Do adverse perinatal events predict mortality in schizophrenia during midlife?

Background: We examined mortality in schizophrenia spectrum disorder (SSD) and non-schizophrenic psychosis (NSSD) compared to individuals without psychosis, and whether perinatal factors predict mortality. Methods: Within Northern Finland Birth Cohort 1966 (n = 10 933; 203 with SSD, 178 with NSSD), mortality was followed until end of 2011 by national register. Wantedness of pregnancy, mother's antenatal depression, smoking and age, parity, paternal socio-economic status (SES) and family type at birth were examined as predictors of mortality. Results: Mortality was higher in SSD (hazard ratio (HR) 3.60; 95% confidence interval (CI) 2.38-5.45) and NSSD (4.05; 2.65-6.17) compared to persons without psychoses after adjustment for gender. HR for natural death was 2.01 (0.82-4.91) in SSD and 4.63 (2.43-8.80) in NSSD after adjustment for gender. Corresponding figures for unnatural deaths were 4.71 (2.94-7.54) and 2.94 (1.56-5.55), respectively. Among non-psychotic persons, mother's depression, smoking and low SES predicted mortality after adjustment for gender and parental psychoses (and SES), whereas among psychosis those whose father was a farmer had lower risk of mortality compared to those with high SES. Conclusions: Individuals with SSD had a higher risk of unnatural death and individuals with NSSD of natural and unnatural deaths. Perinatal factors seem to be more important predictors of mortality in individuals without psychoses than with psychoses. According to population-based long follow-up data, it is important to pay attention to somatic morbidity behind natural causes of death in psychoses and to prevent suicides in order to prevent excess mortality. (C) 2016 Elsevier B.V. All rights reserved.Peer reviewe

Antipsychotics in late-life schizophrenia - a narrative review

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Psykoosin ehkäisyn mahdollisuudet

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Pitkäaikaisen psykoosilääkityksen vaikutukset skitsofreniapotilaan aivojen rakenteeseen

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Effects of gender and psychiatric comorbidity on the age of illness onset and the outcome of psychotic depression-A birth cohort study

Background: Psychotic depression (PD) is an under-researched disorder with severe symptoms and course of illness. Little is known about gender differences relating to this condition and possible variation of prognosis based on comorbid pathology. Our aim was to analyze the effects of gender and psychiatric comorbidities on the age of illness onset and on the outcome of psychotic depression. Methods: The study was carried out in the Northern Finland Birth Cohort 1966. We utilized register data to acquire information about lifetime psychiatric diagnoses, hospitalization, age of illness onset, rate of disability pensions and mortality. The PD group (n = 58) was defined based on a lifetime register diagnosis. We compared outcome variables in sub-groups based on gender and comorbid alcohol use or personality disorder. Results: The prevalence of comorbid personality disorders was 38% (22/58) and comorbid alcohol use disorders 41% (24/58). PD patients with a personality disorder diagnosis had an earlier onset age (pLimitations: National registers were the main source of diagnostic information. Conclusions: Gender and psychiatric comorbidity have significant implications for the course of illness in PD in naturalistic settings, which is an important message for all clinicians. More research into the heterogeneity of PD is needed in order to guide research and clinical practice.</p

Association between developmental milestones and age of schizophrenia onset: Results from the Northern Finland Birth Cohort 1966.

We investigated relationships between early developmental milestones, schizophrenia incidence and variability in its age at onset. We hypothesized that the period of risk for schizophrenia would be longer for those with later development. The Northern Finland Birth Cohort 1966 was followed until 47 years of age, and those members diagnosed with schizophrenia or any other non-affective psychoses identified. Latent profile analysis was used to classify people into homogenous classes with respect to developmental milestones, and subsequently survival analysis explored relationship between classes and age of schizophrenia onset. Results suggest that 4-classes (early, regular, late, and extra late developers) can be identified, but due to few cases in one class (n = 93, <0.01% of 10,501), only 3 classes (early, regular, late) could be meaningfully compared. Schizophrenia incidence until 47 years of age differed systematically between classes: late developers had the highest cumulative incidence (2.39%); regular were intermediate (1.25%); and early developers had the lowest incidence (0.99%). However, age at onset and its variability was similar across classes, suggesting that our hypothesis of a wider 'window' for schizophrenia onset in late developers was not supported

Characteristics and predictors of off-label use of antipsychotics in general population sample

Objective Increasing number of people have been prescribed antipsychotics (APs) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. Methods The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off-label (n = 137), individuals with non-psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. Results The most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed APs off-label, individuals with prescribed off-label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. Conclusion Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use APs.Peer reviewe

Hoitoresistentin skitsofrenian hoitomahdollisuudet

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Tavoitteet nuorten mielenterveyskuntoutuksessa

Johdanto: Tavoitteiden asettaminen on tärkeä osa mielenterveyskuntoutusta. Nuorilla mielenterveyshäiriöt voivat vaikeuttaa kehitystehtävien saavuttamista, joten kuntoutuksen tavoitteiden tulee mukailla niitä. Aiemmat tutkimukset korostavat, että kuntoutuksessa on tärkeää huomioida kuntoutujan henkilökohtaiset tavoitteet yhteiskunnallisten resurssien lisäksi. Tavoite ja menetelmä: Tämän tutkimuksen tavoitteena oli kuvailla nuorten mielenterveyskuntoutuksen tavoitteita ja tämän myötä lisätä ymmärrystä tavoitteiden merkityksestä ja kehittää tavoitteiden asettelua. Tutkimuksen aineistona olivat 18–29-vuotiaiden nuorten (n = 16) asumiskuntoutuksessa laaditut kuntoutustiedotteet. Aineisto analysoitiin laadullisella sisällön analyysillä. Tulokset: Mielenterveyskuntoutuksen tavoitteiden pääkategoriat olivat: ikätasoiset toiminnalliset roolit, sosiaalinen osallisuus sekä sisäinen resilienssi. Yksilön toimiessa ikätasoisten toiminnallisten rooliensa mukaisesti yksilö kykenee suuntautumaan kehitystehtäviinsä. Sosiaalinen osallisuus on mahdollisuutta osallistua sosiaalisiin ympäristöihin. Sisäinen resilienssi tarkoittaa yksilön kykyä vaikeissa tilanteissa käyttää vahvuuksiaan. Aineistosta nousi esille myös nuoren ja ammattilaisen välinen vuorovaikutussuhde kuntoutusprosessin aikana. Pohdinta: Tässä tutkimuksessa löydetyt pääkategoriat ovat aiemman tutkimustiedon perusteella yhteydessä valtaistumiseen, kuntoutumiseen ja toipumiseen. Tulosten perusteella ammattilaisen ja nuoren välinen vuorovaikutussuhde on tärkeä osa kuntoutusta ja kuntoutujan osallisuutta tavoitteiden asettelussa tulee vahvistaa. Toipumisorientaation laajempi käyttö mielenterveyspalveluissa voisi mahdollistaa tätä kehitystä. Abstract Goals in Adolescents` Mental Health Rehabilitation Introduction: Goal setting is a central part of mental health rehabilitation. Especially among young people mental health disorders may delay achieving developmental tasks. Goals of rehabilitation should be in concordance with developmental tasks. According to rehabilitation impact studies, it is important to consider the rehabilitees’ goals in addition to the social and financial perspectives. Purpose and method: The purpose of this study was to increase the understanding of goals set in adolescents’ mental health rehabilitation and develop goal setting. The aim of the study was to describe the goals set in adolescent’s mental health rehabilitation. The study participants were rehabilitees between 18 - 29 years in residential rehabilitation (n=16) and the data was register information. The analyze method was content analysis. Results: The main categories of goals were: age-level occupational roles, social inclusion and inner resilience. When acting according to the age-level occupational roles, people are pursuing their developmental tasks. Social inclusion is the possibility to participate in the social environment. Inner resilience is a psychological process which helps the individual to cope with difficult situations by using their personal skills. The data shows also the importance of collaborative relationship between the professional and the young person during the process of recovery. Discussion: Prior research shows that the main categories are connected to empowerment, rehabilitation and recovery. It is important to support the collaborative relationship between the professional and the adolescent by increasing methods that supports adolescent`s participation in the process of goal setting. Wider use of recovery orientation in mental health services could support this development. Keywords: youth, young adults, adolescent`s, mental health disorders, metal health rehabilitation, goals, register information, qualitative study, retrospective stud

Predictors of response to pharmacological treatments in treatment-resistant schizophrenia - A systematic review and meta-analysis

Background: As the burden of treatment-resistant schizophrenia (TRS) on patients and society is high it is important to identify predictors of response to medications in TRS. The aim was to analyse whether baseline patient and study characteristics predict treatment response in TRS in drug trials. Methods: A comprehensive search strategy completed in PubMed, Cochrane and Web of Science helped identify relevant studies. The studies had to meet the following criteria: English language clinical trial of pharmacological treatment of TRS, clear definition of TRS and response, percentage of response reported, at least one baseline characteristic presented, and total sample size of at least 15. Meta-regression techniques served to explore whether baseline characteristics predict response to medication in TRS. Results: 77 articles were included in the systematic review. The overall sample included 7546 patients, of which 41% achieved response. Higher positive symptom score at baseline predicted higher response percentage. None of the other baseline patient or study characteristics achieved statistical significance at predicting response. When analysed in groups divided by antipsychotic drugs, studies of clozapine and other atypical antipsychotics produced the highest response rate. Conclusions: This meta-analytic review identified surprisingly few baseline characteristics that predicted treatment response. However, higher positive symptoms and the use of atypical antipsychotics - particularly clozapine -was associated with the greatest likelihood of response. The difficulty involved in the prediction of medication response in TRS necessitates careful monitoring and personalised medication management. There is a need for more investigations of the predictors of treatment response in TRS.Peer reviewe