Enhancing identification of nonaffective psychosis in register-based studies.

The Finnish Quality of Psychosis Care Register assesses nonaffective psychosis (NAP) care, acknowledging treatment outside specialized psychiatric services. This approach, while providing a holistic view, raises concerns about diagnostic inaccuracies. Here, we studied situations where the register-based diagnosis might be inaccurate, and whether the first episode can be reliably identified using a 14-year wash-out period. People with first register-based NAP (ICD-10 F20-F29) between years 2010 and 2018 and without NAP diagnoses in 1996-2009 were identified from the Care Register for Health Care. A diagnosis of NAP was deemed unreliable before age 7, when dementia preceded NAP diagnosis, and when a NAP diagnosis had been assigned at admission or during psychiatric hospitalization but was not confirmed by discharge diagnosis. Despite a 14-year follow-back the first register diagnosis may miss the first treatment episode in older patients. Register-based studies on psychotic disorders should pay attention to exclusion criteria and to the definition of treatment onset.

Patients' rights to complain in Finnish psychiatric care: an overview.

Cuts in resources for Finnish psychiatric care may jeopardize the realization of patients' rights in mental health settings. The right to complain is a basic right of all patients in Finland, and is especially important to patients treated involuntarily and also to those who have experienced coercive treatment methods during their hospitalizations. In Finland, a patient's right to complain is guaranteed by law, both in legislation and in national quality recommendations. The complaint process in Finland is very complex, and there are several ways to make a complaint that are not always familiar to patients with severe illnesses. Psychiatric patients may have cognitive impairments that make the formulation of a complaint difficult. Despite help from the patient ombudsman, unbalanced power structures in psychiatric hospitals, insufficient information and long evaluation of appeals makes the complaint process very demanding for psychiatric patients.