Psychiatric disorders and their predictors in young adulthood in Finland

Mental disorders are one main focus of research interest in the 31 year study of the Northern Finland 1966 Birth Cohort Study. Mental disorders are quite common in young adulthood and they have a great impact on quality of life and working ability. Good national registers in Finland ensure the possibility to follow up treated incidence of severe mental disorders. On the other hand, a notable part of those who suffer from non-psychotic mental disorders do not receive any psychiatric treatment. That is why it is not possible to follow up psychiatric morbidity of the non-psychotic disorders from register data. In this review, principles of psychiatric diagnostics, known prevalences of psychiatric disorders in population and factors connected with mental disorder are briefly presented. Especially childhood predictors of mental disorders are reviewed.     

Why do we need more information about the risk factors of the musculoskeletal pain disorders in childhood and adolescence?

Musculoskeletal pain disorders such as low back pain, neck pain and shoulder pain are a major and ever increasing public health problem among the working population in industrialized countries with social insurance. Especially the economic impact of these diseases on society has been rising, but the disorders do also produce a lot of pain and suffering to the people. It is an important challenge to the health care systems to prevent and treat these disorders, but at the moment poor understanding of the risk factors of these diseases has failed in giving any effective tools to control the musculoskeletal pain disorder epidemic. Most of the epidemiological studies made are cross-sectional and they do not extend to childhood and adolescence, when the organs are developing, achieving their loading strength and possibly being traumatized and starting their degenerative process. The longitudinal Northern Finland 1966 birth cohort study offers a unique opportunity to find early risk factors for musculoskeletal pain syndromes.     

Physical and mental comorbidity of substance use disorders in psychiatric consultations. European Consultation-Liaison Workgroup

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.     

Characterization of human IgG1 monoclonal antibody against gangliosides expressed on tumor cells

In this study, our intention was to describe the decision making of nurses practicing in intensive care, and the differences of nurses' decision making in Canada, Finland, Northern Ireland, Switzerland, and the United States. The instrument used in the study was a 56-item Likert-type questionnaire that has been used in previous studies and has proved to be a reliable tool. The target group comprised a nonrandom sample of nurses (N = 314) from five countries. The samples are not representative; therefore, the results in these cases cannot be generalized. The results showed that the decision making of nurses practicing in intensive care was broadly based, and that there were some country differences in data collection, problem definition, and planning. In contrast, decision making related to the implementation and evaluation of nursing is quite similar in the different countries. Canada and the United States on the one hand, and Finland, Northern Ireland, and Switzerland on the other, showed more similarities with each other in data collection, problem definition, and nursing planning related to decision making. Neither experience nor nurse's knowledge structure was associated with different decision-making approaches.     

Mental disorders in elderly suicide

The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among elderly suicide victims and to compare them with the mental disorders among younger victims. Using a psychological autopsy method, we collected comprehensive data on all suicides in Finland during 1 year. Retrospective Axis I-III consensus diagnoses were assigned to a random sample consisting of 43 victims aged 60 years or over and 186 victims aged under 60 from the nationwide suicide population. At least one Axis I diagnosis was made for 91% of the elderly victims. Major depression as the principal diagnosis was more common among the elderly victims. Almost all elderly female victims were major depressives. Psychiatric comorbidity was more common among elderly male than among elderly female victims. More of the elderly victims (88%) than the younger (36%) received Axis III diagnoses. Suicide among the elderly without a diagnosable mental disorder and somatopsychiatric comorbidity seems to be rare.     

Are you treating youngsters who are or should be receiving mental health services?

Psychiatrists now recognize that the disorders of children are serious, treatable conditions and as precursors of adult psychopathology. These conditions can seriously influence the patient's behavior when undergoing dental treatment. The dentist will probably assume that the behavior problems are directly related to the nature of the dental service, rather than particular underlying personality characteristics of preschool and school-age children. It is important that practitioners recognize and understand these conditions as they attempt to provide adequate treatment. No national epidemiological studies have been conducted in this country that would provide valid indicators of either the prevalence or incidence of mental disorders among children. Local studies, however, have been done that diagnosable disorders in children range from 17.6 percent to 22 percent, including 3 percent to 5 percent who have severe emotional or behavioral problems. The prevalence of many mental disorders is greater in males than in females, ranging from a ratio of 2:1 to 9:1. Lifetime prevalence of mental disorders, first diagnosed in infancy, childhood, and adolescence range as high as 15,000 cases per 100,000 persons. It is important for the dentist to recognize that (1) even the youngest of children seen in a dental practice may be in need of mental health services, (2) management problems may stem from mental health problems, and (3) families are unaware or unwilling to admit that a child may need help.     

Epidemiology and prevalence of psychopathology in people with mental retardation.

There is a general consensus that, for several reasons, people with mental retardation are at an increased risk of developing emotional disorders. Numerous research studies have examined the prevalence of psychiatric disorders among people with mental retardation, and a wide range of rates have been reported. Reasons for the variability in these results are discussed, including definitional and identification issues, and sampling issues. A summary of representative studies is presented and discussed in light of the above-mentioned issues. The need for updated epidemiological studies in this area is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The developmental mental-disorder histories of adults with posttraumatic stress disorder: A prospective longitudinal birth cohort study.

Clinical and epidemiologic studies have established that posttraumatic stress disorder (PTSD) is highly comorbid with other mental disorders. However, such studies have largely relied on adults' retrospective reports to ascertain comorbidity. The authors examined the developmental mental health histories of adults with PTSD using data on mental disorders assessed across the first 3 decades of life among members of the longitudinal Dunedin Multidisciplinary Health and Development Study; 100% of those diagnosed with past-year PTSD and 93.5% of those with lifetime PTSD at age 26 had met criteria for another mental disorder between ages 11 and 21. Most other mental disorders had first onsets by age 15. Of new cases of PTSD arising between ages 26 and 32, 96% had a prior mental disorder and 77% had been diagnosed by age 15. These data suggest PTSD almost always develops in the context of other mental disorders. Research on the etiology of PTSD may benefit from taking lifetime developmental patterns of comorbidity into consideration. Juvenile mental-disorder histories may help indicate which individuals are most likely to develop PTSD in populations at high risk of trauma exposure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental disorders are brain disorders: You think?

Recent years have seen an explosion of biologically based studies, interventions, and explanations for most mental disorders. Indeed, the mantra that mental disorders are brain disorders is frequently stated and certainly is at least partially true. Yet, the current landslide of information, produced with new extraordinary technologies, has resulted in limited clarity. The area of mental disorders remains laden with deficient, contradictory, and unproven explanations and treatments. One common rationale for this state is the failure to translate new scientific findings into practise. A more defensible and encompassing explanation focuses on the very basic conceptualizations and definitions of these disorders. Patently powerful methodologies can be no better or worse than the clarity of the problems under study. Numerous examples of definitional and diagnostic problems exist that have led to the lack of clarity and application of research findings. Alternative research strategies are discussed with a focus on the high-risk paradigm. A series of studies of a single characteristic of individuals at risk for problems with alcohol is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing clinical utility by aligning the DSM and ICD with clinicians' conceptualizations.

Clinicians are trained to conceptualize and diagnose mental disorders according to their depiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). But to what extent do the DSM and ICD truly represent the way that clinicians think about mental disorders? We outline the history of studies examining how clinicians think about mental disorders and discuss our current research on clinicians' natural taxonomies of mental disorders, which compares clinicians' conceptualization of mental disorders with their depiction in the DSM and the ICD. We make practical suggestions for how to make the DSM and ICD more like the way clinicians think about mental disorders to improve its clinical utility. We argue that the DSM and ICD would be more useful to clinicians if it had fewer categories, fewer diagnostic levels, removed the Axis I–II distinction used in the DSM, and included practical considerations such as treatment access (and the role of insurance companies in the United States or the local economy in developing countries), stigma, and clinicians' emotional reactions. Another way the DSM and ICD could be more useful to clinicians is if they more accurately represented the way that mental illness is experienced by the person who has the mental illness. Continued research of clinicians' conceptualization of mental disorders is necessary to make the DSM and ICD as useful to clinicians as possible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assortative mating for major psychiatric diagnoses in two population-based samples

BACKGROUND: Previous studies on assortment for psychiatric disorders have reported discrepant findings. We aimed to test whether there is a significant association for psychiatric diagnoses, including alcoholism, generalized anxiety disorder, major depressive disorder, panic disorder and phobias between husbands and wives in two population-based samples. We further evaluated whether marital resemblance occurs primarily within or across psychiatric disorders and if assortment for psychopathology is primary or secondary to assortment for correlated variables. METHODS: A model for mate selection addressed whether the correlation between mates for psychiatric disorders arises from direct assortment (primary homogamy) or through correlation with other variables for which assortment occurs (secondary homogamy) or through cross-variable assortment. The model accounted for within-person co-morbidity as well as across-spouse data. RESULTS: Findings suggested that a moderate degree of assortment exists both within and across psychiatric diagnoses. Only a small amount of the observed marital resemblance for mental illness could be explained by assortment for correlated variables such as age, religious attendance and education. Similar results were obtained for the two samples separately and confirmed in their joint analysis, revealing that the co-morbidity and assortment findings, except for the marital correlation for age, religious attendance and education, replicate across samples. CONCLUSIONS: Significant but moderate primary assortment exists for psychiatric disorders. The bias in twin studies that have ignored the small amount of assortment is negligible.     

Psychopathology in married couples.

Reviews research studies dealing with psychopathology in married couples. Topics included are (a) incidence of mental disorders among the various marital status groups, (b) neurosis and psychosis in marital partners, (c) disturbance in marital interaction, and (d) the patient's spouse. The incidence of mental disorders is lower in married couples than in any other marital status group. When mental disorders do occur among the married, both partners are likely to manifest some degree of disturbance. The spouse is affected not only by the partner's disorder but also by the partner's treatment and hospitalization. Marital interaction may contribute to the development of psychopathology in married couples, but most of the findings in this area tend to be nonspecific and of a post hoc nature. (3 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decreased fertility in Britain compared with Finland

BACKGROUND: There has been much interest in the apparent decrease in semen quality. Because the evidence for such a decrease is open to criticism, a different type of evidence is needed. Finland seems to have escaped this decrease, as well as other disorders of the male reproductive tract, notably testicular cancer. If there has been a true decrease, the implications for fertility are unknown. METHODS: The most sensitive functional measure of fertility is time to pregnancy (TTP); this can be studied retrospectively at group level with a high degree of validity. To test the hypothesis that Finnish men are more fertile than British men, TTP distributions from published Finnish studies and data from Britain were compared. Two comparisons were made: a pair of antenatal studies, and a pair of cross-sectional studies. FINDINGS: In both comparisons, fertility was statistically significantly greater in Finland than in Britain. The findings did not seem to be due to methodological problems; in particular, the results could not be attributed to differences in frequency of intercourse, since this would have had the opposite effect on sperm concentration and on TTP. INTERPRETATION: The previously reported difference in sperm counts between Finland and elsewhere in northwest Europe (including Britain) is probably not artefactual, suggesting that the reported world-wide decline in semen quality is also real. Reasons for the "Finnish exception" may include maternal smoking, which used to be lower in Finnish women than elsewhere, and which might affect developing make offspring.     

Health trends in northern Finland

Along with the process of the epidemiological transition, northern Finland has experienced an increase of cardiovascular diseases, some types of cancer, and accidental and suicidal deaths, particularly in the male population, while the females of northern Finland have shown rather favourable trends during the post-war period. Northern Finland shows a clustering of severe health problems such as coronary heart disease, accidents and suicides in smaller areas, e.g. in north-central Lapland, which records mortality rates 2-3 times higher than areas of lowest mortality. There is some indication of a high prevalence of smoking, increased serum lipids, blood pressure, body weight and alcohol consumption in the areas of highest morbidity and mortality, but evidence based on representative population samples is missing. Accidents and suicides are also common in the Sami (Lapp) area but coronary heart disease is rare, despite the unfavourable risk factor patterns.     

Sleep disorders related to another mental disorder (nonsubstance/primary): a DSM-IV literature review

BACKGROUND: Disturbances of the sleep/wake cycle are fundamental clinical symptoms for patients with many of the mental disorders. This review of the literature on research in sleep and mental disorders from 1966 to 1991 highlights the major developments and findings that are central to the development of a DSM-IV diagnosis of sleep disorders related to another mental disorder (nonsubstance/primary). METHOD: As a framework, the review discusses the classification criteria listed in the International Classification of Sleep Disorders (ICSD, 1990) for sleep disorders associated with mental disorders. Research relevant to the classification system is reviewed and the merits of modifying the DSM-III-R criteria based on the accumulated research are discussed. RESULTS: Overall, the review supports the notion of consistent biological alterations in the sleep/wake cycle for patients with many of the mental disorders. CONCLUSION: On the basis of this evidence, sleep disorders related to another mental disorder warrant separate diagnostic classification within a nosology for sleep disorders. The review also reveals the historical development of sleep research as a tool within the field of psychiatry for characterizing the biological bases of mental disorders.     

Mental health: A report of the Surgeon General--Executive summary.

This surgeon general's report is the first ever issued on mental health. Two messages are conveyed in the report: Mental health is fundamental to health, and mental disorders are real health conditions. The surgeon general's report summarizes the Office's detailed review of more than 3,000 research articles, plus 1st-person accounts from individuals who have been afflicted with mental disorders. Two main findings emerged from the research: (a) The efficacy of mental health treatments is well documented, and (b) a range of treatments exists for most mental disorders. On the basis of these findings, the Office of the Surgeon General recommends that people seek help if they have a mental health problem or think they have symptoms of a mental disorder. Themes covered in the report include adopting a public health perspective, accepting that mental disorders are disabling, and seeing mental health and mental illness as points on a continuum. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telephone surveys as an alternative for estimating prevalence of mental disorders and service utilization: a Montreal catchment area study

BACKGROUND: Large-scale mental health surveys have provided invaluable information regarding the prevalence of specific mental disorders and service use for mental health reasons. Unfortunately, because vast surveys conducted face to face are very costly, many countries and provinces do not embark upon this path of research, thus depriving themselves of a rich source of data useful for service planning. METHOD: As an alternative, the authors undertook a telephone survey with a sample of 893 residents from a Montreal catchment area. Mental disorders were assessed by the Composite International Diagnostic Interview Simplified (CIDIS), an instrument especially designed to be used in mail or telephone surveys. Service utilization was measured by an instrument similar to those used in recent large Canadian or American surveys. RESULTS: The prevalence rate for any mental disorder was lower in this study than in some large-scale epidemiological surveys reviewed. This could be explained by methodological differences, such as number of disorders covered and period of reference. With regard to specific mental disorders, results appeared very similar to those of other studies. Concerning service utilization, rates tended to be higher than in other studies, and this finding could reflect real differences between Quebec and other Canadian provinces or the United States. CONCLUSIONS: Aside from being lower in cost, telephone surveys can yield results comparable to those obtained in large-scale epidemiological surveys conducted by means of face-to-face interviews.     

Lessons from social psychology on discrediting psychiatric stigma.

Advocacy, government, and public-service groups rely on a variety of strategies to diminish the impact of stigma on persons with severe mental illness. These strategies include protest, education, and promoting contact between the general public and persons with these disorders. The authors argue that social psychological research on ethnic minority and other group stereotypes should be considered when implementing these strategies. Such research indicates that (a) attempts to suppress stereotypes through protest can result in a rebound effect; (b) education programs may be limited because many stereotypes are resilient to change; and (c) contact is enhanced in a variety of factors, including equal status, cooperative interaction, and institutional support. Future directions for research and practice to reduce stigma toward persons with severe mental illness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prader-Willi and other syndromes associated with obesity and mental retardation

Constitutional obesity and mental retardation cooccur in several multiple congenital anomaly syndromes, including Prader-Willi syndrome, Bardet-Biedl syndrome, Cohen syndrome, Albright hereditary osteodystrophy, and Borjeson-Forssman-Lehmann syndrome as well as some rarer disorders. Although hypothalamic-pituitary axis abnormalities are thought to be a possible causative mechanism in some of these disorders, current knowledge is insufficient to explain the pathophysiologic mechanism of obesity in most multiple congenital anomaly/mental retardation syndromes. The chromosomal location of many of these syndromes is known, and studies are ongoing to identify the causative genes. Further delineation of the functions of the underlying genes will likely be instructive regarding mechanisms of appetite, satiety, and obesity in the general population. This review details current knowledge of the clinical and molecular genetic findings of multiple congenital anomaly/mental retardation syndromes associated with intrinsic obesity in an effort to delineate causative mechanisms and genetic abnormalities contributing to obesity.     

Emerging issues in research on lesbians' and gay men's mental health: Does sexual orientation really matter?

Theoretical writings and research suggest that the onset, course, treatment, and prevention of mental disorders among lesbians and gay men differ in important ways from those of other individuals. Recent improvements in studies of sexual orientation and mental health morbidity have enabled researchers to find some elevated risk for stress-sensitive disorders that is generally attributed to the harmful effects of antihomosexual bias. Lesbians and gay men who seek mental health services must find culturally competent care within systems that may not fully address their concerns. The affirmative therapies offer a model for intervention, but their efficacy and effectiveness need to be empirically documented. Although methodological obstacles are substantial, failure to consider research questions in this domain overlooks the welfare of individuals who may represent a sizable minority of those accessing mental health services annually. (PsycINFO Database Record (c) 2011 APA, all rights reserved)