Psykoottisten häiriöiden epidemiologia

Abstract: Schizophrenia and other psychoses are among the most severe mental disorders. There are few general population surveys of psychotic disorders. Most epidemiological studies have focused on schizophrenia and bipolar I disorder, while data of many other specific psychotic disorders are scarce. This study investigated the lifetime prevalence and epidemiological features of different psychotic disorders in the adult Finnish general population. The data were derived from the Health 2000 Study, a comprehensive general population survey of Finnish adults aged 30 years and over (N=8028). In the Psychoses in Finland study, the Health 2000 Study sample was screened for psychotic disorders. Those selected by the screens were invited for a mental health interview. Final best-estimate DSM-IV diagnoses were based on systematic evaluation of the interview and the case note data. The lifetime prevalence 3.5% of psychotic disorders was higher than has been estimated in most recent general population studies. The most common disorder was schizophrenia with lifetime prevalence 1%. Substance-induced psychotic disorders were common among working aged men and psychotic disorder due to general medical condition among women aged 65 years or over. Psychotic disorders were generally associated with socioeconomic disadvantage like being unmarried, pensioned or unemployed; having low income or education level. The highest lifetime prevalence of psychotic disorders was found in northern and eastern parts of Finland. The region of birth was a more important determinant of the risk of psychotic disorders than the region of residence, and most marked in schizophrenia. Alcohol-induced psychotic disorders were common in middle-aged men and associated with high morbidity and mortality. Clinical features of delusional disorder were different from schizophrenia. Disorganized schizophrenia was a schizophrenia subtype associated with poor outcome. With a high lifetime prevalence exceeding 3%, psychotic disorders are a major public health concern. The high and unevenly distributed prevalence should be taken into account when resources are allocated to health care.Skitsofrenia ja muut psykoottiset häiriöt kuuluvat vaikeimpiin mielenterveyshäiriöihin. Psykoottisten häiriöiden esiintyvyydestä on tehty vain vähän väestötutkimuksia. Useimmat epidemiologiset tutkimukset ovat keskittyneet skitsofrenian ja tyypin I kaksisuuntaiseen mielialahäiriöön. Monista muista psykoottisista häiriöistä on vain vähän väestötason tietoa. Tässä tutkimuksessa selvitettiin psykoottisten häiriöiden elämänaikaista esiintyvyyttä ja esiintyvyyteen liittyviä piirteitä suomalaisessa aikuisväestössä. Tutkimusaineisto perustuu kattavaan Terveys 2000 väestötutkimukseen yli 30 -vuotiaiden suomalaisten terveydentilasta (N = 8028). Psykoosit Suomessa -jatkotutkimuksessa Terveys 2000 aineistosta kutsuttiin tutkittavia tarkempaan mielenterveyshaastatteluun käyttämällä tutkimusta varten kehitettyä psykoosiseulaa. Mielenterveyshäiriöt diagnosoitiin DSM-IV -tautiluokituksen mukaisilla diagnostisilla kriteereillä hyödyntäen sekä haastattelu- että potilaskertomustietoja. Kaikkien psykoottisten häiriöiden elämänaikainen esiintyvyys oli 3.5 %. Yleisin psykoosi oli skitsofrenia, jonka elämänaikainen esiintyvyys oli 1 %. Päihdepsykoosit olivat yleisiä työikäisillä miehillä ja yleissairauteen liittyvät psykoosit yli 65-vuotiailla naisilla. Psykoottiset häiriöt olivat yhteydessä matalaan sosioekonomiseen asemaan. Erityisesti ei-mielialaoireiseen psykoosiin sairastuneet olivat useammin naimattomia, työttömiä ja eläkeläisiä tai alhaisten peruskoulutuksen ja tulotason omaavia kuin yleisväestö. Syntymäpaikka oli asuinpaikkaa tärkeämpi psykoottisen häiriön ja erityisesti skitsofrenian riskiin vaikuttava tekijä. Alkoholiin liittyvä psykoottinen häiriö oli erityisen yleinen keski-ikäisillä miehillä ja siihen liittyi runsas samanaikaissairastuvuus sekä korkea kuolleisuus. Harhaluuloisuushäiriön kliiniset piirteet erosivat skitsofreniasta. Hajanaisoireiseen skitsofrenian alatyyppiin liittyi huono ennuste verrattuna muihin alatyyppeihin. Tässä tutkimuksessa psykoottisten häiriöiden esiintyvyys yli 3 % oli korkeampi kuin useimmissa viimeaikaisissa väestötutkimuksissa. Psykoottiset häiriöt ovat merkittävä kansanterveydellinen ongelma. Psykoottisten häiriöiden korkea ja epätasaisesti jakaantunut esiintyvyys tulisi huomioida hoitojärjestelmien resursoinnissa

Mortality in people with psychotic disorders in Finland : A population-based 13-year follow-up study

Objectives: We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. Methods: In a nationally representative sample of Finns aged 30-70 years (n = 5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. Results: No people with affective psychoses (n = 36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n = 106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-441) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95%CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). Conclusions: The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Treatment adequacy of anxiety disorders among young adults in Finland

Background: Anxiety disorders are common in early adulthood, but general population studies concerning the treatment adequacy of anxiety disorders taking into account appropriate pharmacological and psychological treatment are scarce. The aims of this study were to examine treatments received for anxiety disorders in a Finnish general population sample of young adults, and to define factors associated with receiving minimally adequate treatment and with dropping out from treatment. Methods: A questionnaire containing several mental health screens was sent to a nationally representative two-stage cluster sample of 1894 Finns aged 19 to 34 years. All screen positives and a random sample of screen negatives were invited to a mental health assessment including a SCID interview. For the final diagnostic assessment, case records from mental health treatments for the same sample were obtained. This article investigates treatment received, treatment adequacy and dropouts from treatment of 79 participants with a lifetime anxiety disorder (excluding those with a single specific phobia). Based on all available information, receiving antidepressant or buspirone medication for at least 2 months with at least four visits with any type of physician or at least eight sessions of psychotherapy within 12 months or at least 4 days of hospitalization were regarded as minimally adequate treatment for anxiety disorders. Treatment dropout was rated if the patient discontinued the visits by his own decision despite having an adequate treatment strategy according to the case records. Results: Of participants with anxiety disorders (excluding those with a single specific phobia), 41.8 % had received minimally adequate treatment. In the multivariate analysis, comorbid substance use disorder was associated with antidepressant or buspirone medication lasting at least 2 months. Those who were currently married or cohabiting had lower odds of having at least four visits with a physician a year. None of these factors were associated with the final outcome of minimally adequate treatment or treatment dropout. Participants with comorbid personality disorders received and misused benzodiazepines more often than others. Conclusions: More efforts are needed to provide adequate treatment for young adults with anxiety disorders. Attention should be paid to benzodiazepine prescribing to individuals with personality disorders.Peer reviewe

Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years

<p>Abstract</p> <p>Background</p> <p>We tested the validity of the SCOFF, a five-question screening instrument for eating disorders, in a general population sample.</p> <p>Methods</p> <p>A random sample of 1863 Finnish young adults was approached with a questionnaire that contained several screens for mental health interview, including the SCOFF. The questionnaire was returned by 1316 persons. All screen positives and a random sample of screen negatives were invited to SCID interview. Altogether 541 subjects participated in the SCID interview and had filled in the SCOFF questionnaire. We investigated the validity of the SCOFF in detecting current eating disorders by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for different cut-off scores. We also performed a ROC analysis based on these 541 persons, of whom nine had current eating disorder.</p> <p>Results</p> <p>The threshold of two positive answers presented the best ability to detect eating disorders, with a sensitivity of 77.8%, a specificity of 87.6%, a PPV of 9.7%, and a NPV of 99.6%. None of the subjects with current eating disorder scored zero points in the SCOFF.</p> <p>Conclusion</p> <p>Due to its low PPV, there are limitations in using the SCOFF as a screening instrument in unselected population samples. However, it might be used for ruling out the possibility of eating disorders.</p

Prevalence of Schizophrenia in Idiopathic Normal Pressure Hydrocephalus

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive and potentially treatable neurodegenerative disease affecting elderly people, characterized by gait impairment and ventricular enlargement in brain imaging. Similar findings are seen in some patients with schizophrenia (SCZ).OBJECTIVE: To determine the prevalence of SCZ among patients suffering from probable or possible iNPH and the specific effects of comorbid SCZ on the outcome of the cerebrospinal fluid (CSF) shunting.METHODS: All medical records of the 521 iNPH patients in the NPH registry were retrospectively analyzed from 1991 until 2017. The prevalence of comorbidity of SCZ was determined and compared to that of general aged (≥65 yr) population in Finland.RESULTS: We identified a total of 16 (3.1%) iNPH patients suffering from comorbid SCZ. The prevalence of SCZ among the iNPH patients was significantly higher compared to the general population (3.1% vs 0.9%, P CONCLUSION: SCZ seems to occur 3 times more frequently among iNPH patients compared to the general aged population in Finland. The outcome of the treatment was not affected by comorbid SCZ and therefore iNPH patients suffering from comorbid SCZ should not be left untreated. These results merit validation in other populations. In addition, further research towards the potential connection between these chronic conditions is warranted.</p

Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years

<p>Abstract</p> <p>Background</p> <p>We tested the validity of the SCOFF, a five-question screening instrument for eating disorders, in a general population sample.</p> <p>Methods</p> <p>A random sample of 1863 Finnish young adults was approached with a questionnaire that contained several screens for mental health interview, including the SCOFF. The questionnaire was returned by 1316 persons. All screen positives and a random sample of screen negatives were invited to SCID interview. Altogether 541 subjects participated in the SCID interview and had filled in the SCOFF questionnaire. We investigated the validity of the SCOFF in detecting current eating disorders by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for different cut-off scores. We also performed a ROC analysis based on these 541 persons, of whom nine had current eating disorder.</p> <p>Results</p> <p>The threshold of two positive answers presented the best ability to detect eating disorders, with a sensitivity of 77.8%, a specificity of 87.6%, a PPV of 9.7%, and a NPV of 99.6%. None of the subjects with current eating disorder scored zero points in the SCOFF.</p> <p>Conclusion</p> <p>Due to its low PPV, there are limitations in using the SCOFF as a screening instrument in unselected population samples. However, it might be used for ruling out the possibility of eating disorders.</p

Treatment received and treatment adequacy of depressive disorders among young adults in Finland

Peer reviewe

"Vaikea sanoa, kun ei tiiä" : pro gradu -tutkielma lukion toisen vuosikurssin poikien ammatinvalintaan liittyvistä tekijöistä ja syistä miesten vähäiseen hakeutumiseen opetusalalle

Tämän pro gradu -tutkielman tarkoituksena on kartoittaa syitä, jotka vaikuttavat miesten suhteellisen vähäiseen kiinnostukseen opetusalalle hakeutumiseen. Tutkimuksen pääongelmat ovat seuraavat:1. Millainen on lukiolaispoikien ammatti- ja koulutuskuva?2. Millainen käsitys lukiolaispojilla on opettajuudesta?3. Millaisia eroja on opetusalasta kiinnostuneiden ja muiden vastaajien välillä?4. Millaisia yhteisiä piirteitä voidaan löytää opetusalalle mahdollisesti hakeutuville vastaajille?5. Miten miehet menestyvät luokanopettajakoulutuksen toisen vaiheen valintakokeissa?Työ on luonteeltaan kvantitatiivinen ja se koostuu kahdesta eri aineistosta. Ensimmäiseen kohderyhmään kuuluu seitsemän eri lukion toisen vuosikurssin poikia (N=196) Helsingistä, Hämeenlinnasta, Kauhajoelta, Kurikasta ja Lahdesta sekä vertailujoukkona 17 luokanopettajaksi opiskelevaa miestä Hämeenlinnasta eri vuosikursseilta. Näille henkilöille tehtiin kyselytutkimus. Toinen aineisto koostuu Helsingin, Tampereen ja Lapin yliopistojen (N=1815) luokanopettajakoulutuksen toisen vaiheen valintakokeen pistemääristä vuosilta 1988, 1995 ja 1996. Analyysimenetelminä on käytetty keskiarvojen erojen testausta, regressioanalyysia ja faktorianalyysia. Aineiston kuvailussa on käytetty lähinnä prosenttijakaumia ja keskilukuja.Tutkimuksen perusteella voidaan todeta lukion toisen vuosikurssin poikien jatko-opintosuunnitelmien olevan melko selkiytymättömiä. Luokanopettajakoulutuksen sisällöstä vastaajilla voidaan katsoa olevan heikko käsitys vaikka alasta kiinnostuneita on suhteellisen suuri määrä. Opetusalalle mahdollisesti hakeutuvilla lukiolaispojilla voidaan katsoa olevan yhteisiä piirteitä kuten sosiaaliset ja eettiset arvostuksen kohteet ja myönteiset mielipiteet opettajuudesta, kasvattamisesta ja omasta kouluajasta. Luokanopettajakoulutuksen valintakokeissa sukupuolten välisten erojen voidaan katsoa lisääntyneen kiintiöajan jälkeisinä vuosina. Etenkin Helsingin ja Tampereen luokanopettajakoulutukseen on hyväksytty opiskelemaan suhteessa suurempi osuus miehistä kuin naisista. Näiden yliopistojen valintakokeissa miehet ovat menestyneet paremmin haastattelussa ja opetusnäytteessä.Tällä tutkimuksella voidaan todeta ammatinvalintaprosessin olevan elinikäinen kehitystapahtuma, jonka merkitys tulee huomioida jo hyvinkin varhaisessa vaiheessa. Tässä prosessissa yksilöllä itsellään ja ympäristöllä on oma merkityksensä.Asiasanat: ammatinvalinta - pojat - lukio, koulutusvalinnat - nuoret - miehet, opettajankoulutus - luokanopettajat - miehet, pääsykokeet - opettajankoulutu