Adolescence predictors for drug crime offending:a follow-up study of former adolescent psychiatric inpatients

Abstract Our aim was to examine adolescent predictors (family- and school-related factors, substance use, and psychiatric disorders) for drug crime offending. The initial study population consisted of 508 former adolescent psychiatric inpatients aged between 13 and 17 years. Of them, 60 (12%) had committed a drug crime by young adulthood and they were matched with 120 (24%) non-criminal controls by sex, age and family type. During adolescent hospitalization, study participants were interviewed using valid semi-structured research instruments. Criminal records were obtained from the Finnish Legal Register Centre up to young adulthood. A distant relationship with a father, lying, and thieving, moderate/high nicotine dependence and weekly use of stimulants were shown to be the most prominent predictors for drug crime offending. Our findings encourage the use of modern child- and family-centered approaches in preventing youth involvement in illegal drug use and drug crimes

Profile of substance misuse among adolescent and young adult gabapentinoid users:a register-based follow-up study of former adolescent psychiatric inpatients

Abstract Aims: Our study examined characteristics of adolescent and young adult study participants using gabapentinoids (gabapentin, pregabalin), with previous history of adolescent psychiatric inpatient hospitalization. Particular focus was on temporal association of age, at first prescription for gabapentinoids, to age at tobacco smoking initiation, regular alcohol use, diagnosis of substance dependence and prescriptions for benzodiazepines and opioids. Methods: The initial study population contained 508 adolescents (300 females, 208 males) admitted to psychiatric inpatient care in Oulu University hospital between the ages 13–17 years. Register-based follow-up information on prescriptions for gabapentinoids, benzodiazepines and opioids, as well as ICD-10 diagnosis for hospital-treated substance dependence, was obtained from the Finnish national health care registers. Results: The users of gabapentinoids accounted for 9.1% of the initial study population. Of adolescence-related characteristics, suicidal ideation, suicide attempts and non-suicidal self-injury was emphasized in females using gabapentinoids. The majority of participants using gabapentinoids had benzodiazepines (80.4%) and opioids (71.7%) as comorbid drugs. Initiation of tobacco smoking and alcohol use and first prescriptions for of benzodiazepines and opioids, and a diagnosis of substance dependence commonly predated first prescriptions for gabapentinoids. Conclusions: In clinical practice, the decision to prescribe gabapentinoids to adolescents or young adults must be made with caution, particularly for those with substance use problems and/or without a clinically approved indication

Light motor vehicle collisions with heavy vehicles:psychosocial and health related risk factors of drivers being at-fault for collisions

Abstract Background: Fatal head-on collisions between passenger cars and trucks are sometimes thought as self-inflicted death of the passenger car drivers. Methods: A total of 378 Finnish drivers of light motor vehicles (LMV) died in collisions with heavy vehicles between the years 2002–2011. These male and female drivers, who were considered as being at fault, and whose collisions with heavy vehicles occurred in the oncoming vehicle’s lane, were explored in relation to information on their socio-demographics, physical and mental health condition and driving-related factors. Results: Cause of death of at-fault LMV drivers, as defined in medico-legal examination, was most commonly accidental (51%), followed by suicide (32%), undetermined intent (17%) and acute illness (0.3%). Ten-year time trend in rates of LMV drivers has remained stable (Annual Percentage Change, APC = −0.03; p = 0.983), the annual proportion varying between 14%–21%. However, a statistically significantly increasing time trend was observed in fatal accidents due to suicides (APC = 5.31, p = 0.028). Generally, at-fault LMV drivers were characterized as having mental health problems susceptibility to risk (44%), personal relationship problems (33%), long-term physical illness (68%) or medication (35%) or driving under influence of alcohol (24%). Male LMV drivers, compared to women, were more commonly unmarried, farm/wood/industrial workers and drove alone and without a planned destination. Female LMV drivers were, more commonly than men, widowed, third degree students, skilled workers, had long term mental illnesses/disturbances, drove with family member(s) and their fatal accidents occurred in winter. Conclusion: The findings give support to the recommendation that suicidal ideation must be considered when assessing fitness-to-drive

Familial risk factors in relation to recurrent depression among former adolescent psychiatric inpatients

Abstract Treating recurrent depression is a challenge for clinical practitioners. We investigated which family environmental factors contribute to differences between recurrent and non-recurrent depression by the young adulthood of the former adolescent inpatients. The initial sample covered 237 adolescent psychiatric inpatients with depression, of which 35.4% had later diagnosed with recurrent depression. Recurrence in depression was associated to distant maternal relationships in both male (p = 0.022) and female patients (p = 0.042). In females, the likelihood for recurrent depression was also related to psychiatric problems of the father (p = 0.013) and siblings (OR = 3.7, p = 0.032), and having a grand multiparous mother (p = 0.005). Our results emphasise the need for effective family-centred approaches in treatment of adolescents with depression

Associations of adolescent psychosocial factors to later benzodiazepine use:a population-based follow-up study of adolescent psychiatric inpatients in Northern Finland

Abstract We investigated factors associated with benzodiazepine (BZD) use during late adolescence and early adulthood. The study population consisted of 508 adolescents admitted to psychiatric inpatient care between April 2001 and March 2006. Information on adolescents’ family- and school-related factors, suicidality and psychiatric disorders were obtained by semistructured interviews. Data on BZD prescriptions from 1999 to 2012 were collected from the Social Insurance Institution of Finland. In males heavy BZD use associated with adolescent substance-use disorder (OR, 3.5; P < 0.004) and parents’ psychiatric problems (OR, 3.5; P = 0.029). Among females, conduct disorder (OR, 3.3; P = 0.016), being a bully/bully-victim (OR, 3.3; P = 0.019) and parental substance-use problems (OR, 2.6; P = 0.024) were related to heavy BZD use. The mean (±SD) age of first BZD prescription was significantly lower in heavy, compared with mild users (men: 19.3 ± 2.5 vs. 21.0 ± 2.5 years, P = 0.027; women: 19.7 ± 2.6 vs. 21.5 ± 3.4 years, P = 0.027). Heavy, compared with mild, BZD use is associated with female suicide attempts (OR, 5.0; P = 0.049). Physicians should be cautious when prescribing BZDs to young adults and must allocate treatment to those with carefully evaluated clinical indications

Miten itsemurhariskiä voidaan arvioida?

Tiivistelmä Suomi on muihin Pohjoismaihin verrattuna suuren itsemurhakuolleisuuden maa. Yksilöllistä itsemurhariskiä ei nykyisillä menetelmillä pystytä luotettavasti määrittämään, mutta suhteellista riskin suurenemista voidaan arvioida selvittämällä riskitekijöiden kasautumista ja potilaan elämäntilannetta kokonaisuutena. Merkittävin yksittäinen itsemurhan riskitekijä on aiempi itsemurhayritys. Muita merkittäviä itsemurhan riskitekijöitä ovat muun muassa mielenterveyden häiriöt, kuten mielialahäiriöt, psykoosit, persoonallisuushäiriöt ja päihdehäiriöt, sekä tietyt sosiodemografiset tekijät kuten työttömyys. Toivottomuus oirekuvassa on diagnoosista riippumatta suuren riskin merkki. Riskiä arvioitaessa tulee itsemurha-ajatuksista kysyä potilaalta suoraan. Myös strukturoituja kyselyjä voidaan käyttää riskinarvion tukena. Arviossa tulee pyrkiä kokonaisvaltaiseen ymmärrykseen potilaan psyykkisestä voinnista ja ajankohtaisista kuormitustekijöistä. Myös suojaavien tekijöiden kartoittaminen on osa onnistunutta kokonaisarviota

Sex-specific predictors of exposure to hospital-treated assaults among former adolescent psychiatric inpatients

Abstract This study examined the associations of psychiatric disorders, suicidal behavior and family-related characteristics during adolescence, to subsequent experiences of hospital-treated physical, or sexual assaults, among 508 young adults with a history of psychiatric inpatient care at adolescence (aged 13–17 years). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) based adolescent psychiatric disorders were assessed at index hospitalization using Schedule for Affective Disorder and Schizophrenia for School-Age children, Present and Lifetime version (K-SADS-PL). Treatment episodes for assaults were obtained from the health care register, provided by the Finnish National Institute for Health Welfare. About 14.4% of the participants had experienced physical or sexual assault during their lifetime. Results of logistic regression analysis indicated that anxiety disorder (odds ratio [OR] = 9.6) and nonsuicidal self-injury (OR = 3.7) in adolescence for males, and personality disorder (OR = 3.4) for females, were associated with increased likelihood for subsequent assault exposure leading to hospitalization. These findings can be used in targeting vulnerable adolescents and designing primary prevention strategies

Assisted living for mentally ill:a systematic literature review and its recommendations

Abstract Background: The reduction in psychiatric hospital beds in the past decades has created a need for assisted living (AL). Even though AL is widely used, studies on it are scarce. Aims: To identify (1) study characteristics of the reviewed articles, (2) characteristics of inhabitants and characteristics of different types of AL, (3) financial costs in different types of AL, (4) the individual outcomes in AL inhabitants and quality of care. Methods: A systematic literature review on AL for the mentally ill focusing on inhabitant and AL features and their costs was conducted. Articles written in English from January 2000 to June of 2020, concerning adults were included. Simple Taxonomy of Supported Housing (STAX-SA) was applied and used for categorizing types of AL. Results: Twenty-five papers met our criteria. The majority of inhabitants were unemployed single male with psychotic disorders. The type of AL is mainly categorized according to staffing, provided support, and housing arrangement. In UK ALs with moderate support (STAX-SA 2–3) had the best quality of care while ALs with low support (STAX-SA 4) was the cheapest. Quality of care was better in small units with preset expected length of stay for inhabitants. Hospital treatment was significantly more expensive than any type of AL. Living in AL improved quality of life compared to hospital treatment, also psychiatric symptoms were reduced. Conclusions: There is an evident need for evidence-based studies in a longitudinal comprehensive manner that evaluates different AL types, function of the inhabitants, and costs with respect to the quality of AL and care and outcome

Misuse of prescribed psychotropic medication and drug crime offending:a follow-up case-control study of former adolescent psychiatric inpatients

Abstract Background: Various psychotropic prescription drugs are known to have potential for misuse. Among teenagers, non-medical use of prescription drugs may predate illicit drug use or occur concomitantly. Aims: Our aim was to examine prescriptions of psychotropic medications among drug crime offenders and non-criminal controls in a psychiatric inpatient cohort of 13–17-year-olds. Our research question was: were prescribed psychotropic and potentially addictive drugs associated with later drug crime offending. Methods: Our sample was of all 60 adolescents who had been convicted of a drug crime by young adulthood with a twice-sized control group, matched for gender, age and family-type, from a cohort of 508 adolescents consecutively admitted to a psychiatric inpatient care in Finland between April 2001 and March 2006. Adolescence-related information on substance use and psychiatric disorders was obtained by semi-structured interviews. Follow-up information on crimes and medication purchases was obtained from Finnish nationwide registers. The association of studied factors to drug crime offending was examined using stepwise binary logistic regression analysis. Results: 75% of drug crime offenders and 47% of non-criminal controls had used addictive psychotropic medications during the follow-up period (p < 0.001). 74% of all drug crime offenders’ purchases of prescribed addictive drugs occurred within the year preceding drug crimes. Of addictive drugs, the use of clonazepam and gabapentinoids was most likely to associate with drug crime offending (AOR 7.77, p < 0.001). Conduct and substance use disorders diagnosed in adolescence (AOR 3.49, p = 0.010; AOR 2.34, p = 0.050) were predictors for drug crime offending. Conclusions: Our findings suggest that, when treating young adults with conduct disorder and a history of substance use, physicians should prescribe addictive medications with caution, favouring instead non-addictive medications complemented by psychosocial interventions

Prevalence of neoplasms among former adolescent psychiatric inpatients

Abstract Objective: To examine the association between psychiatric disorders and neoplasms. Methods: A follow-up study of a population-based cohort of patients admitted for psychiatric care between the ages 13–17 years. The cases were patients with a follow-up diagnosis of neoplasm. The K-SADS-PL interview was used to assess DSM-IV based psychiatric diagnoses at adolescence. The treatment episodes due to neoplasms and related psychiatric disorders were extracted from the National Health Care Registers. Results: Of the original cohort, 6.3% of subjects had a neoplasm diagnosis. Male cases were characterized as taking snuff and females as having a fear of becoming obese. 75% of cases had smoked regularly and 47% suffered from substance misuse disorder already in adolescence. At a mean age of 22 years, the diagnoses of skin or soft tissue neoplasms were prevailing, three being malignant neoplasms of the skin, mouth or colon. Non-psychotic disorders were comorbid both two years before (26%) and after (33%) the neoplasm diagnosis. Conclusion: Focus on psychiatric symptoms of patients with neoplasms may enhance their treatment outcome and quality of life