Psychopathy and Mortality

It is not known how mortality differs between psychopathic and nonpsychopathic individuals. We linked data from subjects having been in forensic mental examinations at Niuvanniemi Hospital during 1984–1993 to the data from the National Death Registry to estimate the association between psychopathy and mortality. One hundred psychopathic individuals scoring 25 or higher in the PCL-R scale were followed up for 20–30 years. Two control groups were used as follows: 178 offenders scoring less than 25 on the PCL-R, and sample of general population drawn from the Finnish National Statistics database. Results reveal that psychopaths die younger than the general population, and the causes of death are more violent than in the nonpsychopath control group. There was a significant positive correlation between PCL-R score and mortality, and the mortality among psychopaths was about fivefold when compared with general population.Peer reviewe

Comorbid opioid use is undertreated among forensic patients with schizophrenia

BackgroundSubstance use disorders are associated with poorer clinical outcomes in patients with schizophrenia. There is no specific treatment for amphetamine or cannabis use disorder, but methadone and buprenorphine are used as replacement therapy in the treatment of opioid dependence. Our aim was to study whether patients with schizophrenia have received opioid replacement therapy for their opioid use disorder.MethodsThe study sample consisted of 148 individuals diagnosed with schizophrenia who were in involuntary psychiatric treatment as forensic patients in Finland in 2012. The proportion of the study sample with comorbid opioid use disorder having received opioid replacement therapy prior to their forensic psychiatric treatment was compared to the available information of opioid dependent patients in general. The data were collected from forensic examination statements, patient files and other medical registers retrospectively.ResultsOf the study sample, 15.6% (23/148) had a history of opioid use disorder, of whom 8.7% (2/23) had received opioid replacement treatment (95% confidence interval (Cl): 1.1-28.0), even though opioid use disorder had been diagnosed in the treatment system. According the available information the corresponding proportion among patients with opioid use disorder and using substance use disorder services was 30.4% (565/1860, 95% Cl: 28.3-32.5). The fraction of patients receiving opioid replacement therapy was significantly lower among patients with schizophrenia (p=0.022).ConclusionsOpioid replacement therapy was seldom used among schizophrenia patients who were later ordered to involuntary forensic psychiatric treatment. More attention should be paid to the possible use of opioids when planning treatment for patients with schizophrenia.Trial registrationOur study is not a randomized controlled trial (but a register-based study); thus the trial registration is not applicable.Peer reviewe

Cause-specific mortality in Finnish forensic psychiatric patients

Purpose: To analyze the causes of mortality among patients committed to compulsory forensic psychiatric hospital treatment in Finland during 1980-2009 by categorizing the causes of mortality into somatic diseases, suicides and other unnatural deaths.Materials and methods: The causes of mortality were analyzed among 351 patients who died during the follow-up. Standardized mortality ratio (SMR) was calculated as the ratio of observed and expected number of deaths by using the subject-years methods with 95% confidence intervals, assuming a Poisson distribution. The expected number of deaths was calculated on the basis of sex-, age- and calendar-period-specific mortality rates for the Finnish population.Results: The vast majority (249/351) of deaths were due to a somatic disease with SMR of 2.6 (mean age at death 61 years). Fifty nine patients committed suicide with a SMR of 7.1 (mean age at death 40 years). Four patients were homicide victims (mean age at death 40 years) and 32 deaths were accidental (mean age at death 52 years). The combined homicides and accidental deaths resulted in a SMR of 1.7.Conclusions: The results of this study point out that the high risk for suicide should receive attention when the hospital treatment and the outpatient care is being organized for forensic psychiatric patients. In addition, the risk of accidents should be evaluated and it should be assured that the patients receive proper somatic healthcare during the forensic psychiatric treatment and that it continues also in the outpatient setting.Peer reviewe

Female Psychopathy and Mortality

The mortality of female psychopaths has scarcely been investigated. To estimate the association between psychopathy and mortality, data from subjects having been in forensic psychiatric assessments at Niuvanniemi Hospital during 1984-1993 were linked to the data from the National Death Registry. Sixteen psychopathic females scoring 25 points or higher in the PCL-R scale (psychopaths) were followed up for a median (IQR) 21 (17-25) years and 41 offenders scoringPeer reviewe

The iPSC perspective on schizophrenia

Over a decade of schizophrenia research using human induced pluripotent stem cell (iPSC)-derived neural models has provided substantial data describing neurobiological characteristics of the disorder in vitro. Simultaneously, translation of the results into general mechanistic concepts underlying schizophrenia pathophysiology has been trailing behind. Given that modeling brain function using cell cultures is challenging, the gap between the in vitro models and schizophrenia as a clinical disorder has remained wide. In this review, we highlight reproducible findings and emerging trends in recent schizophrenia-related iPSC studies. We illuminate the relevance of the results in the context of human brain development, with a focus on processes coinciding with critical developmental periods for schizophrenia.Peer reviewe

The Association of Ambient Temperature and Violent Crime

It is controversial if global warming will result into increased crime and conflict rate, and no causal neurobiological mechanisms have been proposed for the putative association between ambient temperature and aggressive behavior. This study shows that during 1996-2013, ambient temperature explained 10% of variance in the violent crime rate in Finland, corresponding to a 1.7% increase/degree centigrade. Ambient temperature also correlated with a one month delay in circannual changes in peripheral serotonin transporter density among both offenders and healthy control subjects, which itself correlated strongly with the monthly violent crime rate. This suggests that rise in temperature modulates serotonergic transmission which may increase impulsivity and general human activity level, resulting into increase in social interaction and risk of violent incidents. Together, these results suggest that the effect of ambient temperature on occurrence of violent crime is partly mediated through the serotonergic system, and that a 2 degrees C increase in average temperatures would increase violent crime rates by more than 3% in non-tropical and non-subtropical areas, if other contributing factors remained constant.Peer reviewe

Psychosis and the Risk of Stranger Homicides

Funding Information: The study was funded by the Finnish Ministry of Social Affairs and Health, through the developmental fund for Niuvanniemi Hospital. IO has received a personal grant from the Finnish Medical Foundation, and ML has received personal grants from the Finnish Medical Foundation, Emil Aaltonen Foundation, and the Finnish Cultural Foundation. The funders were not involved in the conduct of the study or in the collection, management, analysis, or interpretation of the data. Funding Information: We thank Hannu Kautiainen (Medcare Oy) for his work with statistical analyses and Aija Räsänen for secretarial assistance. IO has received research funding from the Finnish Medical Foundation, honoraria from Ratiopharm, consultancy fees from Camurus, and has attended a congress trip provided by MSD. ML is an owner and board member of Genomi Solutions Ltd and Nursie Health Ltd, and has received honoraria, study grants, or other financial support from Sunovion, Orion Pharma, Janssen-Cilag, Otsuka Pharma, Lundbeck, Medscape, the Finnish Medical Foundation, Emil Aaltonen Foundation, and the Finnish Cultural Foundation. JT has participated in research projects funded by grants from Janssen-Cilag and Eli Lilly to his employing institution. He reports lecture fees from Eli Lilly, Janssen-Cilag, Lundbeck, and Otsuka; consultancy fees from EMA (European Medicines Agency), Fimea (Finnish Medicines Agency), and Lundbeck; He also notes receipt of grants from the Stanley Foundation and the Sigrid Jusélius Foundation. MLe and HP report no conflicts of interest.Psychosis increases the risk of committing homicide, but it remains unclear whether it also affects victim selection. Individual cases of stranger homicide elicit a lot of public attention and outrage, even though evidence of their incidence is scarce. Methods: Forensic psychiatric reports of 389 patients who had committed homicide in Finland during 1980-2014 were examined to determine the relationship between the offender and the victim. The stranger homicide incidence derived from perpetrators with psychosis was compared to a comparative incidence derived from a group of perpetrators without psychosis (other mental disorders were not excluded) over the time frame 2003-2014. Stranger homicide incidence rates were calculated using Finnish population averages of the study years, assuming a Poisson distribution and reported as per 100 000 person-years among potential victims in the Finnish general population. Results: Three hundred and eighty nine patients with psychosis had committed 414 homicides, with 40 complete stranger victims and 15 victims known for less than 24 h. Complete stranger homicide incidence committed by individuals with psychosis was 0.022 per 100 000 person-years and 0.13 for individuals without psychosis. When also including victims known for<24 h, the incidence was 0.031 for individuals with psychosis and 0.28 for individuals without psychosis per 100 000 person-years. Discussion: Nine out of ten stranger homicides are committed by individuals without psychosis. However, on the basis of a 3.1% prevalence of psychotic disorders in Finland, individuals with psychosis have about a 3- to 5-fold risk of committing stranger homicides as compared to individuals without psychosis.Peer reviewe

Allopurinol, dipyridamole and calcium channel blockers in the treatment of bipolar disorder - A nationwide cohort study

Background: Improved treatments for bipolar disorder (BD) are needed. Drug repurposing aims to find novel targets for drugs that have been used for other indications. This study investigated the risk of psychiatric hospitalization associated with use of calcium-channel blockers (CCBs; dihydropyridines, diltiazem, verapamil) and adenosine modulators (allopurinol, dipyridamole) in BD in within-individual design. Methods: Individuals diagnosed with BD (ICD-10: F30-F31) were identified from the inpatient, specialized outpatient, sickness absence, and disability pension registers during 1996-2018 in Finland (N = 60,045). The main outcome was hospitalization due to affective symptoms (ICD-10: F30-F39). Within-individual models in stratified Cox regression were used and adjusted hazard ratios (aHR) with 95 % confidence intervals (CIs) reported. Results: Use of CCBs was associated with a decreased risk of hospitalization due to affective symptoms (aHR 0.83, 95 % CI 0.78-0.88) when all CCBs were analyzed together. Of specific CCBs, use of diltiazem (0.71, 0.55-0.91) and dihydropyridines (0.83, 0.78-0.89) were associated with a decreased risk but verapamil was not (0.93, 0.73-1.19). Use of adenosine modulators in general was associated with a decreased risk of hospitalizations due to affective symptoms (0.87, 0.79-0.96). Both allopurinol (0.85, 0.74-0.97) and dipyridamole (0.89, 0.78-1.00) were associated with a marginally decreased risk. Thiazide diuretic use as a negative control was not associated with the risk of hospitalization due to affective symptoms (0.97, 0.83-1.13). Limitations: Due to the observational nature of this study, causation cannot be confirmed. Conclusions: Dihydropyridines and diltiazem were associated with a decreased risk of psychiatric hospitalization in bipolar disorder. Results for allopurinol and dipyridamole were inconclusive.Peer reviewe

Increased [H-3] quisqualic acid binding density in the dorsal striatum and anterior insula of alcoholics : A post-mortem whole-hemisphere autoradiography study

The function of group I metabotropic glutamate receptors mGluR1 and mGluR5 is involved in the hyperglutamatergic state caused by chronic alcohol. Preclinical studies suggest that group I mGluR modulation could serve as a novel treatment of alcoholism. Considering the wide role of glutamatergic neurochemistry in addiction, group I mGluR binding was studied in brain areas involved in decision-making, learning and memory. Post-mortem whole hemisphere autoradiography was used to study the binding density of [H-3] quisqualic acid, a potent group I mGluR agonist, in 9 Cloninger type 1 alcoholics, 8 Cloninger type 2 alcoholics and 10 controls. Binding was studied in the dorsal striatum, hippocampus and cortex. Alcoholics displayed a trend towards increased [ H-3] quisqualic acid binding in all brain areas. The most robust findings were in the putamen (p = 0.006) and anterior insula (p = 0.005), where both alcoholic subtypes displayed increased binding compared to the controls. These findings suggest altered group I mGluR function in alcoholic subjects in the dorsal striatum, which is involved in habitual learning, and in the anterior insula, which has a pivotal role in the perception of bodily sensations. Increased [H-3] quisqualic acid binding might suggest a beneficial impact of mGluR1/5 modulators in the treatment of alcoholism.Peer reviewe