Toxoplasma gondii infection and common mental disorders in the Finnish general population

Objective: We investigated whether T. gondii seropositivity is associated with 12-month depressive, anxiety and alcohol use disorders and current depressive symptoms and whether inflammation, measured by C-reactive protein (CRP) level, explains these associations. Method: Health 2000 study (BRIF8901), conducted in years 2000-2001, is based on a nationally representative sample of Finns aged 30 and above, with 7112 participants and 88.6% response rate. DSM-IV depressive, anxiety and alcohol use disorders were assessed with the Composite International Diagnostic Interview and depressive symptoms with the Beck Depressive Inventory (BDI-21). We used logistic regression to investigate the association of T. gondii seropositivity with mental disorders and linear regression with BDI-21 scores. Results: T. gondii seroprevalence was significantly associated with 12-month generalized anxiety disorder but not with other anxiety, depressive or alcohol use disorders. T. gondii seropositivity was associated with higher BDI-21 scores (beta 0.56, 95% CI 0.12-1.00, P = 0.013) and with having a comorbid depressive and anxiety disorder (OR 1.86, 95% CI 1.16-2.97, P = 0.010). Higher CRP levels were associated with these outcomes and with T. gondii seropositivity, but adjusting for CRP did not change the effect of T. gondii seropositivity. Limitations: Cross-sectional study design with no information on the timing of T. gondii infection. Conclusion: T. gondii seropositivity is associated with generalized anxiety disorder, depressive symptoms and comorbid depressive and anxiety disorders, which is not mediated by inflammation.Peer reviewe

Association of cytomegalovirus and Epstein-Barr virus with cognitive functioning and risk of dementia in the general population : 11-year follow-up study

Background: Earlier studies have documented an association between cytomegalovirus and cognitive impairment, but results have been inconsistent. Few studies have investigated the association of cytomegalovirus and Epstein-Barr virus with cognitive decline longitudinally. Our aim was to examine whether cytomegalovirus and Epstein-Barr virus are associated with cognitive decline, in adults. Method: The study sample is from the Finnish Health 2000 Survey (BRIF8901, n = 7112), which is representative of the Finnish adult population. The sample was followed up after 11 years in the Health 2011 Survey. In addition, persons with dementia were identified from healthcare registers. Results: In the Finnish population aged 30 and over, the seroprevalence of cytomegalovirus was estimated to be 84% and the seroprevalence of Epstein-Barr virus 98%. Seropositivity of the viruses and antibody levels were mostly not associated with cognitive performance. In the middle-aged adult group, cytomegalovirus serointensity was associated with impaired performance in verbal learning. However, the association disappeared when corrected for multiple testing. No interactions between infection and time or between the two infections were significant when corrected for multiple testing. Seropositivity did not predict dementia diagnosis. Conclusions: The results suggest that adult levels of antibodies to cytomegalovirus and Epstein-Barr virus may not be associated with a significant decline in cognitive function or with dementia at population level. (C) 2018 Published by Elsevier Inc.Peer reviewe

The association between toxoplasma and the psychosis continuum in a general population setting

Toxoplasma gondii infection is associated with increased risk for psychosis. However, the possible association between T. gondii and psychotic-like symptoms in the general adult population is unknown. We investigated whether T. gondii is associated with psychotic-like symptoms and psychosis diagnoses using data from Health 2000, a large cross-sectional health survey of the Finnish general population aged 30 and above. Seropositivity to toxoplasma was defined as a cutoff of 50 IU/ml of IgG antibodies. Lifetime psychotic-like symptoms were identified with section G of the Composite International Diagnostic Interview, Munich version (M-CIDI). Symptoms were considered clinically relevant if they caused distress or help-seeking or there were at least three of them. Lifetime psychotic disorders were screened from the sample and were diagnosed with DSM-IV using SCID-I interview and information from medical records. All data were available for 5906 participants. We adjusted for variables related to T. gondii seropositivity (age, gender, education, region of residence, cat ownership, and C-reactive protein measuring inflammation) in regression models. We found that T. gondii seropositivity was significantly associated with clinically relevant psychotic-like symptoms (OR 1.77, p = 0.001) and with the number of psychotic-like symptoms (IRR = 1.55, p = 0.001). The association between toxoplasma and diagnosed psychotic disorders did not reach statistical significance (OR 1.45 for schizophrenia). In a large sample representing the whole Finnish adult population, we found that serological evidence of toxoplasma infection predicted psychotic-like symptoms, independent of demographic factors and levels of C-reactive protein. Toxoplasma infection may be a risk factor for manifestation of psychotic-like symptoms. (c) 2017 Elsevier B.V. All rights reserved.Peer reviewe

The effectiveness of email-based exercises in promoting psychological wellbeing and healthy lifestyle: a two-year follow-up study

Web-based interventions provide a possibility to enhance well-being in large groups of people. Only a few studies have studied the effectiveness of the interventions and there is no information on the sustainability of the effects. Study aims were to investigate both the short (2-month) and long-term (2-year) effects of email-based training for mental health and lifestyle.Peer reviewe

Immigrants’ mental health service use compared to that of native Finns: a register study

Purpose Many aspects related to migration might predispose immigrants to mental health problems. Yet immigrants have been shown to underuse mental health services. The aim of this study was to compare the intensity of psychiatric care, as an indicator of treatment adequacy, between natives and immigrants living in Finland. Methods We used nationwide register data that included all the immigrants living in Finland at the end of 2010 (n = 185,605) and their matched controls. Only those who had used mental health services were included in the analyses (n = 14,285). We used multinomial logistic regression to predict the categorized treatment intensity by immigrant status, region and country of origin, length of residence, and other background variables. Results Immigrants used mental health services less than Finnish controls and with lower intensity. The length of residence in Finland increased the probability of higher treatment intensity. Immigrants from Eastern Europe, sub-Saharan Africa, the Middle East, and Northern Africa were at the highest risk of receiving low-intensity treatment. Conclusions Some immigrant groups seem to persistently receive less psychiatric treatment than Finnish-born controls. Identification of these groups is important and future research is needed to determine the mechanisms behind these patterns.Peer reviewe

Childhood adversities and clinical symptomatology in first-episode psychosis

In addition to severe traumatic experiences, milder, more common childhood adversities reflecting psychosocial burden may also be common in people with psychotic disorders and have an effect on symptomatology and functioning. We explored eleven negative childhood experiences and their influence on clinical symptoms among young adults with first-episode psychosis (FEP, n = 75) and matched population controls (n = 51). Individuals with FEP reported more adversities than controls. Specifically serious conflicts within the family, bullying at school, maternal mental health problems, and one's own and parents' serious illness during childhood were experienced by the patients more often than by controls. In the FEP group, the severity of adversity was associated with increased anxiety, manic, and obsessive-compulsive symptoms, but not with the severity of positive psychotic symptoms. Adversity produced a more pronounced effect on symptoms in male patients than in female patients. To conclude, in line with earlier studies of more chronic psychosis, a majority of the participants with FEP reported exposure to childhood adversities, with the FEP group reporting more adversities than controls. High levels of mood and anxiety symptoms in patients with FEP may be related to cumulative exposure to childhood adversities. This should be taken into account in the treatment for FEP.Peer reviewe

Theory of mind in a first-episode psychosis population using the Hinting Task

Deficiencies in theory of mind (ToM) are common in psychosis and may largely explain impaired social functioning. Currently, it is unclear whether impairments in ToM are explained by the more general cognitive deficits related to psychosis or whether ToM is impaired in psychosis independently of other cognitive deficits. This study examined ToM using the Hinting Task in young adults (n=66) with first-episode psychosis and matched controls (n=62). The participants were administered a broad neuropsychological assessment. Participants with psychosis performed worse than controls on the Hinting Task. However, 75 % of the variance between the groups was explained by general cognitive deficits, especially impaired processing speed and episodic memory. Hinting Task performance of the best functioning patient group did not differ from that of the control group. When the psychosis group was divided according to diagnosis, the Hinting Task difference between individuals with schizophrenia and controls remained significant even when general cognitive performance was controlled for, suggesting specific verbal ToM deficits in schizophrenia. In contrast, those with other psychotic disorders did not differ from controls. Our results suggest that ToM deficits can be seen in early phases of psychotic disorders, schizophrenia in particular, and are partly independent of other cognitive functions.Peer reviewe

Low-grade inflammation in first-episode psychosis is determined by increased waist circumference

Psychosis is associated with low-grade inflammation as measured by high-sensitivity C-reactive protein (hs-CRP), a risk factor for cardiovascular events and mortality in the general population. We investigated the relationship between hs-CRP and anthropometric and metabolic changes in first-episode psychosis (FEP) during the first treatment year. We recruited 95 FEP patients and 62 controls, and measured longitudinal changes in hs-CRP, weight, waist circumference, insulin resistance, and lipids. We used linear mixed models to analyze the longitudinal relationship between hs-CRP and clinical, anthropometric and metabolic measures. At baseline, patients with FEP had higher levels of insulin resistance, total and low-density lipoprotein cholesterol, apolipoprotein B, and triglycerides. Baseline weight, waist circumference, hs-CRP, fasting glucose, and high-density lipoprotein cholesterol were similar between patients and controls. Marked increases in anthropometric measures and hs-CRP were observed in FEP during the 12-month follow-up. However, glucose and lipid parameters did not change significantly. In the mixed models, waist circumference and female sex were significant predictors of hs-CRP levels in FEP. Prevention of the early development of abdominal obesity in FEP is crucial, as abdominal obesity is accompanied by chronic low-grade inflammation, which increases further the cardiovascular risk in this vulnerable population.Peer reviewe

Lasten mielenterveyspalvelujärjestelmä terveyskeskuslääkäreiden näkökulmasta

JOHDANTO. Kuvaamme, millaisena lasten mielenterveyspalvelujärjestelmä Suomessa näyttäytyy koulu- ja neuvolalääkäreiden näkökulmasta.MENETELMÄT. Laadullisessa poikittaistutkimuksessa 17 eri sairaanhoitopiirin 17 kunnan neuvola- ja koululääkäriä vastasi puolistrukturoidussa haastattelussa lasten mielenterveyspalvelujärjestelmää koskeviin kysymyksiin. Vastausten sisältö koodattiin sisällönanalyyttisellä menetelmällä ja järjesteltiin teemoittain.TULOKSET. Perustasolla tehty yhteistyö ja lastenpsykiatrisen erikoissairaanhoidon jalkautuva toiminta koettiin useimmin myönteisiksi. Perustason kykyä hoitaa tarvetta vastaavasti ja yhdenvertaisesti lasten lieviä ja keskivaikeita psyykkisiä häiriöitä ei pidetty riittävänä.PÄÄTELMÄT. Palvelujärjestelmän valmiutta lasten psyykkisten häiriöiden tunnistamiseen on kehitetty tuloksellisesti. Kehittämistyötä tulisi jatkaa edistämällä perustason hoitomahdollisuuksia ja näyttöön perustuvien hoitomenetelmien käyttöönottoa.Mental health services for children in primary and specialized care in Finland. A qualitative studyBACKROUND. In this qualitative study we describe how children’s mental health service system is being seen from the primary care doctor’s point of view.METHODS. 17 doctors working in school health services and child welfare clinics in municipalities of varying sizes in different parts of Finland answered a semi-structured interview of children’s mental health service system issues. We coded the contents of the answers using content analysis methods and organized them by themes.RESULTS. Co-operation within municipality on the primary level and consultations of child psychiatric special care were most frequently perceived positive. Currently, children in primary care do not get the treatment they need for their mild or moderate mental disorders on an equal basis.CONCLUSIONS. The readiness of the service system to identify children’s mental disorders has been developed successfully in Finland. Evidence-based treatment methods should be promoted to enhance treatment in primary care.</p

Lasten mielenterveyspalvelujärjestelmä terveyskeskuslääkäreiden näkökulmasta

JOHDANTO. Kuvaamme, millaisena lasten mielenterveyspalvelujärjestelmä Suomessa näyttäytyy koulu- ja neuvolalääkäreiden näkökulmasta. MENETELMÄT. Laadullisessa poikittaistutkimuksessa 17 eri sairaanhoitopiirin 17 kunnan neuvola- ja koululääkäriä vastasi puolistrukturoidussa haastattelussa lasten mielenterveyspalvelujärjestelmää koskeviin kysymyksiin. Vastausten sisältö koodattiin sisällönanalyyttisellä menetelmällä ja järjesteltiin teemoittain. TULOKSET. Perustasolla tehty yhteistyö ja lastenpsykiatrisen erikoissairaanhoidon jalkautuva toiminta koettiin useimmin myönteisiksi. Perustason kykyä hoitaa tarvetta vastaavasti ja yhdenvertaisesti lasten lieviä ja keskivaikeita psyykkisiä häiriöitä ei pidetty riittävänä. PÄÄTELMÄT. Palvelujärjestelmän valmiutta lasten psyykkisten häiriöiden tunnistamiseen on kehitetty tuloksellisesti. Kehittämistyötä tulisi jatkaa edistämällä perustason hoitomahdollisuuksia ja näyttöön perustuvien hoitomenetelmien käyttöönottoa.Peer reviewe