Heikki Vartiainen

Citalopram, a selective serotonin reuptake inhibitor, in the treatment of aggression in schizophrenia

The aim of this double‐blind cross‐over study was to investigate whether treatment with the selective serotonin reuptake inhibitor, citalopram reduces aggressiveness in chronically violent schizophrenic inpatients. Initially 19 patients were enrolled into this double‐blind cross‐over study in which the patients were treated for 24 weeks with placebo and 24 weeks with citalopram (20–60 mg/day) as a supplement to their previous neuroleptic medication. Fourteen patients completed the entire study, but sufficient data on 15 patients could be used in the end–point analysis of efficacy. Psychiatric assessments (Brief Psychiatric Rating Scale, Clinical Global Impression Scale for Severity of Illness, Social Dysfunction and Aggression Scale and the Global Aggression Scale) and side effects (UKU Side Effect Scale) were recorded at baseline and 4 times during both periods. Aggressive incidents (Staff Observation Aggression Scale) were recorded throughout the study. During citalopram treatment, the frequency of aggressive incidents was significantly lower and the mental state did not deteriorate. Patients either experienced no side effects or else side effects were equally mild during both periods.

Risk of homicidal behavior among discharged forensic psychiatric patients

We studied the risk of homicidal behavior among 281 released male forensic psychiatric patients during the 14-year period 1978-1991. Released patients were about 300 times more likely to commit a homicide than the general male population during the first year outside hospital, and the corresponding risk was 53-fold during a mean follow-up period of 7.8 years. The odds ratio for committing a homicide among all Finnish schizophrenics during the 12-year period 1980-1991 was 9.7, which indicates that previous criminality associated with schizophrenia also increases the risk of homicidal behavior remarkably when compared with schizophrenia per se. We believe that this kind of epidemiological approach is a useful method of identifying and classifying factors associated with very high risk of homicidal behavior and preventing homicidal behavior among high-risk populations.

A 12-week double-blind multi-centre study of paroxetine and imipramine in hospitalized depressed patients

Fifty‐seven inpatients with major depression (DSM‐III‐R) entered a 12‐week study comparing paroxetine and imipramine. Trends (not reaching statistical significance) in favour of paroxetine were seen on the Hamilton Depression Rating Scale (HDRS) and the Montgomery‐Åsberg Depression Rating Scale (MADRS). The UKU Side Effect Rating Scale showed a significant difference in favour of paroxetine on reduced salivation. Global evaluation of side effect symptoms showed that significantly more paroxetine patients had no side effects, both in the investigators’ and the patients’ opinion. These results are in line with previous findings of paroxetine being an effective and well tolerated antidepressant.

The patients' opinions about curative factors in involuntary treatment.

The patients opinions about their treatment are seldom solicited in psychiatry. We studied the opinions of 225 patients about curative factors in their treatment in a maximum security hospital: 90% answered the questions, which evaluated 38 forms of treatment. The patients received help from free walking in the hospital area in 98% of the patients, holidays in 93%, a personal psychiatric nurse in 91%, trips in 91% communication in 88%, personnels support in 87% and a psychiatrist in 86%. Medication was considered helpful in 77% and even restriction or isolation in 36% of the patients. If the patient experienced help from the psychiatrist, the cross‐tabulation revealed that she or he also received help from many other treatment forms, even from the isolation. Help from the personal psychiatric nurse and medication depended on many other treatment forms. The most helpful treatment factors experienced were liberties and interactive treatment forms.

Double-blind study of mirtazapine and placebo in hospitalized patients with major depression

The purpose of the present 6-week multicenter dose finding study was to compare the efficacy and tolerability of mirtazapine (preferentially presynaptic alpha 2-adrenergic receptor blocker) to placebo in hospitalized patients with major depression. The clinical efficacy was evaluated with the Hamilton Depression Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Beck Self-Rating Depression Scale, Global Assessment Scale (GAS), and Brief Psychiatric Rating Scale (BPRS). The side effects were recorded on a checklist of emergent symptoms (ROSE) and physical examinations, ECG, clinical chemistry, and hematology tests were carried out. The dosages of mirtazapine were gradually raised from 15 mg to 50 mg. One hundred and fourteen patients were included. Twenty-two patients (37%) in mirtazapine group and 24 (44%) in the placebo group were prematurely withdrawn from the study mainly due to inadequate efficacy. The decrease in HAM-D and MADRS was generally more pronounced in the mirtazapine group than in the placebo group. Minor side effects were reported in less than 15% of the patients in both groups. Only fatigue and faintness were slightly more pronounced in the mirtazapine group than in the placebo group. No significant changes were found in laboratory parameters. Because of methodological flaws like combining a dose finding study with a placebo controlled study, further conclusions should not be made on the efficacy of mirtazapine when treating depressive patients.

Clinical multicentre study of citalopram compared double-blindly with mianserin in depressed patients in Finland

Ahlfors UG, Elovaara S, Harma P, Suoniemi I, Heikkila L, Nummi K, Vartiainen A, Var-tiainen H, Tarnminen T, Elgen K, Sundman K. Clinical multicentre study of citalopram compared double-blindly with mianserin in depressed patients in Finland.The aim of the trial was to study the antidepressant effect and side effects of citalopram and mianserin in a double-blind, multicentre study in six psychiatric hospitals in Finland. Patients of both sexes, aged 18 to 70 years, were included. The depression was classified as endogenous or non-endogenous by means of the Newcastle Depression Scale (1). Thirty-seven patients were allocated to treatment with citalopram and 34 to treatment with mianserin. Six patients (5+1) did not fulfil the inclusion criteria and nine patients (4+5) dropped out of the study. Citalopram. 40-60 mg daily, and mianserin, 60-90 mg daily, were given once a day in the evening for 4 weeks. The patients were assessed before treatment and after 1, 2, and 4 weeks. The Clinical Global Impression Scal...

A long-term study of remoxipride in chronic schizophrenic patients

The purpose of this study was to assess the tolerability and efficacy of 150–600 mg remoxipride (predominantly a DA2 receptor antagonist) in an open long‐term (1 year) multicentre trial in chronic schizophrenic patients. The mean duration of illness before entering the study was 21 years and the pre‐study neuroleptic dosage in chlorpromazine equivalents was 930 mg/day. The clinical efficacy was measured with the Brief Psychiatric Rating Scale and the Clinical Global Impression scale. The adverse events were recorded by a 26‐item Adverse Symptom Checklist and by the Abnormal Involuntary Movements Scale. Forty‐five patients were included in the study. The mean daily dose of remoxipride during the last week of treatment was 378 mg. Eighty percent (36 patients) withdrew prematurely (< 1 year). The main reasons for withdrawal were: ineffectiveness (n= 15), treatment refusal (n= 12) and adverse events (n= 8). The most frequently reported adverse events were insomnia (n= 20) and tiredness (n= 7), whereas only a few (n= 6) extrapyramidal symptoms were reported. There was no relationship between remoxipride plasma concentrations and clinical efficacy nor was any relationship found between the ratio of pretrial chlorpromazine equivalent to last remoxipride dose and the therapeutic effect. Remoxipride alone seemed to have an insufficient neuroleptic efficacy in these chronic and treatment‐resistant schizophrenic patients but was well tolerated.

Psychopathic traits in a representative sample of Finnish male prisoners

Abstract Background: The psychopathic traits measured with the Hare Psychopathy Checklist-Revised (PCL-R) in a representative national prisoner sample have not been studied in Finland before. It has been unclear whether there could occur some national differences or whether the PCL-R can be used for assessing psychopathic traits in the Finnish forensic settings. Aims: Our aim was to study the distribution of psychopathic traits in the Finnish male prisoners as well as the correlations of these traits with DSM-IV disorders and to compare the sample with similar samples of Europe and America. Methods: 171 male prisoners representing all Finnish sentenced male offenders (about 3300) were studied using the PCL-R, SCID-I and SCID-II. Results: The results of the first Finnish study utilizing the PCL-R in a representative national sample of male prisoners were quite similar to the findings of the previous studies of male prisoners carried out in North America, the UK and Sweden. The scores of the interpersonal facet are lower in this sample than in the sample of North America. In total, 16.4% of the Finnish male prisoners can be diagnosed as having a psychopathic disorder. Conclusions: The PCL-R is a reliable and valid measure of the psychopathy construct of the Finnish male prisoners. The PCL-R is applicable to the Finnish offenders and it is a useful tool for assessing psychopathy in the Finnish criminal justice settings.

Paroxetine and imipramine: A 12-week, double-blind, multicentre study in hospitalized depressed patients

A multicentre, double-blind comparison of paroxetine and imipramine was carried out in five centres over 12 weeks. Patients received paroxetine (30 mg) or imipramine (150 mg) daily. Efficacy was assessed using HAMD, MADRS, and a global assessment. The Beck self-rating scale was optional. Tolerability was assessed using the UKU side-effects checklist and a global evaluation by both investigators and patients. Fifty-seven patients with DSM-III depression (25 on paroxetine and 32 on imipramine) entered the study. Both treatments showed a fast onset of action, and from week 3 there was a trend with respect to further improvement in favour of paroxetine according to the HAMD scale. Similar results were obtained with the MADRS but the trend in favour of paroxetine occurred at week 2. Eighty-six per cent of patients on paroxetine were judged complete responders compared with 72% on imipramine. Side-effects symptoms increased in severity in patients on imipramine, including the anticholinergic symptoms of reduced...

How changes in mental health law adversely affect offenders discharged from a security hospital

Abstract Serious violent crime relapses (murder, homicide, aggravated assault) of 305 discharged offender patients between 1978 and 1990 were studied. The relapse rate in Finland was found to have dramatically increased. The abolition of monitored conditional release may be the reason for the increase. The typical features of 16 violent patients were determined and analysed.