Add-on mirtazapine improves orgasmic functioning in patients with schizophrenia treated with first-generation antipsychotics

Aim: Sexual dysfunction, common in schizophrenia, may be further exaggerated by antipsychotics, especially those of First Generation (FGAs), and antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRs). Mirtazapine, an antidepressant characterized by its different action mechanism compared with that of the majority of other antidepressants, may improve SSRI-induced sexual dysfunction in patients with depression. It is unknown, however, whether mirtazapine improves sexual functioning in schizophrenia.Methods: This study randomly assigned FGA-treated patients with schizophrenia to receive either an add-on mirtazapine (n=20) or a placebo (n=19) for 6 weeks. Sexual functioning was prospectively measured using five relevant items from the Udvalg for Kliniske Undersogelser side-effect rating scale (UKU-SERS).Results: Orgasmic function improved with statistical significance in the mirtazapine group (p=.03), with no changes in any other sexual functions in either group.Conclusion: Add-on mirtazapine appears to relieve orgasmic dysfunction in FGA-treated patients with schizophrenia.Peer reviewe

Nuorten mielenterveyspalvelut - määrä, tarjonta ja kohdentuminen Uudenmaan alueella

English abstractNuorten pahoinvointi on ollut keskeisenä huolena viimeaikaisessa tutkimuksessa ja julkisessa keskustelussa. Erityisesti lastensuojelun asiakaslapsille kasautuu paljon kuormittavia tekijöitä. Nuoria lähellä olevat palvelut sekä varhainen puuttuminen ovat tehokkaimpia lisäämään yhteiskuntaan kiinnittymistä. Suomessa on käynnissä laaja palvelurakenneuudistus, mutta muutoksen tueksi tarvittava tutkimustieto on kuitenkin puutteellista. Tutkimuksessa kuvataan nuorten mielenterveyspalveluita Uudenmaan alueella vuonna 2014. Kaikki Uudenmaan alueen nuorille tarkoitetut mielenterveyspalvelut kartoitettiin ja toiminnot luokiteltiin nuorille sovelletulla ESMS-R-työkalulla. Palveluita tarkastellaan lukumäärän, monipuolisuuden ja avohoidon henkilöstöresurssien perusteella sekä suhteutetaan lastensuojelun asiakasnuorten määrään. Nuorten hyvinvoinnin riskitekijät ja palveluiden monipuolisuus korreloivat alueen väkiluvun kanssa. Avohoidon henkilöstön resursointi ei ollut suhteessa väkimäärään, lastensuojelun avohuollon asiakkaisiin tai kodin ulkopuolelle sijoitettuihin. Lisäksi monilla alueilta puuttuivat kokonaan esimerkiksi päivätoimintojen ja liikkuvan avohoidon palvelut. Tarkastelun perusteella alueen nuorten mielenterveyspalveluiden avohoito vaikuttaisi eriarvoiselta ja sattumanvaraiselta. Tulokset ovat tarpeen suunniteltaessa palveluiden kehittämistä siten, että kaikilla nuorilla on tarjolla yhtäläisiä palveluita kotikunnasta riippumatta. Nämä asiat tulisi huomioida myös tulevassa sosiaali- ja terveyspalveluiden uudistuksessa.Peer reviewe

Kannattaako skitsofreniapotilaan masennuslääkitys?

English summar

Residential services as a major cost driver in mental health and substance use services in southern Finland

English abstract.Peer reviewe

Psychiatric staff on the wards does not share attitudes on aggression

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Features of borderline personality disorder as a mediator of the relation between childhood traumatic experiences and psychosis-like experiences in patients with mood disorder

Background: Psychosis-like experiences (PEs) are common in patients with non-psychotic disorders. Several factors predict reporting of PEs in mood disorders, including mood-associated cognitive biases, anxiety and features of borderline personality disorder (BPD). Childhood traumatic experiences (CEs), often reported by patients with BPD, are an important risk factor for mental disorders. We hypothesized that features of BPD may mediate the relationship between CEs and PEs. In this study, we investigated the relationships between self-reported PEs, CEs and features of BPD in patients with mood disorders. Methods: As part of the Helsinki University Psychiatric Consortium study, McLean Screening Instrument (MSI), Community Assessment of Psychic Experiences (CAPE-42) and Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n = 282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, multiple regression and mediation analyses were conducted. Results: Total scores of MSI correlated strongly with scores of the CAPE-42 dimension "frequency of positive symptoms" (rho = 0.56; p Conclusions: Self-reported cognitive-perceptual symptoms of BPD fully mediate, while affective, behavioural and interpersonal symptoms only partially mediate the relationships between CEs and PEs. Recognition of co-morbid features of BPD in patients with mood disorders reporting PEs is essential. (c) 2017 Elsevier Masson SAS. All rights reserved.Peer reviewe

Does experienced seclusion or restraint affect psychiatric patients' subjective quality of life at discharge?

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Influence of patient characteristics on duration of seclusion/restrain in acute psychiatric settings in Japan

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Methodological and ethical challenges in studying patients' perceptions of coercion : a systematic mixed studies review

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Scheduled Telephone Support for Internet Cognitive Behavioral Therapy for Depression in Patients at Risk for Dropout : Pragmatic Randomized Controlled Trial

Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficient in the treatment of depression. However, the optimal mode and intensity of therapist support remain to be identified. Scheduled telephone support (STS) may improve adherence and outcomes but, as it is time- and resource-consuming, should be reserved for patients for whom the usual support may be insufficient. Objective: This paper aims to reveal whether add-on STS for patients at risk of dropping out improves treatment adherence and symptoms in iCBT for depression. Methods: Among patients participating in an ongoing large observational routine clinical practice study of iCBT for depression delivered nationwide by Helsinki University Hospital (HUS-iCBT), those demonstrating a >= 14-day delay in initiation of treatment received invitations to this subsidiary STS study. A total of 100 consenting patients were randomly allocated to either HUS-iCBT as usual (control group, n=50) or HUS-iCBT plus add-on STS (intervention group, n=50). Proportions of those reaching midtreatment and treatment end point served as the primary outcome; secondary outcomes were change in Beck Depression Inventory (BDI)-measured depressive symptoms and time spent in treatment. Results: Add-on STS raised the proportion of patients reaching midtreatment compared with HUS-iCBT as usual (29/50, 58% vs 18/50, 36%; P=.045) and treatment end point (12/50, 24% vs 3/50, 6%; P=.02). Change in BDI score also favored add-on STS (3.63 points vs 1.1 points; P=.049), whereas duration of treatment did not differ. Conclusions: Add-on STS enhances adherence and symptom improvement of patients at risk of dropping out of iCBT for depression in routine clinical practice.Peer reviewe