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1.
Nord J Psychiatry ; 77(1): 65-72, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35412416

RESUMO

OBJECTIVE: Major public and scientific interest exists on, whether quarantine as a containment measure, could have adverse effects on individual's mental health. We investigated psychic well-being and distress, symptoms of depression and anxiety among individuals imposed to home quarantine. METHODS: By total population sampling in a Finnish suburban city, a total of 57 quarantined cases (participation rate 97%) were identified and followed up for two weeks until expiration of the quarantine. A randomized control group (n = 53) was formed of people seeking laboratory testing for suspected Sars-CoV-2 infection. Primary outcome was the psychic well-being and distress experienced during quarantine measured by the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM). The cases were followed up by the Clinical Outcomes in Routine Evaluation-10 (CORE-10), Patient Health Questionnaire-9 (PHQ-9), and by the Overall Anxiety Severity and Impairment Scale (OASIS). RESULTS: The median CORE-OM score for the cases was 3.53 (95% CI: 2.23-4.66), and for the controls 3.24 (1.76-3.82), being mostly in the nonclinical to mild range. The difference between the groups was statistically nonsignificant (p = .19). Higher levels of psychic distress were explained by previous psychiatric disorders and living alone, but not having been quarantined. In comparison to controls, the quarantined participants experienced significantly, but slightly lower level of life functioning. At the follow-up, the quarantined participants rated further low on the CORE-10 (median 2.00; 95% CI: 1.00-3.00), the PHQ-9 (1.50; 0.00-3.00), and the OASIS (0.00; 0.00-0.00). CONCLUSIONS: The distress associated with short-term home quarantine may not be to the degree of a mental disorder.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Saúde Mental , Quarentena/psicologia , Pandemias/prevenção & controle , SARS-CoV-2 , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/psicologia
2.
Nord J Psychiatry ; 77(5): 455-466, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36541920

RESUMO

BACKGROUND: The push to systematically follow treatment outcomes in psychotherapies to improve health care is increasing worldwide. To manage psychotherapeutic services and facilitate tailoring of therapy according to feedback a comprehensive and feasible data system is needed. AIMS: To describe the Finnish Psychotherapy Quality Register (FPQR), a comprehensive database on availability, quality, and outcomes of psychotherapies. METHODS: We describe the development of the FPQR and outcome for outsourced psychotherapies for adults in Helsinki and Uusimaa hospital district (HUS). Symptom severity and functioning are measured with validated measures (e.g. CORE-OM, PHQ-9, OASIS, AUDIT, and SOFAS). Questionnaires on therapeutic alliance, risks, methods, and goals are gathered from patients and psychotherapist. RESULTS: During 2018-2021, the FPQR included baseline data for 7274 unique patients and 336 psychotherapists. Response rate of measures was 85-98%. The use of the register was mandatory for the outsourced therapist of the hospital districts, and the patients were strongly recommended to fulfill the questionnaires. We report outcome for three groups of patients (n = 1844) with final/midterm data. The effect sizes for long psychotherapy (Hedge's g = 0.65 of SOFAS) were smaller than those for short psychotherapy (g = 0.75-0.91). Within three months of referral, 26-60% entered treatment depending on short- or long-term therapy. CONCLUSION: The FPQR forms a novel rich database with commensurate data on availability and outcomes of outsourced psychotherapies. It may serve as a basis for a national comprehensive follow-up system of psychosocial treatments. The Finnish system seems to refer patients with milder symptoms to more intensive treatments and achieve poorer results compared to the IAPT model in UK, Norway, or Australia.


Assuntos
Psicoterapia Breve , Psicoterapia , Adulto , Humanos , Finlândia , Psicoterapia/métodos , Resultado do Tratamento , Noruega
3.
Nature ; 604(7906): 509-516, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35396579

RESUMO

Rare coding variation has historically provided the most direct connections between gene function and disease pathogenesis. By meta-analysing the whole exomes of 24,248 schizophrenia cases and 97,322 controls, we implicate ultra-rare coding variants (URVs) in 10 genes as conferring substantial risk for schizophrenia (odds ratios of 3-50, P < 2.14 × 10-6) and 32 genes at a false discovery rate of <5%. These genes have the greatest expression in central nervous system neurons and have diverse molecular functions that include the formation, structure and function of the synapse. The associations of the NMDA (N-methyl-D-aspartate) receptor subunit GRIN2A and AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptor subunit GRIA3 provide support for dysfunction of the glutamatergic system as a mechanistic hypothesis in the pathogenesis of schizophrenia. We observe an overlap of rare variant risk among schizophrenia, autism spectrum disorders1, epilepsy and severe neurodevelopmental disorders2, although different mutation types are implicated in some shared genes. Most genes described here, however, are not implicated in neurodevelopment. We demonstrate that genes prioritized from common variant analyses of schizophrenia are enriched in rare variant risk3, suggesting that common and rare genetic risk factors converge at least partially on the same underlying pathogenic biological processes. Even after excluding significantly associated genes, schizophrenia cases still carry a substantial excess of URVs, which indicates that more risk genes await discovery using this approach.


Assuntos
Mutação , Transtornos do Neurodesenvolvimento , Esquizofrenia , Estudos de Casos e Controles , Exoma , Predisposição Genética para Doença/genética , Humanos , Transtornos do Neurodesenvolvimento/genética , Receptores de N-Metil-D-Aspartato/genética , Esquizofrenia/genética
4.
Nord J Psychiatry ; 71(6): 448-454, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28497707

RESUMO

BACKGROUND: Despite the abundant literature on physical comorbidity, the full range of the concurrent somatic healthcare needs among individuals with schizophrenia has rarely been studied. AIMS: This observational study aimed to assess the distressing somatic symptoms and needs for physical health interventions in outpatients with schizophrenia, and factors predicting those needs. METHODS: A structured, comprehensive health examination was carried out, including a visit to a nurse and a general practitioner on 275 outpatients with schizophrenia. The required interventions were classified by type of disease. Logistic regression was used to assess the influence of sociodemographic factors, lifestyle, functional limitations, factors related to psychiatric disorder, and healthcare use on the need for interventions. RESULTS: In total, 44.9% of the patients (mean age 44.9 years) reported somatic symptoms affecting daily life; 87.6% needed specific interventions for a disease or condition, most commonly for cardiovascular, dermatological, dental, ophthalmological, and gastrointestinal conditions, and for altered glucose homeostasis. Smoking and obesity predicted significantly a need of any intervention, but the predictors varied in each disease category. Strikingly, use of general practitioner services during the previous year did not reduce the need for interventions. CONCLUSIONS: Health examinations for outpatients with schizophrenia revealed numerous physical healthcare needs. The health examinations for patients with schizophrenia should contain a medical history taking and a physical examination, in addition to basic measurements and laboratory tests. Prevention and treatment of obesity and smoking should be given priority in order to diminish somatic comorbidities in schizophrenia.


Assuntos
Assistência Ambulatorial/métodos , Necessidades e Demandas de Serviços de Saúde , Exame Físico/métodos , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Adulto , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/terapia , Esquizofrenia/terapia
5.
Duodecim ; 131(13-14): 1297-301, 2015.
Artigo em Finlandês | MEDLINE | ID: mdl-26536726

RESUMO

Online therapies are partly automated therapies, in which psychotherapeutic contents have been complemented with computer-aided presentational and educational contents, with a therapist giving support to the progress of the patient. As methods, these therapeutic programs incorporate therapeutic methods that have proven effective, such as remodeling of thoughts, activation of behavior and exposure, empathy, strengthening of cooperative relationship and motivation, and general support for self-reflection. For instance, online therapies already constitute part of the Finnish treatment guidelines on depression. Online therapies are available throughout Finland for the essential psychiatric illnesses.


Assuntos
Depressão/terapia , Internet , Psicoterapia/métodos , Telemedicina , Finlândia , Humanos , Motivação
6.
Nord J Psychiatry ; 69(5): 339-45, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25981178

RESUMO

BACKGROUND: Schizophrenia patients are in danger of developing metabolic syndrome (MetS) and its outcomes type 2 diabetes and cardiovascular disease. Antipsychotic treatment and adverse lifestyle increase the burden of metabolic problems in schizophrenia, but little is known about the role of patients' current psychiatric problems and living arrangements in MetS. AIMS: This study aims to evaluate correlations between MetS, severity of psychiatric symptoms, living arrangements, health behaviour and antipsychotic medication in outpatients with schizophrenia spectrum disorders. METHODS: A general practitioner and psychiatric nurses performed a comprehensive health examination for all consenting patients with schizophrenia spectrum disorders treated in a psychosis outpatient clinic. Examination comprised of an interview, a questionnaire, measurements, laboratory tests and a general clinical examination. Diagnosis of MetS was made according to International Diabetes Federation (IDF) definition. Correlations were calculated and logistic regression analysis performed with SAS. RESULTS: 276 patients (men n = 152, mean age ± standard deviation = 44.9 ± 12.6 years) participated in the study; 58.7% (n = 162) of them had MetS according to the IDF definition. Clozapine use doubled the risk of MetS (OR = 2.04, 95% CI 1.09-3.82, P = 0.03), whereas self-reported regular physical activity decreased the risk significantly (OR = 0.32, 95% CI 0.18-0.57, P < 0.001). We found no correlations between MetS and living arrangements or current severity of psychiatric symptoms. CONCLUSIONS: MetS was alarmingly common in our sample. Even moderate physical activity was associated with decreased risk of MetS. Promotion of a physically active lifestyle should be one of the targets in treatment of schizophrenia, especially in patients using clozapine.


Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Síndrome Metabólica/etiologia , Esquizofrenia/tratamento farmacológico , Adulto , Comorbidade , Feminino , Humanos , Masculino , Síndrome Metabólica/induzido quimicamente , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Atividade Motora , Pacientes Ambulatoriais , Características de Residência , Esquizofrenia/epidemiologia , Comportamento Sedentário , Índice de Gravidade de Doença
7.
Neurol Sci ; 35(2): 199-204, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23794113

RESUMO

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.


Assuntos
Benzotiazóis/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Postura , Síndrome das Pernas Inquietas/tratamento farmacológico , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Pramipexol , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/etiologia , Síndrome das Pernas Inquietas/complicações , Síndrome das Pernas Inquietas/diagnóstico , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Visão Ocular , Percepção Visual
8.
Perspect Psychiatr Care ; 48(1): 16-24, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22188043

RESUMO

PURPOSE: This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland. METHODS: The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis. RESULTS: Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient-staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted. PRACTICE IMPLICATIONS: Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development.


Assuntos
Pacientes Internados/psicologia , Transtornos Mentais/enfermagem , Unidade Hospitalar de Psiquiatria/normas , Restrição Física/psicologia , Isolamento Social/psicologia , Adulto , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente
9.
Alcohol Clin Exp Res ; 34(5): 853-60, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20201935

RESUMO

BACKGROUND: A polymorphism in the promoter region of the monoamine oxidase A gene (MAOA) has been shown to alter the effect of persistent drinking and childhood maltreatment on the risk for violent and antisocial behaviors. These findings indicate that MAOA could contribute to inter-individual differences in stress resiliency. METHODS: Recidivism in severe violent crimes was assessed after 8 years of nonincarcerated follow-up in a male sample of 174 impulsive Finnish alcoholic violent offenders, the majority of whom exhibited antisocial (ASPD) or borderline personality disorder (BPD) or both. We examined whether MAOA genotype alters the effects of heavy drinking and childhood physical abuse (CPA) on the risk for committing impulsive recidivistic violent crimes. RESULTS: Logistic regression analyses showed that both heavy drinking and CPA were significant independent predictors of recidivism in violent behavior (OR 5.2, p = 0.004 and OR 5.3, p = 0.003) among offenders having the high MAOA activity genotype (MAOA-H), but these predictors showed no effect among offenders carrying the low MAOA activity genotype (MAOA-L). CONCLUSION: Carriers of the MAOA-H allele have a high risk to commit severe recidivistic impulsive violent crimes after exposure to heavy drinking and CPA.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/enzimologia , Alcoolismo/psicologia , Maus-Tratos Infantis/psicologia , Criminosos/psicologia , Comportamento Impulsivo/psicologia , Monoaminoxidase/fisiologia , Violência/psicologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/metabolismo , Consumo de Bebidas Alcoólicas/fisiopatologia , Alcoolismo/genética , Criança , Seguimentos , Humanos , Comportamento Impulsivo/enzimologia , Masculino , Monoaminoxidase/genética , Fatores de Risco , Adulto Jovem
10.
Brain ; 132(Pt 11): 2994-3001, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19620178

RESUMO

Distortion of the sense of reality, actualized in delusions and hallucinations, is the key feature of psychosis but the underlying neuronal correlates remain largely unknown. We studied 11 highly functioning subjects with schizophrenia or schizoaffective disorder while they rated the reality of auditory verbal hallucinations (AVH) during functional magnetic resonance imaging (fMRI). The subjective reality of AVH correlated strongly and specifically with the hallucination-related activation strength of the inferior frontal gyri (IFG), including the Broca's language region. Furthermore, how real the hallucination that subjects experienced was depended on the hallucination-related coupling between the IFG, the ventral striatum, the auditory cortex, the right posterior temporal lobe, and the cingulate cortex. Our findings suggest that the subjective reality of AVH is related to motor mechanisms of speech comprehension, with contributions from sensory and salience-detection-related brain regions as well as circuitries related to self-monitoring and the experience of agency.


Assuntos
Percepção Auditiva/fisiologia , Córtex Cerebral , Alucinações , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia , Adulto , Vias Auditivas/fisiologia , Vias Auditivas/fisiopatologia , Mapeamento Encefálico/métodos , Córtex Cerebral/anatomia & histologia , Córtex Cerebral/fisiopatologia , Feminino , Alucinações/fisiopatologia , Alucinações/psicologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiologia , Rede Nervosa/fisiopatologia , Percepção da Fala/fisiologia , Adulto Jovem
11.
BMC Psychiatry ; 9: 18, 2009 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-19419577

RESUMO

BACKGROUND: The aim of the study was to evaluate psychopathy-like personality traits in a nationwide consecutive sample of adolescent male homicide offenders and to compare the findings with those of a randomly sampled adult male homicide offender group. A further aim was to investigate associations between psychopathic traits and offender and offence characteristics in adolescent homicides. METHODS: Forensic psychiatric examination reports and crime reports of all 15 to 19- year- old male Finnish offenders who had been subjected to a forensic psychiatric examination and convicted for a homicide during 1995-2004 were collected (n = 57). A random sample of 57 adult male homicide offenders was selected as a comparison group. Offence and offender characteristics were collected from the files and a file-based assessment of psychopathic traits was performed using the Hare Psychopathy Checklist-Revised (PCL-R) by trained raters. RESULTS: No significant differences existed between the adolescents and adults in PCL-R total scores, factor 2 (social deviance) scores, or in facets 3 (lifestyle) and 4 (antisocial). Adults scored significantly higher on factor 1 (interpersonal/affective) and facets 1 (interpersonal) and 2 (affective). The adolescent group was divided into two subgroups according to PCL-R total scores. One in five homicidal male adolescents met criteria for psychopathic personality using a PCL-R total score of 26 or higher. These boys significantly more often had a crime history before the index homicide, more frequently used excessive violence during the index homicide, more rarely lived with both parents until 16 years of age, had more institutional or foster home placements in childhood, had more school difficulties, more often had received special education, and, more often had contact with mental health services prior to age 18 years than boys scoring low on the PCL-R. They also more often had parental criminal history as well as homicide history of parents or near relatives than the group scoring low on the PCL-R. CONCLUSION: Homicidal boys behaved as antisocially as the homicidal adults. The adults, however, showed more both affective and interpersonal features of psychopathy. Homicidal adolescents with psychopathy-like personality character form a special subgroup among other homicidal youngsters. Recognizing their characteristics, especially in life course development, would facilitate effective prevention and intervention efforts.


Assuntos
Comportamento do Adolescente/psicologia , Transtorno da Personalidade Antissocial/diagnóstico , Homicídio/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Transtorno da Personalidade Antissocial/epidemiologia , Crime/psicologia , Crime/estatística & dados numéricos , Família , Finlândia/epidemiologia , Psiquiatria Legal , Homicídio/psicologia , Humanos , Masculino , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Violência
12.
Psychiatry Res ; 168(1): 18-25, 2009 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-19467714

RESUMO

Predictive data supporting prevention of violent criminality are scarce. We examined risk factors for recidivism and mortality among non-psychotic alcoholic violent offenders, the majority having antisocial or borderline personality disorders, or both, which is a group that commits the majority of violent offences in Finland. Criminal records and mortality data on 242 male alcoholic violent offenders were analysed after a 7- to 15-year follow-up, and compared between themselves and with those of 1210 age-, sex- and municipality-matched controls. Recidivism and mortality rates were high. The risk of recidivistic violence was increased by antisocial or borderline personality disorder, or both, childhood maltreatment, and a combination of these. A combination of borderline personality disorder and childhood maltreatment was particularly noxious, suggesting an additive risk increase for a poor outcome. Accurate diagnosis and careful childhood interview may help to predict recidivism and premature death.


Assuntos
Alcoolismo/epidemiologia , Alcoolismo/mortalidade , Crime/estatística & dados numéricos , Transtornos da Personalidade/epidemiologia , Violência/estatística & dados numéricos , Adulto , Alcoolismo/diagnóstico , Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno da Personalidade Antissocial/mortalidade , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/epidemiologia , Transtorno da Personalidade Borderline/psicologia , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Comorbidade , Crime/legislação & jurisprudência , Crime/psicologia , Finlândia/epidemiologia , Seguimentos , Psiquiatria Legal , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Transtornos da Personalidade/diagnóstico , Prognóstico , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Violência/legislação & jurisprudência , Violência/psicologia
13.
Forensic Sci Int ; 186(1-3): 75-80, 2009 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-19272721

RESUMO

Approximately 10% of the homicides in Finland are committed by females. This study was designed to compare offence circumstances and crime scene behaviour among female and male homicide offenders. The forensic examination reports and crime reports of all female offenders prosecuted for a homicide between 1995 and 2004 were collected and content analysed (n=91). A sample of male offenders was selected for a comparison group. In addition to several bivariate analyses, two multidimensional scaling analyses were conducted to identify the underlying structure of the offence characteristics-related variables in male and female offenders. The results showed that family members were the victims of female offenders more frequently than of male offenders. Child victims were almost always killed by females. No significant difference emerged between the gender groups in the proportion of victims being former intimate partners. The results also showed that different offence characteristics relate to offender gender and type of victim. In male offenders, covering the body relates to moving and hiding an acquaintance victim's body, while in females it relates to emotional detachment and family member victim. For females, post-offence behaviours that relate to seek for help and regret were more frequent than for males. There were only marginal differences in the use of violence between females and males.


Assuntos
Psicologia Criminal , Psiquiatria Legal , Homicídio/estatística & dados numéricos , Adulto , Vítimas de Crime/estatística & dados numéricos , Feminino , Finlândia , Homicídio/psicologia , Humanos , Masculino , Métodos , Motivação , Fatores Sexuais , Ferimentos e Lesões/patologia
14.
Alcohol Clin Exp Res ; 33(3): 428-34, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19120058

RESUMO

BACKGROUND: Environmental factors appear to interact with a functional polymorphism (MAOA-LPR) in the promoter region of the monoamine oxidase A gene (MAOA) in determining some forms of antisocial behavior. However, how MAOA-LPR modulates the effects of other factors such as alcohol consumption related to antisocial behavior is not completely understood. METHODS: This study examines the conjunct effect of MAOA-LPR, alcohol consumption, and aging on the risk for violent behavior. Recidivism in severe impulsive violent behavior was assessed after 7 to 15 years in a sample of 174 Finnish alcoholic offenders, the majority of whom exhibited antisocial or borderline personality disorder or both, and featured impulsive temperament traits. RESULTS: The risk for committing new acts of violence increased by 2.3% for each kilogram of increase in yearly mean alcohol consumption (p = 0.004) and decreased by 7.3% for every year among offenders carrying the high activity MAOA genotype. In contrast, alcohol consumption and aging failed to affect violent behavior in the low activity MAOA genotyped offenders. MAOA-LPR showed no main effect on the risk for recidivistic violence. CONCLUSIONS: Violent offenders carrying the high activity MAOA genotype differ in several ways from carriers with the low activity MAOA risk allele previously associated with antisocial behavior. Finnish high activity MAOA genotyped risk alcoholics exhibiting antisocial behavior, high alcohol consumption, and abnormal alcohol-related impulsive and uncontrolled violence might represent an etiologically distinct alcohol dependence subtype.


Assuntos
Agressão/efeitos dos fármacos , Envelhecimento/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Comportamento Impulsivo/genética , Monoaminoxidase/genética , Violência , Adulto , Consumo de Bebidas Alcoólicas/genética , Seguimentos , Humanos , Comportamento Impulsivo/induzido quimicamente , Masculino , Polimorfismo Genético , Adulto Jovem
15.
J Clin Psychiatry ; 69(5): 844-53, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18399727

RESUMO

BACKGROUND: Clinical studies on the outcome of adolescent depression beyond treatment trials are scarce. OBJECTIVE: To investigate the impact of characteristics of the depressive episode and current comorbidity on the 1-year outcome of depression. METHOD: A sample of 174 consecutive adolescent psychiatric outpatients (aged 13 through 19 years) and 17 school-derived matched controls, all with unipolar depressive disorders at baseline, were reinterviewed for DSM-IV Axis I and Axis II disorders at 12 months. The study was conducted between January 1998 and May 2002. RESULTS: The outpatients had equal recovery rate and episode duration but shorter time to recurrence than the controls. Among the outpatients, Axis II comorbidity predicted shorter time to recurrence (p = .02). Longer time to recovery was predicted by earlier lifetime age at onset for depression (p = .02), poor psychosocial functioning (p = .003), depressive disorder diagnosis (p

Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Progressão da Doença , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Valor Preditivo dos Testes , Psicologia , Fatores de Tempo
16.
BMC Neurol ; 8: 10, 2008 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-18419829

RESUMO

BACKGROUND: Neuroleptic-induced movement disorders (NIMDs) have overlapping co-morbidity. Earlier studies have described typical clinical movement patterns for individual NIMDs. This study aimed to identify specific movement patterns for each individual NIMD using actometry. METHODS: A naturalistic population of 99 schizophrenia inpatients using conventional antipsychotics and clozapine was evaluated. Subjects with NIMDs were categorized using the criteria for NIMD found in the Diagnostic and Statistical Manual for Mental Disorders - Fourth Edition (DSM-IV).Two blinded raters evaluated the actometric-controlled rest activity data for activity periods, rhythmical activity, frequencies, and highest acceleration peaks. A simple subjective question was formulated to test patient-based evaluation of NIMD. RESULTS: The patterns of neuroleptic-induced akathisia (NIA) and pseudoakathisia (PsA) were identifiable in actometry with excellent inter-rater reliability. The answers to the subjective question about troubles with movements distinguished NIA patients from other patients rather well. Also actometry had rather good screening performances in distinguishing akathisia from other NIMD. Actometry was not able to reliably detect patterns of neuroleptic-induced parkinsonism and tardive dyskinesia. CONCLUSION: The present study showed that pooled NIA and PsA patients had a different pattern in lower limb descriptive actometry than other patients in a non-selected sample. Careful questioning of patients is a useful method of diagnosing NIA in a clinical setting.


Assuntos
Antipsicóticos/efeitos adversos , Discinesia Induzida por Medicamentos/diagnóstico , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Idoso , Discinesia Induzida por Medicamentos/epidemiologia , Discinesia Induzida por Medicamentos/fisiopatologia , Humanos , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/epidemiologia , Transtornos dos Movimentos/fisiopatologia , Reprodutibilidade dos Testes , Esquizofrenia/epidemiologia , Esquizofrenia/fisiopatologia
17.
BMC Psychiatry ; 8: 97, 2008 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-19116040

RESUMO

BACKGROUND: Accurate assessment of suicidality is of major importance. We aimed to evaluate trained clinicians' ability to assess suicidality against a structured assessment made by trained raters. METHOD: Treating clinicians classified 218 adolescent psychiatric outpatients suffering from a depressive mood disorder into three classes: 1-no suicidal ideation, 2-suicidal ideation, no suicidal acts, 3-suicidal or self-harming acts. This classification was compared with a classification with identical content derived from the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) made by trained raters. The convergence was assessed by kappa- and weighted kappa tests. RESULTS: The clinicians' classification to class 1 (no suicidal ideation) was 85%, class 2 (suicidal ideation) 50%, and class 3 (suicidal acts) 10% concurrent with the K-SADS evaluation (gamma2 = 37.1, df 4, p = 0.000). Weighted kappa for the agreement of the measures was 0.335 (CI = 0.198-0.471, p < 0.0001). The clinicians under-detected suicidal and self-harm acts, but over-detected suicidal ideation. CONCLUSION: There was only a modest agreement between the trained clinicians' suicidality evaluation and the K-SADS evaluation, especially concerning suicidal or self-harming acts. We suggest a wider use of structured scales in clinical and research settings to improve reliable detection of adolescents with suicidality.


Assuntos
Transtorno Depressivo/diagnóstico , Capacitação em Serviço , Programas de Rastreamento/estatística & dados numéricos , Determinação da Personalidade/estatística & dados numéricos , Comportamento Autodestrutivo/diagnóstico , Prevenção do Suicídio , Tentativa de Suicídio/prevenção & controle , Adolescente , Assistência Ambulatorial , Transtorno Depressivo/psicologia , Feminino , Finlândia , Humanos , Entrevista Psicológica , Masculino , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Comportamento Autodestrutivo/psicologia , Suicídio/psicologia , Tentativa de Suicídio/psicologia
18.
BMC Psychiatry ; 7: 36, 2007 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-17662159

RESUMO

BACKGROUND: The validity of traditional categorical personality disorder diagnoses is currently re-evaluated from a continuous perspective, and the evolving DSM-V classification may describe personality disorders dimensionally. The utility of dimensional personality assessment, however, is unclear in violent offenders with severe personality pathology. METHODS: The temperament structure of 114 alcoholic violent offenders with antisocial personality disorder (ASPD) was compared to 84 offenders without ASPD, and 170 healthy controls. Inclusion occurred during a court-ordered mental examination preceded by homicide, assault, battery, rape or arson. Participants underwent assessment of temperament with the Tridimensional Personality Questionnaire (TPQ) and were diagnosed with DSM-III-R criteria. RESULTS: The typical temperament profile in violent offender having ASPD comprised high novelty seeking, high harm avoidance, and low reward dependence. A 21% minority scored low in trait harm avoidance. Results, including the polarized harm avoidance dimension, are in accordance with Cloninger's hypothesis of dimensional description of ASPD. The low harm avoidance offenders committed less impulsive violence than high harm avoidance offenders. High harm avoidance was associated with comorbid antisocial personality disorder and borderline personality disorder. CONCLUSION: Results indicate that the DSM based ASPD diagnosis in alcoholic violent offenders associates with impulsiveness and high novelty seeking but comprises two different types of ASPD associated with distinct second-order traits that possibly explain differences in type of violent criminality. Low harm avoidance offenders have many traits in common with high scorers on the Hare Psychopathy Checklist-Revised (PCL-R). Results link high harm avoidance with broad personality pathology and argue for the usefulness of self-report questionnaires in clinical praxis.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta/psicologia , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia , Inventário de Personalidade , Violência/psicologia , Adolescente , Adulto , Alcoolismo/psicologia , Estudos de Casos e Controles , Crime/psicologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/classificação , Transtornos Disruptivos, de Controle do Impulso e da Conduta/diagnóstico , Comportamento Exploratório , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/classificação
19.
Depress Anxiety ; 24(6): 421-32, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17051545

RESUMO

Our objective was to analyze differences in clinical characteristics and comorbidity between different types of adolescent depressive disorders. A sample of 218 consecutive adolescent (ages 13-19 years) psychiatric outpatients with depressive disorders was interviewed for DSM-IV Axis I and Axis II diagnoses. We obtained data by interviewing the adolescents themselves and collecting additional background information from the clinical records. Lifetime age of onset for depression, current episode duration, frequency of suicidal behavior, psychosocial impairment, and the number of current comorbid psychiatric disorders varied between adolescent depressive disorder categories. The type of co-occurring disorder was mainly consistent across depressive disorders. Minor depression and dysthymia (DY) presented as milder depressions, whereas bipolar depression (BPD) and double depression [DD; i.e., DY with superimposed major depressive disorder (MDD)] appeared as especially severe conditions. Only earlier lifetime onset distinguished recurrent MDD from first-episode MDD, and newly emergent MDD appeared to be as impairing as recurrent MDD. Adolescent depressive disorder categories differ in many clinically relevant aspects, with most differences reflecting a continuum of depression severity. Identification of bipolarity and the subgroup with DD seems especially warranted. First episode MDD should be considered as severe a disorder as recurring MDD.


Assuntos
Transtorno Depressivo/diagnóstico , Adolescente , Assistência Ambulatorial , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Comorbidade , Estudos Transversais , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Diagnóstico Diferencial , Transtorno Distímico/diagnóstico , Transtorno Distímico/epidemiologia , Transtorno Distímico/psicologia , Feminino , Finlândia , Inquéritos Epidemiológicos , Humanos , Entrevista Psicológica , Masculino , Determinação da Personalidade , Inventário de Personalidade , Recidiva , Ajustamento Social , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/epidemiologia , Transtornos Somatoformes/psicologia , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos
20.
Eur Child Adolesc Psychiatry ; 15(4): 199-206, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16604437

RESUMO

OBJECTIVE: We aimed to analyse and compare prevalence and associated clinical features of suicidal ideation, self-harm behaviour with no suicidal intent and suicide attempts among adolescent outpatients with depressive mood disorders with or without comorbidity. METHOD: A sample of 218 consecutive adolescent outpatients aged 13-19 years with depressive mood disorders was interviewed using K-SADS-PL for DSM-IV Axis I diagnoses. They filled out self-report questionnaires assessing depressive and anxiety symptoms. Suicidal behaviour was assessed by K-SADS-PL suicidality items. RESULTS: Half of the subjects reported suicidal ideation or behaviour. There was no difference in prevalence of suicidal behaviour between non-comorbid and comorbid mood disorder groups. Multivariate logistic regression analyses produced the following associations: (1) suicidal ideation with self-reported depressive symptoms and poor psychosocial functioning, (2) deliberate self-harm behaviour with younger age and poor psychosocial functioning, and (3) suicide attempts with self-reported depressive symptoms and poor psychosocial functioning. CONCLUSIONS: Depressed mood disorders, whether comorbid or not, are associated with suicidal ideation and suicide attempts. Diagnostic assessment should be supplemented by self-report methods when assessing suicidal behaviour in depressed adolescents.


Assuntos
Transtorno Depressivo/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Suicídio/psicologia , Adolescente , Adulto , Distribuição por Idade , Transtornos de Ansiedade/epidemiologia , Comorbidade , Transtorno Depressivo/psicologia , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Análise Multivariada , Prevalência , Fatores de Risco , Comportamento Autodestrutivo/psicologia , Distribuição por Sexo , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos
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