Antidepressant treatment of premature ejaculation: discontinuation rates and prevalence of side effects for dapoxetine and paroxetine in a naturalistic setting.

The present study aimed to investigate prevalence of and reasons for selective serotonin reuptake inhibitor (SSRI) discontinuation, and compare the two most common SSRIs used in premature ejaculation (PE) treatment, in naturalistic settings (that is, outside clinical trials). The sample consisted of 132 Finnish men with a mean age of 42.5 years (s.d. = 10.6) who had received medical treatment for lifelong PE. The men were enlisted for the study after identifying individuals from the third author's (a physician specializing in sexual medicine) patient registry. Participants responded to a secure, online questionnaire. PE treatment-related side effects of, and discontinuation rates for, different SSRIs were retrospectively self-reported. Treatment efficacy and happiness with treatment were retrospectively self-assessed. Discontinuation rates were uniformly high, ranging from 28.8 to 70.6% between different SSRIs. Dapoxetine was associated with the highest dropout rates (70.6%), and paroxetine the lowest, discontinuation rates. Limited efficacy and side effects were the most common reasons for discontinuation. Paroxetine was more effective and better tolerated than dapoxetine. A considerable number of patients chose to spontaneously discontinue treatment, especially so in the case of dapoxetine, corroborating recent studies conducted in naturalistic settings. Further research efforts are necessary to develop new and improve existing PE treatment alternatives.

Childhood bullying behaviors at age eight and substance use at age 18 among males. A nationwide prospective study.

Childhood bullying behaviors (bullying and victimization) were studied as risk factors for substance use among Finnish males. The study design was a nationwide prospective general population study, where information was collected in 1989 and 1999. Bullying behaviors and childhood psychopathology at age eight were collected from teachers, parents and boys themselves. At age 18, self-reports of frequent drunkenness (once a week or more often), daily heavy smoking (10 cigarettes or more per day), and illicit drug use during the past six months were obtained from 78% of the boys attending the study at age eight (n=2946). Being frequently victimized at age eight predicted daily heavy smoking, and this was evident even after adjusting for childhood family background, psychopathology at age eight and at age 18, and other forms of substance use. In multivariate analysis, bullying others frequently predicted illicit drug use, while being a victim of bullying associated with a lower occurrence of illicit drug use. Bullying behaviors had no association with frequent drunkenness independent of other factors. Accordingly, being a victim of bullying predisposes in particular to subsequent smoking. Bullying others in childhood can be regarded as an early indicator to illicit drug use later in life. The screening and intervention possibilities in order to recognize the risk group for later health compromising behaviors are emphasized.

Do mental health problems in childhood predict chronic physical conditions among males in early adulthood? Evidence from a community-based prospective study.

BACKGROUND: Previous studies have documented associations between mental and physical health problems in cross-sectional studies, yet little is known about these relationships over time or the specificity of these associations. The aim of the current study was to examine the relationship between mental health problems in childhood at age 8 years and physical disorders in adulthood at ages 18-23 years. METHOD: Multiple logistic regression analyses were used to examine the relationship between childhood mental health problems, reported by child, parent and teacher, and physical disorders diagnosed by a physician in early adulthood. RESULTS: Significant linkages emerged between childhood mental health problems and obesity, atopic eczema, epilepsy and asthma in early adulthood. Specifically, conduct problems in childhood were associated with a significantly increased likelihood of obesity and atopic eczema; emotional problems were associated with an increased likelihood of epilepsy and asthma; and depression symptoms at age 8 were associated with an increased risk of asthma in early adulthood. CONCLUSIONS: Our findings provide the first evidence of an association between mental health problems during childhood and increased risk of specific physical health problems, mainly asthma and obesity, during early adulthood, in a representative sample of males over time. These data suggest that behavioral and emotional problems in childhood may signal vulnerability to chronic physical health problems during early adulthood.

[Psychotherapy training in specialist child and adolescent psychiatry].

This paper presents the guidelines for psychotherapy training as part of specialist child and adolescent psychiatry training, as approved by the Section of Child and Adolescent Psychiatry and Psychotherapy (CAPP) of the European Union of Medical Specialties (UEMS). The goal of psychotherapy training as part of specialist CAPP training is to raise the trainees` awareness as regards the requirements in force in each EU country, for one or all the main psychotherapeutic modes. That is: psychoanalytic/psychodynamic individual psychotherapy, cognitive behavioral psychotherapy, or family psychotherapy. Psychotherapy training consists of three elements described in detail for each psychotherapeutic mode: (a) familiarity with theoretical models, (b) personal skills and knowledge of techniques, and (c) awareness of own life experience. The guidelines also include the following: (a) Τhe volume of training for each mode, while stressing the need for individual and group supervision of the trainees by a qualified child and adolescent therapist, (b) Τhe competence level and what is included in each psychotherapeutic mode, (c) Τhe evaluation of the training process. It should be noted that the situation in the field of psychotherapy training, as well as the educational resources and potential, vary from one European country to another.

Cancer families with children: factors associated with family functioning--a comparative study in Finland.

OBJECTIVE: The objective is to examine the factors associated with family functioning in families with children where a parent has cancer in comparison to families without cancer. SAMPLE AND METHODS: Eighty-five families including 85 cancer patients, 61 healthy spouses and 68 children between 11 and 17 years of age, and a control group of 59 families including 105 adults and 65 children were given a set of questionnaires including a background variable questionnaire, the Family Assessment Device, the Beck Depression Inventory and the Sense of Coherence (SOC). A statistical multilevel model allowing the use of data from several informants belonging to the same family was constructed for the analysis of associations between variables. RESULTS: Maternal depression and SOC of family members were associated with family functioning; maternal depression impaired family functioning and family members' SOC improved it. No difference was found between the clinical group and the control group. CONCLUSION: In clinical work with cancer families with children, maternal depression and SOC should be focused on.

Factors associated with the mental health of adolescents when a parent has cancer.

This study explored factors associated with the mental health in adolescents (ages 11-17; n = 54) within 12 months after a parent had been diagnosed with cancer. A control group was included (ages 11-17; n = 49). A demographic questionnaire, the SF-8 Health Survey, the Youth Self Report and the McMaster Family Assessment Device were used. Similar levels of psychological distress and healthy family functioning were reported in the clinical and the control group. No effect of gender of the ill parent and that of the adolescent was found. A negative correlation was found between the physical health of the ill parent and the mental health of the adolescent. Healthy family functioning correlated with less psychological distress in adolescents with a parent with cancer. Open communication, flexible problem solving and appropriate affective involvement were significant predictors for less psychological distress in the adolescents. The study concludes that a healthy family functioning facilitated the adolescent's adjustment to parental cancer.

Characteristics and staff resources of child and adolescent psychiatric hospital wards in Finland.

The aim of this study is to describe structural characteristics and staff resources of child psychiatric and adolescent psychiatric hospital wards in Finland. The target group of the survey consisted of 69 child and adolescent psychiatric hospital units in Finland. Information was obtained from 64 units (93%). Most of the wards were based on 24-h-a-day provision. There were only 7-day-treatment programmes including two family wards. When compared internationally, the numbers of units, beds and staff levels were high in Finland, with all members of staff qualified. The nurse-patient ratio and psychiatrist resources were rather satisfactory. However, in many units there was a lack of psychologists, social workers and occupational therapists. General recommendations and guidelines for staff resources in child and adolescent hospital treatment wards are warranted.

Children younger than 4 years and their substance-dependent mothers in the child welfare clinic.

AIM: To explore the prevalence of substance dependency among mothers of small children and to evaluate the value of a routine-style maternal report on social support, child's somatic health history and child caregiving experiences to differentiate the substance-dependent group from the non-dependent group. METHODS: Mothers (n = 413) of children less than 4 y in the child welfare clinics filled in the Substance Abuse Subtle Screening Inventory (SASSI, Miller 1985) and questionnaires concerning social support, somatic history of the child, difficulties in social environment and in caring for the child. RESULTS: The prevalence of substance dependency was 5.8%. The maternal perceptions of the child's somatic history could not differentiate the dependent from the non-dependent group, while the child caregiving difficulties were more often present in the group of substance-dependent mothers. The combined group of substance dependency and substance use was significantly associated with low social support and difficulties in social environment. CONCLUSIONS: The prevalence of substance dependency among mothers of small children is considerable and significantly associated with child caregiving difficulties and low social support, while the perceptions on the somatic health of the child did not differentiate the dependent from the non-dependent group. This suggests the value of considering the maternal experiences in caring for the child and well-being of the mother during check-ups in the child welfare clinic in order to identify the mother-child pairs at risk.

Effects of moxonidine and metoprolol in penile circulation in hypertensive men with erectile dysfunction: results of a pilot study.

Centrally acting (moxonidine) and peripherally acting (metoprolol) sympatholytic agents might have different actions upon penile circulation in hypertensive men with erectile dysfunction. A total of 11 nonsmoking, hypertensive but otherwise healthy men with erectile dysfunction were studied after 8 weeks on moxonidine monotherapy (0.4 mg per day, increased to 0.6 mg if needed) and then after 8 weeks of metoprolol monotherapy (100 mg per day, increased to 200 mg if needed) in a crossover design. At the end of each treatment phase, the subjects were asked about their subjective erectile capacity (nocturnal and coital erections), and resting and stimulated (after intracavernosal injection of a mixture of alprostadil and phentolamine) penile deep artery diameters and systolic peak velocities were measured by color Doppler ultrasonography. There were no significant differences in blood pressure after either therapy. The change from earlier antihypertensive therapy, moxonidine produced significant subjective amelioration of sexual dysfunction in 9/11 of the men (< or = 0.001), whereas 9/11 returned to impaired dysfunction after crossover to metoprolol treatment. Resting and stimulated deep penile diameters and peak systolic velocities were higher after moxonidine treatment compared with metoprolol (diameters: < or = 0.004, < or = 0.0001; velocities: < or = 0.008, < or = 0.038). The centrally acting sympatholytic agent moxonidine seems to improve erectile function both subjectively and objectively and has a better effect on penile circulation compared with the peripherally acting sympatholytic agent metoprolol.

Use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment.

The aim of the study was to analyse the use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment in Finland. The study included 504 child and adolescent psychiatric in-patients in the year 2000. Time-out had been used for 28 %, holding for 26 %, seclusion for 8 %, and mechanical restraints for 4 % of the in-patients. In multivariate analysis, aggressive acts were the strongest factor associated with all kinds of restraint practices. Psychosis, suicidal acts and older age (13-18 years) were associated with seclusion and mechanical restraints. Younger age (< 13 years), attachment disorder and autism were associated with holding. The longer children had been in treatment, the more likely they were to have been restrained. The high prevalence of restraint techniques used indicates a need for guidelines of restraint and seclusion which take into account the child's need for protection from his/her own impulses and the legal rights of the child.

Poor sleep and psychiatric symptoms at school: an epidemiological study.

The objective of this study was to evaluate associations between sleep problems and psychiatric symptoms at school. A random sample consisting of 5813 eight- to nine-year-old children was selected from ordinary schools. Both parents' and children's reports of sleep problems were taken into account. The psychiatric symptoms were addressed according to the teachers' reports (the Rutter Scale B). Children with severe sleep problems were more likely to have a psychiatric disturbance according to the Rutter B Scale (OR 2.45, 95% CI 1.85-3.25). Logistic regression models showed that severe sleep problems were highly associated with emotional problems (OR 2.74, 95% CI 1.84-4.13), school attendance problems (OR 2.53, 95% OR 1.45-4.41), behavioural problems (OR 2.44, 95% CI 1.59-3.75) and hyperactivity (OR 2.02, 95% CI 1.30-3.13). Over 95% of severe sleep problems were reported only by the children themselves. In conclusion, children with severe sleep problems have substantially more teacher-reported psychiatric symptoms than those with no or mild sleep complaints. In diagnosing sleep disorders, it is important to include children as informants because relevant information may be overlooked when only parents are questioned.

Child and adolescent mental health service use in Finland.

BACKGROUND: The study examines the associations of parent, teacher and self-report evaluations of child psychopathology, help-seeking variables and family factors with the use of child mental health services. METHOD: The study comprised an 8-year follow-up of the Epidemiological Child Psychiatry Study in Finland. Children were evaluated at age 8 with Rutter parent and teacher scales and with the Child Depression Inventory, and at age 16, with the Child Behavior Checklist and the Youth Self Report. Information was obtained from about 70% of the follow-up sample (n=857). RESULTS: About 7% of the sample had been in contact with child mental health services during the follow-up. The most potent predictors at age 8 of later referral were total problem behaviours and antisocial problems in parental evaluation, teacher's evaluation of the child's need for referral and living in other than a biological two-parent family. At age 16, externalizing and internalizing problems, total competence and family composition were independently associated with service use. CONCLUSIONS: Both child psychopathology and family disruption were associated with service use. Only a minority of children at risk of psychiatric disorders had used child mental health services.

Antenatal depression, substance dependency and social support.

BACKGROUND: The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women. METHOD: 391 women who were 14-37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2). RESULTS: 7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression. LIMITATION: The caseness was defined with a self-report instrument. CONCLUSION: Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.

An early report on the mother-baby interactive capacity of substance-abusing mothers.

OBJECTIVE: Examination of maternal interactive behavior and psychosocial situation of substance-abusing mothers in treatment. METHOD: Twelve mothers with an alcohol or drug abuse problem and 12 control mothers were assessed in random order with the Parent-Child Early Relational Assessment, for the analysis of videotaped mother-infant interactions at 3 and 6 months' postpartum. Depressive symptoms were assessed with Edinburgh Postnatal Depression Scale and aspects of social support with two Social Support Questionnaires. RESULTS: Substance-abusing mothers tended to have more problematic areas in their interactive behavior, a tendency which increased during the study period. As was expected, they were more often depressive, and experienced more social environment difficulties and less social support. CONCLUSIONS: Mothers with alcohol and drug abuse problems need intensive professional support in early motherhood, and are seen to be particularly motivated to strive for abstinence and accept help at this stage of life.

Psychosocial functioning and psychiatric comorbidity among substance-abusing Icelandic adolescents.

Our objectives were to compare behaviour problem scores (BPS) for Icelandic adolescents admitted for detoxification treatment for alcohol and narcotic abuse as compared with the general population, in accordance with the Youth Self Report (YSR), and to describe psychosocial functioning and psychiatric comorbidity for the treated adolescents. The case series consisted of 103 adolescents, ages 12-18 years, who completed the YSR at the end of a 10-day stay at the National Hospital of Addiction Medicine. The total BPS tallied from the YSR items was compared with scores for the general population. The psychiatric comorbidity and psychosocial functioning of the case series were assessed through diagnostic interviews in accordance with DSM-IV and ICD-10 criteria. The BPS for the 36 treated girls was significantly higher than for the general population (104 versus 36) and higher than for the 56 treated boys (82 versus 56) with 2 standard deviations above the norm for the population. Three-quarters of the adolescents had psychiatric comorbidity: conduct disorder (44%), depression (28%), or posttraumatic stress disorder (11%). The findings support the discriminative validity of the YSR as part of a structured global assessment of substance-abusing adolescents, in particular to identify the frequently present psychiatric comorbidities.

Comparison of autonomic withdrawal in men with obstructive sleep apnea syndrome, systemic hypertension, and neither condition.

Obstructive sleep apnea syndrome is characterized by obesity, nocturnal breathing abnormalities, arterial hypertension, and an increased number of cardiovascular events. Sympathetic activity is increased during nocturnal apneic episodes, which may mediate the cardiovascular complications of sleep apnea. We studied 15 male subjects with obstructive sleep apnea syndrome and associated hypertension, 54 subjects with mild to moderate essential hypertension, and 25 healthy normotensive men. Cardiovascular autonomic control was assessed using frequency domain measures of heart rate variability (HRV) during a controlled breathing test and during orthostatic maneuver. Compared with normotensive and hypertensive groups, total power and low- and high-frequency components of HRV during controlled breathing were significantly (analysis of variance, p<0.0001) lower in the obstructive sleep apnea syndrome. During the orthostatic maneuver, the change in total power of HRV was different between the 3 groups (analysis of variance, p = 0.004). The total power of HRV tended to increase in the normotensive (4.11+/-12.29 ms2) and in hypertensive (2.31+/-12.65 ms2) groups, but decreased (1.13+/-1.23 ms2) in the hypertensive group with obstructive sleep apnea syndrome. According to multivariate regression analysis, age and sleep apnea were the major independent determinants of HRV. This study found that an abnormal response to autonomic nervous tests characterizes hypertension in overweight subjects with obstructive sleep apnea syndrome. This could be due to autonomic withdrawal or supersaturation of the end-organ receptors by excessive and prolonged sympathetic stimulation. Our results also show the reduced response of orthostatic maneuver and controlled breathing in the hypertensive group compared with the normotensive group.

Persistence of bullying from childhood to adolescence--a longitudinal 8-year follow-up study.

OBJECTIVE: To examine factors associated with bullying and victimization from age 8 to 16. METHOD: An 8-year longitudinal study included questions about bullying and victimization at age 8 and 16. Children were evaluated with Rutter scales by parents and teachers and with the Child Depression Inventory filled in by the children at age 8. When the children were at the age of 16 parents filled in the CBCL and adolescents the YSR. RESULTS: About 15% of boys and 7% of girls were bullied and 12% of girls and 13% of boys were victimized at age 16. Both bullying and victimization at age 16 were associated with a wide range of psychological problems at age 8 and 16, and with referral to child mental health services. Bullying at age 8 was associated with bullying at age 16, while victimization at age 8 was associated with victimization 8 years later. CONCLUSIONS: Bullying and victimization are often persistent and associated with severe emotional and behavior problems. Preventive efforts should be focused, and targeted at those children who are characterized by both psychological disturbance and bullying.

Sleep problems of school-aged children: a complementary view.

The aim of this population-based multicentre study was to evaluate the prevalence rates of sleep problems among 8-9-y-old children. The sample consisted of 5813 Finnish children, making up 10% of the age cohort. Both parents and children provided information. Disturbed sleep was reported by 21.7% of parents. Most of the problems were mild; only 0.3% were serious. Dyssomnias were frequent: 11.1% had difficulties with sleep onset, 7.1% with night waking and 2.3% with waking too early. Multiple sleep problems were present in 9.1% of the children. 17.8% of children reported disturbed sleep, 12.7% had problems many nights and 5.1% every night. In 32.0% of cases, either the parent or the child reported disturbed sleep; 7.4% of these reports came from both the parent and the child, 14.1% from the parent only and 10.3% from the child only. The correspondence between informants was poor (kappa = 0.224). Sleeping problems were associated with somatic and psychiatric problems. It is concluded that by restricting questioning to parents only, one-third of all potential cases of sleep problems may go unnoticed. In order to increase the sensitivity of screening children's sleep problems, both parents and children should provide information in epidemiological settings as well as in clinical work.

Widespread pain and neck pain in schoolchildren. A prospective one-year follow-up study.

The aims of this study were to prospectively follow up population-based cohorts of children with widespread pain, children with neck pain and pain-free children, in order to evaluate 1-y changes in pain symptoms and to evaluate predictors for persistent widespread pain and for the change of neck pain to widespread pain. A structured pain questionnaire, the Children's Depression Inventory, and a sleep questionnaire were completed by the pre-adolescent cohorts, and clinical evaluation with tender point palpation and pain threshold measurements was carried out in both years. The Child Behavior Checklist, the Teacher's Report Form and a sociodemographic questionnaire were completed at baseline. More children in the 2 pain cohorts reported pain at follow-up than did controls (p < 0.0001). Children with persistent widespread pain had lower pain thresholds compared with those whose pain classification changed. In the neck pain group, 19 (20.4%) reported widespread pain at follow-up. Although depressive symptoms and sleep problems were associated with the change of neck pain to widespread pain, neither they nor other measured factors showed independent explanatory power in multiple logistic regression analysis. In conclusion, fluctuation of pain symptoms occurred mainly among pain cohorts. Depressive and sleep problems may have an effect on the spreading of regional neck pain to widespread pain. Pain threshold measurement and evaluation of depressive and sleep problems may be useful tools for secondary prevention of musculoskeletal pain in pre-adolescents.

Maternal substance abuse: infant psychiatric interest: a review and a hypothetical model of interaction.

Substance abuse problems have strongly increased among Finnish women during the last decade. The negative effects that maternal substance abuse is thought to have on the quality of early mother-baby interaction are an area of interest and concern to specialists in infant mental health. During pregnancy and the newborn period of the infant, substance-abusing women have been shown to be especially willing and able to reduce use once the problem is identified. The desire to stop abusing substances appears to be predicated on a strong desire to be a good mother to the child. Interventions that focus on abstaining during pregnancy and on the early mother-child relationship have shown promise in helping these mothers improve the developmental prognosis of the child and become better parents through sobriety.