Skitsofreniaan ja muihin psykooseihin sairastuneiden toimintakyvyn rajoitukset ja elämänlaatu

There is substantial evidence of the decreased functional capacity, especially everyday functioning, of people with psychotic disorder in clinical settings, but little research about it in the general population. The aim of the present study was to provide information on the magnitude of functional capacity problems in persons with psychotic disorder compared with the general population. It estimated the prevalence and severity of limitations in vision, mobility, everyday functioning and quality of life of persons with psychotic disorder in the Finnish population and determined the factors affecting them. This study is based on the Health 2000 Survey, which is a nationally representative survey of 8028 Finns aged 30 and older. The psychotic diagnoses of the participants were assessed in the Psychoses of Finland survey, a substudy of Health 2000. The everyday functioning of people with schizophrenia is studied widely, but one important factor, mobility has been neglected. Persons with schizophrenia and other non-affective psychotic disorders, but not affective psychoses had a significantly increased risk of having both self-reported and test-based mobility limitations as well as weak handgrip strength. Schizophrenia was associated independently with mobility limitations even after controlling for lifestyle-related factors and chronic medical conditions. Another significant factor associated with problems in everyday functioning in participants with schizophrenia was reduced visual acuity. Their vision was examined significantly less often during the five years before the visual acuity measurement than the general population. In general, persons with schizophrenia and other non-affective psychotic disorder had significantly more limitations in everyday functioning, deficits in verbal fluency and in memory than the general population. More severe negative symptoms, depression, older age, verbal memory deficits, worse expressive speech and reduced distance vision were associated with limitations in everyday functioning. Of all the psychotic disorders, schizoaffective disorder was associated with the largest losses of quality of life, and bipolar I disorder with equal or smaller losses than schizophrenia. However, the subjective loss of qualify of life associated with psychotic disorders may be smaller than objective disability, which warrants attention. Depressive symptoms were the most important determinant of poor quality of life in all psychotic disorders. In conclusion, subjects with psychotic disorders need regular somatic health monitoring. Also, health care workers should evaluate the overall quality of life and depression of subjects with psychotic disorders in order to provide them with the basic necessities of life.Psykoosiin sairastuneiden toimintakykyä on tutkittu paljon kliinisissä aineistoissa, muttei niinkään väestöaineistoissa. Tämän tutkimuksen tarkoituksena oli tuottaa tietoa psykoosisairauksista kärsivien toimintakyvyn rajoitusten suuruudesta verrattuna yleisväestöön. Tutkimus arvioi näkökyvyn, liikkumiskyvyn ja arkielämästä selviytymisen ongelmien sekä alentuneen elämänlaadun yleisyyttä ja vakavuutta psykoosia sairastavilla sekä tutki niihin vaikuttavia tekijöitä. Tämä väitöskirja perustuu Terveys 2000 tutkimukseen, joka on kansallisesti edustava väestötutkimus, johon kutsuttiin 8028 30 vuotta täyttänyttä Suomen kansalaista. Tutkimukseen osallistuneiden psykoosidiagnoosit määritettiin Terveys 2000 tutkimusta syventävässä Psykoosit Suomessa tutkimuksessa. Skitsofreniaa sairastavien arkielämän toiminnoista selviämistä on tutkittu paljon, mutta yksi siihen liittyvä tekijä, liikkumiskyky on laiminlyöty. Skitsofreniaa ja muita ei-mielialaoireisia psykooseja sairastavat sekä ilmoittivat itse merkittävästi enemmän ongelmia liikkumiskyvyssään että suoriutuivat merkittävästi heikommin liikkumiskykytesteissä kuin yleisväestö. Skitsofrenia vaikutti itsenäisesti liikkumiskykyongelmiin vaikka elämäntapatekijöiden ja kroonisten sairauksien vaikutus oli otettu huomioon. Toinen tärkeä arkielämän toimintoihin vaikuttava tekijä oli heikentynyt näkökyky, mikä koski vain skitsofreniaa sairastavia. He olivat olleet näöntarkastuksessa viimeisten viiden vuoden aikana merkittävästi harvemmin kuin yleisväestö. Kaiken kaikkiaan, skitsofreniaa ja muita ei-mielialaoireisia psykooseja sairastavilla oli merkittävästi enemmän rajoituksia niin arkielämän toiminnoissa kuin sanasujuvuudessa ja muistissakin kuin yleisväestöllä. Vakavammat negatiiviset oireet, masennus, korkeampi ikä, sanallisen muistin ongelmat, puheen tuottamisen ongelmat ja heikentynyt kaukonäkö olivat yhteydessä arkielämästä selviytymisen ongelmiin. Psykoosisairauksista huonoin elämänlaatu oli skitsoaffektiivista häiriötä sairastavilla. Seuraavaksi huonoin se oli skitsofreniaa sairastavilla, sitten tyypin I kaksisuuntaista mielialahäiriötä sairastavilla. Huomionarvoista kuitenkin on, että psykoosisairauksista kärsivät ilmoittavat parempaa elämänlaatua kuin objektiivisesti on havaittavissa. Ilmiön syynä voi olla osittain kroonisiin sairauksiin liittyvä sopeutuminen. Masennusoireet olivat tärkein huonon elämänlaadun määrittäjä kaikissa psykoosisairauksissa. Psykoottisia häiriöitä sairastavat tarvitsevat säännöllisiä terveystarkastuksia. Myös elämänlaatu ja masennuksen hoito ovat asioita, joihin terveydenhuollon pitää kiinnittää huomiota psykoosisairauksien hoidossa

Sleep symptoms and long-term outcome in adolescents with major depressive disorder : a naturalistic follow-up study

Sleep abnormalities in major depressive disorder (MDD) have been suggested to represent a vulnerability trait, which might predispose the individual to long-term psychiatric morbidity. In this study, we sought to assess whether the presence of sleep symptoms among adolescents with MDD is associated with poorer long-term outcome in young adulthood during naturalistic follow-up. Adolescent outpatients diagnosed with MDD (n=166; age 13-19 years, 17.5% boys) were followed up during 8 years in naturalistic settings. N=112 adolescents (16.1% boys) completed the 8-year assessment. Sleep symptoms and psychosocial functioning were assessed with structured clinical interviews, and depressive and anxiety symptoms with questionnaires. The severity of sleep symptoms at baseline was not associated with worse outcome at 8 years in terms of any of the outcome measures tested. In particular, the presence of a disturbed sleep-wake rhythm at baseline was associated with a more favourable outcome at 8 years: less depression and anxiety symptoms and higher level of psychosocial functioning. The presence of sleep symptoms in young adulthood was associated with the presence of current depression and anxiety symptoms and poorer psychosocial functioning. The presence of sleep symptoms at follow-up seems to be state-dependent: they are observed in conjunction with other psychiatric symptoms. Contrary to our hypothesis, our results suggest that sleep complaints among adolescents with MDD do not lead to poorer long-term clinical outcome in young adulthood. The link between sleep-wake rhythm disturbance and better long-term outcome needs to be confirmed and examined in detail in further studies, but here we speculate about possible explanations.Peer reviewe

Factors contributing to psychological distress in the working population, with a special reference to gender difference

Abstract Background Psychological distress refers to non-specific symptoms of stress, anxiety and depression, and it is more common in women. Our aim was to investigate factors contributing to psychological distress in the working population, with a special reference to gender differences. Methods We used questionnaire data from the nationally representative Finnish Regional Health and Well-being Study (ATH) collected in the years 2012–2016 (target population participants aged 20 +, n = 96,668, response rate 53%), restricting the current analysis to those persons who were working full-time and under 65 of age (n = 34,468). Psychological distress was assessed using the Mental Health Inventory-5 (MHI-5) (cut-off value <=52). We studied the following factors potentially associated with psychological distress: sociodemographic factors, living alone, having children under18 years of age, lifestyle-related factors, social support, helping others outside of the home and work-related factors. We used logistic regression analysis to examine association between having work-family conflict with the likelihood for psychological distress. We first performed the models separately for men and women. Then interaction by gender was tested in the combined data for those independent variables where gender differences appeared probable in the analyses conducted separately for men and women. Results Women reported more psychological distress than men (11.0% vs. 8.8%, respectively, p < 0.0001). Loneliness, job dissatisfaction and family-work conflict were associated with the largest risk of psychological distress. Having children, active participation, being able to successfully combine work and family roles, and social support were found to be protective factors. A significant interaction with gender was found in only two variables: ignoring family due to being absorbed in one’s work was associated with distress in women (OR 1.30 (95% CI 1.00–1.70), and mental strain of work in men (OR 2.71 (95% CI 1.66–4.41). Conclusions Satisfying work, family life and being able to successfully combine the two are important sources of psychological well-being for both genders in the working population

Sleep symptoms and long-term outcome in adolescents with major depressive disorder: a naturalistic follow-up study

Sleep abnormalities in major depressive disorder (MDD) have been suggested to represent a vulnerability trait, which might predispose the individual to long-term psychiatric morbidity. In this study, we sought to assess whether the presence of sleep symptoms among adolescents with MDD is associated with poorer long-term outcome in young adulthood during naturalistic follow-up. Adolescent outpatients diagnosed with MDD (n = 166; age 13-19 years, 17.5% boys) were followed up during 8 years in naturalistic settings. N = 112 adolescents (16.1% boys) completed the 8-year assessment. Sleep symptoms and psychosocial functioning were assessed with structured clinical interviews, and depressive and anxiety symptoms with questionnaires. The severity of sleep symptoms at baseline was not associated with worse outcome at 8 years in terms of any of the outcome measures tested. In particular, the presence of a disturbed sleep-wake rhythm at baseline was associated with a more favourable outcome at 8 years: less depression and anxiety symptoms and higher level of psychosocial functioning. The presence of sleep symptoms in young adulthood was associated with the presence of current depression and anxiety symptoms and poorer psychosocial functioning. The presence of sleep symptoms at follow-up seems to be state-dependent: they are observed in conjunction with other psychiatric symptoms. Contrary to our hypothesis, our results suggest that sleep complaints among adolescents with MDD do not lead to poorer long-term clinical outcome in young adulthood. The link between sleep-wake rhythm disturbance and better long-term outcome needs to be confirmed and examined in detail in further studies, but here we speculate about possible explanations.</p