Jyrki Korkeila

Striatal Dopamine Synthesis in First-degree Relatives of Patients with Schizophrenia

BACKGROUND First degree relatives (FDR) of patients with schizophrenia have higher risk of developing schizophrenia than the general population. Previous positron emission tomography (PET) studies have shown that striatal presynaptic dopamine synthesis capacity is increased in schizophrenia. We investigated whether this same phenomenon is shared by individuals with increased genetic risk for schizophrenia. METHODS We used 6-[18F]-fluorodopa (FDOPA) PET imaging to measure striatal dopamine synthesis capacity. We studied 17 nonpsychotic subjects with an FDR with schizophrenia. This group was compared to 17 healthy subjects with no FDRs with schizophrenia. RESULTS A conventional region of interest (ROI)-analysis indicated that FDOPA uptake (K(i)) in the caudate-putamen was statistically significantly higher in the FDR group than in the control group. A voxel-level analysis confirmed these results. CONCLUSIONS These results suggest that the changes of striatal presynaptic dopamine synthesis seen previously in neuroleptic-naive schizophrenic patients is also present in FDRs of patients with schizophrenia. These findings have implications for the early detection of psychosis as well as for pharmacological interventions in individuals at risk for psychosis.

Reasons for using seclusion and restraint in psychiatric inpatient care

R. Kaltiala-Heino*, C. Tuohimaki, J. Korkeila, V. Lehtinen Professor of Social Psychiatry, Tampere School of Public Health, University of Tampere, Tampere, Finland MD DrMedSci, Department of Psychiatry, Tampere University Hospital, Tampere, Finland MD, Department of Psychiatry, Oulu University Hospital, Oulu, Finland Professor, Kupittaa Hospital, Turku, Finland Professor, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland

Axis-I disorders and vulnerability to psychosis

BACKGROUND The psychopathology that manifests during the prodromal phase of first-episode psychosis is varied. Little is known about the clinical diagnoses of subjects with so-called prodromal or psychotic-like symptoms. METHOD Samples of psychotic patients, first-degree relatives (FDRs) of psychotic, or severely ill patients, treatment-seeking patients, and a random community sample (in all 157 subjects) were assessed by the Structured Interview for Prodromal Symptoms (SIPS) and the SCID-I. Vulnerability to psychosis (VTP) was defined by severity of positive symptoms reported in the SIPS interview and associated with lifetime SCID-I diagnoses. RESULTS The number of lifetime diagnoses received increased linearly as the SIPS symptoms approached more psychotic-like phenomena. All VTP subjects received on average 2.5, and currently prodromal subjects 2.9 lifetime SCID-I diagnoses, while the corresponding figure for non-VTP subjects was 0.7 (p<0.0001). Mood disorders and comorbid anxiety disorders were particularly common. CONCLUSION Vulnerability to psychosis seems to be associated with a high number of lifetime Axis-I diagnoses. Occurrence of anxiety disorders is remarkable, and most VTP subjects can be diagnosed with a lifetime mood disorder. VTP subjects require careful assessment of mood and anxiety symptoms and adequate treatment for their multiple disorders.

Childhood adversities, adult risk factors and depressiveness: a population study.

ObjectiveChildhood adversities have been associated with adulthood depressiveness, but the contribution of adult risk factors is seldom described. We examined whether adult risk factors lie on the pathway from childhood adversity to adult depressiveness (pathway hypothesis) or whether the association depends on life events (vulnerability hypothesis).MethodAmong 21,101 randomly sampled working-aged respondents [the Health and Social Support in Finland (HeSSup) Study], the hypotheses were tested with logistic regression analysis models studying the associations between Beck Depression Inventory (BDI)-assessed depressiveness and self-reported childhood adversities alone and in combination with recent adverse events.ResultsChildhood adversities were consistently associated with depressiveness (women, age-adjusted odds ratio 3.1, 95% confidence intervals 2.6–3.7; men, 2.6, 2.1–3.3), although the risks were decreased by more than 30% after adjustments for adult risk factors such as living alone, education, alcohol consumption, social support and negative affectivity. Childhood adversities combined with recent life events were associated with depressiveness in an additive manner. Women with childhood adversities and recent person-independent events especially had increased vulnerability for depressiveness.ConclusionsThe childhood adversity–depressiveness associations were partly mediated by adult risk factors, supporting a pathway from childhood adversities to depressiveness through adult risk factors. Increased vulnerability for depressiveness was found among respondents with childhood adversities in combination with recent death/illness events. The findings emphasize the importance of early risk factors when identifying persons at risk of depression.

Coercion and restrictions in psychiatric inpatient treatment.

To find out to what extent coercion and restrictions are used in psychiatric inpatient treatment and with which patient characteristics the use of coercion is associated. To this end, the hospital records of 1,543 admissions (six-month admission samples) to the psychiatric clinics in three Finnish university towns were evaluated by retrospective chart review. The study clinics provide all psychiatric inpatient treatment for the working-age population in their catchment areas. Use of coercion and restrictions was recorded in a structured form. Coercion and restrictions were applied to 32% of the patients. Mechanical restraints were used on 10% of the patients, and forced medication on 8%. Compared to international statistics the figures in the current study are high.

Childhood adversities as predictors of incident coronary heart disease and cerebrovascular disease

Background Studies suggest that childhood adversities are important determinants of various types of later illnesses as well as poor health behaviour. However, few large-scale prospective studies have examined the associations between childhood adversities and cardiovascular disease. Objective To investigate whether childhood adversities are associated with increased risk of incident cardiovascular disease Design and setting Participants were 23 916 men and women in four age groups (20–24, 30–34, 40–44, and 50–54 years) from the Health and Social Support study, a longitudinal study on a random sample representative of the Finnish population. Data from national health registers on coronary heart disease and cerebrovascular disease during a mean follow-up of 6.9 years were linked to survey responses on childhood adversities. Cox proportional hazard models were adjusted for age group and potential mediators (education, health risk behaviours, diabetes and depression). Results There was a significant linear trend between the number of childhood adversities and disease end points in women. The risk of incident cardiovascular disease was threefold among women exposed concurrently to three types of childhood adversities (financial difficulties, interpersonal conflicts and longstanding illness of a family member). Among men, increased risk was observed only among those with longstanding illness of a family member (HR=1.44; 95% CI 1.06 to 1.96). Conclusions In this prospective population-based sample, childhood adversities were associated with a significantly increased risk of objectively verified cardiovascular disease, especially among women but to a lesser extent among men. More studies with prospective settings are needed to confirm the association and possible mechanisms.

Living situation, subjective quality of life and social network among individuals with schizophrenia living in community settings.

Objective:  To investigate the relationships between characteristics of the living situation in the community and subjective quality of life and social network among community‐based individuals with schizophrenia.

Establishing a set of mental health indicators for Europe.

Aims: This review presents the background work for developing a set of mental health indicators as part of a comprehensive health monitoring system in the European Union. The review focuses on the appraisal of mental health at population level with special emphasis on assessments that could be useful for mental health promotion. Methods: A functional model of mental health is used to delineate variables important for a set of mental health indicators. Variables that are not possible to monitor at population level are not discussed here. Literature searches were conducted through the MEDLINE, PSYCHLIT, and SOCIOLOGICAL ABSTRACTS databases and available textbooks. Results: The review presents findings from research seeking associations between mental health and ill health and different individual, social, economic, ecological, and service-related characteristics. Specific domains as key starting points in establishing a set of mental health indicators are outlined according to the research findings. Conclusion: A set of mental health indicators can enhance the visibility of mental health issues in the European context. Ultimately the indicators could be used in estimating how the targets set for health policies are met, and whether there has been a measurable decrease in disability, suffering, and disease.

Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: A Nordic multicentre study

Background: Few studies have investigated differences between subjective and externally assessed quality of life in individuals with a severe mental illness. In a sample of 387 patients with schizophrenia living in the community the present study investigated the association between subjective and interviewer-rated quality of life, clinical and sociodemographic factors related to the two assessments, and if discrepancies in the assessments were related to any clinical or social features of the patients. Method: The study was a Nordic multicentre study with a cross-sectional design. Instruments used were the Lancashire Quality of Life Profile, the Brief Psychiatric Rating Scale, the Interview Schedule for Social Interaction, Camberwell Assessment of Needs and General Assessment of Functioning. Results: The correlation between subjective and interviewer-rated quality of life was moderate (ICC=0.33). More severe affective symptoms, fewer emotional relations and a lower monthly income were related to poorer subjectively rated quality of life but in a stepwise multiple regression analysis accounted for only 14.1 of the variance. Poorer interviewer-rated quality of life was mainly related to a more severe psychopathology but also to a lower monthly income, fewer emotional relations and not being employed. Together these factors accounted for 45.5 of the variance. A greater discrepancy between the subjective and the interviewer rating was found in patients with less affective symptoms, unemployment, and a better social network. Conclusion: Only a moderate correlation between subjective and interviewer-assessed global quality of life was found, implying that the sources of assessment differed, as was also shown in subsequent regression models. It is concluded that both perspectives on the patient’s quality of life may be valuable for treatment planning, especially in cases where differences in quality of life assessment related to the patient’s psychopathology may be expected.

Frequently hospitalised psychiatric patients: a study of predictive factors

Abstract The purpose of this study was to investigate the factors predicting readmission and the interval between readmissions to psychiatric hospital during the early 1990s in Finland. Data were retrieved using the national register of all discharges from psychiatric hospitals during the early 1990s. Frequently admitted patients were an identifiable group. The factors associated with an increased risk of multiple readmissions were: previous admissions, long length of stay (LOS) and diagnosis of psychosis or personality disorder. Patients with psychosis or personality disorder were also readmitted more rapidly than patients with an organic disorder. There seemed to be a small proportion of psychiatric patients in need of frequent or lengthy hospital treatment. The expansion of community care did not as such seem to have diminished the need and use of psychiatric hospital care. However, the differences between the years 1990 and 1993 were less important than the other factors that predicted readmission, namely LOS and diagnosis.