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Background: Disorganized speech, manifested as derailment, tangentiality, incoherence and loss of goal, occurs commonly in schizophrenia. Studies of language processing have demonstrated that semantic activation in schizophrenia is often disordered and, moreover, the ability to use contextual cues is impaired. Aims: To reconstruct the origins and most plausible intended meanings of disorganized discourse sequences in a clinical interview with a patient with thought-disordered schizophrenia. Methods & Procedures: We assessed the so-called pragmatic felicity of every turn using a novel tool called the Overall Comprehensibility of Turn (OCT) Scale. In addition to felicity analysis, all topics and referents of turns were registered. Three most disorganized discourse sequences from the transcribed interview were chosen for the thematic and semantic analysis, in which we attempted to reconstruct the structure and meaning of those sequences utilizing (1) the notion of discourse model extending up to contextual background knowledge, (2) the (re)occurrence of topical items, together with (3) the knowledge from findings of disordered semantic activation in schizophrenia. Outcomes & Results: The linguistic analyses showed that the disrupted sequences were characterized by (1) unexpected, seemingly irrelevant topic intrusion, (2) pragmatically inappropriate chain of topic extensions, and (3) fuzzy reference together with disturbed ordering of propositions. The underlying causes seemed to be, respectively, (1) long-term semantic activation of topics, which popped out sporadically along the conversation, (2) overreliance on lexical-semantic associations, and (3) the inability to sequence the utterances and link them together using explicit or implicit bridging assumptions necessary to a coherent and cohesive message. All scrutinized passages violated the expectations of the addressee in on-line conversation. However, the post-hoc analysis showed that they contained items which were relevant to the global topic. Conclusions & Implications: Latent sources, motivations and even meanings, at least to some extent, of seemingly disorganized utterances can become analysable through linguistic analyses. The results suggest that continuity in the treatment is essential, because a practitioner who shares background knowledge with the patient has better opportunities to capture the relevance of the superficially disorganized utterances. Moreover, especially the most disorganized sequences should warrant thorough attention because they can convey, beneath their unexpected or obscure surface structure, items which are psychologically important to the patient. The results of this study should be taken into account in the training of interactional skills of professionals who work with schizophrenia patients. (Contains 1 table.)

Background: Research on the use of psychotropic drugs in people with alcohol-related neurocognitive disorders is virtually nonexistent. We examined the prevalence of antipsychotic drug use and its effect on mortality among patients with Wernicke–Korsakoff syndrome (WKS) or alcohol-related dementia (ARD). Methods: In this nationwide register study, we collected data on the medication use and mortality of all persons aged ≥40 diagnosed with WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the prevalence of antipsychotic use within one year of diagnosis and the adjusted cumulative mortality of antipsychotic users versus non-users in relation to the age-, sex-, and calendar year-matched general population. Results: Of the WKS and ARD patients, 35.9% and 38.5%, respectively, purchased one or more antipsychotic drugs in the year following diagnosis. The adjusted cumulative mortality of the antipsychotic users was significantly lower than that of non-users in both the WKS and ARD groups, where the adjusted hazard ratios (95% CI) were 0.85 (0.72–0.99) and 0.73 (0.65–0.81), respectively. WKS and ARD patients using antipsychotics were less likely to die of alcohol-related causes than antipsychotic non-users, but the difference was significant only in the ARD group. Conclusions: This population-based study shows that antipsychotic use is common in patients with WKS or ARD. In contrast to other dementia studies, our results indicate that the mortality of antipsychotic users is significantly lower than that of non-users. The lower mortality could be explained by decreased alcohol use and better healthcare coverage in antipsychotic users. [ABSTRACT FROM AUTHOR]

Objectives: To explore mortality of patients with Alzheimer's disease (AD), frontotemporal dementia (FTD), or Lewy body dementias (LBD) who had criminal behavior in the year preceding diagnosis. Methods: Data were obtained from the nationwide registers. Mortality was compared between disorder groups with and without criminal acts and with the general population. The cohort included patients who had received a discharge register diagnosis of AD (N = 80,540), FTD (N = 1060), or LBD (N = 10,591) between 1998 and 2015. The incidences of crimes were calculated in the year preceding diagnosis. We further calculated age‐ and sex‐adjusted survivals of different dementia groups with and without criminal acts, and in relation to the general population (SMR, Standardized Mortality Ratio). Results: Criminal behavior was more common in men than in women. It was associated with decreased mortality in the AD group. SMRs due to unnatural causes, and in the LBD and FTD female groups, were higher in patients with criminal behavior than in those without. Conclusion: LBD and female FTD patients, who had criminal behavior before diagnosis, were at higher risk of death than patients without such behavior. Novel criminality in older adults may be associated with neurocognitive disorder, in which case medical attention is justified. [ABSTRACT FROM AUTHOR]

Background: Individuals with depression and depressive symptoms have a higher mortality rate than non‐depressed individuals. The increased comorbidity and mortality associated with depression has remained largely unexplained. The underlying pathophysiological differences between depressive subtypes, melancholic and non‐melancholic, may provide some explanation to this phenomenon. Methods: One thousand nine hundred and ninety five participants (mean age 61 years) from the Helsinki Birth Cohort Study were recruited for this prospective study and followed up for a mean of 14.1 years. Information regarding medical history, lifestyle, and biochemical parameters were obtained. Depressive symptoms were assessed using the Beck Depression Inventory. Standardized mortality ratios were calculated. Results: Participants were followed up for a total of 28,044 person‐years. The melancholic depressive group had an increased adjusted risk of mortality [HR 1.49 (95% CI: 1.02–2.20)] when compared to the non‐depressive group. Comparing mortality to the whole population of Finland using standardized mortality ratios (SMR) both the non‐melancholic [1.11 (95% CI: 0.85–1.44)] and melancholic depressive [1.26 (95% CI: 0.87–1.81)] groups had higher mortality than the non‐depressive group [0.82 (95% CI: 0.73–0.93)]. Conclusions: Melancholic depressive symptoms are most strongly related to a higher mortality risk. Highlights: Depression is associated with mortality.Depressive symptoms based on BDI‐IA show an association with increased risk for mortality.Specifically melancholic depressive symptoms present with increased risk for mortality. [ABSTRACT FROM AUTHOR]

Background objective indicators of sleep and mental health problems in family caregivers have rarely been reported. Objective to study the use of prescription benzodiazepines and related drugs (BZDRD) in Finnish family caregivers and matched controls. Design prospective follow-up in 2012–17. Setting nationwide register-linkage study. Subjects all individuals who received family caregiver's allowance in Finland in 2012 (N  = 42,256; mean age 67 years; 71% women) and controls matched for age, sex and municipality of residence (N  = 83,618). Methods information on purchases of prescription BZDRD, including the number of defined daily doses (DDDs), between 2012 and 2017 was obtained from the Dispensations Reimbursable under the National Health Insurance Scheme register. Background information was obtained from national registers. Results more caregivers than controls used BZDRD, both among women (users per 100 person-years: 17.2 versus 15.2, P  < 0.001) and men (14.6 versus 11.8, P  < 0.001). These differences were largely explained by hypnotic BZDRD use. There were also more long-term BZDRD users per 100 person-years among caregivers than controls, both among women (5.0 versus 4.3, P  = 0.001) and men (5.3 versus 3.8, P  < 0.001). Use of hypnotic BZDRD in number of DDDs was higher in caregivers than in controls, particularly among men above 50 years. Caregivers used more anxiolytic BZDRD than controls from middle age to 75 years but less in the oldest age groups. Conclusions higher level of BZDRD use among caregivers indicates that caregivers have more sleep and mental health problems than non-caregivers. Adequate treatment of these problems and support for caregiving should be ensured for caregivers. [ABSTRACT FROM AUTHOR]

Background: Epidemiological data on alcohol-related cognitive disorders are scarce. Up-to-date population-based incidence and mortality rates for Wernicke-Korsakoff syndrome (WKS) and alcohol-related dementia (ARD) are necessary to understand the burden of these diseases.Methods: We collected diagnostic data from the Finnish Hospital Discharge Register and mortality data from Statistics Finland for all persons aged ≥40 years who had received a diagnosis of WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the incidences and mortality in relation to the age-, sex- and calendar year-matched general population. Causes of death were ascertained from death certificates.Results: For WKS, the incidence per 100,000 person-years (95% confidence interval (CI)) was 3.7 (3.4-3.9) in men and 1.2 (1.1-1.3) in women. For ARD, the incidence was 8.2 (7.9-8.6) in men and 2.1 (1.9-2.3) in women. The incidence of WKS peaked in people aged 50-59 years and the incidence of ARD in people aged 70-79 years. The standardized mortality ratio (95% CI) was 5.67 (5.25-6.13) in WKS patients and 5.41 (5.14-5.70) in ARD patients. Most of the excess mortality resulted from alcohol-related causes.Conclusions: To our knowledge, this is the first study describing population-based incidence and mortality rates, sex-segregated data and causes of death in patients with WKS or ARD. Our results establish a point of reference for the incidence of WKS and ARD and show the high mortality and poor prognosis of these disorders. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the use of antidepressants over 6 years between family caregivers providing high-intensity care and a matched control population using register-based data.Methods: The study includes all individuals, who received family caregiver's allowance in Finland in 2012 (n = 29,846 females, mean age 66 years; n = 12,410 males, mean age 71 years) and a control population matched for age, sex, and municipality of residence (n = 59,141 females; n = 24,477 males). Information on purchases of antidepressants, including the number of defined daily doses (DDD) purchased, between 2012 and 2017 was obtained from the national drugs reimbursement register.Results: During the follow-up, 28.5% of female caregivers and 23.5% of the female controls used antidepressants, while the numbers for males were 21.1% and 16.4%, respectively. Adjusted for socioeconomic status, female caregivers used 43.7 (95% confidence interval 42.4-45.0) and their controls used 36.2 (35.3-37.2) DDDs of antidepressants per person-year. Male caregivers used 29.6 (27.6-31.6) and their controls used 21.6 (20.2-23.0) DDDs of antidepressants per person-year. Among female caregivers, the relative risk for use of antidepressants was similar (about 1.3) from 20 to 70 years, after which the relative risk declined. In male caregivers, the relative risk was highest (about 1.4-1.5) between 45 and 65 years.Conclusions: Family caregivers providing high-intensity care use more antidepressants and hence, are likely to have poorer mental health than the age-matched general population in virtually all age groups. However, the magnitude of the higher use varies as a function of age and gender. [ABSTRACT FROM AUTHOR]

Objective. Pain and depressive disorders often present together, but little is known about the prevalence of pain in depression subgroups. The objective of this study was to examine the possible differences in the prevalence of musculoskeletal pain between participants in melancholic and atypical depression subgroups. Design. Cross-sectional study. Setting. Depression nurse case managers where depression patients receive treatment in primary health care. Subjects. Participants included 413 depression patients and 401 controls. Methods. Depressive symptoms were determined with the Beck Depression Inventory (BDI-21), and diagnosis of depression was confirmed with the Mini-International Neuropsychiatric Interview (MINI). The participants were dichotomized into subgroups with melancholic depression (n5269), atypical depression (n5144), and controls (n5401). Musculoskeletal pain was identified during last four weeks. Participants were enrolled in the study between 2008 and 2009. Results. The prevalence of pain was 37% in controls, 57% in atypical depression, and 71% in melancholic depression (P< 0.001, after adjusting for sex and age). A logistic regression model showed that the odds ratio of pain after adjusting for confounding factors was 2.35 (1.56 to 3.56) with atypical depression compared with controls (P< 0.001) and 4.38 (3.03 to 6.33) with melancholic depression compared with atypical depression (P50.006). BDI scores were higher for those with melancholic depression than for those with atypical depression (P< 0.001). Conclusions. Melancholic depression showed to be associated with a higher prevalence of musculoskeletal pain in comparison with atypical depression. This finding highlights the need for further studies about the mechanisms behind the association, particularly in melancholic depression. [ABSTRACT FROM AUTHOR]

Background: Studies using traditional measures of socio-economic position, such as education, income and occupation,have found inequalities in depressive symptoms, but less is known about the association between financial satisfactionand depressive symptoms.Aims: To examine the association of depressive symptoms with financial satisfaction in Finnish adults in a populationbasedcross-sectional FIN-D2D survey.Methods: Four thousand, five hundred randomly selected individuals aged 45-C74 years were invited to the study.Participation rate for health examinations was 64%. Complete information on depressive symptoms and financial satisfactionwas available for 2,819 individuals. Financial satisfaction was asked using a questionnaire. Depressive symptoms weremeasured by Beck Depression Inventory (≥10) and/or use of antidepressants.Results: Altogether 11.6% of individuals who were satisfied with their financial situation had depressive symptoms.Corresponding figures for individuals who were somewhat satisfied or dissatisfied were 20.6% and 42.6%, respectively.Individuals who were less satisfied with their financial situation were more likely to suffer from depressive symptomseven after adjusting for gender, age, marital status, number of chronic diseases, smoking, binge drinking, physical activity,education and household income.Conclusions: Instead of more traditional measures of socio-economic position, financial dissatisfaction seems to beassociated with depressive symptoms in Finnish adults. [ABSTRACT FROM AUTHOR]

In addition to psychoses, antipsychotic drugs are nowadays also prescribed for other psychiatric disturbances, such as mood disorders. We wanted to find out whether there is any association between the use of antipsychotic drugs and suicidality in cases of psychotic and non-psychotic disorders. Our sample was the population-based Northern Finland 1966 Birth Cohort. Information on the use of prescribed drugs was collected in 1997 from the nationwide medication register and with a postal questionnaire ( N = 8218). The presence of suicidal ideation was assessed cross-sectionally using the Symptom Check List-25 questionnaire. We studied associations between suicidal ideation, adjusted for symptoms of depression and anxiety, and antipsychotic medication in different diagnostic groups (schizophrenia, other psychosis and no psychosis). Individuals receiving antipsychotic medication ( n = 70, 0.9%) had in general more suicidal ideation regardless of diagnostic group, although the associations diminished when taking other symptoms into account. There were no statistically significant differences between those taking typical and atypical antipsychotics. In the non-psychotic group, higher antipsychotic doses were associated with more suicidal ideation even when adjusted for symptoms of depression and anxiety ( p < 0.05). In the cases of schizophrenia or other forms of psychosis, no such associations were observed. Our results suggest that one should take suicidal ideation into account when prescribing antipsychotic medication, especially for off-label use. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims: To examine whether persons with psychological distress have a greater risk of all-cause mortality in the Scandinavian population; whether this association is gender-specific; and what is the influence of socioeconomic status, body mass index (BMI) and health behaviour in this association. Methods: A total of 923 (414 male and 509 female) people, aged 36 to 56 years, participated in a population-based study from 1997—98 in Pieksämäki, Finland. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 points were summed to a global score ranging from 0—12. Mortality data until 31 December 2009 were drawn from the national mortality register. Results: There were 44 death events (27 men, 17 women) during the mean observation time of 11 years. The hazard ratio (HR) increased by 16% for every GHQ-12 point (gender and age adjusted HR 1.16, 95% confidence interval (95% CI): 1.07—1.25, p < 0.001). In the fully adjusted model with gender, age, socioeconomic status, BMI, smoking and physical activity, HR was 1.13 (95% CI: 1.04—1.22, p = 0.003). In men, the 10-year survival for distressed (GHQ-12 score ≥4) participants was 84% (95% CI: 73— 91) and for non-distressed (GHQ-12 score 0—3) participants it was 96% (95% CI: 93—97), HR = 3.38 (95% CI: 1.55—7.39, p = 0.002). Among women, no significant association was found. Conclusions: Psychological distress measured by the GHQ-12 is associated with all-cause mortality risk during an 11-year observation time. This is mainly due to excess mortality among distressed men. [ABSTRACT FROM PUBLISHER]

The metabolic syndrome (MetS) is associated with elevated risk of diabetes and cardiovascular morbidity. However, little is known of the sensitivity, specificity and predictive value of individual criteria in patients with schizophrenia. We studied the prevalence of MetS using the International Diabetes Federation (IDF) and adapted National Cholesterol Education Program (NCEP-ATPIII) criteria in the Northern Finland 1966 Birth Cohort population. In addition, the sensitivity, specificity and predictive values for individual criteria were determined. Both adapted NCEP-ATPIII and IDF criteria for MetS identified the same cases (29% of all schizophrenia patients). Among the IDF criteria, hypertriglyceridemia had the highest sensitivity, correctly identifying 77.8% of the patients. Reduced HDL cholesterol was the most specific criteria, with 95% specificity equalling a positive likelihood ratio of 9.78. Thus both the IDF and NCEP-ATPIII criteria may be equally useful in identifying MetS. [ABSTRACT FROM AUTHOR]

Objective Suicide rates in persons over 65 have been reported to be higher than those of younger age groups. Since the absolute number of suicides in the elderly is expected to rise, more precise ways to identify potential risk factors for elderly suicides are needed. Methods On the basis of forensic examinations suicide rates and methods in elderly Finns of northern Finland were compared with those of adults aged 18–64 years. Data from earlier illnesses of the suicide victims were scrutinized for records of multiple physical disorders. Results Over the 15-year period the mean annual suicide rate per population of 100 000 was significantly lower in the elderly (22.5) than adults aged 18–64 years (38.4). A decrease in suicide rates over time occurred in both groups. Suicide methods among elderly were more often violent, and they were seldom under the influence of alcohol. They also had a high prevalence of previous hospital-treated depressive episodes and hospital-treated physical illnesses. A lifetime history of hospital-treated depression was more common among elderly victims who had received hospital treatment for genitourinary diseases, injuries or poisonings after their 50th birthday. Conclusions Our results from elderly suicide victims suggest an association between multiple physical illnesses and a history of depression. Especially, genitourinary diseases as well as hospital treatment due to injuries or poisonings were shown to associate with depression. Elderly Northern Finns showed lower suicide rates, and they decreased during the study period suggesting that active preventive measures against suicide are also feasible in the elderly. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We report patterns of hospitalization in schizophrenic psychoses by age 34 in a longitudinal population-based cohort. We test the predictive ability of various demographic and illness-related variables on patterns of hospitalization, with a special focus on the length of the first psychiatric hospitalization. All living subjects of the Northern Finland 1966 Birth Cohort with DSM-III-R schizophrenia ( n =88) and other schizophrenia spectrum cases ( n =27) by the year 1997 in the Finnish Hospital Discharge Register were followed for an average of 10.5 years. Measures of psychiatric hospitalization included time to re-hospitalization (as continuous and as re-hospitalization within 2 years) and the number of hospital episodes. Length of the first hospitalization, other illness-related and various socio-demographic predictors were used to predict hospitalization patterns. After adjusting for gender, age at first admission and number of hospital days a short (1–14 days) first hospitalization (reference >30 days; adjusted odds ratio 6.39; 95% CI 2.00–20.41) and familial risk of psychosis (OR 3.36; 1.09–10.39) predicted re-hospitalization within 2 years. A short first hospitalization also predicted frequent psychiatric admissions defined as the first three admissions within 3 years (OR 13.77; 3.92–48.36). A short first hospitalization was linked to increased risk of re-hospitalizations. Although short hospitalization is recommended by several guidelines, there may be a group of patients with schizophrenic psychoses in which too short a hospitalization may lead to inadequate treatment response. [ABSTRACT FROM AUTHOR]

Abstract: Obesity is a serious health problem, especially in patients with long-term mental disorders. We explored the socio-demographic, psychiatric, and clinical factors that increase the risk of changing from under- or normal weight in adolescence to overweight/obese in adulthood. We found a 3.6-fold risk of weight gain in females with psychotic disorder. Other significant correlates of weight gain in males were physical inactivity, unhealthy diet, high alcohol consumption, and being single; and in females, chronic diseases, physical inactivity, high alcohol consumption, and having at least three children. These findings emphasize the importance of regular weight monitoring in clinical practice, especially in females with psychotic disorders. [Copyright &y& Elsevier]

Background: The association between the course of cognition and long-term antipsychotic medication in schizophrenia remains unclear. We analysed the association between cumulative lifetime antipsychotic medication dose and change of verbal learning and memory during a 9-year follow-up.Method: Forty schizophrenia subjects and 73 controls from the Northern Finland Birth Cohort 1966 were assessed by California Verbal Learning Test (CVLT) at the ages of 34 and 43 years. Data on the lifetime antipsychotic doses in chlorpromazine equivalents were collected. The association between antipsychotic dose-years and baseline performance and change in CVLT was analysed, controlling for baseline performance, gender, age of onset and severity of illness.Results: Higher antipsychotic dose-years by baseline were significantly associated with poorer baseline performance in several dimensions of verbal learning and memory, and with a larger decrease in short-delay free recall during the follow-up (p=0.031). Higher antipsychotic dose-years during the follow-up were associated with a larger decrease of immediate free recall of trials 1-5 during the follow-up (p=0.039). Compared to controls, decline was greater in some CVLT variables among those using high-doses, but not among those using low-doses.Conclusion: This is the first report of an association between cumulative lifetime antipsychotic use and change in cognition in a long-term naturalistic follow-up. The use of high doses of antipsychotics may be associated with a decrease in verbal learning and memory in schizophrenia years after illness onset. The results do not support the view that antipsychotics in general prevent cognitive decline or promote cognitive recovery in schizophrenia. [ABSTRACT FROM AUTHOR]

Abstract: Background: Duration of untreated psychosis (DUP) has been linked with poor prognosis and changes in the brain structure in schizophrenia at least at the beginning of the disease, but it is still unknown whether DUP relates to brain morphometry in the longer term. Our aim was to analyze the relation between DUP and the brain structure in schizophrenia in the general population, after several years of illness. Methods: Brains of subjects with psychosis from the Northern Finland 1966 Birth Cohort (NFBC 1966) were scanned with MRI during 1999–2001 after an 11-year follow-up. DUP was assessed from medical records and regressed against global and local tissue density measurements. The brain morphometric and the DUP information were available for 46 subjects with DSM-III-R schizophrenia. Results: The DUP did not correlate with volumes of the total gray or white matter or the cerebrospinal fluid. The length of DUP associated positively with reduced densities of the right limbic area and the right hippocampus. Conclusions: Long DUP was slightly associated with reductions of gray matter densities in the limbic area and especially the hippocampus after several years follow-up, supporting the hypothesis that, compared to short DUP, long DUP might be a marker of different disease trajectories including subtle morphometric changes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether there is an association between maternal mental health, purchase of psychotropic drugs, socioeconomic status and major congenital anomalies in offspring., Methods: A register-based cohort study of 6189 Finnish primiparous women who had a singleton delivery between 2009 and 2015. Data on pregnancy and delivery outcomes, psychiatric diagnosis, prescription drug purchases and offspring congenital anomalies were obtained from Finnish national registers., Results: Severe depressive disorders were diagnosed in 2.0% of women and severe anxiety disorders in 1.1%. During pregnancy, 9.6% of women purchased psychotropic drugs. Of these women, 5.7% delivered an offspring with a major congenital anomaly. Women who purchased psychotropic drugs in pregnancy had an increased risk of delivering a child with major congenital anomalies compared with women who did not purchase psychotropic drugs. Multivariate regression analysis showed that purchase of benzodiazepines increased the risk of major congenital anomalies (odds ratio 2.11 [95% confidence interval 1.17 to 3.81]). Pregnant women purchasing psychotropic drugs more often lived alone and smoked, had higher body mass index, and had lower annual income and educational attainment than women not purchasing psychotropic drugs., Conclusions: Benzodiazepine use, but not socioeconomic status, may be associated with major congenital abnormalities in offspring., Competing Interests: Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Background: Depression is associated with metabolic abnormalities linked to metabolic syndrome and tissue inflammation, but the interplay between metabolic markers and their association with subsequent depression is unknown. Therefore, we aimed to describe the network of metabolites and their prospective association with depressive symptoms., Methods: The Finnish Depression and Metabolic Syndrome in Adults (FDMSA) cohort, originally a prospective case-control study, comprised a group with Beck Depression Inventory (BDI)-I scores ≥10 at baseline, and controls (n = 319, BDI-I < 10); mean (sd) follow-up time: 7.4 (0.7) years. Serum metabolic biomarkers were determined by proton nuclear magnetic resonance (NMR), and depressive symptoms sum-score by using the BDI-I. We examined the prospective associations between metabolites at baseline and BDI score at follow-up utilizing multivariate linear regression, parsimonious predictions models and network analysis., Results: Some metabolites tended to be either negatively (e.g. histidine) or positively associated (e.g. glycoprotein acetylation, creatinine and triglycerides in very large high density lipoproteins [XL-HDL-TG]) with depressive symptoms. None of the associations were significant after correction for multiple testing. The network analysis suggested high correlation among the metabolites, but that none of the metabolites directly influenced subsequent depressive symptoms., Limitations: Although the sample size may be considered satisfactory in a prospective context, we cannot exclude the possibility that our study was underpowered., Conclusions: Our results suggest that the investigated metabolic biomarkers are not a driving force in the development of depressive symptoms. These findings should be confirmed in studies with larger samples and studies that account for the heterogeneity of depressive disorders., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To explore criminal behavior of individuals with Alzheimer's disease (AD), frontotemporal dementia (FTD), or Lewy body dementias (LBD) after the diagnosis., Design: Nationwide register study., Setting: Information on diagnoses and criminality was received from Finnish registers. Crime types and incidences were compared between disorders and the general population., Participants: All Finnish individuals diagnosed with AD, LBD, or FTD (n = 92 189) during 1998-2015., Measurements: Types of crimes and incidences, the standardized criminality ratio (SCR, number of actual crimes per number of expected crimes), numbers of observed cases, and person-years at risk counted in 5-year age groups and for both sexes and yearly., Results: Among men, at least one crime was committed by 2.8% of AD, 7.2% of FTD, and 4.8% of LBD patients. Among women, the corresponding figures were 0.4%, 2.0%, and 2.1%. The most frequent type of crime was traffic offence, followed by property crime. After age adjustment, the relative number of crimes between groups did not differ, except that men with FTD and LBD committed more crimes than those with AD. The SCR (95% CI) among men were 0.40 (0.38-0.42) in AD, 0.45 (0.33-0.60) in FTD, and 0.52 (0.48-0.56) in LBD. Among women, these were 0.34 (0.30-0.38), 0.68 (0.39-1.09), and 0.59 (0.51-0.68)., Conclusions: The diagnosis of a neurocognitive disorder does not increase criminal behavior, but rather reduces it by up to 50%. Differences in crime activity are present between different neurocognitive disorders and between the sexes., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up., Methods: A total of 258 patients aged ≥35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score ≥10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point., Results: Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69-2.95) for participants with moderate LTPA and 0.92 (CI 0.42-2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future ( β= 0.14 [95% CI: 0.02-0.26] for linearity = 0.024)., Conclusion: Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.

Objective: To explore the criminality of patients with subsequent diagnosis of Alzheimer's disease (AD), frontotemporal dementia (FTD), or Lewy body dementias (LBD) in the four years preceding diagnosis., Design: Nationwide register study., Setting: Data on Finnish patients were collected from the discharge register and data on criminal offending from the police register. Research findings were compared with the same-aged general population., Participants: A total of 92,191 patients who had received a diagnosis of AD (N = 80,540), FTD (N = 1,060), and LBD (N = 10,591) between 1998 and 2015., Measurements: Incidences and types of crimes, the standardized criminality ratio (number of actual crimes per number of expected crimes), and the numbers of observed cases and person-years at risk counted in five-year age groups and separately for both genders and yearly., Results: At least one crime was committed by 1.6% of AD women and 12.8% of AD men, with corresponding figures of 5.3% and 23.5% in FTD, and 3.0% and 11.8% in LBD. The first crime was committed on average 2.7 (standard deviation 1.1) years before the diagnosis. The standardized criminality ratio was 1.85 (95% confidence interval [CI] 1.43-2.37) in FTD women and 1.75 (95% CI 1.54-1.98) in FTD men, and in AD 1.11 (95% CI 1.04-1.17) and 1.23 (95% CI 1.20-1.27), respectively. Traffic offences and crimes against property constituted 94% of all offences., Conclusion: Criminal acts may occur several years prior to the diagnosis of dementia. If novel criminality occurs later in life, it may be associated with neurocognitive disorder., (Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the relationship between leisure-time physical activity (LTPA) and ability to meet different work requirements among adult working men with or without current depressive symptoms., Methods: We measured LTPA with the long version of the International Physical Activity Questionnaire (IPAQ). The Work Ability Index (WAI) and Beck Depression Inventory (BDI) were used to assess the work ability and depression of 921 Finnish employed male volunteers. Participants were divided into three groups according to the WAI for their work requirements: mental (MENT), physical (PHYS), and an equal amount of mental and physical work (BTH)., Results: When adjusted for age, BMI and employment years, there was a significant difference in weekly LTPA between WAI groups {p = 0.003, [F (2902) = 5.58]}, but not for depression. It appeared that participants with depressive symptoms scored lower WAI in each group regardless of LTPA. In addition, a linear relationship was found between higher LTPA and WAI in nondepressed workers in the PHYS [p = 0.011, β = 0.10 (95% CI 0.03-0.18)] and BTH [p = 0.027, β = 0.19 (95% CI 0.03-0.34)] groups. Among workers with depressive symptoms, similar linearity was found in BTH [p = 0.003, β = 0.20 (95% CI 0.03-0.55)]. In group-wise comparison, work requirements {p = 0.001, [F (2902) = 11.2]} and depressive symptoms {p < 0.001, [F (1902) = 177.0]} related with lower WAI., Conclusion: Depressive symptoms were associated with lower work ability regardless of the job description. Therefore, higher levels of weekly LTPA was linked with better work ability among nondepressed working men. Workers with depressive symptoms in jobs that require extensive mental or physical work might need more than exercise to improve work ability.

Background and aims Restless legs syndrome is a sensorimotor disorder associated with mental health conditions notably depression. Restless legs symptoms and depression are commonly associated with pain. The study investigated the influence of restless legs symptoms on musculoskeletal pain in patients with depression or with increased depressive symptoms. Methods A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in patients with depressive symptoms (n = 695) and controls without a psychiatric diagnosis (n = 410) by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory and the psychiatric diagnosis was confirmed by means of a diagnostic interview (MINI). The prevalence and intensity of musculoskeletal pain was captured with form-based questions. A single-question screen for restless legs symptoms was applied. Results There was a significant difference in the prevalence of continuous widespread musculoskeletal pain between the three study groups: the controls 4.6% (95% CI: 2.8-7.1), the patients with symptoms of depression without a diagnosis 16.0% (11.7-21.1), and the patients with diagnosed depression 22.1% (18.3-23.3) (p = 0.006 after being adjusted for age, sex, smoking, use of alcohol, education years, body mass index, use of antidepressants, and physical activity, after multiple corrections, all groups were significantly different from each other). Compared with those not having restless legs symptoms, subjects with restless legs symptoms had more often continuous widespread musculoskeletal pain in the control subjects (p = 0.001; 2.3% vs. 10.5%) and in the patients with depressive symptoms without a depression diagnosis (p = 0.024; 9.1 vs. 18.7%) but not in those with diagnosed depression (p = 0.98; 19.5 vs. 19.4%). The restless legs symptoms were associated with the intensity of pain in all groups (p < 0.001). Conclusions Restless legs symptoms were related to continuous widespread musculoskeletal pain in subjects without depressive symptoms and in patients with depressive symptoms without a depression diagnosis. Pain intensity was higher in the subjects with restless legs symptoms regardless of depressive symtoms or depression. Implications Clinical management of pain in patients with restless legs symptoms should include an increased focus on the prevention and treatment of either conditions.

Purpose: The study aim was to examine association between leisure time physical activity (LTPA) and psychiatric comorbidities among people with depression., Methods: Total 447 patients aged 35 years and older suffering from depressive symptoms (DS) and who were confirmed depression positive participated this study. The study was conducted between 2008 and 2011 in municipalities within Central Finland Hospital District. DS were determined with Beck Depression Inventory (BDI-21) with cutoff score ≥10 and psychiatric diagnoses were confirmed by Mini-International Neuropsychiatric Interview (M.I.N.I.). LTPA, other diseases as well as use of antidepressant were captured by self-reported questionnaire. Participants also took part in physical examination. The associations between LTPA and psychiatric comorbidities were analyzed using generalized linear models., Results: LTPA level was not related to number of psychiatric comorbidities (after adjustment for age, gender, BMI, BDI and use of antidepressant p = 0.24) among depressed patients. The higher levels of LTPA were linearly associated with lower cardiovascular diseases (p = 0.036) and obesity (p = 0.006) as well as fewer DS (p < 0.001) among depressed patients., Limitations: Possibility of LTPA level overestimation and study results generalizability to younger persons., Conclusions: According to this study, LTPA level is not associated with psychiatric comorbidities among depressed patients in Finnish adult population. However, our results showed that the higher the LTPA level was, the less the participants suffered from depressive symptoms. In addition, higher levels of physical activity were associated with fewer heart diseases and obesity outlining the importance of overall health-care and health promotion although other forms of treatment are also needed., (Copyright © 2019. Published by Elsevier B.V.)

Background: Screening of depression has been recommended in primary care and Beck's 21-item Depression Inventory (BDI-21) is a commonly used tool for screening. Depression has been shown to be frequently accompanied by comorbidities., Aims: This study aimed to analyze the characteristics, psychiatric diagnoses, and psychiatric comorbidity of primary care patients who have been screened for depression and referred to a depression nurse., Methods: The study subjects were primary care patients aged ≥ 35 years with depressive symptoms (BDI-21 > 9). Their psychiatric diagnosis were based on a diagnostic interview (Mini-International Neuropsychiatric Interview; M.I.N.I.) conducted by a trained study nurse., Results: Of the 705 study subjects, 617 (87.5%) had at least one and 66.1% had at least two psychiatric diagnoses. The most common diagnosis was depression (63.4%). The next most common diagnoses were generalized anxiety disorder (GAD) (48.1%) and panic disorder (22.8%). Only 8.8% of the study subjects had depression without other psychiatric disorders. Ten percent of the subjects had both depression and a generalized anxiety disorder (GAD). Also other psychiatric comorbidities were common. Age was inversely associated with the psychiatric diagnosis in the M.I.N.I., Conclusions: This study suggests that most of the primary care patients with increased depressive symptoms have a psychiatric disorder. Although depression is the most common diagnosis, there are several other concurrent psychiatric comorbidities. Therefore, diagnostic assessment of primary care patients with a screening score over 9 in the BDI-21 should be reconsidered.

The aim of this paper was to investigate differences in brain structure volumes between schizophrenia and affective psychoses, and whether cumulative lifetime antipsychotic or benzodiazepine doses relate to brain morphology in these groups. We conducted two systematic reviews on the topic and investigated 44 schizophrenia cases and 19 with affective psychoses from the Northern Finland Birth Cohort 1966. The association between lifetime antipsychotic and benzodiazepine dose and brain MRI scans at the age of 43 was investigated using linear regression. Intracranial volume, sex, illness severity, and antipsychotic/benzodiazepine doses were used as covariates. There were no differences between the groups in brain structure volumes. In schizophrenia, after adjusting for benzodiazepine dose and symptoms, a negative association between lifetime antipsychotic dose and the nucleus accumbens volume remained. In affective psychoses, higher lifetime benzodiazepine dose associated with larger volumes of total gray matter and hippocampal volume after controlling for antipsychotic use and symptoms. It seems that in addition to antipsychotics, the severity of symptoms and benzodiazepine dose are also associated with brain structure volumes. These results suggest, that benzodiazepine effects should also be investigated also independently and not only as a confounder., (Copyright © 2018. Published by Elsevier B.V.)

Background: To assess the cost-utility of vortioxetine versus relevant comparators (agomelatine, bupropion SR, sertraline, and venlafaxine XR) in the finnish setting in major depressive disorder (MDD) patients with inadequate response to selective serotonin- /serotonin-norepinephrine reuptake inhibitors., Methods: A one-year analysis was conducted using a decision tree with a Markov state transition component. The health states were remission, relapse and recovery. A Finnish healthcare payer perspective was adopted., Results: Vortioxetine was less costly and more effective versus all comparators in both direct and societal perspectives. Vortioxetine reduced the average annual direct costs by 4% versus venlafaxine XR and 8% versus sertraline. The greater efficacy associated with vortioxetine was translated into a higher percentage of patients in remission and recovery. The model was most sensitive to changes in remission rates at 8 weeks., Conclusion: This cost-utility analysis showed vortioxetine to be a good alternative for MDD patients switching therapy in Finland.

Objective: The aim was to study the association between use of antidepressant medication and suicidal ideation in different diagnostic groups in a large population-based cohort., Methods: Information on prescribed drugs within the Northern Finland Birth Cohort 1966 was collected at the age of 31 years with postal questionnaire (N= 8218). The presence of suicidal ideation was assessed via the Hopkins Symptom Checklist-25 questionnaire. We studied associations between suicidal ideation and antidepressant medication in various diagnostic and symptom groups, and it adjusted for symptoms of depression and anxiety., Results: Suicidal ideation was associated with the use of antidepressant medication in all diagnostic groups, but the association disappeared with adjustment for other symptoms of depression and anxiety. Subjects who reported insomnia and used antidepressants had suicidal ideation more commonly than did subjects who were not using antidepressants even when other symptoms were adjusted for (p = 0.02). There were no statistically significant differences between antidepressant groups or doses., Conclusion: In a large unselected cohort, antidepressant medication was not associated with increased suicidal ideation when other symptoms of depression and anxiety were taken into account. The assessment of insomnia might be useful for identifying individuals liable to have increased suicidal ideation while on antidepressant medication.

Understanding the fate of persistent organic chemicals in the environment is fundamental information for the successful protection of ecosystems and humans. A common dilemma in risk assessment is that monitoring data reveals contaminant concentrations in wildlife, while the source concentrations, route of uptake and acceptable source concentrations remain unsolved. To overcome this problem, different models have been developed in order to obtain more precise risk estimates for the food webs. However, there is still an urgent need for studies combining modelled and measured data in order to verify the functionality of the models. Studies utilising field-collected data covering entire food webs are particularly scarce. This study aims to contribute to tackling this problem by determining the validity of two bioaccumulation models, BIOv1.22 and AQUAWEBv1.2, for application to a multispecies aquatic food web. A small boreal lake, Lake Kernaalanjärvi, in Finland was investigated for its food web structure and concentrations of PCBs in all trophic levels. Trophic magnification factors (TMFs) were used to measure the bioaccumulation potential of PCBs, and the site-specific environmental parameters were used to compare predicted and observed concentrations. Site-specific concentrations in sediment pore water did not affect the modelling endpoints, but accurate site-specific measurements of freely dissolved concentrations in water turned out to be crucial for obtaining realistic model-predicted concentrations in biota. Numerous parameters and snapshot values affected the model performances, bringing uncertainty into the process and results, but overall, the models worked well for a small boreal lake ecosystem. We suggest that these models can be optimised for different ecosystems and can be useful tools for estimating the bioaccumulation and environmental fate of PCBs., (© 2013 Elsevier B.V. All rights reserved.)

Background: Long duration of untreated psychosis (DUP) may relate to poor outcome in schizophrenia. However, the associations between DUP and outcomes, particularly in later course of illness, remain unclear. Our aim was to explore the associations between DUP and short- and long-term outcomes in schizophrenia., Methods: Data was collected for subjects with schizophrenia (n=89) in the population-based Northern Finland 1966 Birth Cohort. DUP was obtained from medical records, and its associations with short- (under 2years) and long-term clinical and social outcomes were assessed extending to 20years after the onset of the illness., Results: Longer DUP predicted longer length of first hospitalisation and increased the risk of rehospitalisation during the first two years. Longer DUP associated with decreased probability of disability pension, smaller amount of time spent in hospital, and higher proportion of time at work during the first 10years of the follow-up., Conclusions: Regarding early outcome, long DUP may be a modest marker and proxy measure of a more severe clinical phenotype. The divergent results of earlier studies and the association between long DUP and better long-term outcome in our study, indicate that the length of DUP does not necessarily predict poor outcome in long-term follow-up. This may also be due to methodical difficulties, e.g. insufficient power and residual confounding linked to long follow-up studies., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: Thioridazine is a first-generation antipsychotic drug that was withdrawn from the market worldwide in 2005. The outcome of clinically stable schizophrenia patients who used thioridazine before market withdrawal was evaluated., Methods: Nationwide registers in Finland were utilized to study thioridazine use, hospitalization rate and length of hospital stay., Results: Although thioridazine use continued to diminish year after year, the hospitalization rate remained constant until the withdrawal year of 2005, when the percentage of patients hospitalized for schizophrenia doubled., Conclusion: The market withdrawal of thioridazine predisposed many stable patients towards psychotic relapses. In order to minimize this kind of risk, an overall risk-benefit assessment and a clear-cut plan for the replacement of an antipsychotic should be established before market withdrawal., (Copyright © 2012 John Wiley & Sons, Ltd.)

Background: There is a lack of knowledge on the influence of different levels of physical activity (PA) on unintentional injuries among those with depressive symptoms (DS). The aim of this study was to evaluate the relationship between PA categories and unintentional injuries among participants with and without DS based on a cross-sectional population-based FIN-D2D survey conducted in 2007., Methods: Out of 4500, 2682 participants (60%) aged 45-74 years attended in this study. The unintentional injuries over the past year were captured in a questionnaire. DS were determined with the Beck Depression Inventory (≥ 10 points) and PA with the International Physical Activity Questionnaire. The statistical significance between DS and unintentional injury categories was evaluated by using t-test, chi-square test, or permutation test, analysis of covariance, or regression models. The factors related to unintentional injuries were estimated by univariate and multivariate logistic regression models., Results: The proportion of subjects with unintentional injuries was higher among those with DS (17%) compared to those without DS (10%) (age- and gender-adjusted p = 0.023). The median (range) number of activity-loss days after injury was 22 (0-365) in participants with DS and 7 (0-120) in participants without DS ( p = 0.009). The percentage of subjects with unintentional injuries was not significantly different between PA categories in participants with DS and without DS. A stepwise multivariate logistic regression analysis showed that DS, functional ability, and musculoskeletal diseases were related to unintentional injuries., Conclusions: PA level was not related to unintentional injuries, whereas those with DS had a higher prevalence of unintentional injuries and prolonged activity-loss after injury. These results underline the importance of injury prevention, especially among those who have DS and additional risk factors.

Introduction: Advanced paternal age (APA) is a reported risk factor for schizophrenia in the offspring. We performed a meta-analysis of this association, considering the effect of gender and study design., Methods: We identified articles by searching Pub Med, PsychInfo, ISI, and EMBASE, and the reference lists of identified studies. Previously unpublished data from the Northern Finland 1966 Birth Cohort (NFBC 1966) study were also included., Results: There were 6 cohort studies and 6 case-control studies that met the inclusion criteria. In both study designs, there was a significant increase in risk of schizophrenia in the offspring of older fathers (≥30) compared to a reference paternal age of 25-29, with no gender differences. The relative risk (RR) in the oldest fathers (≥50) was 1.66 [95% confidence interval (95% CI): 1.46-1.89, P < 0.01]. A significant increase in risk was also found for younger fathers (<25) in males (RR = 1.08, 95% CI: 1.02-1.14, P = 0.01) but not females (RR = 1.04, 95% CI: 0.97-1.14, P = 0.28). The population attributable risk percentage (PAR%) was 10% for paternal age ≥30 and 5% for paternal age <25., Discussion: Both APA (≥30) and younger paternal age (<25) increase the risk of schizophrenia; younger paternal age may be associated with an increased risk in males but not females. This risk factor increases the risk of schizophrenia as much as any single candidate gene of risk. The mechanism of these associations is not known and may differ for older and younger fathers.

Negative symptoms are a major scientific and therapeutic challenge in schizophrenia. We report the occurrence and predicting factors of negative symptoms at two time points in a population-based birth cohort. The negative symptoms of subjects with Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) schizophrenia (n=46) were scrutinized at the first hospitalization due to psychosis from hospital records (first-episode psychosis) and with an interview approximately 10 years later (follow-up phase). Developmental and sociodemographic predictors of negative symptoms in first-episode psychosis, follow-up phase and at both measurements were analysed. Forty-one percent of the subjects had negative symptoms at the first episode, 39% in the follow-up phase, and in 24% the symptoms persisted at both measurements. Smoking at the age of 14, definite psychosocial stressor and not being married predicted more negative symptoms whereas good school performance and using less alcohol at age 14 predicted fewer persistent negative symptoms. These findings are new. However, we were not able to identify any major premorbid phenotype or endophenotype predicting negative symptoms which support the view that negative symptoms might mainly be a specific part of the illness.

Objective: Unipolar depression has been found to associate with elevated C-reactive protein (CRP) levels in men, but findings among women have been conflicting. It has been hypothesized that this would be explained by a different hormonal environment (compared with men) and its changes throughout the lifecycle in women, but until now, the corresponding evidence has been lacking. We investigated the association between CRP levels and depressive symptoms in a population-based study in pre-, peri-, and postmenopausal women and, also, whether this association is affected by the use of exogenous hormones (contraceptives and postmenopausal hormone therapy)., Methods: The entire age classes of those born in 1942, 1947, 1952, 1957, and 1962 and living in Pieksämäki, Finland, were invited (n=1294), and out of 730 women, 512 (70.1%) participated in this cross-sectional study in 1997 to 1998. Depressive symptoms were assessed by Beck's Depression Inventory-21 (BDI-21), and CRP was measured with a high-sensitivity CRP (hs-CRP) assay., Results: We found a positive correlation between hs-CRP levels and depressive symptoms in peri- and postmenopausal women not using exogenous hormones (Pearson correlation coefficient, r=.248, P<.001; and r=.343, P=.059, respectively). After multivariate adjustment, a statistically significant interaction was noted between hs-CRP levels and the exogenous hormone use on total score of BDI-21 (P=.022) among "peri- and postmenopausal women.", Conclusions: Our novel findings suggest that female hormones may have moderating effect at peri- and postmenopausal women on the association between elevated CRP levels and depressive symptoms. Further studies are, however, needed to confirm our findings., (Copyright 2010 Elsevier Inc. All rights reserved.)

Advanced paternal age is a risk factor for adverse health outcomes in the offspring. In a population-based birth cohort from Finland, 10,965 singleton offspring born in 1966 and alive at age 1 were followed to age 39. Hazard ratios were calculated, adjusting for maternal age, gender, paternal social class, and maternal parity. In females but not in males, increasing paternal age was associated with a linear increased risk of suicide (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.04-1.24, p < 0.01) and all-causes mortality (HR = 1.06, 95% CI = 1.01-1.10, p = 0.02). Increasing maternal age was associated with a significantly decreased risk of suicide (HR = 0.93, 95% CI = 0.86-1.00, p = 0.04) and all-causes mortality (HR = 0.96, 95% CI = 0.93-1, p = 0.02) in the entire cohort. For paternal age >/=30, the population attributable risk percentage was 13.7% for all deaths and 7.5% for suicides. Parental age at birth may affect suicide and all-causes mortality risk in the offspring in the general population. The causal pathways and specific disorders associated with this increased mortality are largely unknown.

Objective: To compare self-reported (SR) medication use and pharmacy data for major psychoactive medications and three classes of medications used for different indications, and to determine the socio-economic factors associated with the congruence., Methods: Postal questionnaire data collected in 1997 were compared with the register of the Social Insurance Institution of Finland on the reimbursed prescriptions purchased during 1997. Altogether 7625 subjects were included in this study. Drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) system., Results: Kappa values were 0.77, 0.68, 0.84, 0.92 and 0.55 for antipsychotics, antidepressants, antiepileptics, antidiabetics and beta-blocking agents, respectively. Prevalence-adjusted and bias-adjusted kappa values were almost perfect (0.98-1.00). Reliability of antipsychotics use was better for married subjects than for those who were not married; and of antidepressants use for highly educated and married subjects than for those who were less educated and were not married. Altogether 414 (5.4%) responders and 285 (7.1%) non-responders had used at least one of the selected medications., Conclusion: Agreement between the SR and pharmacy data was moderate for psychoactive medication use. Even though data collected by postal questionnaire may underestimate the prevalence of medication use due to non-participation it can be assumed accurate enough for study purposes.

Previous studies with selected patient populations have suggested that cytokines, the immune system messengers, may play a role in the aetiology of depression. However, the data concerning the increase or decrease of the plasma cytokine levels in depression is controversial and the effects of the medications and type of depression are largely unknown. We studied the connections between plasma interleukin-1 beta (IL-1 beta) and interleukin 1 receptor antagonist (IL-1RA) levels, and depressive symptomatology measured with the Beck Depression. Inventory in a large, middle-aged population-based sample collected from Central Finland. In addition, the effects of various medications and type of depressive symptomatology on the cytokine levels were scrutinized. In the whole study population, IL-1RA levels were higher in the subgroup with depressive symptomatology. In the males with depressive symptomatology, higher IL-1RA levels and lower interleukin-1 beta levels were observed as compared with the non-depressed males. The IL-1RA/IL-1 beta ratio was significantly higher in males with depressive symptomatology. The IL-1RA levels were also higher and IL-1 beta levels lower in the depressed females, but the trend was not significant. The elevated IL-1RA-levels and IL-1RA/IL-1 beta ratio suggest a role for cytokines in the pathogenesis of depression. The higher IL-1RA levels may reflect an endogenous repairing process against depression.

Objective: This study examined the timing of suicide among elderly and middle-aged persons after their final hospitalization and examined characteristics of suicides in relation to the timing of suicide., Methods: Data were examined for Northern Finnish middle-aged (50-64 years, N=370) and elderly (65 years or older, N=194) suicide victims. Suicides were classified by a forensic examiner., Results: Compared with elderly persons whose suicide occurred more than 180 days after hospitalization or who had had no hospitalizations, elderly persons who committed suicide within one week after hospitalization were more likely to have a history of hospital-treated psychiatric and alcohol-related disorders and depression and were more likely to have been given a psychiatric diagnosis at their last hospitalization. Compared with elderly men, elderly women were more likely to commit suicide in the first month after being discharged from the hospital., Conclusions: An increased risk of suicide after hospitalization should be taken into account in the treatment arrangements for elderly persons.

In bipolar disorder, mood stabilizers and second-generation antipsychotics have a central role in pharmacotherapy. There are, however, substantial differences in how the treatment is realized in different countries. The aim of this paper was to compare the treatment of acute mania in the Nordic countries with other European countries during the first 12 weeks of the EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) study. Adult patients with bipolar disorder were enrolled within standard course of care as in/outpatients if they initiated/changed oral medication with antipsychotics, anticonvulsants or lithium for treatment of acute mania. Five hundred and thirty European psychiatrists including 23 Nordic psychiatrists enrolled 3459 patients including 79 Nordic patients eligible for analysis using the same study methods assessing demographics, psychiatric history, clinical status, functional status and pharmacological treatment. Psychiatric status at inclusion measured by the Young Mania Rating Scale (YMRS) and the Clinical Global Impression-Bipolar Disorder (CGI-BP) were similar in the Nordic and European patient groups, which is surprising as 73% of the Nordic patients compared with 38% of the European patients were inpatients. In the Nordic group of patients, more patients were living independently. Before inclusion in the study more patients in the Nordic group had combination therapy, but after inclusion in the study the prescription pattern of psychopharmacy was similar in the Nordic and the European patient groups. This study indicated differences in admission patterns, patient social functioning and medical treatment in the Nordic patients compared with the European patients.

Objective: Elderly people commit suicide more often than people under the age of 65. An elevated risk is also attached to depression and other axis I psychiatric disorders. However, little is known about the preferred suicide method, effect of primary psychiatric diagnosis, and length of time between discharge from psychiatric hospitalization and suicide. The lack of information is most apparent in the oldest old (individuals over 75 years)., Methods: On the basis of forensic examinations, data on suicide rates were separately examined for the 50-64, 65-74 and over 75 year-olds (Total n=564) with regard to suicide method, history of psychiatric hospitalization and primary diagnoses gathered from the Finnish Hospital Discharge Register. Study population consisted of all suicides committed between 1988 and 2003 in the province of Oulu in Northern Finland., Results: Of the oldest old, females had more frequent hospitalizations than males in connection with psychiatric disorders (61% vs 23%), of which depression was the most common (39% vs 14%). In this age group, 42% committed suicide within 3 months after being discharged from hospital and 83% used a violent method. Both elderly males and females were less often under the influence of alcohol, but used more often violent methods than middle-aged persons., Conclusions: Suicide rates within the first 3 months following discharge from hospital in the 65-74 and the over 75 year olds were substantial and should influence post-hospitalization treatment strategies. To reduce the risk of suicides in elderly patients discharged from hospital, close post-hospitalization supervision combined with proper psychoactive medication and psychotherapy, are possible interventions., (Copyright (c) 2007 John Wiley & Sons, Ltd.)

We present bibliometric methods that can be utilized in evaluation processes of scientific work. In this paper, we present some practical clues using Finnish schizophrenia research as an example and comparing the research output of different institutions. Bibliometric data and indicators including publication counts, impact factors and received citations were used as tools for evaluating research performance in Finnish schizophrenia research. The articles and citations were searched from the Web of Science database. We used schizophrenia as a keyword and defined address Finland, and limited years to 1996-2005. When we analysed Finnish schizophrenia research, altogether 265 articles met our criteria. There were differences in impact factors and received citations between institutions. The number of annually published Finnish schizophrenia articles has tripled since the mid-1990s. International co-operation was common (43%). Bibliometric methods revealed differences between institutions, indicating that the methods can be applied in research evaluation. The coverage of databases as well as the precision of their search engines can be seen as limitations. Bibliometric methods offer a practical and impartial way to estimate publication profiles of researchers and research groups. According to our experience, these methods can be used as an evaluation instrument in research together with other methods, such as expert opinions and panels.

We studied occupational status of persons with schizophrenic psychoses by age 34 in a longitudinal population-based cohort and predicted which demographic and illness-related factors could support the patients to maintain their occupational capacity. Subjects of the Northern Finland 1966 Birth Cohort with the diagnosis of DSM-III-R schizophrenic psychoses (n=113) by the year 1997 were followed until the end of year 2000. Various illness and socio-demographic factors at the time of onset of illness were used as predictors. At the end of the follow-up time 50 (44%) of patients were not pensioned and 22 (20%) were also working at least half of the time during year 2000. After adjusting for gender, being unemployed at onset, educational level and proportion of time spent in psychiatric hospitals, those who were married or cohabiting at the time of onset of illness were less often on pension than those who were single (OR 6.51; 95% CI 1.83-23.12). Thus, nearly half of the patients with schizophrenic psychoses were not pensioned after an average 10 years follow-up. Based on our findings, those who were single at time of their onset of illness probably need most support to retain their contacts to work life.

Background: The elderly use more sedatives than other populations. Reports on the sedative load of drugs and their associations with health items are scarce., Objective: To investigate the prevalence of sedatives and drugs with sedative properties and the associations between those drugs and demographic or health items in the home-dwelling elderly in a cross-sectional community survey., Methods: Information was obtained from 1197 persons (43% men) aged >or=64 years in the Finnish municipality of Lieto in 1998-1999. The brand names of the prescription drugs taken by each interviewee during one week prior to the interview were recorded. The classification created in a previous study, where the drugs used in Finland were divided into 4 groups by their sedative properties, was utilized to determine associations with health items., Results: A total of 88% (n = 1056) of the participants used some drug. Forty percent (n = 422 persons) of the drug users took sedatives or drugs with sedative properties. The oldest individuals (>or=80 y), women, those with low education, smokers, those with poor self-perceived health, people with dementia and mobility problems, and especially those with depression had an independent association with the simultaneous use of many (>or=2) sedatives or drugs with sedative properties., Conclusions: In a population of home-dwelling elderly patients, abundant sedative drug use was common and especially associated with high age, female gender, poor basic education, poor health habits (eg, smoking), depression, dementia, or impaired mobility. Users also had poor self-perceived health. The need to further develop the classification will be a major challenge, and the classification needs to be updated every year. More studies are needed in this field.

Background: Shortly after phenothiazines were introduced, they were found to elevate serum triglyceride and total cholesterol levels. During the past decade, an increasing body of literature has also documented this effect in atypical antipsychotics. Previous studies of antipsychotic-associated hyperlipidemias are based on clinical samples, mostly from case series. We studied the prevalence of hyperlipidemia in subjects who did and did not take antipsychotic medication in a prospective, general population-based birth cohort., Method: The study sample consisted of 5654 members of the unselected Northern Finland 1966 Birth Cohort who participated in the 1997-1998 clinical examination at 31 years of age. Blood samples were taken after an overnight fast, and serum total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels were determined. Health habits and other possible correlates for hyperlipidemia were assessed using a questionnaire. The sample was analyzed in 4 categories according to use of antipsychotic medication: (1) atypical, (2) typical, (3) atypical and typical (for the 3 antipsychotic categories, total N = 45), and (4) no antipsychotic medication (N = 5609). Nonparametric tests and multiple logistic regression analysis were used to measure the effect of antipsychotics on serum lipids., Results: High lipid levels were found in persons treated with both atypical and typical medication (mean total cholesterol = 233 mg/dL, mean triglycerides = 163 mg/dL). Mean total cholesterol and triglycerides were also high in subjects who used only typical medication (215 mg/dL and 148 mg/dL, respectively). The prevalence of hypercholesterolemia, high LDL cholesterol, and hypertriglyceridemia was high in persons using antipsychotic medication (31.1%, 20.0%, and 22.2%, respectively) compared with persons not using such medication (12.2%, 10.2%, and 7.0%, respectively). After we adjusted for risk factors for hyperlipidemia (sex, diet, waist circumference, physical exercise, smoking, and alcohol consumption), the results of logistic regression analysis showed that in persons treated with antipsychotic medication the risk of hypercholesterolemia was 2.8 (95% CI = 1.4 to 5.6); of hypertriglyceridemia, 2.3 (95% CI = 1.0 to 5.4); and of high LDL cholesterol, 1.6 (95% CI = 0.7 to 3.5)., Conclusion: Lipid levels in subjects who used both atypical and typical medication and those who used only typical medication were high even in young age. As these persons are at special risk of hyperlipidemia, their lipid levels should be regularly monitored, and a cholesterol-lowering diet, as well as medication, should be considered. The results indicate an elevated risk of hyperlipidemia in persons using antipsychotic medication independent of the other risk factors assessed.

Central nervous system (CNS) viral infections have been suggested to increase the risk of schizophrenia, although most of the evidence is indirect and comes from rather few studies on exposure to various infections in general. In the Northern Finland 1966 Birth Cohort the association between schizophrenia and other psychoses and childhood CNS infections has been analysed, and in this paper we present the follow-up results up to the end of 1994 and 1997. Data regarding the infections were collected prospectively between 1966-1980 and data on psychoses from 1982. The registered psychiatric diagnoses were validated using the DSM-III-R classification. Out of the 11017 subjects (96% of all births in that year) 145 had suffered a CNS infection during childhood, which in 102 cases was a viral infection. In the follow-up to the end of 1994, 76 had schizophrenia, and their number increased to 100 to the end of 1997. In addition, up to the end of 1994, 52 patients had a non-schizophrenic psychosis. Four cases in the schizophrenia patient group and none of the patients with other psychosis had suffered a viral CNS infection. None of the schizophrenia cases and two of the patients with other psychosis had had a bacterial infection. The adjusted odds ratio for schizophrenia after a viral CNS infection was 4.8 (95% confidence intervals [CI] 1.6-14.0) in the follow-up to the end of 1994 and 2.5 (0.9-7.0) in the follow-up to the end of 1997. The clinical course variables did not differ between the schizophrenia patients with or without CNS infection. Our results suggest that viral CNS infections during childhood may have a role as a risk factor for schizophrenia. Their role may be modest at the population level due to their relative rareness.