Psychosis among "healthy" siblings of schizophrenia patients

BACKGROUND: Schizophrenia aggregates in families and accurate diagnoses are essential for genetic studies of schizophrenia. In this study, we investigated whether siblings of patients with schizophrenia can be identified as free of any psychotic disorder using only register information. We also analyzed the emergence of psychotic disorders among siblings of patients with schizophrenia during seven to eleven years of follow-up. METHODS: A genetically homogenous population isolate in north-eastern Finland having 365 families with 446 patients with a diagnosis of schizophrenia was initially identified in 1991 using four nationwide registers. Between 1998 and 2002, 124 patients and 183 siblings in 110 families were contacted and interviewed using SCID-I, SCID-II and SANS. We also compared the frequency of mental disorders between siblings and a random population comparison group sample. RESULTS: Thirty (16%) siblings received a diagnosis of psychotic disorder in the interview. 14 siblings had had psychotic symptoms already before 1991, while 16 developed psychotic symptoms during the follow-up. Over half of the siblings (n = 99, 54%) had a lifetime diagnosis of any mental disorder in the interview. CONCLUSION: Register information cannot be used to exclude psychotic disorders among siblings of patients with schizophrenia. The high rate of emergence of new psychotic disorders among initially healthy siblings should be taken into account in genetic analysis

Can mental health diagnoses in administrative data be used for research? A systematic review of the accuracy of routinely collected diagnoses

BACKGROUND: There is increasing availability of data derived from diagnoses made routinely in mental health care, and interest in using these for research. Such data will be subject to both diagnostic (clinical) error and administrative error, and so it is necessary to evaluate its accuracy against a reference-standard. Our aim was to review studies where this had been done to guide the use of other available data. METHODS: We searched PubMed and EMBASE for studies comparing routinely collected mental health diagnosis data to a reference standard. We produced diagnostic category-specific positive predictive values (PPV) and Cohen’s kappa for each study. RESULTS: We found 39 eligible studies. Studies were heterogeneous in design, with a wide range of outcomes. Administrative error was small compared to diagnostic error. PPV was related to base rate of the respective condition, with overall median of 76 %. Kappa results on average showed a moderate agreement between source data and reference standard for most diagnostic categories (median kappa = 0.45–0.55); anxiety disorders and schizoaffective disorder showed poorer agreement. There was no significant benefit in accuracy for diagnoses made in inpatients. CONCLUSIONS: The current evidence partly answered our questions. There was wide variation in the quality of source data, with a risk of publication bias. For some diagnoses, especially psychotic categories, administrative data were generally predictive of true diagnosis. For others, such as anxiety disorders, the data were less satisfactory. We discuss the implications of our findings, and the need for researchers to validate routine diagnostic data. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-016-0963-x) contains supplementary material, which is available to authorized users

Toimeentuloturvan oikeellisuus : Toimeentuloturvaa koskevan lainsäädännön suhde perustuslakiin, erityisesti perusoikeuksiin, ihmisoikeuksiin ja yhteisöoikeuteen

Tutkimuksessa selvitetään Suomen toimeentuloturvaa koskevan lainsäädännön oikeellisuutta suhteessa perustuslakiin, erityisesti perusoikeuksiin, ihmisoikeuksiin ja yhteisöoikeuteen. Oikeellisena pidetään toimeentuloturvaa koskevaa säännöstä, jos 1) se aineelliselta sisällöltään vastaa perus- ja ihmisoikeuksien sekä yhteisöoikeuden asettamia vaatimuksia, 2) sitä toimeenpannaan samojen säännösten kannalta moitteettomilla säännöksillä, 3) se on säädetty asianmukaisella tasolla ja 4) siihen ei sisälly muutenkaan lainsäädännöllisiä virheitä. Toimeentuloturvaksi on määritelty lainsäädäntöön perustuvat rahamääräiset etuudet. Menettelyllisestä lainsäädännöstä tutkimuksesta on rajattu yleinen hallinto-oikeus sekä muutoksenhaku. Toimeentuloturvaa koskevina perus- ja ihmisoikeuksina on tarkasteltu vain nimenomaisesti toimeentuloa koskevia oikeuksia. Näin ollen tutkimuksesta on rajattu sellaisia perus- ja ihmisoikeuksia kuin yhdenvertaisuus ja yksityiselämän suoja. Vastaava rajaus on tehty yhteisöoikeuden tarkasteluun. Tutkimuksessa on lainvalmisteluasiakirjojen, tuomioistuinten päätösten ja tieteellisen kirjallisuuden avulla selvitetty perustuslain, ihmisoikeuksien ja yhteisöoikeuden sisältöä. Perus- ja ihmisoikeuksia ja yhteisöoikeuden sisältöä vasten on arvioitu, onko toimeentuloturvaa koskeva lainsäädäntö oikeellista. Suomen voimassa oleva lainsäädäntö pääosin täyttää oikeellisuuden vaatimukset. Etuuksien tasossa ja kestossa sekä vähäisemmässä määrin henkilöpiirin kattavuudessa on eräitä puutteellisuuksia. Menettelyllisten säännösten suhteellisen vähäiset puutteet johtuvat etupäässä lainsäädännön vanhentuneisuudesta ja laatimisesta ennen perusoikeuksien uudistamista.10,45 euro

Eureka! On Courts' Discretion in 'Ascertaining' Rules of Customary International Law

The ascertainment of rules of customary international law has been typically inserted in the methodological dualism between induction and deduction. By induction, lawyers find existing legal rules on the basis of the empirical material – state practice and opinio juris. By deduction, instead, lawyers find legal rules by deducing them from existing principles and rules of international law. Notably, while induction is portrayed as empirically grounded – therefore objective – deduction is presented as a logical exercise, thus disguising the margin of manoeuvre that interpreters enjoy in ascertaining rules of customary international law.  The present contribution contends that the methodological dualism informing the discourse on the ascertainment of rules of customary international law shall be revisited to reflect the argumentative nature of such an ascertainment. The alternative dualism between discovery and justification is thus proposed. This twist is conducive to unveil the range of discretion exercised by courts in the formulation of rules of customary international law, instead of embracing the methodological lens which rather mystifies it. Accordingly, courts operate within an argumentative framework in that they necessarily select and appreciate evidence of practice and opinio juris, which is far from being incontrovertible, let alone fully representative of the majority of states. In other terms, the selection and assessment of practice and opinio juris are but the result of an act of judicial discretion, which is obscurely surfacing every act of legal interpretation. Yet, owing to the authority of courts in a legal order, their formulation of presumably existing rules of customary international law is a necessary endeavour for the materialization of such ‘rules’ and their fruition by the legal practice.</div