Helinä Hakko

A comparison of clinical and research DSM-III-R diagnoses of schizophrenia in a Finnish national birth cohort : Clinical and research diagnoses of schizophrenia

As a prerequisite to the use of the Finnish National Hospital Discharge Register in psychiatric epidemiological research, we studied the diagnostic reliability of the register in terms of the psychiatric morbidity experienced by a national birth cohort. We investigated all entries to the register for a sample based upon the Northern Finland 1966 birth cohort at the age of 16 years (n=11017). Until the end of 1993 (age 27 years), a total of 563 subjects had a register diagnosis indicating a psychiatric illness, 37 of them being schizophrenia. When operational criteria (DSM-III-R) were applied to clinical information in the available original hospital records for cases of psychosis, personality disorder and substance abuse (n=249), 71 fulfilled criteria for schizophrenia, including all of the 37 cases in the register and an additional 34 (48% false-negatives), most frequently diagnosed in the register as schizophreniform or other psychosis. Despite the official use of DSM-III-R nomenclature, it appears that the clinical concept of schizophrenia in Finland, manifest within the register, remains very restrictive. The application of operational criteria is a necessary prerequisite for scientific research on schizophrenia.

Vitamin D supplementation during the first year of life and risk of schizophrenia: A Finnish birth-cohort study

OBJECTIVE Based on clues from epidemiology and animal experiments, low vitamin D during early life has been proposed as a risk factor for schizophrenia. The aim of this study was to explore the association between the use of vitamin D supplements during the first year of life and risk of developing schizophrenia. METHOD Subjects were drawn from the Northern Finland 1966 Birth Cohort (n=9,114). During the first year of life, data were collected about the frequency and dose of vitamin D supplementation. Our primary outcome measures were schizophrenia, psychotic disorders other than schizophrenia, and nonpsychotic disorders as diagnosed by age 31 years. Males and females were examined separately. RESULTS In males, the use of either irregular or regular vitamin D supplements was associated with a reduced risk of schizophrenia (Risk ratio (RR)=0.08, 95% CI 0.01-0.95; RR=0.12, 95% CI 0.02-0.90, respectively) compared with no supplementation. In males, the use of at least 2000 IU of vitamin D was associated with a reduced risk of schizophrenia (RR=0.23, 95% CI 0.06-0.95) compared to those on lower doses. There were no significant associations between either the frequency or dose of vitamin D supplements and (a) schizophrenia in females, nor with (b) nonpsychotic disorder or psychotic disorders other than schizophrenia in either males or females. CONCLUSION Vitamin D supplementation during the first year of life is associated with a reduced risk of schizophrenia in males. Preventing hypovitaminosis D during early life may reduce the incidence of schizophrenia.

Seasonal variation in suicide occurrence in Finland

The aim of this study was to investigate the age‐, gender‐ and suicide method‐related seasonality of suicide occurrence by using the largest database examined so far (n=21 279). The Chi‐square test for multinomials was used as the overall measure of deviation. The monthly observed and expected numbers of suicides were calculated and classified by year, month, gender, age groups and suicide methods. To identify the statistically significant peak and trough months, the ratio of observed numbers of suicides to expected numbers with 95% confidence intervals was calculated. For males, there was a suicide peak from April to July, while for females the distribution was bimodal (with peaks in May and October). In elderly people there was a significant excess in the number of suicides in autumn, and the troughs were deeper in winter. For violent suicides there was a unimodal spring peak, but for non‐violent suicides the distribution was bimodal. The results indicate that suicides among elderly subjects, as well as non‐violent suicides, occur significantly more often during autumn than would be expected.

The association of preceding traumatic brain injury with mental disorders, alcoholism and criminality: the Northern Finland 1966 Birth Cohort Study

The purpose of this study was to test the hypothesis that traumatic brain injury (TBI) during childhood and adolescence is associated with psychiatric disorders, heavy alcohol use and criminal offenses in adulthood. We made use of an unselected, general population birth cohort (n=12058) in Northern Finland, which was followed up prospectively up to the age of 31. The data on TBIs of the cohort members were collected from the hospital case notes of the outpatient clinics of the hospitals in the region and from the Finnish Hospital Discharge Registers (FHDR). The data on mental disorders including alcohol diagnoses were also collected from the FHDR after a careful validation process. The Ministry of Justice provided information on criminal offenses for all subjects. The final number of subjects in our study was 5589 males and 5345 females. We found that after controlling for confounders, TBI during childhood or adolescence increased the risk of developing mental disorders two-fold (OR 2.1, 95% CI 1.1-3.6) and TBI was significantly related to later mental disorder with coexisting criminality in male cohort members (OR 4.1, 95% CI 1.2-13.6). The results support the TBIs association with psychiatric morbidity, which should not be overlooked when treating psychiatric patients, especially those with comorbid criminality.

Seasonal variation in specific methods of suicide: a national register study of 20,234 Finnish people.

BACKGROUND Previous studies have suggested differences in seasonal variation of violent and non-violent suicides, but seasonal distribution of the specific methods of suicide is less clear. METHOD We investigated the seasonal distribution of the specific suicide methods for both genders during a 16-year period. The seasonal effect was explored by monthly ratio statistics from the large population-based data including all suicides in Finland during years 1980-1995 (n=20,234). RESULTS Hanging peaked in spring among both genders. In summer, the significant peaks were occurred in suicides by drowning, jumping and gassing among males. The bimodality in female suicides with autumn peaks was explained by poisoning and drowning. Traffic suicides showed substantial winter-troughs for both genders. CONCLUSIONS The results suggested that specific violent and nonviolent methods of suicides grouped into their traditional clusters on the basis of their seasonality, except suicides by gassing and shooting. The seasonal distribution in specific suicide methods should take into account in suicide prevention at clinical work and also it should be considered while determining which methods of suicides are regarded as violent or non-violent methods in research.

Depression in relation to survival among neurosurgical patients with a primary brain tumor: a 5-year follow-up study.

OBJECTIVE: The adverse impact of depression in relation to survival among cancer patients is currently a subject of great interest in research. In a 5-year follow-up study, we investigated the association of depression with survival of patients with a primary brain tumor. METHODS: The study population consisted of 75 patients with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery, Oulu University Hospital, in Northern Finland. The patients were interviewed during admission to the hospital for the tumor surgery. Assessment of depression was made using the Beck Depression Inventory and the Crown-Crisp Experiential Index. Information on all deaths within 60 months after tumor operation was collected from the Cause of Death Register, provided by Statistics Finland. RESULTS: The patients with a high-grade glioma had a survival time of 22.5 months (standard deviation, 21.4 mo), whereas the corresponding time was 50.2 months (standard deviation, 19.9 mo) for patients with a low-grade glioma and 58.2 months (standard deviation, 9.4 mo) for the patients with a histologically benign tumor (P < 0.001, difference between groups, Kruskal-Wallis test). In the subgroup of patients with low-grade gliomas, depressive patients had a significantly shorter survival time compared with nondepressive subjects (P = 0.031, Kaplan-Meier survival analysis). A corresponding difference was not found in patients with high-grade gliomas or benign tumors. Tumor location in one hemisphere compared with bilateral location and wider extent of tumor surgery was associated with better survival in patients with low-grade gliomas and benign tumors but not in patients with high-grade gliomas. CONCLUSION: Preoperative depression seemed to be a significant prognostic factor for worse survival in low-grade glioma patients. In clinical practice, an evaluation of depression among brain tumor patients by structured and standardized diagnostic methods is needed to distinguish the patients whose depression actually needs treatment. The effective treatment of clinical depression among brain tumor patients and the impact of treatment on the patients’ chances of survival should be a focus of future research.

Is a child's risk of early onset schizophrenia increased in the highest social class?

In a sample from the unselected, general population Northern Finland 1966 Birth Cohort, 11017 individuals alive at the age of 16 years were studied until the age of 27. The cumulative incidence of early onset schizophrenia until 23 years was higher (1.14%; 9/792) among young persons from the highest social class or class I (determined according to fathers occupation) than among children from lower social classes (0.47%; 48/10225), the difference being statistically significant (p < 0.05). The incidence of schizophrenia in the highest social class was higher than expected among girls, firstborns, children of young mothers under 30 and urban residents (p < 0.05) compared with lower social classes. When cases from the highest and other social classes were compared, there was no clear difference in background factors or clinical course. Four alcoholics, one of them also schizophrenic, were found among nine social class I fathers. The results suggest that in some families in Northern Finland, a fathers professional advancement, often linked to mental disorder, may be one determinant of an increased risk of schizophrenia in the child.

Interaction of genetic risk and adoptive parent communication deviance: longitudinal prediction of adoptee psychiatric disorders

BACKGROUND In the Finnish Adoptive Family Study of Schizophrenia, adoptee thinking disorders have been shown to be a joint effect of genetic liability for schizophrenia spectrum disorders and adoptive rearing-parent communication patterns. However, longitudinal predictions of clinical psychiatric disorders of the adoptees have not been reported. METHOD Adoptees (n = 109) who had no DSM-III-R disorder at initial assessment (median age 18 years) were selected from the total sample of the Finnish Adoption Study of Schizophrenia. They were defined as at high versus low genetic risk based upon the lifetime diagnoses of their biological, adopting-away mothers - schizophrenia spectrum disorder versus no spectrum disorder. At initial assessment, adoptive rearing parents were independently evaluated from tape-recorded Rorschach protocols scored as manifesting either high or low Communication Deviance (CD), a composite index of communication patterns that distract and befuddle listeners. Adoptees were independently re-diagnosed after a median interval of 14 years and followed-up from national registers for an additional 7 years. RESULTS The main effects of genetic liability (G) and CD of the adoptive parents (E), each taken separately, predicted significantly for psychiatric disorders of the adoptees as adults. However, when G, E, and their joint interaction effect were entered into the same logistic model, only the interaction effect was significant. The sample included seven adoptees with schizophrenia spectrum disorders, but a separate analysis to predict them was non-significant. CONCLUSION Genetic liability for schizophrenia spectrum disorder and an adoptive family rearing variable interact, predicting longitudinally and significantly to broadly defined adoptee psychiatric disorder.

Excess mortality among long-stay psychiatric patients in Northern Finland.

Abstract.Background: According to several studies, mortality in psychiatric patients is higher than in the general population, but cause-specific mortality analyses in long-stay psychiatric patients have not been studied very much. Individual follow-ups have been called for in order to identify possible treatment deficiencies and to make recommendations for clinical practices. In this study, mortality of long-stay psychiatric patients has been monitored for the years 1992–2000 and contrasted with that prevalent in the general population. Method: Data on psychiatric patients (N = 253) who were treated without a break for at least 6 months during 1992 in the Department of Psychiatry at Oulu University Hospital were linked with the National Death Register. Standardised mortality rates (SMRs) were determined according to gender, age groups, and different causes of death. Results: Of the total study population, 80.2 % had schizophrenia, 5.1 % other functional psychoses, 9.5 % organic mental disorders, 2.4 % personality disorders and 2.8 % mood disorders. Sixty-nine (27.3 %) of the patients (aged 31–88 years) had died before the end of the year 2000. The all-cause death risk for both males and females was four times that of the general population. The mortality risk was over ten-fold for males and almost 30-fold for females in the youngest age group (25–34 years), with suicides explaining about 75 % of these deaths. SMRs were found to decrease at older age, mortality thus approaching that of the general population. Diseases of the circulatory system were the most common single cause of death in both genders and mortality due to that cause exceeding mortality in the general population nearly 3.6-fold. However, the probability of death was highest (SMR 17.5) in connection with diseases of the digestive system. Increased risks of death due to respiratory complications (SMR 9.3), accidents (SMR 5.1) and neoplasms (SMR 2.1) were also noted. The overall death rates did not differ in relation to social class or professional education. Conclusions: Long-stay psychiatric patients were found to die from the same natural causes as the rest of the general population. However, the mortality risk of the long-stay psychiatric patients compared with that of the general population was notably higher, despite ongoing improvements in medical care and facilities. Inadequately organised somatic care and the prevailing culture of “non-somatic” treatment in psychiatry were suggested to, at least in part, explain this phenomenon. Attention ought to increasingly focus on somatic examinations and various health educational programmes specially designed for psychiatric patients and involving matters like healthy diet, smoking cessation and physical exercise. These practices should be a regular part of any patients treatment programme. Also, the need to recognise factors associated with a patients psychiatric disorder that could limit that patients ability to communicate somatic symptoms and/or even lead to a refusal by that patient to have somatic diseases treated was seen as essential for providers of psychiatric services.

A systematic narrative review of the studies on structured child‐centred interventions for families with a parent with cancer

Objective: To perform a systematic narrative review of the current state of published articles on the structured interventions targeted at children with a parent suffering from cancer.