The association of family size and birth order in adolescence to the likelihood of developing psychotic disorders in young adulthood: A follow-up study of former adolescent inpatients.

This is a clinical follow-up study of 508 former adolescent psychiatric inpatients admitted to hospital between 2001 and 2006 in Northern Finland. The participants were interviewed using the K-SADS-PL and the EuropASI instruments. Until 2016, the national Finnish Care Register for Health Care provided data on psychiatric diagnoses. Using logistic regression analysis, we examined how birth order and childhood family size affected the incidence of schizophrenia spectrum disorder (SSD) and other psychotic disorders by young adulthood. Participants were separated into three diagnostic subgroups 1) participants with SSD (n = 76), 2) participants with a psychotic disorder other than SSD (n = 107) and 3) participants with only one nonpsychotic depressive episode (n = 118). The main conclusions were that large family size in adolescence (six or more children), male sex and father having psychiatric problems or being unemployed, were significantly associated with a higher likelihood of SSD among study participants. Large family size also associated to a higher likelihood of developing other psychotic disorders. Being the first born or an only child reduced the likelihood of psychotic disorders other than SSD. When diagnosing and treating children and teenagers with psychotic symptoms, information regarding their family size and sibling position may be relevant.

Injuries, Poisonings, and Other External Causes of Morbidity among Drug Crime Offenders: A Follow-Up Study of Former Adolescent Psychiatric Inpatients.

INTRODUCTION: Criminal offenders have high incidences of injury- and substance-related emergency department visits. Very few studies focus on drug crime offenders or the medical specialties involved in treating these offenders. We aimed to study how drug crime offenders' treatment events in specialized health care due to injuries, poisonings, or other external causes of morbidity differed from treatment of non-criminal controls and which of the medical specialties were involved in their care. METHODS: The study population included 508 former adolescent psychiatric inpatients (age 13-17 years), who were followed up through Finnish national registers. A total of 60 had committed a drug crime during the 10-15 years' follow-up. They were matched with 120 non-criminal controls from the study population. Hazard ratios (HRs) with 95% confidence intervals (Cl) for drug crime offending were assessed using a Cox regression model. RESULTS: Almost 90% of drug crime offenders had treatment events in specialized health care due to injuries, poisonings, and other external causes of morbidity, compared to 50% of non-criminals. The majority of the drug crime offenders had been treated for accidental injuries (65% vs. 29%; p < 0.001) in comparison to non-criminal controls. More drug crime offenders had been treated for intentional poisonings (42% vs. 11%; p < 0.001) than non-criminal controls. For drug crime offenders, the lifetime probability of a treatment event due to poisoning was almost doubled (HR: 1.89, 95% CI: 1.26-2.84; p = 0.002), and for treatments due to injury, there was a 2.5-fold increase (HR: 2.54, 95% CI: 1.69-3.82; p < 0.001) in comparison to non-criminal controls. CONCLUSION: In emergency care, substance use screening and referral for appropriate psychiatric and substance abuse treatment services should be considered for all adolescents and young adults attending hospitals due to injuries or poisonings.

Association of aggressivity at adolescence and criminality to severe assault exposure among former adolescent psychiatric inpatients.

This study investigated the associations of adolescent aggression, and criminality, to severe hospital-treated assault exposures among young adults (n = 508) with a history of adolescent psychiatric inpatient treatment between 2001-2006. Participants were interviewed during hospitalization using K-SADS-PL to assess psychiatric disorders, and to obtain information on aggressivity. Data on crimes committed were obtained from the Finnish Legal Register Centre, and the treatment episodes for assault exposures from the Finnish National Care Register for Health Care, up to end of 2016. Predictors for severe assault exposure were male sex (OR = 2.1), short temperedness (OR = 2.4), non-violent offending (OR = 2.6), and violent offending (OR = 4.8). These results indicate that the participants most vulnerable to severe assaults were those suffering from a continuum of aggressivity across their lifetime. Our findings can be utilized to identify adolescents at risk of severe assault exposure, and to reduce this risk by focusing on appropriate treatments for these vulnerable adolescents.

Associations of adolescent psychosocial factors to later benzodiazepine use: a population-based follow-up study of adolescent psychiatric inpatients in Northern Finland.

We investigated factors associated with benzodiazepine (BZD) use during late adolescence and early adulthood. The study population consisted of 508 adolescents admitted to psychiatric inpatient care between April 2001 and March 2006. Information on adolescents' family- and school-related factors, suicidality and psychiatric disorders were obtained by semistructured interviews. Data on BZD prescriptions from 1999 to 2012 were collected from the Social Insurance Institution of Finland. In males heavy BZD use associated with adolescent substance-use disorder (OR, 3.5; P < 0.004) and parents' psychiatric problems (OR, 3.5; P = 0.029). Among females, conduct disorder (OR, 3.3; P = 0.016), being a bully/bully-victim (OR, 3.3; P = 0.019) and parental substance-use problems (OR, 2.6; P = 0.024) were related to heavy BZD use. The mean (±SD) age of first BZD prescription was significantly lower in heavy, compared with mild users (men: 19.3 ± 2.5 vs. 21.0 ± 2.5 years, P = 0.027; women: 19.7 ± 2.6 vs. 21.5 ± 3.4 years, P = 0.027). Heavy, compared with mild, BZD use is associated with female suicide attempts (OR, 5.0; P = 0.049). Physicians should be cautious when prescribing BZDs to young adults and must allocate treatment to those with carefully evaluated clinical indications.

Misuse of prescribed psychotropic medication and drug crime offending: A follow-up case-control study of former adolescent psychiatric inpatients.

BACKGROUND: Various psychotropic prescription drugs are known to have potential for misuse. Among teenagers, non-medical use of prescription drugs may predate illicit drug use or occur concomitantly. AIMS: Our aim was to examine prescriptions of psychotropic medications among drug crime offenders and non-criminal controls in a psychiatric inpatient cohort of 13-17-year-olds. Our research question was: were prescribed psychotropic and potentially addictive drugs associated with later drug crime offending. METHODS: Our sample was of all 60 adolescents who had been convicted of a drug crime by young adulthood with a twice-sized control group, matched for gender, age and family-type, from a cohort of 508 adolescents consecutively admitted to a psychiatric inpatient care in Finland between April 2001 and March 2006. Adolescence-related information on substance use and psychiatric disorders was obtained by semi-structured interviews. Follow-up information on crimes and medication purchases was obtained from Finnish nationwide registers. The association of studied factors to drug crime offending was examined using stepwise binary logistic regression analysis. RESULTS: 75% of drug crime offenders and 47% of non-criminal controls had used addictive psychotropic medications during the follow-up period (p < 0.001). 74% of all drug crime offenders' purchases of prescribed addictive drugs occurred within the year preceding drug crimes. Of addictive drugs, the use of clonazepam and gabapentinoids was most likely to associate with drug crime offending (AOR 7.77, p < 0.001). Conduct and substance use disorders diagnosed in adolescence (AOR 3.49, p = 0.010; AOR 2.34, p = 0.050) were predictors for drug crime offending. CONCLUSIONS: Our findings suggest that, when treating young adults with conduct disorder and a history of substance use, physicians should prescribe addictive medications with caution, favouring instead non-addictive medications complemented by psychosocial interventions.

Familial Risk Factors in Relation to Recurrent Depression Among Former Adolescent Psychiatric Inpatients.

Treating recurrent depression is a challenge for clinical practitioners. We investigated which family environmental factors contribute to differences between recurrent and non-recurrent depression by the young adulthood of the former adolescent inpatients. The initial sample covered 237 adolescent psychiatric inpatients with depression, of which 35.4% had later diagnosed with recurrent depression. Recurrence in depression was associated to distant maternal relationships in both male (p = 0.022) and female patients (p = 0.042). In females, the likelihood for recurrent depression was also related to psychiatric problems of the father (p = 0.013) and siblings (OR = 3.7, p = 0.032), and having a grand multiparous mother (p = 0.005). Our results emphasise the need for effective family-centred approaches in treatment of adolescents with depression.

Profile of Substance Misuse among Adolescent and Young Adult Gabapentinoid Users: A Register-Based Follow-up Study of Former Adolescent Psychiatric Inpatients.

AIMS: Our study examined characteristics of adolescent and young adult study participants using gabapentinoids (gabapentin, pregabalin), with previous history of adolescent psychiatric inpatient hospitalization. Particular focus was on temporal association of age, at first prescription for gabapentinoids, to age at tobacco smoking initiation, regular alcohol use, diagnosis of substance dependence and prescriptions for benzodiazepines and opioids. Methods: The initial study population contained 508 adolescents (300 females, 208 males) admitted to psychiatric inpatient care in Oulu University hospital between the ages 13-17 years. Register-based follow-up information on prescriptions for gabapentinoids, benzodiazepines and opioids, as well as ICD-10 diagnosis for hospital-treated substance dependence, was obtained from the Finnish national health care registers. Results: The users of gabapentinoids accounted for 9.1% of the initial study population. Of adolescence-related characteristics, suicidal ideation, suicide attempts and non-suicidal self-injury was emphasized in females using gabapentinoids. The majority of participants using gabapentinoids had benzodiazepines (80.4%) and opioids (71.7%) as comorbid drugs. Initiation of tobacco smoking and alcohol use and first prescriptions for of benzodiazepines and opioids, and a diagnosis of substance dependence commonly predated first prescriptions for gabapentinoids. Conclusions: In clinical practice, the decision to prescribe gabapentinoids to adolescents or young adults must be made with caution, particularly for those with substance use problems and/or without a clinically approved indication.

Higher Levels of Nicotine Dependence in Adolescence are Associated with Younger Onset Age of Violent Criminality: A Follow-Up Study of Former Adolescent Psychiatric Inpatients.

OBJECTIVE: Earlier studies have reported that smoking is associated with violent behaviour. This study investigated nicotine dependence (ND), defined as already present in adolescence, and its relation to subsequent violent criminal offending. METHOD: The baseline dataset is composed of 508 former adolescent inpatients, admitted to a psychiatric hospital between the ages of 13-17. Adolescent ND was assessed using the modified Fagerström Tolerance Questionnaire. Follow-up data on crimes up to young adulthood was acquired from the Legal Register Centre of Finland. The study analyzes the participants with violent offences (n = 78) and those without any criminal history (n = 368). RESULTS: Over 80% of the violent offenders had ND already in adolescences. One third (32.2%) of those with high ND had committed their first violent crime before 18 years of age, the proportions being 15.2% in moderate and 7.1% in no-ND groups. The likelihood for committing first violent crimes at a younger age was increased in the participants with high (adjusted Hazard Ratio (aHR) = 2.66, p = .008) or moderate ND (aHR = 2.40, p = .011). CONCLUSIONS: Adolescent psychiatric patients, showing moderate to high levels of addiction to nicotine, should be a target population for adolescent focused smoking cessation interventions and programs. Adolescents addicted to nicotine may benefit from intensive clinical attention in order to avoid more adverse and unfavorable outcomes in life, beyond merely physical health related problems.

OBJECTIF: Les études précédentes ont rapporté que le tabagisme est associé au comportement violent. La présente étude a investigué la dépendance à la nicotine (DN), définie comme étant déjà présente à l'adolescence, et sa relation aux infractions criminelles violentes subséquentes. MÉTHODE: L'ensemble des données de base se compose de 508 anciens patients adolescents hospitalisés dans un hôpital psychiatrique entre 13 et 17 ans. La DN des adolescents a été évaluée à l'aide du questionnaire de tolérance Fagerström modifié. Les données de suivi sur les crimes jusqu'au jeune âge adulte ont été obtenues du centre de registre légal de Finlande. L'étude analyse les participants qui ont des infractions avec violence (n = 78) et ceux qui n'ont pas d'antécédents criminels (n = 368). RÉSULTATS: Plus de 80 % des délinquants violents avaient la DN déjà à l'adolescence. Un tiers (32,2 %) de ceux ayant une DN élevée avaient commis leur premier crime violent avant l'âge de 18 ans, dans des proportions de 15,2 % chez les modérés et de 7,1 % chez les groupes sans DN. La probabilité de commettre les premiers crimes violents plus jeune était accrue chez les participants ayant (un rapport de risque ajusté (RRa) = 2,66, p = ,008) élevé ou une DN modérée (RRa = 2,40, p = ,011). CONCLUSIONS: Les patients psychiatriques révélant des niveaux modérés à élevés de dépendance à la nicotine devraient constituer une population cible pour les interventions et les programmes de cessation du tabagisme axés sur les adolescents. Les adolescents dépendants à la nicotine peuvent bénéficier d'une attention clinique intensive afin d'éviter des résultats indésirables et défavorables dans la vie, au- delà des simples problèmes de santé physique.

Role of involvement in bullying as predictor for hospital-treated assault exposures among former adolescent psychiatric inpatients.

OBJECTIVE: Bullying is a common problem among children and adolescents. Previous studies have investigated the associations between involvement in bullying and various psychosocial and mental health outcomes thoroughly. However, only few studies have focused on the association between bullying and exposure to assaults. This study investigated whether the likelihood for severe assault exposure varies among three subgroups of bullying behavior: bullies/bully-victims, victims of bullying, and those not involved in bullying. METHOD: The study population consisted of 508 adolescents (208 boys, 300 girls) aged between 13 and 17 years (mean age 15.5 years), admitted for psychiatric inpatient treatment between the years 2001-2006. Adolescents were interviewed at index hospitalization using semi-structured interview, K-SADS-PL, to assess DSM-IV based adolescent psychiatric disorders, and to obtain information on bullying behavior. Treatment episodes for assault incidents were obtained from the Finnish National Care Register for Health Care covering the entire-life of the study participants up to end of year 2016. RESULTS: 14.4% (n = 73) of the study participants had experienced severe physical or sexual assault leading to hospital treatment during their lifetime. Results of Cox regression analysis showed that girl bullies/bully-victims had nearly threefold increased likelihood for later assault exposure. CONCLUSIONS: Since bullying behavior in childhood and adolescence is a significant predictor for later exposure to severe assault in girls, it should be paid attention to and intervened as early as possible. Moreover, psychosocial risk factors should be taken into account considering those in hospital treatment for severe assault exposure.

Adolescence Predictors for Drug Crime Offending: A Follow-up Study of Former Adolescent Psychiatric Inpatients.

Our aim was to examine adolescent predictors (family- and school-related factors, substance use, and psychiatric disorders) for drug crime offending. The initial study population consisted of 508 former adolescent psychiatric inpatients aged between 13 and 17 years. Of them, 60 (12%) had committed a drug crime by young adulthood and they were matched with 120 (24%) non-criminal controls by sex, age and family type. During adolescent hospitalization, study participants were interviewed using valid semi-structured research instruments. Criminal records were obtained from the Finnish Legal Register Centre up to young adulthood. A distant relationship with a father, lying, and thieving, moderate/high nicotine dependence and weekly use of stimulants were shown to be the most prominent predictors for drug crime offending. Our findings encourage the use of modern child- and family-centered approaches in preventing youth involvement in illegal drug use and drug crimes.

Reproductive health outcomes among eating disordered females: a register-based follow-up study among former adolescent psychiatric inpatients.

OBJECTIVE: To analyze an association of eating disorders (EDs) to reproductive health outcomes among former adolescent psychiatric inpatients, hospitalized between the ages 13 and 17 years. The register-based follow-up information on psychiatric comorbidity and use of prescribed addictive psychotropic medication up to early adulthood were also explored. METHODS: A total of 31 (10.3%) women with a diagnosed ED were identified from the initial sample of 300 female adolescents, treated in psychiatric inpatient care between 2001 and 2006. The K-SADS-PL and EuropASI research instruments were used to gather information during the adolescent psychiatric hospitalization. The follow-up data for reproductive health outcomes and psychiatric comorbidity up to early adulthood were obtained from the national health care registers. Information on prescribed addictive psychotropic medication was provided by the Social Insurance Institution of Finland. In analyses, EDs were categorized into anorexia nervosa (AN) and other EDs (OED). AN accounted for 58.1% of all EDs. Of OEDs, the majority (69.1%) were bulimia. RESULTS: None of the women with AN, but 53.8% of those with OED had undergone medical abortions by early adulthood. Childbirths were emphasized in women with OED (61.5%) and a history of hospital-treated poisonings in women with AN (55.6%). High nicotine dependence in adolescence (30.8%) was a characteristic of women with OED. CONCLUSION: Our study findings suggest that OED may expose affected women to various unfavorable reproductive health outcomes, particularly women with a history of psychiatric admissions. Recognizing the differences in young women with different subtypes of ED is important when discussing contraception and pregnancy.

Sex-Specific Predictors of Exposure to Hospital-Treated Assaults Among Former Adolescent Psychiatric Inpatients.

This study examined the associations of psychiatric disorders, suicidal behavior and family-related characteristics during adolescence, to subsequent experiences of hospital-treated physical, or sexual assaults, among 508 young adults with a history of psychiatric inpatient care at adolescence (aged 13-17 years). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) based adolescent psychiatric disorders were assessed at index hospitalization using Schedule for Affective Disorder and Schizophrenia for School-Age children, Present and Lifetime version (K-SADS-PL). Treatment episodes for assaults were obtained from the health care register, provided by the Finnish National Institute for Health Welfare. About 14.4% of the participants had experienced physical or sexual assault during their lifetime. Results of logistic regression analysis indicated that anxiety disorder (odds ratio [OR] = 9.6) and nonsuicidal self-injury (OR = 3.7) in adolescence for males, and personality disorder (OR = 3.4) for females, were associated with increased likelihood for subsequent assault exposure leading to hospitalization. These findings can be used in targeting vulnerable adolescents and designing primary prevention strategies.

Psychotropic medication use among personality disordered young adults. A follow-up study among former adolescent psychiatric inpatients.

OBJECTIVE: To analyze the use of prescribed psychotropic medication in subjects with personality disorder (PD) diagnosed in early adulthood. METHODS: The study population consisted of former adolescent psychiatric inpatients (N=508). 63 had a diagnosis of PD, including with borderline PD (BPD) (N=38) and other PD (OPD) (N=25). DSM IV-based psychiatric diagnoses in adolescence were based on the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL). The information on in-or outpatient hospital treatments until the end of 2016 were extracted from the National Care Register for Health Care. Lifetime data on purchases of physician-prescribed psychotropic medications was obtained from the Social Insurance Institution of Finland. RESULTS: 98.4% (N=62) of subjects with PD had purchased at least one type of psychotropic medication during the follow-up period. The use of non-opioid analgesics and antipyretics was over twice as common among subjects with BPD than subjects with OPD (57.9% vs.28.0%, p=0.020). Anxiolytic use was 1.5 times more common among subjects with BPD than subjects with OPD (65.8% vs. 40.0%, p=0.044) CONCLUSIONS: Psychotropic medication use was common among subjects with PD. The use of non-opioid analgesics, antipyretics and anxiolytics was more common among subjects with BPD.

Nicotine dependence in adolescence predicts later drug criminality: a register-based follow-up of adolescent psychiatric inpatients.

Cigarette smoking is common among adolescent psychiatric patients and often precedes the initiation of substance and illicit drug use. This study investigates the association of nicotine dependence (ND), assessed already in adolescence, to subsequent drug crime offenses committed up to young adulthood. The special focus was to examine the dose-response between adolescent ND and later drug-crime offenses. The initial data consist of former adolescent psychiatric inpatients treated in psychiatric inpatient care between the ages 13-17 years. Adolescent DSM-IV based psychiatric disorders were based on the semi-structural diagnostic K-SADS-PL interview. ND in adolescence was measured using the modified Fagerström Tolerance Questionnaire for children and adolescents. Follow-up data on crimes of the study subjects from 15 years of age to early adulthood was obtained from the nationwide Legal Register Center of Finland. A total of 60 (11.8%) drug crime offenders were identified from the initial study population. The likelihood for drug crime offending was statistically significantly increased among those with moderate to severe ND already in adolescence. The higher level of adolescent ND indicated greater number of drug offenses. The common characteristics of drug crime offenders were male gender, out-of-home placement background, exposure to parental divorce and a diagnosis for affective, conduct and substance-use disorder in adolescence. Our study finding, that higher level of ND in adolescence predicts greater number of drug crime offenses up to young adulthood, warrants identification of adolescent smokers at-risk of later drug-related crimes.

Substance Dependence and Hepatitis among Tramadol Prescription Users: A Study of Former Adolescent Psychiatric Inpatients in Northern Finland.

We investigated the association between tramadol use, co-morbid substance use disorders and hepatitis in former adolescent psychiatric inpatients. The study sample consisted of 508 adolescents, admitted to psychiatric inpatient care between 13 and 17 years of age. Follow-up information of tramadol prescriptions, substance use disorders and hepatitis were obtained from the Finnish national health care registers. The users of prescription tramadol were categorized as follows: single users (one tramadol purchase), mild users (2-5 purchases) and heavy users (≥6 purchases). About one tenth (11.0%, n = 56) of study participants were tramadol users. Heavy users of tramadol had mothers with psychiatric problems (p = .039), and a diagnosis of substance use disorder (p < .001) in adolescence. Heavy use of tramadol was predicted with adolescent substance use disorder (OR = 8.31, 95%Cl 2.10-32.91, p = .003) and with mother´s psychiatric problems (OR = 5.85, p = .003). Hepatitis C (n = 54, 10.6%) associated with mild and heavy tramadol use (p < .001). Comorbid diagnosis of opioid dependence prevailed among heavy tramadol users (p <.001). Tramadol should only be prescribed to adolescents after careful evaluation. Particular caution is required in adolescents with a history of substance use disorders.

A short survival time after last psychiatric hospitalization in drivers with psychotic disorder killed in fatal motor vehicle accidents.

BACKGROUND: Research-based evidence on patients with psychotic disorders involved in fatal motor vehicle accidents (FMVA) remains limited. The current study analyzes the characteristics of FMVA drivers, who had been hospitalized due to psychotic disorders within a five-year-time-period prior to their death in traffic accidents. MATERIAL AND METHODS: Data sources included three national registers: The Finnish Database of Road and Cross-Country Accidents, the Care Register for Health Care and the National Cause of Death Register. The register-linkage was made using personal identity codes, unique for each Finnish citizen. The initial study population consisted of 4930 drivers killed in FMVA in Finland between the years 1990-2011. A total of 94 (1.9%) Finnish drivers had a hospital-diagnosed psychotic disorder made during the five years preceding their FMVA. The psychotic disorders of the study subjects were categorized into: schizophrenia (n = 27, 28.7%), other specified psychoses (n = 39, 41.5%) and unspecified psychoses (n = 28, 29.8%). RESULTS: About one half of the FMVA drivers with schizophrenia or unspecified psychoses and 41% of those with other specified psychoses had been discharged from psychiatric care within three months prior to their death in traffic accidents. CONCLUSIONS: Based on our study findings and the lack of concise guidelines for assessing psychotic patients' fitness-to-drive, we recommend a minimum temporary driving restriction of three months for all patients after hospitalization for psychosis.

Associations of Adverse Childhood Experiences to Smoking and Nicotine Dependence Among Adolescent Psychiatric Inpatients.

Our aim was to examine whether ACEs associate to regular smoking and nicotine dependence (ND) among 508 psychiatric inpatients aged 13-17 years. Adolescents were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children and the European Addiction Severity Index -instruments. ND was measured with the modified Fagerström Tolerance Questionnaire. In girls, all violent ACEs (domestic violence, physical abuse at home, sexual abuse) were related to regular smoking and some family-related ACEs (parental divorce and substance use problems) both to regular smoking and ND. After controlling for covariates, girls with parental substance use had an increased likelihood for being a regular smoker and having ND. Greater number of ACEs in girls indicated higher level of ND. Corresponding associations were not observed in boys. Our findings suggest that girls after experiencing ACEs are more prone to becoming smokers and developing ND already in adolescence compared to boys.

Prevalence of Neoplasms among Former Adolescent Psychiatric Inpatients.

OBJECTIVE: To examine the association between psychiatric disorders and neoplasms. METHODS: A follow-up study of a population-based cohort of patients admitted for psychiatric care between the ages 13-17 years. The cases were patients with a follow-up diagnosis of neoplasm. The K-SADS-PL interview was used to assess DSM-IV based psychiatric diagnoses at adolescence. The treatment episodes due to neoplasms and related psychiatric disorders were extracted from the National Health Care Registers. RESULTS: Of the original cohort, 6.3% of subjects had a neoplasm diagnosis. Male cases were characterized as taking snuff and females as having a fear of becoming obese. 75% of cases had smoked regularly and 47% suffered from substance misuse disorder already in adolescence. At a mean age of 22 years, the diagnoses of skin or soft tissue neoplasms were prevailing, three being malignant neoplasms of the skin, mouth or colon. Non-psychotic disorders were comorbid both two years before (26%) and after (33%) the neoplasm diagnosis. CONCLUSION: Focus on psychiatric symptoms of patients with neoplasms may enhance their treatment outcome and quality of life.

Characteristics of Adolescent Psychiatric Inpatients in Relation to Their History of Preceding Child Psychiatric Inpatient Care.

Among psychiatric inpatients aged 13 to 17, various familial and clinical characteristics were compared between those with and without a previous history of specialized child psychiatric care (CPSY versus non-CPSY). CPSY adolescents were younger (boys: odds ratio [OR], 0.7; girls: OR, 0.4) at admission to adolescent psychiatric inpatient care, and they more likely had mothers with psychiatric problems (boys: OR, 4.0; girls: OR, 4.8) and child welfare placement background (boys: OR, 2.8; girls: OR, 6.7) compared with non-CPSY adolescents. CPSY girls were also characterized as having unemployed mothers (OR, 3.1) and engaging in nonsuicidal self-injury (OR, 3.1), whereas CPSY boys were diagnosed with anxiety (OR, 2.7) or conduct disorder (OR, 2.8). Based on our study, family-focused care and intervention services are required to prevent continuity of psychiatric disorders from childhood into adolescence.

Gender Specific Characteristics of Revolving Door Adolescents in Acute Psychiatric Inpatient Care.

This study examined the impact of clinical and family related factors on adolescent revolving door (RD) phenomenon, defined as having three or more psychiatric hospitalizations before the age of 18. A clinical sample of adolescents (N = 508) aged 13-17 years, admitted to psychiatric inpatient care between April 2001 through March 2006, were interviewed using the k-SADS-PL and the EuropASI instruments. The national Finnish Care Register for Health Care provided life-time data on child and adolescent psychiatric inpatient hospitalizations. RD boys were shown to be significantly more likely than non-RD boys to be admitted to psychiatric inpatient care from child welfare placements and have previous self-mutilative behavior (SMB) and suicide attempts. RD girls were more likely to come from child welfare placements, have unemployed mothers and a history of SMB. Mortality in RD boys was significantly higher compared to non-RD boys. Frequent use of psychiatric inpatient care warrants comprehensive assessment of suicidal behavior in adolescents.