The Finnish psychiatric birth cohort consortium (PSYCOHORTS) - content, plans and perspectives.

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality.

Extralevator versus standard abdominoperineal excision in locally advanced rectal cancer: a retrospective study with long-term follow-up.

PURPOSE: To analyze the results of abdominoperineal excisions (APE) for locally advanced rectal cancer at our institution before and after the adoption of extralevator abdominoperineal excision (ELAPE) with a special reference to long-term survival. METHODS: A retrospective cohort study conducted in a tertiary referral center. All consecutive patients operated for locally advanced (TNM classification T3-4) rectal cancer with APE in 2004-2009 were compared to patients with similar tumors operated with ELAPE in 2009-2016. RESULTS: Forty-two ELAPE and 27 APE patients were included. Circumferential resection margin (CRM) was less than 1 mm (R1-resection) in 10 (24%) of ELAPE patients and 11 (41%) of APE patients (p = 0.1358). Intraoperative perforation (IOP) occurred in 4 (10%) patients and 6 (22%) patients in ELAPE and APE groups, respectively (p = 0.1336). There were 3 (7%) local recurrences (LRs) in ELAPE group and 5 (19%) in APE (p = 0.2473). There were no statistical differences in adverse events, overall survival, or disease-free survival between ELAPE and APE groups. CONCLUSIONS: We found a non-significant tendency to lower rates of IOP and positive CRM as well as lower rate of LR in the ELAPE group. Long-term survival and adverse events did not differ between the groups. ELAPE is beneficial for the surgeon in offering better vicinity to the perineal area and better work ergonomics. These technical aspects and the clinically very important tendency to lower rate of LR support the use of ELAPE technique in spite of the lack of survival benefit.

Genetic risk clustering increases children's body weight at 2 years of age - the STEPS Study.

BACKGROUND: Genetic determinants have an impact on adult weight but the association between genetic determinants and weight at young age is still poorly understood. OBJECTIVE: The objective of this study was to examine the association between genetic risk scores and early growth from birth to 2 years of age. METHODS: Genetic risk scores of 83 adiposity-related or obesity-related single nucleotide polymorphisms (SNPs) (genetic risk score [GRS]83) were calculated for 1278 children. Specific phenotype score for 16 weight-related SNPs (weightGRS) was calculated. Anthropometric data were obtained at birth, 13 months and 2 years of age. RESULTS: The GRS83 was associated with weight at 13 months (ß = 0.080, P = 0.015) and 2 years (ß = 0.080, P = 0.017) of age and with weight gain from birth to 13 months (ß = 0.069, P = 0.036) and to 2 years of age (ß = 0.074, P = 0.028). At 2 years of age, the GRS83 was also associated with weight for height (ß = 0.065, P = 0.046), weight-for-height standard deviation score (SDS) (ß = 0.074, P = 0.022) and body mass index SDS (ß = 0.068, P = 0.045). WeightGRS was associated with higher body weight at 13 months (ß = 0.081, P = 0.014) and 2 years of age (ß = 0.086, P = 0.011). The genetic effect on weight varied from 0.69 to 1.89 kg at 2 years of age according to number of risk alleles. Children with high genetic risk for adiposity were heavier than children with low genetic risk at 2 years of age (12.8 vs. 13.4 kg, P = 0.017). CONCLUSION: The GRS 83 revealed increased genetic risk for higher weight in children already at 13 months and 2 years of age, which may result in increased obesity risk later in life.

Maternal overweight impacts infant feeding patterns--the STEPS Study.

OBJECTIVES: We examined how maternal overweight impacts full breastfeeding (BF), total duration of BF and the age of introduction of complementary foods (CFs) and whether these have effect on children's growth from 0 to 2 years. SUBJECTS/METHODS: From 1797 families participating in the STEPS Study, 848 children had data on BF and anthropometric data at 13 months and 2 years of age and were included in this study. Data on BF and CFs were collected using a self-administered follow-up diary. Information regarding maternal weight, height, pregnancy and delivery were received from maternity clinics and the National Longitudinal Census Files. The children's weight and length/height were recorded during the study visits at 13 months and 2 years. RESULTS: Overweight women breastfed fully (2.2 vs 2.8 months, P<0.0001) and totally (7.4 vs 9.0 months, P<0.0001) for a shorter time and introduced CFs earlier (4.1 vs 4.3 months, P=0.02) than normal weight women. Children of overweight women were heavier and had a higher body mass index at 2 years than children of normal weight women. At 2 years of age 30% of boys and 17% of girls were overweight or obese. However, children's obesity risk was not increased by maternal overweight (odds ratio (OR) 1.04, P=0.12). Longer duration of full BF (OR 0.86, P=0.04) and partial BF (OR 0.91, P=0.02) and delayed introduction of CFs (OR 0.69, P=0.03) were protective against obesity. CONCLUSIONS: Our study suggests that women who were overweight or obese before pregnancy breastfed for a shorter time and introduced CFs earlier than normal weight women, which may further impact children's growth.

Patient education and health-related quality of life: surgical hospital patients as a case in point.

The purpose of this study was to analyze the connections between patient education and health-related quality of life as an outcome variable. Data were collected among surgical hospital patients (n = 237) in Finland. On the basis of the results, there seems to be a positive relationship between received knowledge and health-related quality of life, and as such, the study produced knowledge about one quality indicator in nursing care. More research is needed to explore this connection in greater details.

Psychodynamic personality profile in first-episode severe mental disorders.

OBJECTIVE: The aim of this study was to relate measures of psychoanalytically derived personality traits to descriptive diagnosis and psychopathology in severe mental disorders. METHOD: Sixty-one consecutive first-episode patients with schizophrenia, bipolar disorder and severe major depression were interviewed. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP) and compared with the DSM-IV diagnosis and symptom clusters derived from the BPRS. RESULTS: There were no marked differences in personality traits between the three diagnostic groups, between schizophrenia and affective disorders or between psychotic and non-psychotic illness. However, personality traits had significant associations with symptoms, especially with the emotional retardation cluster. CONCLUSION: Our findings do not support the hypothesis that severe mental disorders would differ from each other in terms of long-standing psychodynamic personality profiles. Certain dysfunctional personality traits may predict especially negative emotional symptoms and possibly also predispose a person to them.

Patients' autonomy in surgical care: a comparison of nurses' perceptions in five European countries.

BACKGROUND: This report forms part of the results of an international comparative study funded by the European Commission (1998-2001). AIM: To describe and compare the maintenance of patients' autonomy on surgical wards, from the point of view of nursing staff, in five European countries (Finland, Spain, Greece, Germany and Scotland). Autonomy is defined in terms of information received and decision making by patients. METHOD: The data were collected using a questionnaire specifically designed for use in this study. Responses (response rate 66%) were obtained from 1280 nurses working on surgical wards. Data analysis was based on descriptive statistics, t-tests, analysis of variance (ANOVA) with posthoc Tukey's HSD test and logistic regression. RESULTS: There were clear between-country differences in nurses' perceptions, especially on a north-south axis (Finland and Scotland vs. Greece and Spain), regarding the extent to which the autonomy of surgical patients is supported by nursing staff. Training and ethics education, in particular, were associated with nurses' perceptions of the maintenance of patient autonomy in Finland and Greece. CONCLUSION: Further research is needed to establish whether the results obtained are caused by differences in cultures, nursing practices or roles of health-care personnel or patients in different European countries.

Structural magnetic resonance imaging in patients with first-episode schizophrenia, psychotic and severe non-psychotic depression and healthy controls. Results of the schizophrenia and affective psychoses (SAP) project.

BACKGROUND: Structural brain abnormalities are prevalent in patients with schizophrenia and affective disorders. AIMS: To study how regional brain volumes and their ratios differ between patients with schizophrenia, psychotic depression, severe non-psychotic depression and healthy controls. METHOD: Magnetic resonance imaging scans of the brain on first-episode patients and on healthy controls. RESULTS: Patients with schizophrenia had a smaller left frontal grey matter volume than the other three groups. Patients with psychotic depression had larger ventricular and posterior sulcal cerebrospinal fluid (CSF) volumes than controls. Patients with depression had larger white matter volumes than the other patients. CONCLUSIONS: Left frontal lobe, especially its grey matter volume, seems to be specifically reduced in first-episode schizophrenia. Enlarged cerebral ventricles and sulcal CSF volumes are prevalent in psychotic depression. Preserved or expanded white matter is typical of non-psychotic depression.

Comparison of clinical and best-estimate research DSM-IV diagnoses in a Finnish sample of first-admission psychosis and severe affective disorder.

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.

Habituation of the blink reflex in first-episode schizophrenia, psychotic depression and non-psychotic depression.

OBJECTIVE: Electrophysiological recording of the electrically elicited blink reflex is the most reliable method of investigating habituation of the startle reflex. The purpose of this study was to compare the habituation and the late R3-component of the blink reflex between control subjects (N=19) and first-episode patients with schizophrenia (N=17), psychotic depression (N=23), and severe non-psychotic depression (N=25). METHODS: The blink reflex was evoked by electrical stimulation of the supraorbital nerve, and the deficient habituation of the R2i-component was measured with a computer-assisted integral area measurement. Prefrontal executive function of the patients was assessed with the Wisconsin Card Sorting Test. Current psychiatric symptoms were assessed with the Brief Psychiatric Rating Scale, the Hamilton Depression Scale, the Positive and Negative Syndrome Scale, and the Calgary Depression Scale. RESULTS: Deficient habituation of the blink reflex and occurrence of the late R3 component were associated both with a previous diagnosis of psychotic disorder and with the presence of current psychosis. The sensitivity and specificity of the abnormal habituation of the blink reflex in detecting psychotic disorder were 0.50 and 0.80, respectively. The abnormalities of the blink reflex were not associated with psychotropic medication. In schizophrenic patients, defective habituation of the blink reflex was associated with negative and cognitive symptoms, and in depressive patients with the presence of delusions. CONCLUSIONS: The deficient habituation of the blink reflex and occurrence of the late R3 component seem to be both trait and state markers of a psychotic disorder. The results suggest that schizophrenia and psychotic depression share some common neurobiological mechanisms involved in the modulation of the startle reflex.

The Strengths and Difficulties Questionnaire among Finnish school-aged children and adolescents.

The emotional and behavioural problems of 7- to 15-year-old Finnish children and adolescents (n = 735) were assessed in a community population by a brief screening instrument, the Strengths and Difficulties Questionnaire (SDQ). The parent-, teacher- and self-reports of the SDQ were obtained. The results show that for the total scores, the inter-rater agreement between the pairs of reports was 0.38-0.44. The internal consistency in all three questionnaires was 0.71. Functioning above the 90th percentile of the SDQ total difficulties scores in parent-, teacher- and self-reports was strongly associated with help-seeking variables and problematic behaviour according to parents. The correlation of the parental SDQ total scores and the Child Behaviour Checklist total scores was 0.75 and the correlation of the self-report SDQ total scores with the Youth Self Report total scores was 0.71. The differences in sex, grade and informants of the SDQ total difficulties scores are reported. The study gives further evidence of the usefulness of the SDQ as a promising screening instrument for epidemiological research and clinical purposes.

Contagion of deliberate self-harm among adolescent inpatients.

OBJECTIVE: To explore the quantitative importance and clinical features of deliberate self-harm (DSH) contagion in a closed adolescent psychiatric unit. METHOD: The authors investigated with statistical methods and a sociogram whether acts of DSH were clustered during a 12-month study period. Twelve subjects were involved in acts of DSH, and their mean length of hospitalization during the study period was about 90 days. Six adolescents with four or more contagion incidents were interviewed. RESULTS: DSH incidents were clustered during the study period (p < .05). Most DSH incidents were skin cutting committed by depressed female subjects with borderline personality disorder. The majority of DSH contagion can be understood in terms of small-group rites for feelings of togetherness. CONCLUSIONS: Even a majority of DSH events in closed adolescent units may be triggered by contagion, and DSH can spread to previously DSH-naive adolescents.

Developing a global psychotherapeutic approach to schizophrenia: results of a five-year follow-up.

This is an account of a long-range action research project to determine indications for and effects of a comprehensive psychotherapeutic approach, including various treatment modalities, in the treatment of schizophrenics. Four diagnostic groups were established among the 100 patients. In the course of data analysis, the group of typical schizophrenics (56 percent) was contrasted to or compared with the entire series. A further diagnostic differentiation was established according to ego functioning; i.e., imminent, acute, regressive, and paranoid ego disintegrations, respectively. Patients and family members were interviewed upon admission, and again two and five years later, and the data recorded on a 163-item form from which 40 clinical and psychosocial variables were constructed after the baseline examinations. In addition to cross-tabulation, logistic regression analysis was employed. The conclusion that the follow-up study supports the effectiveness of our global psychotherapeutic approach to treating schizophrenia seems justified. Results so far indicate that five modes of therapy in addition to drug treatments are optimal for different patients. The five modes are long-term individual psychotherapy, couple or conjoint family therapy for married patients, family therapy with the family of origin, flexible short-term crisis intervention with a family focus, and extensive long-term treatment focused on social rehabilitation for the most ill-starred patients.

Psychotherapeutically oriented treatment of schizophrenia: results of 5-year-follow-up.

The authors have developed a psychotherapeutic approach to schizophrenia within the community psychiatric health care system. The orientation is psychodynamic but global in the meaning that the therapeutic plans are made on the basis of case-specific need of the patients and of their families and include both individual psychotherapy, family therapy and therapeutic communities. The material is composed of 100 successive patients of the schizophrenia group aged 16 - 44 years and for the first time admitted for treatment into the different units of the Turku Mental Health District in 1976 - 77. A multiprofessional staff was acting as therapists, supported by a continuous and intensive on-the-job -training and supervision. The results preliminary reported in this paper are based on a follow-up study 5 years after admission to treatment. 56 patients could be included in the psychotherapy group given at least some mode of psychotherapy in an adequate amount. The background variables of patients selected for various modes of therapy as well as the prognostic results are studied with the aid of logistic regression analyses. The findings indicate that the development of a global psychotherapeutic orientation is possible in the field of community psychiatry and yields results that demonstrate its meaningfulness. The implementation of psychotherapy had clearly positive explanatory connections with a favourable prognosis, and although these connections were not equally strong as the connections of some central clinical and psychosocial variables, they were obvious and manifold.