R.K.R. Salokangas

Screening for depression in primary care Development and validation of the Depression Scale, a screening instrument for depression

Depression is a common mental disorder; effective methods for treating it are also available. Its recognition and diagnosis are prerequisite to effective treatment. A majority of depressed patients are generally managed in the primary care setting; only a half of the cases, however, are identified at their first visit. Screening instruments to improve recognition of depression have therefore been developed. The Depression Scale (DEPS), consisting of 10 items, was developed and tested in primary care patients aged 18 to 64 years. Clinical assessments were made on the basis of Present State Examination interviews with 436 patients. The DEPS proved to be satisfactory. Increasing age and poor education had an adverse effect on the screening process, however. The sensitivity of the DEPS for clinical depression was 74% and the specificity for non‐depression 85%. The sensitivity for severe depression was 84% and the specificity for symptom‐free patients 93%. The DEPS seems to improve the recognition of depression in primary care and may also be suitable for screening depression in the general population and for identifying high‐risk groups.

Living situation, social network and outcome in schizophrenia : a five-year prospective follow-up study

A representative sample of 227 first‐contact schizophrenic patients (according to DSM‐III) was followed up for 5 years. The psychiatric teams responsible for the treatment of the patients conducted detailed standardized interviews with the patients at entry and at the end of the first, second and fifth years. Changes in patients’ clinical and functional outcome were analysed according to their living situation and social network. Positive changes in clinical state and functional ability were most prominent among patients who were living with their spouse. The social and functional outcome of men living with their parents was better than that of women in the same situation, while among patients living alone or with some other person the gender difference was reversed. Family environment can be of great importance to schizophrenic patients, supporting their clinical and functional recovery from psychosis. Patients living outside families — and men in particular — are at great risk of poor outcome, perhaps because they often lose their social contacts. In the treatment of such individuals a more active strategy of out‐patient and rehabilitative care is therefore needed.

Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis

Dragt S, Nieman DH, Schultze‐Lutter F, van der Meer F, Becker H, de Haan L, Dingemans PM, Birchwood M, Patterson P, Salokangas RKR, Heinimaa M, Heinz A, Juckel G, Graf von Reventlow H, French P, Stevens H, Ruhrmann S, Klosterkötter J, Linszen DH, on behalf of the EPOS group. Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis.

Structure of schizophrenic symptomatology and its changes over time: prospective factor‐analytical study

A representative sample of 156 new schizophrenic patients (DSM‐III) were examined at the time of their first treatment contact for psychosis, and reexamined 2 and 5 years thereafter. The symptom variables, assessed by the Comprehensive Psychopathological Rating Scale (CPRS), were factored and compared with each other. The following major dimensions were found: (i) a fairly stable negative dimension with affective and speech impoverishment and withdrawal; (ii) a delusional dimension; (iii) hallucinatory dimensions; (iv) a disorganization dimension; and (v) a depressive dimension with unreal experiences. The negative dimension was more prevalent in unmarried patients. Neither the two‐syndrome model of negative and positive symptoms nor the three‐syndrome model of psychomotor poverty, disorganization and reality distortion proved to be satisfactory. In a representative sample of schizophrenic patients, the syndrome structure described by symptom dimensions appears to be more complex and varies considerably according to the duration of the illness.

Prevalence of depression among patients seen in community health centres and community mental health centres

Depression is a common disorder in the general population. However, its prevalence among patients attending various health‐care facilities is less well known. There have been very few Finnish studies of this topic. The Tampere Depression Project (TADEP) dealt with the prevalence of depression and factors associated with it in individuals seen in community health centres (CHC) and in psychiatric‐service (PS) patients. The diagnosis of depression was based on a standardized Present State Examination interview and a DSM‐III‐R assessment, carried out on 436 CHC patients and 428 PS patients. The severity of depression was assessed using the Hamilton Rating Scale of Depression. About 10% of CHC patients and 50% of PS patients suffered from clinical depression. In addition to these, some depressive symptoms were displayed by just under 10% of subjects. Similar prevalence rates were obtained by the various methods used. The 1–year prevalence rate of clinical depression was 20% for the CHC patients and almost 60% for the PS patients. Mild depression represented the largest group. In the CHC group, depression was found more often in middle‐aged and widowed subjects and in patients with a lower educational level and blue‐collar workers than in others. In the PS group, depression was found more often in women, the oldest subjects and the widowed than in others.

The Finnish National Schizophrenia Project 1981–1987: 10-year evaluation of its results

This study reports the 10‐year evaluation of the Finnish National Schizophrenia Project. The aims of the national project were achieved. The number of long‐stay schizophrenic patients in psychiatric hospitals decreased by 63% between 1982 and 1992. Both the treatment of schizophrenic patients and the structure of mental health services have changed greatly in Finland. Psychosocial treatment methods in particular have developed. The major innovations of the Project are the acute psychosis teams now serving over 50% of the country, and social skills training programmes. The 10‐year evaluation of the Finnish National Schizophrenia Project shows that it is possible to conduct successfully nation‐wide projects to develop the treatment of schizophrenic patients and psychiatric practices across an entire country.

Psychodynamic personality profile in first-episode severe mental disorders

Objective:  The aim of this study was to relate measures of psychoanalytically derived personality traits to descriptive diagnosis and psychopathology in severe mental disorders.

First admissions for psychosis in Turku. A time trend study.

Patients over 15 years of age from Turku hospitalized for psychosis for the first time during the years 1949–50, 1959–60 or 1969–70 were investigated.

Mental health in the population approaching retirement age. Preliminary findings of the TURVA project

ABSTRACT— The present paper deals with a Finnish long‐term prospective study, the objective of which is to shed light on adjustment to retirement and old age. In this phase, only the preliminary findings of the initial survey carried out in 1982 are available. For the purposes of the study, a random sample of 200 individuals was drawn from among Turku inhabitants born in 1920. Another sample, consisting of 189 persons of the same age, was drawn from rural municipalities in the neighborhood of Turku. An extensive structured psychosocial interview could be conducted with a total of 339 subjects. The research methods used included e.g. the 36‐item version of Goldbergs General Health Questionnaire (GHQ).

Hospital and outpatient care for psychotic patients during the last three decades SUBSEQUENT HOSPITAL AND OUTPATIENT TREATMENT OF PSYCHOTIC PATIENTS HOSPITALIZED FOR THE FIRST TIME IN 1949–50, 1959–60 OR 1969–70

The study deals with the development in the extent of hospital treatment and trends concerning outpatient visits for psychotics in Turku hospitalized for the first time in 1949‐50 (period of shock therapy), 1959–60 (period of neuroleptics) or 1969–70 (period of intensified outpatient treatment).