When and why we ostracize others: Motivated social exclusion in group contexts.

Research on ostracism has mostly focused on ostracized targets' reactions to being excluded and ignored. In contrast, the ostracizing sources' perspective and reasons for why individuals decide to ostracize others are still a largely unexplored frontier for empirical research. We propose two fundamental motives situated in the target's behavior that drive motivated ostracism decisions for the benefit of one's group: A perceived norm violation of the target and perceived expendability of the target for achieving group goals. Two survey studies and five experiments (total N = 2,394, all preregistered) support our predictions: When asked to recall a recent ostracism decision and the motives for it, participants reported both perceived norm violations and/or expendability of the target as motives (Study 1). Switching to the target perspective, the frequency of experienced ostracism was associated with both self-perceived norm violations and expendability (Study 2). In five experiments (Studies 3-7), participants consistently choose to ostracize targets more often when they perceived them to be either norm-violating, or inept in a skill important for the group and thus expendable. Additionally, Studies 5-7 show that strategic considerations about the requirements of the situational context influence ostracism decisions: Participants were more likely to ostracize norm-violating targets in cooperative contexts, and more likely to ostracize inept targets in performance contexts. Results have strong theoretical implications for research on ostracism and group dynamics, as well as for interventions targeting ostracism behavior: Particularly, adjusting the requirements of the situational context might be a viable option to decrease ostracism and promote inclusion in groups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders.

OBJECTIVE: Comorbidity of substance abuse disorders with schizophrenia is associated with a greater risk for serious illness complications and poorer outcome. Methodologically sound studies investigating treatment approaches for patients with these disorders are rare, although recommendations for integrated and comprehensive treatment programs abound. This study investigates the relative benefit of adding an integrated psychological and psychosocial treatment program to routine psychiatric care for patients with schizophrenia and substance use disorders. METHOD: The authors conducted a randomized, single-blind controlled comparison of routine care with a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family or caregiver intervention. RESULTS: The integrated treatment program resulted in significantly greater improvement in patients' general functioning than routine care alone at the end of treatment and 12 months after the beginning of the study. Other benefits of the program included a reduction in positive symptoms and in symptom exacerbations and an increase in the percent of days of abstinence from drugs or alcohol over the 12-month period from baseline to follow-up. CONCLUSIONS: These findings demonstrate the effectiveness of a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family intervention over routine psychiatric care alone for patients with comorbid schizophrenia and alcohol or drug abuse or dependence.

Long-term stability of communication deviance.

Communication deviance (CD), forms of communication that are not bizarrely thought disordered but are hard to follow and that make difficult the consensual sharing of attention and meaning, has been hypothesized as a nonspecific contributor of rearing parents to psychopathology of offspring, including schizophrenia. This hypothesis, or an alternative of genetic transmission, would gain plausibility if CD has long-term stability. CD was evaluated, using tape-recorded and reliably scored Rorschachs in 158 Finnish adoptees, and retested after a median interval of 11 years. Adolescent CD was not stably correlated with follow-up CD. However, initial CD at a mean age of 32 and follow-up CD were significantly correlated. Gender, genetic risk for schizophrenia, and DSM-III-R (American Psychiatric Association, 1987) psychiatric diagnoses had no effect on adult CD stability. CD appears to be a stable, traitlike feature of adult but not adolescent functioning.

Psychiatric inpatient care planning via telemedicine.

We assessed the costs of psychiatric inpatient care-planning consultations to remote areas using videoconferencing, instead of the conventional face-to-face consultations at a hospital. The data were collected from all wards at the department of psychiatry of Oulu University Hospital over 11 months. A total of 14 videoconferences were conducted with two primary-care centres located 220 km and 160 km from Oulu. During the same period, 20 conventional consultations at the Oulu University Hospital were also assessed. A questionnaire was completed by a total of 124 patients, relatives and health-care personnel; the response rate was about 90%. Of the respondents, 90% were satisfied with the quality of communication afforded by videoconferencing. At a workload of 20 patients per year, the cost of the videoconferences was FM2510 per patient; the cost of the conventional alternative was FM4750 per patient. At 50 care consultations per year, a remote municipality would save about FM117,000.

Finnish adoptive family study: sample selection and adoptee DSM-III-R diagnoses.

OBJECTIVE: To evaluate the genetic contribution to schizophrenia using an adoption design that disentangles genetic and environmental factors. METHOD: Finnish hospital diagnoses of schizophrenic/paranoid psychosis in a nationwide sample of adopting-away women are compared with DSM-III-R research diagnoses for these mothers. DSM-III-R diagnoses of their index offspring are blindly compared with adopted-away offspring of epidemiologically unscreened control mothers. RESULTS: Primary sampling diagnoses of index mothers were confirmed using DSM-III-R criteria. Lifetime prevalence of typical schizophrenia in 164 index adoptees was 6.7% (age-corrected morbid risk 8.1%), significantly different from 2.0% prevalence (2.3% age-corrected morbid risk) in 197 control adoptees. When adoptees with diagnoses of schizoaffective disorder, schizophreniform disorder, schizotypal disorder and affective psychoses were added, the contrast between the index and control adoptees increased. CONCLUSION: The genetic liability to 'typical' DSM-III-R schizophrenia is decisively confirmed. Additionally, the liability also extends to a broad spectrum of other psychotic and non-psychotic disorders.

Thought disorder index of Finnish adoptees and communication deviance of their adoptive parents.

BACKGROUND: Diverse forms of thought disorder, as measured by the Thought Disorder Index (TDI), are found in many conditions other than schizophrenia. Certain thought disorder categories are primarily manifest during psychotic schizophrenic episodes. The present study examined whether forms of thought disorder qualify as trait indicators of vulnerability to schizophrenia in persons who are not clinically ill, and whether these features could be linked to genetic or environmental risk or to genotype-environment interactions. The Finnish Adoptive Study of Schizophrenia provided an opportunity to disentangle these issues. METHODS: Rorschach records of Finnish adoptees at genetic high risk but without schizophrenia-related clinical diagnoses (N = 56) and control adoptees at low genetic risk (N = 95) were blindly and reliably scored for the Thought Disorder Index (TDI). Communication deviance (CD), a measure of the rearing environment, was independently obtained from the adoptive parents. RESULTS: The differences in total TDI between high-risk and control adoptees were not statistically significant. However, TDI subscales for Fluid Thinking and Idiosyncratic Verbalization were more frequent in high-risk adoptees. When Rorschach CD of the adoptive rearing parents was introduced as a continuous predictor variable, the odds ratio for the Idiosyncratic Verbalization component of the TDI of the high-risk adoptees was significantly higher than for the control adoptees. CONCLUSIONS: Specific categories of subsyndromal thought disorder appear to qualify as vulnerability indicators for schizophrenia. Genetic risk and rearing-parent communication patterns significantly interact as a joint effect that differentiates adopted-away offspring of schizophrenic mothers from control adopted-away offspring.

Community placement of long-stay psychiatric patients in northern Finland.

Rapid deinstitutionalization occurred in Finland in the 1990s, a decade later than in many other Western countries. A four-year follow-up study in northern Finland examined community placements of 253 long-stay psychiatric inpatients after deinstitutionalization in 1992 and at follow-up at the end of 1995. About 70 percent of the patients were discharged. Only 15 percent were able to live outside the hospital without continuous support. No patient was homeless at follow-up. Being unmarried, living in the city of Oulu, and having greater severity of illness were associated with hospitalization at follow-up. The results showed that long-stay patients are dependent on considerable support. Alternative residential facilities have made deinstitutionalization possible.

Passive patients: a challenge to psychiatric nurses.

TOPIC: Psychiatric patients' participation in their care. PURPOSE: To describe psychiatric patients' participation in their own care in a hospital environment. METHODS: Data were collected by videotaping different nursing situations (n = 10) and recording interviews of the patients (n = 16), nurses (n = 29), and nursing students (n = 7) afterward. Deductive content analysis techniques were used to analyze the written data, using the following categories of psychiatric patients' participation as a theoretical framework: passive recipient, responsible recipient, and responsible participant. FINDINGS: The results showed that 64% of the patients were passive recipients of care, 22% were responsible recipients, and 14% were responsible participants. CONCLUSIONS: Patients' participation as responsible participants in their care provides a foundation for better collaboration, listening to the patient, participatory dialogue, and resource recognition.

Schizophrenia, alcohol abuse, and violent behavior: a 26-year followup study of an unselected birth cohort.

It has been suggested that schizophrenia and alcoholism are associated with violent behavior. But so far there are no published studies from unselected cohorts quantifying the actual risk associated with schizophrenia both with and without comorbid alcoholism. In this study, an unselected birth cohort (n = 11,017) was prospectively followed to the age of 26, and data on psychiatric disorders and crimes were collected from national registers. The odds ratios for violent offenses and recidivism were calculated for each diagnostic group. Men who abused alcohol and were diagnosed with schizophrenia were 25.2 (95% confidence interval (CI) 6.1-97.5) times more likely to commit violent crimes than mentally healthy men. The risk for nonalcoholic patients with schizophrenia was 3.6 (95% CI 0.9-12.3) and for other psychoses, 7.7 (95% CI 2.2-23.9). None of the patients with schizophrenia who did not abuse alcohol were recidivists (> 2 offenses), but the risk for committing more crimes among alcoholic subjects with schizophrenia was 9.5-fold (95% CI 2.7-30.0). This study suggests that to prevent the crimes being committed by people with schizophrenia, it is important that clinicians watch for comorbid alcohol abuse.

Sex differences in the association between childhood experiences and adult depression.

BACKGROUND: In the present paper, sex differences in the association between adult depression and childhood experiences were examined. METHODS: The study series of the Finnish UKKI Study consisted of a population sample of 501 men and 499 women. Information concerning childhood experiences was gathered retrospectively in a baseline survey carried out in 1969-72. After the initial phase, the mental health of the subjects was evaluated by interviews, questionnaires and register data at the 5-year follow-up (1974-6) and at the 16-year follow-up (1985-7). RESULTS: Twelve per cent of men and 21% of women had suffered from depression during the 16-year follow-up period. A disturbed mother-child relationship and neurotic symptoms in childhood were associated with depression in women but not in men in the logistic model that included gender interaction. In separate analyses by gender several childhood factors showed statistically significant associations with depression in women but only a few in men. CONCLUSIONS: The finding suggests that childhood experiences are more highly predisposing factors to depression in women than in men.

Juvenile mortality, mental disturbances and criminality: a prospective study of the Northern Finland 1966 birth cohort.

Mortality, criminality and mental illness among young adults were studied in an unselected birth cohort of 12 058 children born live in Northern Finland during 1966. The cohort members were followed up to the age of 27 years. The total number of all deaths was 117, and 79.5% of these deaths were from unnatural causes. The mortality of males was more than threefold higher than that of females. There was a significantly higher mortality risk in men with schizophrenia (OR, 9.31; 95% CI, 3.14-25.53), other psychoses (OR, 10.28; 95% CI, 2.40-37.02), personality disorders (OR, 4.28; 95% CI, 1.04-14.67) and combined personality disorders and criminality (OR, 3.27, 95% CI, 0.99-9.59). In the group of major mental disorders, 75% of deaths were suicides.

Ethical dilemmas in a psychiatric nursing study.

This article describes the ethical dilemmas encountered by the authors while conducting qualitative research with psychiatric patients as participants. The ethical conflicts are explored in terms of the principles of personal autonomy, voluntariness and awareness of the purpose of the study, with illustrations from the authors' research experience. This study addresses the everyday life of psychiatric nursing in a psychiatric hospital as described by patients, nurses and nursing students. The data were collected in a university hospital in northern Finland, using videotaped observations and recorded interviews. Although no definitive resolutions are proposed to the conflicts, the article endeavours to enhance awareness of the ethically perplexing situations possibly encountered by researchers during a study process. The institution where the study was conducted has a Research Board entitled to resolve ethical questions. The Ethics Review Committee of the Medical Faculty at the University and the Research Board of the University Hospital's Department of Psychiatry reviewed and accepted this research plan. They also recommended solutions to some specific ethical problems that occurred in the course of the study. Moreover, some ethical dilemmas required further study and debate during the process.

Hospital-treated psychiatric disorders in adults with a single-parent and two-parent family background: a 28-year follow-up of the 1966 Northern Finland Birth Cohort.

This study investigates the relationship between the family type (two-parent and 4 different single-parent types, mainly divorced) during childhood up to 14 years of age and adult hospital-treated psychiatric disorders in a sample from the unselected, general population Northern Finland 1966 Birth Cohort (N = 11,017). Up to the end of 1994, a total of 387 individuals (3.5%) had a hospital-treated psychiatric disorder, with 3.1% in two-parent families and 5.4% in single-parent families (p < .001). The single-parent family was not associated with the child's schizophrenia or other psychotic disorders. The adjusted odds ratios (OR) for personality disorders were highest among individuals without a father before the age of 14 years (OR 4.8), or at birth only (OR 4.0), or with a history of parental divorce (OR 2.8). Parental divorce was also associated with alcoholism (OR 3.7) and parental death with depressive disorders (OR 3.4). In conclusion, we found an elevated risk of hospital-treated nonpsychotic disorder among individuals from a single-parent family background. It is likely that a combination of the single-parent family and psychosocial and/or genetic risk may influence the development of these disorders.

The use of videoconferencing for telepsychiatry in Finland.

Some of the first telepsychiatry experiments in Finland were carried out at the Department of Psychiatry of the University of Oulu, where videoconferencing has been used for family therapy, occupational counselling, consultation and teaching. In 1996 videoconferencing was used for a total of 249 hours, which increased to 434 hours in 1997. During 1997, 45% of the time was used for teaching, 26% for occupational counselling, consultations and therapies, 23% for training and 6% for administration (mainly testing the connections). In a survey, 37 participants rated aspects of the quality of the videoconferences on a scale from 4 (poor) to 10 (excellent). The audio quality had a mean value of 8.0 (SD 0.9), the picture quality 7.5 (SD 1.5), and the general value of the videoconference was rated 7.5 (SD 1.0). Preliminary results with telepsychiatry in Finland have been promising. Interactive videoconferencing provides an easy, fast and relatively inexpensive method of providing psychiatric services over long distances.

Accuracy of register-based schizophrenia diagnoses in a genetic study.

In order to assess the accuracy of schizophrenia diagnoses for genetic studies, we identified all schizophrenia patients (n = 492) in an isolated community with a diagnosis of schizophrenia in the Finnish Hospital Discharge Register (HDR) between 1969-1991. For the accuracy study we identified a sample of 73 patients from registers with Diagnostic and Statistical Manual (DSM)-III-R for schizophrenia (codes 295.10, 295.30, 295.60, 295.90) (n = 62) or "schizophrenia spectrum" diagnoses (295.40, 295.70, 297.10, 301.20, 301.22) (n = 11). When the operational criteria (DSM-III-R) were applied by two senior researchers using information from the original mental hospital records, 93% (68/73) of the cases fulfilled criteria for schizophrenia or schizophrenia spectrum. The results demonstrate that the schizophrenia diagnoses of the registers are accurate when a broad concept of schizophrenia is applied. When using operational DSM-III-R schizophrenia criteria, eight false positive cases were found among the 62 mental hospital schizophrenia diagnoses. Consequently, there may be a need to reassess schizophrenia diagnoses depending on the purpose of the study. We also found good agreement between DSM-III-R (kappa 0.93) and operational criteria (OPCRIT) diagnostic system (kappa 0.89) diagnoses, made by one researcher, compared with operational diagnoses. This indicates the possibility for the reliable use of one of these methods alone for diagnostic reassessment. The information in the HDR on primary diagnoses and on the dates of admission and discharge was accurately transferred from the hospital records.

Association between central nervous system infections during childhood and adult onset schizophrenia and other psychoses: a 28-year follow-up.

BACKGROUND: Maternal exposure to influenza epidemics during pregnancy may increase the risk of schizophrenia in the offspring. We investigated the association between central nervous system (CNS) infections defined prospectively up to the age of 14, and later onset of schizophrenia and other psychoses in the 1966 birth cohort in Northern Finland, which covers 96% of all births in the area during that year. METHODS: Data regarding CNS infections were collected 1966-1980. Registered diagnoses of psychoses in 1982-1993 were validated on DSM-III-R criteria. RESULTS: Out of 11,017 subjects, 145 had suffered a CNS infection during childhood, 102 of them a viral infection, 76 had DSM-III-R schizophrenia and 53 some other psychosis. Four cases of schizophrenia had suffered viral CNS infection and two cases of other psychosis bacterial infection. When neurological abnormalities and father's social class were adjusted odds ratio (OR) of schizophrenia after viral CNS infection was 4.8 (95% confidence intervals [CI] : 1.6-14.0); the other significant risk factors being intelligence quotient (IQ) < 85, perinatal brain damage and male sex but not epilepsy. Similarly adjusted OR of other psychoses was 6.9 (95% CI: 1.4-32.8) after bacterial CNS infection; the other significant risk factors being IQ < 85 and severe hearing defect. Two of the live viral infections were caused by Coxsackie B5 during an epidemic in which 16 neonates were infected together. CONCLUSIONS: Central nervous system infections during childhood clearly carried an increased risk of adult onset schizophrenia or other psychoses, viral infections being important for schizophrenia, particularly Coxsackie B5 during the newborn period.

A comparison of clinical and research DSM-III-R diagnoses of schizophrenia in a Finnish national birth cohort. Clinical and research diagnoses of schizophrenia.

As a prerequisite to the use of the Finnish National Hospital Discharge Register in psychiatric epidemiological research, we studied the diagnostic reliability of the register in terms of the psychiatric morbidity experienced by a national birth cohort. We investigated all entries to the register for a sample based upon the Northern Finland 1966 birth cohort at the age of 16 years (n = 11017). Until the end of 1993 (age 27 years), a total of 563 subjects had a register diagnosis indicating a psychiatric illness, 37 of them being schizophrenia. When operational criteria (DSM-III-R) were applied to clinical information in the available original hospital records for cases of psychosis, personality disorder and substance abuse (n = 249), 71 fulfilled criteria for schizophrenia, including all of the 37 cases in the register and an additional 34 (48% false-negatives), most frequently diagnosed in the register as schizophreniform or other psychosis. Despite the official use of DSM-III-R nomenclature, it appears that the clinical concept of schizophrenia in Finland, manifest within the register, remains very restrictive. The application of operational criteria is a necessary prerequisite for scientific research on schizophrenia.

Specific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort.

OBJECTIVE: The purpose of the study was to examine the quantitative risk of criminal behavior associated with specific mental disorders. METHOD: An unselected 1966 birth cohort (N = 12,058) in Northern Finland was prospectively studied until the end of 1992. The investigation started during the mothers' pregnancy, and the data on the subjects' family characteristics, mental and physical development, living habits, psychiatric morbidity, and criminal records were gathered at various times. RESULTS: The prevalence of offenses was the highest among males with alcohol-induced psychoses and male schizophrenic subjects with coexisting alcohol abuse, and more than half of the schizophrenic offenders also had problems with alcohol. Eleven (7%) of the 165 subjects who committed violent crimes were diagnosed as psychotic. Male schizophrenic subjects had a moderately high risk for violent offenses, but the risk for other types of crimes was not elevated significantly. Odds ratios for criminal behavior were adjusted according to the socioeconomic status of the childhood family and were the same as or slightly lower than the crude odds ratios for all disorders except schizophrenia and mood disorders with psychotic features. CONCLUSIONS: The results indicate that the risk of criminal behavior was significantly higher among subjects with psychotic disorders, even though the socioeconomic status of the childhood family was controlled. The higher risk for violent behavior was associated especially with alcohol-induced psychoses and with schizophrenia with coexisting substances abuse. The results suggest that schizophrenia without substance abuse may also be associated with a higher risk of offenses, but this finding is tentative and requires further investigation.

Gene-environment interaction in vulnerability to schizophrenia: findings from the Finnish Adoptive Family Study of Schizophrenia.

OBJECTIVE: This study assessed the interaction of genetic risk and rearing-family risk as a subsyndromal test measure of schizophrenic thought disorder in adoptees. METHOD: A group of 58 adoptees with schizophrenic biological mothers was compared with 96 comparison adoptees at ordinary genetic risk; putative adoptee vulnerability was assessed blindly and reliably by using the Rorschach Index of Primitive Thought. Environmental risk was measured by using frequency of communication deviance as a continuous variable, scored independently from Rorschach assessments of the adoptive parents. RESULTS: High genetic risk in itself was not associated with greater vulnerability to schizophrenic thought disorder in the adoptees, as indicated by the Index of Primitive Thought. Also, greater communication deviance in the adoptive parents was not associated with greater thought disorder in the comparison adoptees. However, there was a highly significant gene-environment interaction. Among the offspring of the adoptive parents with high levels of communication deviance, a higher proportion of high-risk than comparison adoptees showed evidence of thought disorder. In contrast, among the offspring of adoptive parents with low communication deviance, a lower proportion of high-risk than comparison adoptees showed evidence of thought disorder. The distribution of communication deviance scores did not differ significantly between the adoptive parents of high-risk offspring and the adoptive parents of comparison offspring. CONCLUSIONS: The findings are consistent with genetic control of sensitivity to the environment. There is no evidence that high genetic risk of schizophrenia among offspring is associated with high levels of communication problems in rearing parents.

Occurrence and concentrations of polycyclic aromatic hydrocarbons in semipermeable membrane devices and clams in three urban streams of the Dallas-Fort Worth Metropolitan Area, Texas.

Semipermeable membrane devices (SPMDs) and Asiatic clams, Corbicula fluminea (MüLLER), were deployed at stream sites in the Dallas-Fort Worth Metropolitan Area to assess the presence of bioavailable, dissolved polycyclic aromatic hydrocarbons (PAHs). Twenty-four PAHs were detected in SPMDs, 20 of which occurred at all sites. Only three PAHs were detected in the co-deployed clams. Throughout all sites, non-alkylated PAHs were found at greater levels in SPMDs than alkylated forms. Nine of 16 Priority Pollutant PAHs were detected in SPMDs. Estimated concentrations of PAHs in water were generally two to three orders of magnitude less than standard minimum analytical reporting levels; however, for benz (a) anthracene, benzo (a) pyrene, and chrysene, estimated concentrations in water exceeded the U.S. Environmental Protection Agency's human health criteria for these carcinogens in water and aquatic organisms.