title: Beta-Blockers for Exams Identify Students at High Risk of Psychiatric Morbidity.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark .
authors: Jawad H
authors: JH
authors: Butt
authors: 2 National Centre for Register-based Research, Aarhus University , Aarhus, Denmark .|3 The Lundbeck Foundation Initiative for Integrative Psychiatric Research , iPSYCH, Aarhus, Denmark .
authors: Søren
authors: S
authors: Dalsgaard
authors: 4 Department of Health Science and Technology, Aalborg University , Aalborg, Denmark .
authors: Christian
authors: C
authors: Torp-Pedersen
authors: 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark .
authors: Lars
authors: L
authors: Køber
authors: 5 Department of Cardiology, Herlev and Gentofte University Hospital , Hellerup, Denmark .|6 The Danish Heart Foundation , Copenhagen, Denmark .|7 The National Institute of Public Health, University of Southern Denmark , Odense, Denmark .
authors: Gunnar H
authors: GH
authors: Gislason
authors: 8 Department of Neurology, Herlev and Gentofte University Hospital , Herlev Denmark .
authors: Christina
authors: C
authors: Kruuse
authors: 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark .|6 The Danish Heart Foundation , Copenhagen, Denmark .
authors: Emil L
authors: EL
authors: Fosbøl
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D001007:Anxiety / Q000517:prevention & control* / Q000523:psychology; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D012042:Registries; D012307:Risk Factors; D013334:Students; D013406:Suicide, Attempted; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: antidepressants; antipsychotics; anxiety; beta-blockers; epidemiology; students