A population-based follow-up study shows high psychosis risk in women with PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% of women. Besides metabolic and fertility aspects, attention has lately been directed towards the detrimental effect of PCOS on psychological health. The objective of the study was to investigate whether women with PCOS are at higher risk for psychotic disorders. The study population derives from the Northern Finland Birth Cohort 1966 (N = 5889 women). The women with PCOS were identified by two simple questions on oligo-amenorrhea and hirsutism at age 31. Women reporting both symptoms were considered PCOS (N = 124) and asymptomatic women as controls (N = 2145). The diagnosis of psychosis was traced using multiple national registers up to the year 2016. Symptoms of psychopathology were identified using validated questionnaires at age 31. Women with PCOS showed an increased risk for any psychosis by age 50 (HR [95% CI] 2.99, [1.52-5.82]). Also, the risk for psychosis after age 31 was increased (HR 2.68 [1.21-5.92]). The results did not change after adjusting for parental history of psychosis, nor were they explained by body mass index or hyperandrogenism at adulthood. The scales of psychopathology differed between women with PCOS and non-PCOS controls showing more psychopathologies among the affected women. PCOS cases were found to be at a three-fold risk for psychosis, and they had increased psychopathological symptoms. PCOS should be taken into consideration when treating women in psychiatric care. More studies are required to further assess the relationship between PCOS and psychotic diseases.Peer reviewe

The Long-Term Footprint of Endometriosis : Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years

Previous studies have shown increased pain sensitivity in fertile-aged women with endometriosis in response to mechanical stimuli. As yet, population-based studies on the association of endometriosis with pain sensation and pain symptoms in late fertile age are lacking. The main objective of this population-based cohort study was to investigate whether a history of endometriosis is associated with altered pain sensation and musculoskeletal pain symptoms at age 46 years. Our data are derived from the Northern Finland Birth Cohort 1966, which contains postal questionnaire data (72% response rate) as well as clinical data assessing pressure-pain threshold and maximal pain tolerance. The study population consisted of 284 women with endometriosis and 3,390 controls. Our results showed that at age 46 women with a history of endometriosis had a 5.3% lower pressure-pain threshold and 5.1% lower maximal pain tolerance compared with controls. The most significant contributors besides endometriosis were anxiety, depression, and current smoking status. Women with endometriosis also reported an increased number of pain sites (0 pain sites, 9.6 vs 17.9%; 5-8 pain sites, 24.8 vs 19.1%, endometriosis vs controls respectively; P Perspective: This population-based cohort study showed decreased pain threshold and maximal pain tolerance in women with endometriosis in the late fertile age of 46 years. The pain was also found to be more bothersome and intense compared with controls. (C) 2018 by the American Pain SocietyPeer reviewe

Psychological Distress Is More Prevalent in Fertile Age and Premenopausal Women With PCOS Symptoms : 15-Year Follow-Up

Context: Polycystic ovary syndrome (PCOS) is associated with increased psychological distress, obesity and hyperandrogenism being suggested as key promoters. Objectives: To investigate the prevalence of anxiety/depression and their coexistence in women with PCOS/PCOS-related symptoms at ages 31 and 46. The roles of obesity, hyperandrogenism, and awareness of PCOS on psychological distress were also assessed. Design: Population-based follow-up. Setting: Northern Finland Birth Cohort 1966 with 15-year follow-up. Participants: At age 31, a questionnaire-based screening for oligoamenorrhea (OA) and hirsutism (H): 2188 asymptomatic (controls), 331 OA, 323 H, and 125 OA plus H (PCOS). Follow-up at age 46: 1576 controls, 239 OA, 231 H, and 85 PCOS. Interventions: Questionnaire-based screening for anxiety and depression symptoms (Hopkins Symptom Checklist-25) and previously diagnosed/treated depression at ages 31 and 46. Body mass index (BMI), serum testosterone/free androgen index, and awareness of polycystic ovaries/PCOS on psychological distress were also assessed. Main Outcomes: Population-based prevalence of anxiety and/or depression in women with PCOS/PCOS-related symptoms at ages 31 and 46. Results: Anxiety and/or depression symptoms, their coexistence, and rate of depression were increased at ages 31 and 46 in women with PCOS or isolated H compared with controls. High BMI or hyperandrogenism did not associate with increased anxiety or depression symptoms. The awareness of PCOS was associated with increased anxiety. Conclusions: Women with PCOS or isolated H present more often with anxiety and/or depression symptoms and their coexistence compared with controls. High BMI or hyperandrogenism did not provoke psychological distress in PCOS. The awareness of PCOS increased anxiety but did not associate with severe anxiety or depression.Peer reviewe

Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age : A population-based cohort study

Introduction This population-based follow-up study investigated the comorbidities, medication use, and healthcare services among women with polycystic ovary syndrome (PCOS) at age 46 years. Material and methods The study population derived from the Northern Finland Birth Cohort 1966 and consisted of women reporting oligo/amenorrhea and hirsutism at age 31 years and/or a PCOS diagnosis by age 46 years (n = 246) and controls without PCOS symptoms or diagnosis (n = 1573), referred to as non-PCOS women. The main outcome measures were self-reported data on symptoms, diagnosed diseases, and medication and healthcare service use at the age of 46 years. Results Overall morbidity risk was increased by 35% (risk ratio [RR] 1.35, 95% confidence interval [CI] 1.16-1.57) and medication use by 27% [RR 1.27, 95% CI 1.08-1.50) compared with non-PCOS women, and the risk remained after adjusting for body mass index. Diagnoses with increased prevalence in women with PCOS were migraine, hypertension, tendinitis, osteoarthritis, fractures, and endometriosis. PCOS was also associated with autoimmune diseases and recurrent upper respiratory tract infections and symptoms. Interestingly, healthcare service use did not differ between the study groups after adjusting for body mass index. Conclusions Women with PCOS are burdened with multimorbidity and higher medication use, independent of body mass index.Peer reviewe

Psychological Distress Is More Prevalent in Fertile Age and Premenopausal Women With PCOS Symptoms : 15-Year Follow-Up

Context: Polycystic ovary syndrome (PCOS) is associated with increased psychological distress, obesity and hyperandrogenism being suggested as key promoters. Objectives: To investigate the prevalence of anxiety/depression and their coexistence in women with PCOS/PCOS-related symptoms at ages 31 and 46. The roles of obesity, hyperandrogenism, and awareness of PCOS on psychological distress were also assessed. Design: Population-based follow-up. Setting: Northern Finland Birth Cohort 1966 with 15-year follow-up. Participants: At age 31, a questionnaire-based screening for oligoamenorrhea (OA) and hirsutism (H): 2188 asymptomatic (controls), 331 OA, 323 H, and 125 OA plus H (PCOS). Follow-up at age 46: 1576 controls, 239 OA, 231 H, and 85 PCOS. Interventions: Questionnaire-based screening for anxiety and depression symptoms (Hopkins Symptom Checklist-25) and previously diagnosed/treated depression at ages 31 and 46. Body mass index (BMI), serum testosterone/free androgen index, and awareness of polycystic ovaries/PCOS on psychological distress were also assessed. Main Outcomes: Population-based prevalence of anxiety and/or depression in women with PCOS/PCOS-related symptoms at ages 31 and 46. Results: Anxiety and/or depression symptoms, their coexistence, and rate of depression were increased at ages 31 and 46 in women with PCOS or isolated H compared with controls. High BMI or hyperandrogenism did not associate with increased anxiety or depression symptoms. The awareness of PCOS was associated with increased anxiety. Conclusions: Women with PCOS or isolated H present more often with anxiety and/or depression symptoms and their coexistence compared with controls. High BMI or hyperandrogenism did not provoke psychological distress in PCOS. The awareness of PCOS increased anxiety but did not associate with severe anxiety or depression.Peer reviewe

Tervetuloa osastolle 60 : Opas Oulun yliopistollisen sairaalan osaston 60 potilaiden vanhemmille

TIIVISTELMÄ Oulun seudun ammattikorkeakoulu Hoitotyö, Sairaanhoitaja Tekijät: Salla Breilin & Maria Karjula Opinnäytetyön nimi: ”Tervetuloa osastolle 60” – Opas Oulun Yliopistollisen sairaalan osaston 60 potilaiden vanhemmille Työn ohjaajat: Marja-Liisa Majamaa & Seija Mattila Työn valmistumislukukausi ja -vuosi: Syksy 2011 Sivumäärä: 43 sivua + 1 liite Opinnäytetyönämme teimme tuotekehitysprojektin, jonka tavoitteena oli tuottaa opas Oulun yliopistollisen sairaalan osaston 60 potilaiden vanhemmille. Osastolla on ollut tarvetta oppaalle, joka esittelee osaston ja sisältää perheelle tietoa tulevasta sairaalajaksosta. Myös englanninkielisen materiaalin tarve on tullut ajankohtaiseksi, sillä vieraskieliset potilaat ovat yhä enemmän nykypäivää, joten käänsimme oppaan myös englanniksi. Oppaiden merkitys ohjauksen osana on kasvanut, sillä suullinen ohjaus jää ajan puutteen vuoksi usein riittämättömäksi ja lisäksi nykypäivän potilaat haluavat yhä enemmän tietoa sairaudestaan ja hoidosta. Tavoitteenamme oli tehdä selkeä ja tarkoituksenmukainen opas kirurgisen lapsipotilaan vanhemmalle. Oppaan tavoitteena oli helpottaa perheen tutustumista osastoon ja selventää heille osaston toimintaperiaatteita. Pidemmän ajan toiminnallisena tavoitteena oli, että osaston henkilökunta oppisi hyödyntämään opasta jokapäiväisessä työssään. Lasten hoitotyön taustalla olevat periaatteet: perhekeskeisyys, turvallisuus, yksilöllisyys, omatoimisuus, kasvun ja kehityksen tukeminen sekä hoidon jatkuvuus, ohjaavat lasten parissa tapahtuvaa työtä ja toimintaa. Tekemämme opas pohjautuu lasten hoitotyön periaatteisiin, joiden kautta käsitellään lapsen hoitoon ja sairaalassa oloon liittyviä seikkoja. Oppaan sisältöä laatiessa käytimme lähteenä alan kirjallisuutta sekä osastolta saamaamme tietoa. Tiiviin yhteistyön avulla saimme koottua oppaasta kaikkia osapuolia miellyttävän. Tulevaisuudessa opasta voi hyödyntää kotiin lähetettävän kirjeen muodossa, jolloin vanhemmat voisivat tutustua siihen etukäteen ennen sairaalaan tuloa. Oppaan voi tulevaisuudessa kääntää myös muille kielille, kuten ruotsiksi ja venäjäksi. Myös muilla lasten ja nuorten klinikan osastoilla voidaan hyödyntää tuotostamme oppaita tehtäessä. Asiasanat: Potilasohjaus, opas, projektityö, lasten hoitotyön periaatteet, kirurginen lapsipotila

Long-term consequences of polycystic ovary syndrome on mental health and health-related quality of life

Abstract Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. It affects 9–18% of the female population, but often remains undiagnosed. In addition to the common somatic comorbidities of the syndrome, including decreased fertility and hormonal and metabolic issues, there is emerging evidence showing higher risk for psychological distress, especially depression and anxiety, in PCOS. Furthermore, the latest studies indicate an increased prevalence of more severe psychiatric diseases, e.g., schizophrenia, in females with PCOS. Thus, PCOS exerts a severe health burden which decreases the health-related quality of life (HRQoL). Despite increasing interest and research, it is still unclear how the psychological and psychiatric health and HRQoL of women with PCOS are affected through aging up to menopause, as most studies have been conducted on reproductive-aged women. The main aim of this work was to assess the risk for psychological distress and decreased HRQoL in PCOS during two different time points, at age 31 and 46, using data from the prospective longitudinal Northern Finland Birth Cohort 1966 (NFBC66). Additionally, the long-term psychosis risk in women with PCOS was assessed by linking the NFBC66 data with the national registers. The results showed a higher prevalence of anxiety and/or depression symptoms in women with PCOS at both ages. The lifetime risk for depression was nearly 2-fold higher up to age 46. PCOS was also associated with a 3-fold higher risk for psychosis until age 50, even after adjusting for parental history of psychosis, which is the most common risk factor. The affected women showed a lower HRQoL up to age 46, in addition to a decreased health status and life satisfaction. The analyses indicated that the findings could not be explained by overweight, obesity, hyperandrogenism, or infertility. Overall, the findings suggest that PCOS is an independent risk factor for psychological distress up to a late reproductive age. The study showed that women with PCOS have an increased risk for psychosis and that they experience a long-term decrease in their HRQoL. These observations highlight the need to recognize the long-term health impacts of PCOS beyond metabolic and fertility issues, especially regarding psychological distress and quality of life.Tiivistelmä Monirakkulainen munasarjaoireyhtymä (PCOS) on lisääntymisikäisten naisten yleisin hormonaalinen häiriö. Sen esiintyvyys on 9–18 % naisväestössä, mutta se on yleisesti kuitenkin alidiagnosoitu. Tavallisten somaattisten liitännäisongelmien, kuten alentuneen hedelmällisyyden sekä metabolisten vaikutusten lisäksi PCOS on näyttänyt lisääntyvässä määrin olevan yhteydessä myös psyykkisten ongelmien riskiin, esimerkiksi masennukseen ja ahdistuneisuuteen. Tämän lisäksi viimeisimmät tutkimustulokset ovat osoittaneet, että myös vakavampien mielenterveyden sairauksien, kuten skitsofrenian, esiintyvyys on kasvanut PCOS-naisilla. PCOS aiheuttaakin merkittävän terveysriskin naisille, mikä johtaa terveyteen liittyvän elämänlaadun laskuun. Lisääntyneestä kiinnostuksesta ja tutkimuksista huolimatta on edelleen epäselvää, miten PCOS:n vaikutukset psyykkiseen terveyteen ja elämänlaatuun mahdollisesti muuttuvat lähestyttäessä vaihdevuosia, sillä aiemmat tutkimukset ovat pääasiassa käsitelleet lisääntymisikäisiä naisia. Tämän työn päätavoite oli tutkia PCOS-naisten psyykkistä terveyttä ja elämänlaatua 31- ja 46-vuotiaina käyttäen tutkimusaineistona Pohjois-Suomen syntymäkohorttia 1966. Lisäksi PCOS-naisten pitkäaikaista psykoosiriskiä tutkittiin hyödyntämällä syntymäkohortin lisäksi kansallisia rekisteritietoja. Tutkimuksen tulokset osoittivat ahdistus- ja/tai masennusoireiden lisääntyneen PCOS-naisilla molemmissa aikapisteissä. Masennusriski oli lähes kaksinkertainen ikävuoteen 46 mennessä kontrolleihin verrattuna. Psykoosiriski 50 vuoden ikään mennessä oli kolminkertainen, vaikka huomioon otettiin vanhempien psykoosihistoria. Oireisilla naisilla myös elämänlaatu sekä itsearvioidut elämäntyytyväisyys ja terveydentila olivat heikentyneet 46-vuotiaaksi saakka. Analyysit osoittivat myös sen, etteivät ylipaino, hypernadrogenismi tai infertiliteetti selittäneet löydöksiä. Tutkimuksen tulokset osoittivat PCOS:n olevan itsenäinen riskitekijä psyykkisen terveyden heikentymiselle ja elämänlaadun laskulle vaihdevuosiin saakka. Tutkimus osoitti myös psykoosiriskin olevan kohonnut. Tutkimustulokset korostavat tarvetta tunnistaa PCOS:n pitkäaikaisvaikutuksia myös metaboliaan ja lisääntymiseen liittyvien seikkojen ulkopuolelta, erityisesti koskien psyykkistä terveyttä ja elämänlaatua

A population-based follow-up study shows high psychosis risk in women with PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% of women. Besides metabolic and fertility aspects, attention has lately been directed towards the detrimental effect of PCOS on psychological health. The objective of the study was to investigate whether women with PCOS are at higher risk for psychotic disorders. The study population derives from the Northern Finland Birth Cohort 1966 (N = 5889 women). The women with PCOS were identified by two simple questions on oligo-amenorrhea and hirsutism at age 31. Women reporting both symptoms were considered PCOS (N = 124) and asymptomatic women as controls (N = 2145). The diagnosis of psychosis was traced using multiple national registers up to the year 2016. Symptoms of psychopathology were identified using validated questionnaires at age 31. Women with PCOS showed an increased risk for any psychosis by age 50 (HR [95% CI] 2.99, [1.52-5.82]). Also, the risk for psychosis after age 31 was increased (HR 2.68 [1.21-5.92]). The results did not change after adjusting for parental history of psychosis, nor were they explained by body mass index or hyperandrogenism at adulthood. The scales of psychopathology differed between women with PCOS and non-PCOS controls showing more psychopathologies among the affected women. PCOS cases were found to be at a three-fold risk for psychosis, and they had increased psychopathological symptoms. PCOS should be taken into consideration when treating women in psychiatric care. More studies are required to further assess the relationship between PCOS and psychotic diseases.Peer reviewe

Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age : A population-based cohort study

Introduction This population-based follow-up study investigated the comorbidities, medication use, and healthcare services among women with polycystic ovary syndrome (PCOS) at age 46 years. Material and methods The study population derived from the Northern Finland Birth Cohort 1966 and consisted of women reporting oligo/amenorrhea and hirsutism at age 31 years and/or a PCOS diagnosis by age 46 years (n = 246) and controls without PCOS symptoms or diagnosis (n = 1573), referred to as non-PCOS women. The main outcome measures were self-reported data on symptoms, diagnosed diseases, and medication and healthcare service use at the age of 46 years. Results Overall morbidity risk was increased by 35% (risk ratio [RR] 1.35, 95% confidence interval [CI] 1.16-1.57) and medication use by 27% [RR 1.27, 95% CI 1.08-1.50) compared with non-PCOS women, and the risk remained after adjusting for body mass index. Diagnoses with increased prevalence in women with PCOS were migraine, hypertension, tendinitis, osteoarthritis, fractures, and endometriosis. PCOS was also associated with autoimmune diseases and recurrent upper respiratory tract infections and symptoms. Interestingly, healthcare service use did not differ between the study groups after adjusting for body mass index. Conclusions Women with PCOS are burdened with multimorbidity and higher medication use, independent of body mass index.Peer reviewe