Partners in crime: A 21-year cohort comparison of people who commit serious crimes together with those who act alone.

BACKGROUND: Perpetrators who act together violently occur frequently in police and media discussions, but are rarely the focus of forensic psychiatric research. AIMS: We aimed to characterise people who act together when committing a serious crime and to map the frequency of such crimes over 21 years in Finland. METHODS: Data for the study were retrieved from the national database of forensic psychiatric examinations for the period 2000-2020, with reports on file for nearly all people charged with serious criminal offences in the country. Index cases were defined as those with two or more perpetrators attacking a single victim; people who acted alone were comparison cases. Sex and age at the time of the crime were extracted together with all diagnoses listed in the reports. RESULTS: Seventy-five multiple perpetrator groups (MPG) were identified, accounting for 165 individuals whose reports were compared with 2494 single-perpetrator (SPR) reports. Most group and solitary offenders were male (87%: 86%, respectively). The index offence was more likely to be homicide among the group perpetrators (mean 1.12) than the solitary offenders (mean 0.83). Proportionately more of the group offenders had personality disorder or substance use disorders (antisocial personality disorder MPG 49%: SPR 32%; any personality disorder MPG 89%: SPR 76%); alcohol (MPG 79%: SPR 69%; cannabis MPG 15%: SPR 9%). By contrast, psychosis was about twice as common among the solitary offenders (MPG 12%; SPR 26%). CONCLUSIONS: The number of group-perpetrated crimes has not increased, according to these Finnish forensic psychiatric report data of 2000-2020, but the relatively high prevalence among them of personality and substance use disorders is a constant. Understanding psychiatric disorders as factors in both leading to and avoiding violent conflicts may help plan new approaches to further diminish group violence.

Lifelong mental health service use among 15-22 years old offenders: a document-based, mixed-methods descriptive study.

OBJECTIVES: Among young offenders, psychiatric morbidity and comorbidity are common, but our knowledge about their use of mental health services during childhood and adolescence is scarce. We aimed to describe the lifelong use of mental health services of young offenders who have committed serious crimes. DESIGN AND STUDY SETTING: Using data on forensic psychiatric examinations of 42 Finnish offenders aged 15-22 years, we analysed the timing and typical patterns of their prior mental health service use with qualitative and quantitative content analysis and typification. RESULTS: Young offenders appeared in this study as children with plenty of perinatal and developmental risks, and risks related to their family situation and peer relations. Most subjects were described as having had emotional or behavioural symptoms, or both, since childhood. Involvement in mental health services was rare before the age of 7 years but increased markedly after that, staying on the same level during adolescence. Five categories of mental health service users were identified: (1) continuing service use around a decade (14.3%), (2) one brief fixed treatment (11.9%), (3) involuntary use of services (31.0%), (4) evasive use of services (21.4%) and (5) no mental health service use (21.4%). CONCLUSIONS: Young offenders had symptoms from early ages, but during childhood and adolescence, involvement in mental health services appeared for most as relatively short, repetitive or lacking. To help children at risk of criminal development, a multiprofessional approach, an early evidence-based intervention for behavioural symptoms and screening for learning problems, traumatic experiences and substance use are necessary. Results can help identify children and adolescents with a risk of criminal development, to develop mental health services and to plan further research.

Forensic psychiatry in Finland: an overview of past, present and future.

Despite a recent contrary trend, Finland has been for decades one of the most violent countries in Western Europe. Also, Finland has had one of the highest number of psychiatric beds per capita in Europe, although this, too, has seen a sharp decline. Against this background, among other national idiosyncrasies, Finland has developed its forensic psychiatric services. Here, we describe the legal, organizational and clinical structure of these services, and outline the historical and current issues that have shaped them. Finally, we consider future challenges facing the Finnish forensic service system, as part of wider European and global trends.

Excess mortality from breast cancer in female breast cancer patients with severe mental illness.

Women with a history of severe mental illness (SMI) have elevated breast cancer mortality. Few studies have compared cancer-specific mortality in women with breast cancer with or without SMI to reveal gaps in breast cancer treatment outcomes. We compared breast-cancer specific mortality in women with or without SMI and investigated effects of stage at presentation, comorbidity, and differences in cancer treatment. Women with their first breast cancer diagnosis in 1990-2013 (n = 80,671) were identified from the Finnish Cancer Registry, their preceding hospital admissions due to SMI (n = 4,837) from the Hospital Discharge Register and deaths from the Causes of Death Statistics. Competing risk models were used in statistical analysis. When controlling for age, year of cancer diagnosis, and comorbidity, breast cancer mortality was significantly elevated in patients with SMI. Relative mortality was highest in breast cancer patients with non-affective psychosis, partly explained by stage at presentation. Mortality was also significantly elevated in breast cancer patients with a substance use disorder and mood disorder. Patients with SMI received radiotherapy significantly less often than patients without SMI. Our findings emphasize the need to improve early detection of breast cancer in women with SMI and the collaboration between mental health care and oncological teams.

The impact of severe mental illness on lung cancer mortality of patients with lung cancer in Finland in 1990-2013: a register-based cohort study.

BACKGROUND: Although the link between severe mental illness (SMI) and elevated cancer mortality is well established, few studies have examined lung cancer survival and SMI in detail. Our study compared cancer-specific mortality in patients with lung cancer with and without a history of SMI and analysed whether mortality differences could be explained by cancer stage at presentation, comorbidity or differences in cancer treatment. METHODS: We identified patients with their first lung cancer diagnosis in 1990-2013 from the Finnish Cancer Registry, their preceding hospital admissions due to SMI from the Hospital Discharge Register and deaths from the Causes of Death statistics. Competing risk analyses were used to estimate hazard ratios (HRs) for the impact of SMI on mortality. RESULTS: Of the 37,852 lung cancer cases, 12% had a history of SMI. Cancer-specific mortality differences were found between patient groups in some cancer types after controlling for stage at representation and treatment. Men with a history of psychosis had excess mortality risk (HR = 1.24, 1.06-1.45) in squamous cell carcinoma. Similar excess risk was found among women with psychosis in small-cell carcinoma (HR = 1.76, 1.41-2.19) and in squamous cell carcinoma (HR = 1.67, 1.26-2.20) and among women with mood disorders in adenocarcinoma (HR = 1.37, 1.08-1.74). Patient group differences in HRs in five-year mortality did not markedly change from the 1990s. CONCLUSIONS: We found elevated cancer-specific mortality among persons with a history of SMI. Collaboration between patients, mental healthcare professionals and oncological teams is needed to reduce the mortality gap between patients with cancer with and without SMI.

The effect of history of severe mental illness on mortality in colorectal cancer cases: a register-based cohort study.

BACKGROUND: While the link between mental illness and cancer survival is well established, few studies have focused on colorectal cancer. We examined outcomes of colorectal cancer among persons with a history of severe mental illness (SMI). MATERIAL AND METHODS: We identified patients with their first colorectal cancer diagnosis in 1990-2013 (n = 41,708) from the Finnish Cancer Registry, hospital admissions due to SMI preceding cancer diagnosis (n = 2382) from the Hospital Discharge Register and deaths from the Causes of Death statistics. Cox regression models were used to study the impact on SMI to mortality differences. RESULTS: We found excess colorectal cancer mortality among persons with a history of psychosis and with substance use disorder. When controlling for age, comorbidity, stage at presentation and treatment, excess mortality risk among men with a history of psychosis was 1.72 (1.46-2.04) and women 1.37 (1.20-1.57). Among men with substance use disorder, the excess risk was 1.22 (1.09-1.37). CONCLUSION: Understanding factors contributing to excess mortality among persons with a history of psychosis or substance use requires more detailed clinical studies and studies of care processes among these vulnerable patient groups. Collaboration between patients, mental health care and oncological teams is needed to improve outcomes of care.

Effect of stage, comorbidities and treatment on survival among cancer patients with or without mental illness.

BackgroundEarlier research suggests poorer outcome of cancer care among people with severe mental illness (SMI).AimsTo assess the effect of stage at presentation, comorbidities and treatment on differences in survival among cancer patients with and without a history of SMI in Finland.MethodThe total population with a first cancer diagnosis in 1990-2013 was drawn from the Finnish Cancer Registry. Hospital admissions because of SMI and deaths were obtained from administrative registers. We calculated Kaplan-Meier estimates and Cox regression models to examine survival differences.ResultsWe found excess mortality in people with a history of psychotic and substance use disorders. Cancer stage and comorbidity did not explain mortality differences. Controlling for cancer treatment decreased the differences. The mortality gap between patients with psychosis and cancer patients without SMI increased over time.ConclusionsIntegrated medical and psychiatric care is needed to improve outcomes of cancer care among patients with SMI.

Postural control in restless legs syndrome with medication intervention using pramipexole.

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.

Disrupted central inhibition after transcranial magnetic stimulation of motor cortex in schizophrenia with long-term antipsychotic treatment.

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.

Recurrent CSPs after Transcranial Magnetic Stimulation of Motor Cortex in Restless Legs Syndrome.

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.

Effect of visual information on postural control in patients with schizophrenia.

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.