRAs) and inhaled corticosteroids (ICS) are two classes of asthma medications. Although there have been concerns about the psychiatric side effects of LTRAs and ICS, their effects on self-harm, one of the most severe outcomes, remains unclear.

Aims
To evaluate the association between LTRA and ICS use and self-harm among patients with asthma.

Methods
Asthmatic patients aged>10 years, who received at least one prescription of ICS, one prescription of LTRA, and had at least one self-harm during 2005-2020, were identified from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics. A self-controlled case series (SCCS) study design was used to compare the incidence rates of self-harm during the following five risk windows to baseline (in the order of precedence if they overlapped): 90-day before first LTRA use (pre-LTRA exposure), 90-day before first ICS use (pre-ICS exposure), LTRA alone, ICS alone, combination use of LTRA and ICS. Incidence rate ratios (IRRs) were calculated using conditional Poisson regression model, adjusted for age, season, and concomitant medications.

Results
Of 313,943 individuals prescribed both LTRA and ICS during the study period, 2,900 had an incident self-harm. Compared to baseline, a lower incidence of self-harm was observed during the pre-LTRA exposure period (IRR=0.74; 95%CI=0.56-0.97) but not pre-ICS exposure period (IRR=0.99; 95%CI=0.71-1.39). No increased risk was observed during ICS alone (IRR=0.83; 95%CI=0.71-0.97), LTRA alone (IRR=0.67; 95%CI=0.56-0.81), and combination use (IRR=0.65; 95%CI=0.53-0.79). Results from sensitivity analyses to check SCCS assumptions and negative control analysis supported the robustness of results.

Discussion
The incidence of self-harm was lower before exposure to LTRA and did not increase to above baseline level during exposure to LTRA or ICS. Our results do not support an association between LTRA and ICS use and an increased risk of self-harm in patients with asthma.

Background: Psychiatric disorders are one of the common comorbidities among patients with systemic lupus erythematosus. Hydroxychloroquine is the mainstay treatment for systemic lupus erythematosus. Concern has been raised by case series regarding hydroxychloroquine could cause psychiatric side effects. To our knowledge, no large nationwide study has focused on the use of hydroxychloroquine and psychiatric disorders among patients with systemic lupus erythematosus.

Objectives: To evaluate the association of hydroxychloroquine and psychiatric disorders among patients with systemic lupus erythematosus

Methods: We included patients aged over 20 years and newly received HCQ treatment between 2010 and 2021 using Taiwan's NHIRD database. We classified patients into two treatment strategies of initiating hydroxychloroquine within three months versus non- hydroxychloroquine treatment within three months. We defined a period of three months to screen for treatment initiation and applied cloning, censoring, and weighting approach to emulate the target trial. The primary outcome of interest was psychiatric disorders. We estimated the hazard ratio, five-year absolute risks, risk differences and risk ratio with 95% confidence intervals (CIs) with pooled logistic regression.

Results: We included a total of 15,210 patients with systemic lupus erythematosus. The hazard ratio of psychiatric disorders was 2.54 (95% CI, 1.24 to 3.61). The five-year absolute risk of psychiatric disorders was 1.72% (95% CI, 0.40% to 3.51%) among hydroxychloroquine users, and 0.67% (95% CI, 0.30% to 1.18%) among non-hydroxychloroquine users, respectively. The five-year absolute risk difference and risk ratio between the two treatment strategies for psychiatric disorders were 1.13% (95% CI, 0.13% to 2.52%) and 2.55 (95% CI, 1.14 to 3.54), respectively.

Conclusion: The use of hydroxychloroquine was associated with an increased risk of psychiatric disorders among patients with systemic lupus erythematosus. Because hydroxychloroquine is the first-line treatment for systemic lupus erythematosus, vigilant monitoring of hydroxychloroquine therapy is essential.

Introduction:
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. Chinese children and adolescents exhibit unique patterns in ADHD medication treatment compared to their Western counterparts.

Aim:
To identify medication treatment patterns for ADHD in Chinese children and adolescents.

Methods:
A retrospective study was conducted on patients aged 6 to 17 diagnosed with ADHD between January 2020 and November 2023, using electronic medical records from Jiangsu Province's Population Health Record Big Data Platform. Descriptive analysis explored demographic factors and medication prescriptions. Age- and sex-adjusted logistic regression examined the relationship between comorbidity and multiple medication prescriptions.

Results:
Of 25,637 patients aged 6-17 years diagnosed with ADHD, 25,530 (99.5%) received medication treatment, with 21,213 (83.1%) being male. The most commonly used medication was methylphenidate, prescribed to 15,421 (60.4%) patients, followed by atomoxetine with 11,987 (47.0%) patients. Among the 1,817 patients treated with both atomoxetine and methylphenidate, 1,272 (70.0%) were initially treated with methylphenidate. ADHD patients with comorbidity were more likely to receive multiple medications (adjusted odds ratio [aOR], 3.26; 95% CI, 2.75-3.84).

Discussion:
Medication treatment for ADHD is highly prevalent among children and adolescents in China. However, compared to other countries, the variety of medications is limited, with methylphenidate being the predominant treatment. Patients with comorbid psychiatric disorders may experience more severe ADHD symptoms, necessitating the use of multiple medications.