Satu Viertiö

Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders

BACKGROUNDnHealth utility and quality of life (QoL) are increasingly important outcome measures in healthcare and health economics.nnnAIMSnTo compare the loss of subjective QoL and utility-based health-related quality of life (HRQoL) associated with psychotic disorders.nnnMETHODnA representative sample of 8028 Finns was screened for psychotic disorders and bipolar I disorder. Lifetime psychotic disorders were diagnosed using the Structured Clinical Interview for DSM-IV and/or case records. Health-related quality of life was measured with EQ-5D and 15D, and QoL was measured with a 10-point scale.nnnRESULTSnSchizoaffective disorder was associated with the largest losses of QoL and HRQoL, with bipolar I disorder associated with similar or smaller losses than schizophrenia. Current depressive symptoms explained most of the losses.nnnCONCLUSIONSnDepressive symptoms are the strongest predictors of poor QoL/HRQoL in psychotic disorders. Subjective loss of QoL associated with psychotic disorders may be smaller than objective loss of functioning suggests. The EQ-5D is problematic as an outcome measure in psychotic disorders.

Inflammation in psychotic disorders: a population-based study.

We investigated inflammatory markers in psychotic disorders and their association with metabolic comorbidity, antipsychotic medication, smoking, alcohol use, physical condition, and mood. From the population-based Finnish Health 2000 study, we identified all persons with schizophrenia (n=45), other nonaffective psychosis (ONAP) (n=57), affective psychosis (n=37) and chose controls matched by age, sex, and region of residence. We found that persons with schizophrenia had significantly higher sIL-2Rα, IL-1RA and C-reactive protein (CRP), persons with ONAP significantly higher IL-1RA and CRP and persons with affective psychosis almost significantly higher TNF-α compared to their matched controls. Current antipsychotic use was associated with elevated IL-1RA and CRP. After taking metabolic and lifestyle-related variables that associated with inflammatory markers into account, only antipsychotic medication remained associated with elevated IL-1RA and TNF-α which are markers related to the activation of innate immune system. CRP was influenced by both antipsychotic medication and nonaffective psychosis. sIL-2Rα, a marker of T-cell activation, was associated with depressive symptoms, schizophrenia, and affective psychosis. We conclude that in persons with psychotic disorders, activation of mononuclear phagocyte system was mostly related to metabolic comorbidity and antipsychotic medication use, whereas T-cell activation had a more direct relationship with both psychotic disorders and depressive symptoms.

Alcohol-induced psychotic disorder and delirium in the general population

BACKGROUNDnEpidemiological data on alcohol-induced psychotic disorder and delirium (alcohol-induced psychotic syndrome, AIPS) are scarce.nnnAIMSnTo investigate the epidemiology of AIPS, the risk factors for developing AIPS among people with alcohol dependence, and mortality associated with alcohol dependence with or without AIPS, in a sample drawn from the general population of Finland.nnnMETHODnA general population sample of 8028 persons were interviewed with the Composite International Diagnostic Interview and screened for psychotic disorders using multiple sources. Best-estimate diagnoses of psychotic disorders were made using the Structured Clinical Interview for DSM-IV Axis I Disorders and case notes. Data on hospital reatments and deaths were collected from national registers.nnnRESULTSnThe lifetime prevalence was 0.5% for AIPS and was highest (1.8%) among men of working age. Younger age at onset of alcohol dependence, low socioeconomic status, fathers mental health or alcohol problems and multiple hospital treatments were associated with increased risk of AIPS. Participants with a history of AIPS had considerable medical comorbidity, and 37% of them died during the 8-year follow-up.nnnCONCLUSIONSnAlcohol-induced psychotic disorder is a severe mental disorder with poor outcome.

Activities of daily living, social functioning and their determinants in persons with psychotic disorder

OBJECTIVEnThe determinants of everyday functioning in persons with psychotic disorder have not been widely studied in community dwelling samples. Our aim was to investigate limitations in everyday functioning among subjects with psychotic disorders in a population-based study.nnnMETHODnEveryday functioning was assessed in a nationally representative sample of 7112 persons aged 30+ using interviewer observations and self-reports, while verbal fluency and memory were also measured. Diagnostic assessment of DSM-IV psychotic disorders was based on SCID interview and case-note data. Lifetime-ever diagnoses of psychotic disorder were classified into schizophrenia (n=61), other non-affective psychotic disorders (ONAP) (n=79) and affective psychoses (n=45).nnnRESULTnNon-affective psychotic disorder was significantly associated with limitations in everyday functioning, as well as with deficits in verbal fluency and memory. Negative symptoms, depression, age, gender, verbal memory deficits, and reduced visual acuity were predictors of limitations in everyday functioning even after controlling for sociodemographic factors and chronic medical conditions, and difficulties in social functioning were also related to expressive speech problems.nnnCONCLUSIONnPersons with schizophrenia and ONAP have significantly more problems in everyday functioning than the general population. One significant predictor of problems was reduced visual acuity, which at least in some situations could be easily corrected.

Mortality and its determinants in people with psychotic disorder.

Objective We investigated mortality and its determinants in people with psychotic disorder. Methods A nationally representative two-stage cluster sample of 8028 persons aged 30 years or older from Finland was selected for a comprehensive health survey conducted from 2000 to 2001. Participants were screened for psychotic disorder, and screen-positive persons were invited for a Structured Clinical Interview for DSM-IV. The diagnostic assessment of DSM-IV psychotic disorders was based on the Structured Clinical Interview for DSM-IV, case records from mental health treatments, or both. Mortality was followed up until September 2009 and analyzed using Cox proportional hazards model. Results People with schizophrenia (hazard ratio [HR] = 3.03; 95% confidence interval [CI] = 1.93–4.77) and other nonaffective psychoses (HR = 1.84; 95% CI = 1.17–2.91) had elevated mortality risk, whereas people with affective psychoses did not (HR = 0.61; 95% CI = 0.24–1.55). Antipsychotic medication use was associated with increased mortality (HR = 2.34; 95% CI = 1.86–2.96). There was an interaction between antipsychotic medication use and the presence of a psychotic disorder: antipsychotic medication use was only associated with elevated mortality in persons who were using antipsychotics and did not have primary psychotic disorder. In persons with psychotic disorder, mortality was predicted by smoking and Type 2 diabetes at baseline survey. Conclusions Schizophrenia and nonaffective psychoses are associated with increased mortality risk, whereas affective psychoses are not. Antipsychotic medication use increases mortality risk in older people without primary psychotic disorder, but not in individuals with schizophrenia. Smoking and Type 2 diabetes are important predictors of elevated mortality risk in persons with psychotic disorder.

Visual impairment in persons with psychotic disorder

BackgroundPersons with psychotic disorder may have poorer visual acuity (VA). The aim of the study is to investigate in a general population the prevalence of impaired habitual VA and self-reported difficulties in vision among persons with different psychotic disorders.MethodA nationally representative sample of 6,663 persons aged 30 or older whose binocular VA for distance and for near vision was measured with current spectacles, if any. Diagnostic assessment of DSM-IV psychotic disorders used both SCID interview and case note data. Life-time ever diagnoses of psychotic disorders were classified into schizophrenia, other non-affective psychotic disorders and affective psychoses.ResultsAfter adjusting for age and sex, schizophrenia was associated with significantly increased odds of having visual impairment for distance (OR 5.04, Pxa0<xa00.0001) and for near vision (OR 6.22, Pxa0<xa00.0001), while other psychotic disorders were not. Self-reported problems in VA were more common in persons with schizophrenia and other non-affective psychotic disorders than in the remaining study sample. Only 43.9% of persons with schizophrenia, compared with 69.7% in the total sample (χ2xa0=xa013.79, d.f. 1, Pxa0=xa00.0002), had had their vision examined during the 5xa0years before the VA measurement.ConclusionsBecause persons with schizophrenia attend vision examinations substantially less frequently than others, and their vision is notably weaker, regular ocular evaluations should be included in physical health monitoring in psychotic disorders.

Prevalence and correlates of major depressive disorder and dysthymia in an eleven-year follow-up – Results from the Finnish Health 2011 Survey

BACKGROUNDnUp-to-date epidemiological data on depressive disorders is needed to understand changes in population health and health care utilization. This study aims to assess the prevalence of major depressive disorder (MDD) and dysthymia in the Finnish population and possible changes during the past 11 years.nnnMETHODSnIn a nationally representative sample of Finns aged 30 and above (BRIF8901), depressive disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000 and 2011. To account for nonresponse, two methods were compared: multiple imputation (MI) utilizing data from the hospital discharge register and from the interview in 2000 and statistical weighting.nnnRESULTSnThe MI-corrected 12-month prevalence of MDD was 7.4% (95% CI 5.7-9.0) and of dysthymia was 4.5% (95% CI 3.1-5.9), whereas the corresponding figures using weights were 5.4% (95% CI 4.7-6.1) for MDD and 2.0% (95% CI 1.6-2.4) for dysthymia. Women (OR 2.33, 95% CI 1.6-3.4) and unmarried people (OR 1.54, 95% CI 1.2-2.0) had a higher risk of depressive disorders. There was a significant increase in the prevalence of depressive disorders during the follow-up period from 7.3% in 2000 to 9.6% in 2011. Prevalences were two percentage points higher, on average, when using MI compared to weighting. Hospital treatments for depressive disorders and other mental disorders were strongly associated with nonparticipation.nnnLIMITATIONSnThe CIDI response rate dropped from 75% in 2000 to 57% in 2011, but this was accounted for by MI and weighting.nnnCONCLUSIONSnDepressive disorders are a growing public health concern in Finland. Non-participation of persons with severe mental disorders may bias the prevalence estimates of mental disorders in population-based studies.

Mobility limitations in persons with psychotic disorder: findings from a population-based survey.

BackgroundThere are few reports on mobility limitations in persons with psychotic disorder although restrictions in mobility may aggravate the general functional limitations of these patients. Our aim was to investigate mobility limitations among subjects with psychotic disorder in a general population-based sample.MethodsA nationally representative sample of 6,927 persons aged 30 and older self-reported mobility limitations in an interview and was examined in performance tests. Diagnostic assessment of DSM-IV psychotic disorders combined SCID interview and case note data. Lifetime-ever diagnoses of psychotic disorder were classified into schizophrenia, other nonaffective psychotic disorders and affective psychoses.ResultsSelf-reported mobility limitations were highly prevalent in persons with schizophrenia and other nonaffective psychosis, but not in the affective psychosis group. After adjusting for age and sex, persons with schizophrenia and other nonaffective psychoses but not affective psychoses had significantly increased odds of having both self-reported and test-based mobility limitations as well as weak muscle strength. Schizophrenia remained an independent predictor of mobility limitations even after controlling for lifestyle-related factors and chronic medical conditions. Among persons with nonaffective psychoses, higher levels of negative symptoms predicted mobility limitations.ConclusionSelf-reported mobility limitations are prevalent already at a young age in persons with schizophrenia and other nonaffective psychotic disorders, and among older persons with these disorders both self-reported limitations and measured performance tests show lower capacity in mobility. Difficulties in mobility are associated with negative symptoms. Mental health care professionals should pay attention to mobility limitations in persons with psychotic disorder.

Hearing loss in persons with psychotic disorder—Findings from a population-based survey

Hearing impairment is associated with psychotic symptoms, but has not been systematically studied in people with psychotic disorder. We used a population-based sample of 6654 persons aged 30+ to compare hearing, as measured by audiometry, in persons with schizophrenia, other non-affective psychosis and affective psychosis in the general population. The prevalence of hearing impairment did not differ in persons with psychotic disorder compared with the general population. Participants with schizophrenia and affective psychotic disorder had significantly more difficulties to hear in a noisy environment than the general population. Our results suggest that psychotic disorders are associated with minor hearing difficulties but not hearing impairment.

19.3 APPLYING COGNITIVE ADAPTATION TRAINING IN FINLAND: INTERIM RESULTS OF THE FINNISH CAT IMPLEMENTATION PROJECT

Abstract Background In Finland, approximately 50 000 people have a diagnosis of schizophrenia. In practice 6% of them reside permanently in mental hospitals. There is a national target to reduce the number of psychiatric hospital beds. However, as hospitals are closed there is a tendency to place schizophrenia patients in different types of sheltered housing instead of supporting them to live independently in the community. In the Danish OPUS-study 94 patients with first episode schizophrenia were followed and even those who had attended a vigorous rehabilitation program lived about two and a half months in sheltered housing in the fifth year after their diagnosis. Thus, with deinstitutionalization we are building up a poorly monitored system of sheltered housing for schizophrenia patients. This system may increase chronic need for support, is expensive and marginalizes a large section of people from the community. When service users are asked they usually prefer having their own homes. Cognitive adaptation training (CAT) is a home-based, manual-driven treatment that utilizes environmental supports and compensatory strategies to bypass cognitive deficits and improve target behaviors and functional outcomes in individuals with schizophrenia. Unlike traditional case management, CAT provides environmental supports and compensatory strategies tailored to meet the behavioral style and neurocognitive deficits of each individual patient. CAT has been shown to be effective in improving service users’ ability live independently. Methods The study started in 2014. After formal CAT training the program was implemented in the Hyvinkää Hospital and Helsinki University Central Hospital treatment catchment areas (approx. 1 350 000 inhabitants). For the study we selected patients that were in risk of moving to a more supported housing environment due to the presence of cognitive deficits that threatened their ability to live independently. The only exclusion criteria were heavy alcohol and drug abuse and known aggressive behavior. The outcome measurements include both qualitative and quantitative methods: transfer to a different type of housing, need for hospital treatment, psychiatric rating scales, observed measurements and open interviews, and are measured after 4 months after the start of the intervention, at the end of the 9 month intervention and after a 6 months follow-up period. Results We report here preliminary interim results for the patients who have completed the study so far. Altogether 48 patients were selected for the intervention, which was found to be well-received with 7 patients dropping out. The mean age was 38.9 year, with 39.3 % women and 60.4 % men. 27.6 % were living independently, 22.9 % with their parents, and 29.6 % living in some form of sheltered housing. Participants had severe to moderately-severe psychiatric symptoms and functional impairment (mean GAF 47.8, mean SOFAS 54.8). Apathetic was the most common behavioral subtype (70.7 %), with disinhibited (14.6 %) and mixed (14.6 %) subtypes following. Discussion Cognitive Adaptation Training can be used to help patients in a wide range of living situations and with severe psychiatric symptoms and functional impairment to maintain their ability to live independently.