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Laughter is a contagious prosocial signal that conveys bonding motivation; adult crying conversely communicates desire for social proximity by signalling distress. Endogenous mu-opioid receptors (MORs) modulate sociability in humans and non-human primates. In this combined PET–fMRI study ( n = 17), we tested whether central MOR tone is associated with regional brain responses to social signals of laughter and crying. MOR availability was measured with positron emission tomography (PET) using the high-affinity agonist radioligand [ 11 C]carfentanil. Haemodynamic responses to social laughter and crying vocalizations were measured using functional magnetic resonance imaging (fMRI). Social laughter evoked activation in the auditory cortex, insula, cingulate cortex, amygdala, primary and secondary somatosensory cortex, and primary and secondary motor cortex; crying sounds led to more restricted activation in the auditory cortex and nearby areas. MOR availability was negatively correlated with the haemodynamic responses to social laughter in the primary and secondary somatosensory cortex, primary and secondary motor cortex, posterior insula, posterior cingulate cortex, precuneus, cuneus, temporal gyri and lingual gyrus. For crying-evoked activations, MOR availability was negatively correlated with medial and lateral prefrontal haemodynamic responses. Altogether our findings highlight the role of the MOR system in modulating acute brain responses to both positive and negative social signals. This article is part of the theme issue ‘Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience’.

Laughter is a contagious prosocial signal that conveys bonding motivation; adult crying conversely communicates desire for social proximity by signalling distress. Endogenous mu-opioid receptors (MORs) modulate sociability in humans and non-human primates. In this combined PET-fMRI study (n=17) we tested whether central MOR tone is associated with regional brain responses to social signals of laughter and crying sounds. MOR availability was measured with positron emission tomography using high-affinity agonist radioligand [11C]carfentanil. Haemodynamic responses to social laughter and crying sounds were measured using functional magnetic resonance imaging (fMRI). Social laughter evoked activation in the auditory cortex, insula, cingulate cortex, amygdala, primary and secondary somatosensory cortex, primary and secondary motor cortex; crying sounds led to more restricted activation in auditory cortex and nearby areas. MOR availability was negatively correlated with the haemodynamic responses to social laughter in primary and secondary somatosensory cortex, primary and secondary motor cortex, posterior insula, posterior cingulate cortex, precuneus, cuneus, temporal gyri, and lingual gyrus. For crying-evoked activations, MOR availability was negatively correlated with medial and lateral prefrontal haemodynamic responses. Altogether our findings highlight the role of MOR system in modulating acute brain responses to both positive and negative social signals.

Psychopathy and autism are both associated with aberrant social skills and empathy, yet only psychopaths are markedly antisocial and violent. Here, we compared the functional neural alterations underlying these two groups that both have aberrant empathetic abilities but distinct behavioral phenotypes. We studied 19 incarcerated male offenders with high psychopathic traits, 20 males with high-functioning autism, and 19 age-matched healthy controls. All groups underwent functional magnetic resonance imaging while they viewed dynamic happy, angry, and disgusted faces or listened to laughter and crying sounds. Psychopathy was associated with reduced somatomotor responses to almost all expressions, while participants with autism demonstrated less marked and emotion-specific alterations in the somatomotor area. These data suggest that psychopathy and autism involve both common and distinct functional alterations in the brain networks involved in the socioemotional processing. The alterations are more profound in psychopathy, possibly reflecting the more severely disturbed socioemotional brain networks in this population.

Hankkeessa selvitettiin mielentilatutkimusten vähenemisen syitä ja seurauksia, alentuneesti syyntakeisten hoidon toteutumista vankilassa sekä psykiatrisista syistä keskeytettyjen vankeusrangaistuksen määriä. Aikaisempia havaintoja vahvistaen mielentilatutkimusten määrä vaikuttaa laskeneen sen seurauksena, että alentunut syyntakeisuus -kategorian käyttö on supistunut marginaaliseksi. Tutkimusten määrään näyttävät vaikuttaneen myös oikeudenkäymiskaareen vuonna 2006 tehty muutos sekä henkirikosten määrän väheneminen. Alentuneen syyntakeisuuden kategoria puolestaan on vähentynyt lääketieteellisissä diagnoosikäytännöissä ja persoonallisuushäiriöiden arvioinneissa tapahtuneiden muutosten takia. Syyntakeisuussäännösten soveltamiskäytäntöä kiristivät myös korkeimman oikeuden ennakkoratkaisut etenkin 2000-luvulla.Alentuneesti syyntakeisiksi katsotut henkilöt vaikuttivat hyötyvän mielentilatutkimuksesta. Alentunutta syyntakeisuutta ei kuitenkaan tunnisteta erityisen kohtelun syyksi vankilassa, mutta ryhmän rangaistusajan suunnitelmissa terveydellisiä tavoitteita huomioitiin. Heillä oli myös muita vankeja enemmän terveyteen liittyviä käyntejä vankilan ulkopuolella. Alentuneesti syyntakeisten tarpeenmukainen hoito tulee turvata vankilassa sekä lisätä keinoja hoitoon sitouttamiseksi. Vankeusrangaistuksia on keskeytetty lisääntyvästi psykiatrisen tahdosta riippumattoman hoidon tarpeen vuoksi.

Psychopathy is characterized by persistent antisocial behavior, impaired empathy, and egotistical traits. These traits vary also in normally functioning individuals. Here, we tested whether such antisocial personalities are associated with similar structural and neural alterations as those observed in criminal psychopathy. Subjects were 100 non-convicted well-functioning individuals, 19 violent male offenders, and 19 matched controls. Subjects underwent T1-weighted magnetic resonance imaging and viewed movie clips with varying violent content during functional magnetic resonance imaging. Psychopathic traits were evaluated with Levenson Self-Report Psychopathy Scale (controls) and Psychopathy Checklist-Revised (offenders). Psychopathic offenders had lower gray matter density (GMD) in orbitofrontal cortex and anterior insula. In the community sample, affective psychopathy traits were associated with lower GMD in the same areas. Viewing violence increased brain activity in periaqueductal grey matter, thalamus, somatosensory, premotor, and temporal cortices. Psychopathic offenders had increased responses to violence in thalamus and orbitofrontal, insular, and cingulate cortices. In the community sample, impulsivity-related psychopathy traits were positively associated with violence-elicited responses in similar areas. We conclude that brain characteristics underlying psychopathic spectrum in violent psychopathy are related to those observed in well-functioning individuals with asocial personality features.

Neurocognitive deficits and psychiatric disorders are often brought up as risk factors of recidivism. In this study, we investigated how neurocognitive and academic deficits and psychiatric disorders (including substance dependence) are associated with criminal recidivism and prison career among male offenders. In a health survey of Finnish prisoners, 72 sentenced male prisoners were examined in Turku prison using a neurocognitive test battery and psychiatric assessment including a standardized psychiatric interview (SCID-I, II). The neurocognitive and academic tests were chosen to assess domains of cognitive functioning and reading, spelling and mathematical skills. Our results showed that the combination of neurocognitive deficits and substance dependence was connected to recidivism. Axis I diagnosis (major mental disorders) and substance dependence were connected with neurocognitive and academic deficits. Moreover, first-time offenders had fewer neurocognitive deficits and Axis I disorders, les...

Vuonna 2016 185 vankia eli 5,9 prosenttia suomalaisista vangeista sai psykoosidiagnoosin (1). Vankilassa vuosittain psykoosidiagnosoitujen vankien määrä on kymmenkertaistunut vuodesta 2005, vaikka psykoosisairauksien esiintyvyys väestössä ei ole kasvanut. Tänä aikana diagnosointikäytännöt ja diagnosointiin käytettävät resurssit eivät ole muuttuneet. Tässä tutkimuksessa eivät myöskään olleet mukana huumeiden aiheuttamat psykoosit. Olemme tehneet tutkimuksen vangeista, jotka ovat vuosien 2008–2018 aikana vapautettu vakavan ja vaikeahoitoisen psykoosin vuoksi vankilan ulkopuoliseen tahdosta riippumattomaan oikeuspsykiatriseen hoitoon ja kuntoutukseen. Tilastollisesti tarkasteltuna viisivuotisjaksolta 2008–2012 jaksolle 2013–2017 vankilan ulkopuolelle hoidettavaksi vapautettujen määrä kasvoi 50 prosenttia. Tuottamamme tutkimustieto käsittää tutkittavan ryhmän sosiaaliset taustatekijät, rikollisuuden, mielentilatutkimukset, psyykkisen sairastavuuden sekä aiemman psykiatrisen hoidon. Tutkimus on tehty laadullisena tutkimuksena valmiista aineistosta, joka koostuu kaikista psykoosin vuoksi hoitoa varten vapautettujen vankien vapautustarvetta perustelevista esityksistä viimeisen kymmenen vuoden ajalta. Psykoosin vuoksi vankilan ulkopuolelle hoitoa varten vapautetut vangit ovat huono-osainen, syrjäytynyt ja sairas ihmisryhmä. He ovat elämässään kohdanneet monia vääryyksiä ja sairastuneet psyykkisesti. Heidän rikollisuutensa on vakavaa, uusiutuvaa ja heidän mielentilaansa ei ole arvioitu oikeusprosessin yhteydessä tarpeeksi usein. Lisäksi näiden henkilöiden määrä on kasvussa, mikä johtuu mahdollisesti varhaisen sosiaalisen tuen ja oikeanlaisten ja oikea-aikaisten terveyspalveluiden puutteesta sekä mielentilatutkimusten vähentymisestä.

As in many European countries, Finnish psychiatric services experienced a rapid process of deinstitutionalization in the 1990s. In recent decades, the decrease in numbers of psychiatric hospital beds has in several countries been found to be linked with increasing criminality among severely mentally ill individuals. It has been concluded that deinstitutionalization could be the main reason for this development.To investigate whether the prevalence of severely mentally ill persons to prison is a growing trend also in Finland.We searched for the annual data in electronic case files of all prisoners about the ICD-10 diagnostic group of the most severe psychotic disorders. We also searched for the comorbid substance use disorders. Psychotic disorders due to substance abuse only were excluded from this study.During the years 2005-2016, a rapid 10-fold increase in psychotic disorders has occurred in Finnish prisons. In 2016, 185 prisoners (5.9% of all Finnish prisoners) were diagnosed as having a psychotic disorder that was not induced by substance abuse. The causes of this dramatic change are unclear. Comorbid substance abuse disorders were detected in only 39.5% of these prisoners and therefore substance abuse can only partly explain the increasing criminality of the severely mentally ill persons. 80.5% of psychotic disorders were diagnosed in Psychiatric Hospital for prisoners and 19.5% in prison policlinic services.Trans-institutionalization has become a serious challenge for the Finnish criminal justice and mental health systems. Further studies are needed to detect the causes of this change. More specialized services for severely mentally ill persons are needed both in the community psychiatry and also inside the prison services.

Purpose– The purpose of this paper is to determine the nature of the academic skills deficits in male offenders and their relation to neurocognitive deficits.Design/methodology/approach– In total, 72 Finnish male prisoners were tested with regard to reading, spelling, and mathematical abilities.Findings– Low academic skills, especially reading, were related to poor neurocognitive performance in verbal memory, visual memory, attention, and motor dexterity. The results showed a high number (29-36 percent) of reading and spelling disorders. In all, 15 percent of those with medium to severe problems in academic skills had marked difficulties in mathematics. In total, 88 percent of the participants with at least one problem area in literacy skills had neurocognitive deficits. In the present study, the pervasive neurocognitive deficits, occurring comorbidly with reading and spelling difficulties, seem to refer to a fundamental set of deficits which are only minimally explained by IQ, educational background or training.Research limitations/implications– Reading and spelling difficulties could be seen as functional illiteracy which, combined with a broad spectrum of neuropsychological function deficits, pose a challenging task for rehabilitation. Only after proper identification of deficits has been achieved is it possible to set goals and select the appropriate means for rehabilitation. One obvious limitation is the moderate number of subjects (n=72).Practical implications– It may not be enough just to train reading or develop literacy activities among prisoners; focussing intervention on comprehensive neurocognitive deficits is also necessary.Originality/value– Correlates and comorbidity between academic difficulties and neurocognitive deficits among offenders, especially in arithmetic difficulties, have been less studied.

In developed countries, the majority of all violent crime is committed by a small group of antisocial recidivistic offenders, but no genes have been shown to contribute to recidivistic violent offending or severe violent behavior, such as homicide. Our results, from two independent cohorts of Finnish prisoners, revealed that a monoamine oxidase A (MAOA) low-activity genotype (contributing to low dopamine turnover rate) as well as the CDH13 gene (coding for neuronal membrane adhesion protein) are associated with extremely violent behavior (at least 10 committed homicides, attempted homicides or batteries). No substantial signal was observed for either MAOA or CDH13 among non-violent offenders, indicating that findings were specific for violent offending, and not largely attributable to substance abuse or antisocial personality disorder. These results indicate both low monoamine metabolism and neuronal membrane dysfunction as plausible factors in the etiology of extreme criminal violent behavior, and imply that at least about 5–10% of all severe violent crime in Finland is attributable to the aforementioned MAOA and CDH13 genotypes.

Background Neurocognitive deficits are frequent among male offenders and tend to be associated with a more serious risk of anti-social activity, but they are not systematically allowed for in rehabilitation programmes. Aim The aim of this study was to evaluate neurocognitive performance in a sample of sentenced Finnish male prisoners and consider the implications for prison programme entry. Methods Seventy-five sentenced male prisoners were examined using a neurocognitive test battery. Results Depending on the neurocognitive domain, from 5% to 49% of the men demonstrated marked neurocognitive deficits in tests of motor dexterity, visuospatial/construction skills, verbal comprehension, verbal and visual memory and attention shift. Verbal IQ was more impaired than performance IQ. There was no association between most serious offence type and neurocognitive performance, but correlations between attention deficit indices and number of previous convictions suggested that recidivists may have an attention disorder profile. Cluster analysis identified two subgroups of offenders, separated by very poor or merely poor cognitive performance. Motor dexterity, visuo-construction and verbal memory deficits were not wholly explained by lower IQ measures. Conclusions and implications for practice Our sample was small, but the nature and extent of the neurocognitive deficits found suggest that wider use of neurocognitive assessments, which the men generally tolerated well, could help select those most likely to need offender programmes and that the effectiveness of these may be enhanced by some specific cognitive remediation before progressing to more complex social tasks. Copyright © 2013 John Wiley & Sons, Ltd.

Central dopamine regulation is involved in postural control and in the pathophysiology of restless legs syndrome (RLS) and Parkinson’s disease (PD). Postural control abnormalities have been detected in PD, but there are no earlier studies with regard to RLS and postural control. Computerized force platform posturography was applied to measure the shift and the velocity (CPFV) of center point of forces (CPF) with eyes open (EO) and eyes closed (EC) in controls (n = 12) and prior and after a single day intervention with pramipexole in RLS subjects (n = 12). CPFV (EO) was significantly lower in the RLS group (p < 0.05) than in controls. After pramipexole intake, the difference disappeared and the subjective symptom severity diminished. Pramipexole did not significantly influence CPFV (EC) or CPF shift direction. Subjects with RLS used extensively visual mechanisms to control vestibule-spinal reflexes to improve or compensate the postural stability. Further research is needed to clarify altered feedback in the central nervous system and involvement of dopamine and vision in the postural control in RLS.

Aims. Schizophrenia is a neuropsychiatric disorder associated with mental and motor disturbances. We aimed to investigate motor control, especially central silent period (CSP) in subjects with schizophrenia (n=11) on long-term antipsychotic treatment compared to healthy controls (n=9). Methods. Latency and duration of motor evoked potentials (MEPs) and CSPs were measured with the help of single pulse transcranial magnetic stimulation (TMS) and intramuscular electrodes. After stimulation of the dominant and nondominant motor cortex of abductor digiti minimi (ADM) and tibialis anterior (TA) muscle areas, respective responses were measured on the contralateral side. Results. MEPs did not differ significantly between the groups. Multiple CSPs were found predominantly in subjects with schizophrenia, which showed a higher number of CSPs in the dominant ADM and the longest summarized duration of CSPs in the nondominant ADM (P<0.05) compared to controls. Conclusions. There were multiple CSPs predominantly in the upper extremities and in the dominant body side in subjects with schizophrenia. Behind multiple CSPs may lie an impaired regulation of excitatory or inhibitory neurotransmitter systems in central motor pathways. Further research is needed to clarify the role of the intramuscular recording methods and the effect of antipsychotics on the results.

During the early 20th century, psychopathy referred to "borderland states" between normality and mental illness, corresponding to the current personality disorders. In psychiatric assessment, a significant proportion of psychopaths were considered to be not of sound mind, i.e. of diminished responsibility in contemporary language, which in most cases also led to shorter punishments. Psychopathy as diagnosis was abandoned in 1969, after which use has been made of the terms disorders of character and, later on, personality disorders. Nowadays, personality disorders can have a punishment-shortening effect only if they come close to a psychotic disorder. A psychopathy assessed by using current methods may even result in a longer verdict.

The current study examined offence and offender characteristics in female and male offenders claiming no, partial or complete homicide-related amnesia. Pre-trial file information consisting of forensic examination reports and crime reports of all female (n = 79) and male (n = 577) offenders subject to forensic psychiatric examination in 1995–2004 and convicted of homicide were retrospectively analysed. The Psychopathy Check List Revised (PCL-R) was used for scoring psychopathy. Claiming homicide-related amnesia was significantly more frequent in female (60.7%) than male (42.1%) offenders. Findings indicate that in males the use of sharp instrument, intoxication, staying at the scene and feeling regret for the killing accompany claims of crime-related amnesia. In females, personality disorder and criminal history were significantly more frequent in offenders claiming crime-related amnesia. Analysis of intelligence, psychopathology or psychopathy indicated no significant relationship with claims of amnesia in either gender groups.

Expressed emotion (EE) in families is able to predict the clinical outcome of patients with schizophrenia and mood disorders. However, the origins of EE and its interactions with the patient's clinical characteristics are not clear. In this respect, cognitive functioning of schizophrenic and mood-disorder patients has yielded contradictory results. In this cross-sectional study, we examined a sample of 42 consecutive first-episode patients with schizophrenia-related psychoses and severe mood disorders. Forty-two relatives were interviewed with the Five-Minute Speech Sample method. The relationships between EE and 3 clusters of patient-related variables (sociodemography, performance in cognitive tests, and psychopathology) were analyzed with stepwise regression analysis. With the exception of premorbid adjustment in childhood, only the cognitive variables were significantly associated with EE after controlling for the effect of the other variables. High EE was significantly associated with good performance in cognitive tests. Our results favor the attribution hypothesis of EE instead of the hypothesis that patient psychopathology would explain EE. Good cognitive functioning may lead to higher EE scores because of the higher expectations by the relatives.

Schizophrenia tends to be associated with a general decline in cognitive functioning. However, some studies have found neuropsychologically normal schizophrenia patients. To address this contradiction, we screened first-episode schizophrenic patients according to degree of neuropsychological dysfunction. At least three different neuropsychological subtypes of schizophrenia were found. Memory, specifically delayed recall, was the most important factor that discriminated the groups. Neuropsychological assessment, covering a range of functional domains of the major dimensions of behavior, has an important role in identifying preserved and impaired capacities, in predicting outcome, and in planning treatment.

Ganser Syndrome is a rare and controversial disorder, a form of pseudodementia, which has often been associated with prison environments. It is classified under dissociative disorder, not otherwise specified in the DSM-IV, and as a dissociative disorder with its own code in the ICD-10. In the literature, it has also been described as a psychotic illness, a factitious disorder, a histrionic disorder, and an organic illness. Despite special interest in dissociative disorders, we have diagnosed only one case of Ganser Syndrome during six years in Mental Hospital for Prisoners (that houses) with about 300 treatment periods per year of 3,000 male prisoners from a base population of five million people. While dissociative symptoms were clear, the patient also suffered from progressing organic dementia. Antipsychotic medication had no beneficial effect, but hypnosis clearly ameliorated the patient's symptoms. We conclude that Ganser Syndrome is rare, and may co-occur with organic dementia. The positive ...

Background: The aim of this study was to extend our knowledge of associations among the constructs of alexithymia, depression, somatization and dissociation. Sampling and Methods: 924 nonclinical subjects answered questions about depression (21-item Beck Depression Inventory), somatization (13-item somatization part of Symptom Check List-90), dissociation (28-item Dissociative Experiences Scale) and alexithymia (20-item Toronto Alexithymia Scale). In addition, a 12-item General Health Questionnaire (GHQ-12) was administered to detect psychiatric distress among subjects. Results: The results suggested that there was a significant clinical correlation between somatization, dissociation, depression and alexithymia (rho varied from 0.31 to 0.56). The principal component analysis revealed the presence of four components: depression, somatization, dissociation and alexithymia. The use of factor scores diminished the covariance between measures (rho varied from –0.10 to 0.01 between the factor scores). There was almost no correlation between the dissociation factor (rho = 0.06) and alexithymia factor (rho = 0.09) scores and general distress (GHQ-12). Conclusions: This study suggests that while somatization, dissociation, depression and alexithymia are distinct constructs, they correlate to a considerable extent. The use of factor analysis and factor scores should be considered to diminish covariance between the above constructs. Comparing results between factored and unfactored results may prove illuminating. As a case in point, the results suggest that the part of dissociation that coincides with other constructs (overlaps) is associated with distress, whereas the distinct part of dissociation (no shared covariance) is not associated with distress. The same applies to the alexithymia construct. Longitudinal studies are needed to show whether there is a trait such as a relatively stable dissociation component and also whether a separate state-dependent dissociation component exists that is associated with coincident distress, somatization and depression.

Somnophilia is a rare paraphilia, a form of sexual fetishism which is characterized by the desire to have sex with an unconscious human object who is unable to respond. To the author's knowledge, this is the first case study concerning somnophilic sexual abuse associated with vaginal administration of triazolam. The perpetrator video-recorded his sexual acts with two unconscious female victims with whom he also had normal sexual intercourse and who were unaware of his paraphilic activities. His Internet conversations with other persons whom he thought to be interested in somnophilic sex and his plans to kidnap a child were recorded by the police. It was evident that sex with an unconscious object played a specific fetishistic role for this man. He obviously used a combination of drugs mixed with alcoholic drinks to make his victims fall sleep and videotaped vaginal administration of triazolam used to deepen the victim's unconscious state.

Frightening negative hallucinations as a side effect of fencamfamine (a central nervous system stimulant), aggressive behavior and amnesia due to interactions between metoprolol (a beta adrenergic blocking agent) and alcohol, chronic and severe sleep terrors and conversion disorder are described in a middle-aged man with high social status and no personality disorder. Rare mental side effects should draw attention to the possibility of a latent dissociative disorder. The relationship between beta-blocker induced disturbing dreams, dissociative disorders and sleep terrors is discussed.

The confirmatory factor structure of the Finnish version of the Dissociative Experiences Scale II (DES-II) was exactly the same in the non-clinical population (n=924) as was found in the most recent study in the USA (with the original English version) and as suggested by the authors of the original version. The Finnish version of the DES-II has a Cronbach's alpha of 0.92, and there is a clear positive correlation (from 0.31 to 0.66) between all 28 items and the total score (P

The purpose of this study was to investigate diagnostic agreement between clinicians and a research group in a sample of first-admission psychosis and severe affective disorder patients. Clinical DSM-IV discharge diagnoses and best-estimate DSM-IV research diagnoses were compared in 116 first-episode patients in the city of Turku, Finland. The best-estimate research diagnoses were made at consensus meetings by integrating longitudinal data; patients' medical records; and findings of a clinical interview, the structured SCAN-interview, and symptom severity ratings. Overall diagnostic agreement was moderate, with a kappa value 0.51 (95% confidence interval (CI), 0.39- 0.63). Of the diagnostic groups, schizophrenic disorders had the lowest kappa value of 0.44 (95% CI, 0.26-0.63). Clinicians had a tendency to miss depressive symptoms in psychotic patients; to overdiagnose psychotic symptoms in depressive patients; and to fail to discover earlier hypomanic or depressive episodes in depressive patients. In conclusion, hospital diagnoses were not reliable in first-episode patients. Inappropriate diagnoses may compromise both treatment and epidemiologic findings based on discharge diagnoses.

Klinefelter's Syndrome, a sex chromosomal abnormality and the most common cause of male hypogonadism, is characterized by cognitive and psychosexual dysfunction and abnormalities in physical maturation. It may be relatively common yet often undiagnosed and untreated among psychiatric patients. A case of undiagnosed Klinefelter's Syndrome associated with poor psychosocial functioning, an obsessive impulse to damage women'sgenitals and finally a sexual homicide, is presented. Precipitating factors for maladjustment were strongly cathected surgery of undescended testicles, violent and abusive parents, and a fantasy about the mother's being guilty for the patient's physically poor sexual development. Prevention of psychiatric sequelae of Klinefelter's Syndrome should be based on early diagnostics.

An important issue in the practice of clinical neuropsychology is to define the degree to which impaired executive functions associated with severe depression are a result of organic dysfunction or of only current depressive experience, reflecting clinical state. Twenty-eight patients with psychotic depression, 29 with nonpsychotic depression and 30 healthy controls, matched for age and education were tested on WCST, WAIS-R, and the Rorschach according to the Comprehensive System, providing indices of depression (DEPI) and coping deficit (CDI). Patients were impaired in WCST performance. The stepwise regression for WCST scores yielded two significant predictor variables: the DEPI and Digit Symbol as a measure of complex attention and response speed. Within the groups, Picture Completion in patients with nonpsychotic depression and the CDI in patients with psychotic depression emerged as the significant predictors of WCST scores. Patients with severe major depressive disorder have profound executive impair...

Three-channel actometry was used to study neuroleptic-induced akathisia (NIA), a common and often serious disorder in association of traditional neuroleptic therapy. The aim was to explore the diagnostic possibilities of actometry in NIA and to examine in detail the motor phenomenology of the disorder in detail. The actometers were attached to the ankles and waists of ten patients, suffering from NIA, and to ten matched healthy controls. Five of the patients were changed to olanzapine treatment, and these patients were re-examined during the no-NIA condition. NIA was associated with manyfold movement activity during controlled rest (sitting) but not with increased daily overall motor activity. Movement frequencies in NIA seemed to be pathognomonic. Actometry is promising for investigation and clinical assessment of NIA. Olanzapine proved to be an adequate treatment choice for NIA patients.

The neural mechanisms associated with hypnosis were investigated in a single highly hypnotizable subject by measuring the mismatch negativity (MMN) component of auditory ERP, reflecting the preattentive discrimination of change in stimulus flow, in normal baseline state and under hypnosis. It has been proposed that the frontal inhibition associated with hypnosis can be measured as a decrease in MMN. ERPs were elicited using the passive oddball paradigm with standard and deviant sine tone stimuli of 500 and 553Hz, respectively. The measurement was repeated in five separate sessions. In hypnosis the MMN was significantly larger compared to baseline. The results indicate that hypnosis can give rise to altered information processing in the brain even at a relatively early, i.e. preattentive level and that the larger MMN measured under hypnosis does not support frontal inhibition theory.

We investigated the prevalence of seasonal affective disorder (SAD) and subsyndromal SAD (S-SAD) in rural populations in south-western and northern Finland by using the Seasonal Pattern Assessment Questionnaire (SPAQ). A total of 1710 SPAQs were analysed. The prevalences of overall SAD and S-SAD were 12.0% and 27.1%, respectively. Winter SAD (W-SAD) was the most common type, with prevalences of 9.5% for W-SAD and 18.4% for W-S-SAD. The prevalences of overall and winter SAD did not differ between Finns living in northern and south-western Finland. Among the Lapps, W-SAD cases were less frequent than among the Finns in Lapland. Overall seasonality correlated significantly with female gender, high body mass index, high level of education and young age.

We describe two cases of neurological motor disorders which were experienced as religious–mystical phenomena by elderly psychotic ladies. One of the patients interpreted a mild hemiparesis as a message from divine forces that changed her left to her right and vice versa. The other patient felt that her perphenazine-induced tardive dyskinesia was the voluntary reading of a silent mantra. Involvement of mystical or religious terms in the interpretation of physical symptoms may lead to the lack of adequate treatment and care. We suggest that a psychosis-related inability to monitor one's own motor behavior is the crucial factor leading to peculiar perception of motor disorders.

The widely accepted negative association between schizophrenia and rheumatoid arthritis (RA) is based on the results of investigations which sought RA in large samples of schizophrenic patients. Using a discharge register, we examined the frequency of schizophrenia in a sample of 5626 RA patients. Appendicitis patients (n = 5330) were used as a comparison group. The cumulative incidence of hospital care with the diagnosis of schizophrenia during 8 years was higher in the RA group (0.64%) than in the appendicitis group (0.47%). Schizophrenia was significantly more common in the RA group than in the appendicitis group among the young. The age-adjusted prevalence of schizophrenia was 0.96% in the RA group and 0.51% in the appendicitis group. Because of this unexpected finding, we examined the incidence of RA and appendicitis among a birth cohort born in 1966. The frequencies of RA and appendicitis among schizophrenic cohort members (n = 76), cohort members with psychiatric diagnosis other than schizophrenia (n = 438), and members without psychiatric diagnosis (n = 10503) were similar. These findings do not support the negative association between schizophrenia and RA. Prolonged institutionalization per se may have been the protective factor against RA in the previous studies. The findings also raise the hypothesis that genes that predispose to schizophrenia provide protection from appendicitis, historically a common cause of mortality.

There are no previous reports concerning comorbidity of psychosis and idiopathic familial restless legs syndrome (RLS). In the psychiatric literature the concept “Ekbom's syndrome” has been equated with delusions of parasitosis and not to a paresthetic, organic disorder. Psychotic patients invariably receive the diagnosis of akathisia. We report a family with genetic disposition to idiopathic RLS and psychotic illness. Excellent short-term treatment effect of tramadol for idiopathic RLS is reported for the first time. Four-limb actometry. a novel method for diagnosing and measuring RLS and alcathisia, is described. We suggest that the relationship of RLS, psychosis, and idiopathic or drug-induced akarhisia has been obscured by nosologic difficulties. RLS should be considered a diagnosis and treated even among psychotic patients, although it may be rare. Tramadol may be useful in short-term treatment of RLS.

The psychopathic traits measured with the Hare Psychopathy Checklist-Revised (PCL-R) in a representative national prisoner sample have not been studied in Finland before. It has been unclear whether there could occur some national differences or whether the PCL-R can be used for assessing psychopathic traits in the Finnish forensic settings.Our aim was to study the distribution of psychopathic traits in the Finnish male prisoners as well as the correlations of these traits with DSM-IV disorders and to compare the sample with similar samples of Europe and America.171 male prisoners representing all Finnish sentenced male offenders (about 3300) were studied using the PCL-R, SCID-I and SCID-II.The results of the first Finnish study utilizing the PCL-R in a representative national sample of male prisoners were quite similar to the findings of the previous studies of male prisoners carried out in North America, the UK and Sweden. The scores of the interpersonal facet are lower in this sample than in the sample of North America. In total, 16.4% of the Finnish male prisoners can be diagnosed as having a psychopathic disorder.The PCL-R is a reliable and valid measure of the psychopathy construct of the Finnish male prisoners. The PCL-R is applicable to the Finnish offenders and it is a useful tool for assessing psychopathy in the Finnish criminal justice settings.

The aim was to determine the rate of dissociative disorders among psychiatric in- (n = 34) and out-patients (n = 37) and to compare the rate to that of nonclinical subjects (n = 297). Dissociative disorders (17% of patients) could be grouped according to the severity of the symptoms and their relation to affective disorders.

Aims.The aim of this study was to investigate the motor control and central silent period (CSP) in restless legs syndrome (RLS).Methods.Transcranial magnetic stimulation was focused on the dominant and nondominant hemispheric areas of motor cortex in six subjects with RLS and six controls. The responses were recorded on the contralateral abductor digiti minimi (ADM) and tibialis anterior (TA) muscles with intramuscular needle electrodes.Results.No significant differences were found in the motor conduction or central motor conduction time, in the latency, or in the duration of the CSPs between or within the groups, but multiple CSPs were observed in both groups. The number of the CSPs was significantly higher in both ADMs and in the dominant TA (P≤0.01) in the RLS group compared to the controls.Conclusion.Descending motor pathways functioned correctly in both groups. The occurrence of the recurrent CSPs predominantly in the RLS group could be a sign of a change of function in the inhibitory control system. Further research is needed to clarify the role of the intramuscular recording technique and especially the role of the subcortical generators in the feedback regulation of the central nervous system in RLS.

We present a case of a man whose severe and chronic nocturnal hallucinosis and daytime sleepiness, based on an atypical variant of sleep terror (ST), had been unsuccessfully treated under a diagnosis of possible temporal epilepsy and narcolepsy. To the patient sleep served a special function of changing coping style, which he was unable to do during waking. In this case, psychotherapy was an unexpectedly effective treatment of the disorder. Movement activity during sleep was lateralized to the non-dominant side of the body as normally, but during parasomnia there was a dominant lateralization. Implications of the asymmetry are discussed.

Lateralized motor and attentional abnormalities contribute to schizophrenia, but little is known about possible abnormalities in neural machinery involved in postural control. We examined postural stability of 22 patients with schizophrenia taking medication and 14 healthy control participants using computerized force platform posturography. The shift in the center point of pressure in the condition of eyes open versus eyes closed characterizes the effect of visual information on body posture. Closing the eyes had less of an effect on the center point of velocity (velocity sm/s) in the patients with schizophrenia than in the control group (median change, 36% vs. 70%, p = 0.0006). Change in the body position during eye closure tended to be directed rightwards in the control group but leftwards in the group with schizophrenia (p = 0.025). The results show that visual component had less dominance in the balance control of these patients with schizophrenia. The lateralized effect of visual information on posture was also impaired.

In a review, Gardner and Grossman (1976) discussed the possibility that small and large sleep movements may be of different neural origin. Small, usually distal, twitches are possibly due to bursts of spinal disinhibition, whereas large movements are mort. likely caused or timed by afferent stimuli. Jovanovic (1971 ) found that daring sleep the nondominant hand is moved twice as much as the dominant, independent of the REM/NREM cycle. Nondominant hand mevements while awake have been shown to reflect higher cerebral functions, spatial rather than verbal problem solving (Hampson and Kimura 1984), and possibly the personal use of visual imagery in verbal encoding (Sousa-Poza et al 1979). The significance of~Ie iiohdominant activity for the psychophysiology of sleep is unclear becw.u,e the laterality might be due to the preferred right-side sleeping posture. Movemel,~t activity might also consist of typical left hz~nd movemei~t~, thus reflecting no difference in activity between wakefulness and sleep. Many subtle forms of deviant lateralizntion

Here, we will discuss the concept of subjective akathisia and present a patient case. Our patient was suffering from neuroleptic-induced hypokinesia and akathisia at the same time. The typical motor manifestations of akathisia were masked by hypokinesia, which made the diagnosis difficult. However, the subjective symptoms of akathisia were evident and distressing. Although not observable to bare eye, the pathognomonic pattern of motor activity detected in akathisia was demonstrated by actometric recording. Changing the conventional neuroleptic to an atypical one brought relief to the subjective symptoms of akathisia and hypokinesia, while the motor activity was clearly diminished in actometric recording. Actometric recording may be useful in diagnosing akathisia masked by hypokinesia, but the typical subjective symptoms of akathisia should not be ignored, even when actometry is not available to demonstrate the missing motor component of akathisia. Not only akathisia defined by DSM-IV but also subjective akathisia should be adequately treated to relieve the subjective distress, and to diminish the unfavorable effects on psychotic symptoms, behavior, and drug compliance.

Psychotic symptoms are common among prisoners, a diagnosis of schizophrenia probably more likely than in the general population; however, less is known about the extent to which prisoners may show a different course of illness.The aims of the study were to characterise schizophrenic male offenders and to compare their age at diagnosis with that of people with schizophrenia in general mental health services in Finland.The study population comprised all the male offenders in Finland who left the national psychiatric prison hospital between 1 January 2003 and 31 December 2006 with an International Classification of Diseases, Tenth Edition, diagnosis of schizophrenia. The comparison group was drawn from 9992 Finnish people screened at random for psychotic illnesses.There was no overall difference in age of diagnosis between prisoners and their community peers, but three-quarters of the offenders had received their diagnosis of schizophrenia in the prison hospital rather than in the community, and for them, the median age at diagnosis (30) was significantly older than that (27) in the community comparison group.Our findings show that men with schizophrenia who have to serve prison sentences are not a homogenous group, but that for a majority, complex presentations are likely to delay diagnosis and appropriate treatment. If replicated, the findings raise concerns that psychiatry is failing such men who can only access treatment for a severe illness through the penal system.

Metabolic side-effects of atypical antipsychotics have led to concern about their relative safety compared with low doses of conventional neuroleptics. Akathisia is an often misdiagnosed side-effect, which leads to non-compliance and sometimes even exacerbation of psychosis or suicidal behaviour. In fact, little is known about the differences between antipsychotic drugs in clinical practice, since only as few as 20% of patients may be eligible for studies comparing antipsychotic medications with each other. The aim of this study was to find out if the use of conventional antipsychotics is associated with an increased risk of akathisia (compared with atypical antipsychotics) even when low doses of conventional antipsychotics are used. The Barnes Akathisia Rating Scale was used to evaluate akathisia in 100 outpatients on antipsychotic medication. Conventional antipsychotics were associated with an increased risk of akathisia compared with atypical antipsychotics, although the chlorpromazine equivalent doses of conventional antipsychotics were lower than those of the atypicals. An additional akathisia-provoking effect of SSRIs could not be ruled out. The results suggest favouring atypical antipsychotic medication in patients who may easily develop akathisia.

Two cases of restless legs syndrome in association with mirtazapine treatment of 5–6 weeks are presented. Rather than akathisia related to serotonine reuptake inhibitors, which usually emerges during the first weeks of treatment, our cases resemble previously described mianserin-induced RLS cases. This suggests that although blockade of 5-HT2 receptors by mirtazapine may be protective against acute akathisia, it does not protect against slowly developing restless legs syndrome similar to that induced by mianserin. © 1997 John Wiley & Sons, Ltd.

In a previous, controlled study we demonstrated that the general lower limb activity measured by three-channel actometry is a promising objective measure of restless legs syndrome (RLS) severity. In the present study we have further evaluated the method in measuring RLS symptom severity in an open, single-day pramipexole intervention with 15 RLS patients. Both our standardized actometric parameters (nocturnal lower limb activity and controlled rest activity) decreased significantly during the intervention in parallel with the subjectively reported relief of RLS symptoms.

An objective marker of restless legs syndrome (RLS) is needed for developing diagnostic tools and monitoring symptoms. Actometric ambulatory monitoring of 15 RLS patients and 15 healthy controls was undertaken in order to differentiate between RLS-related motor symptoms and normal motor activity. Nocturnal lower-limb activity per minute differentiated and discriminated between groups with no overlap, whereas the periodic limb movement index and the controlled rest activity during sitting showed less discriminative power. The naturalistic recording of nocturnal activity by actometry may prove useful for assessing the severity of RLS and for finding an objective marker to support the diagnosis of RLS.