Biomedical subjects

J Lonnqvist

Publications and source records attributed to J Lonnqvist.

17 recordsLinked to original sources

PubMed2001

Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behaviour.

OBJECTIVE: The authors present an analysis of findings for the 65 years and over age group from the WHO/EURO Multicentre Study of Suicidal Behaviour (1989-93). METHODS: Multinational data on non-fatal suicidal behaviour is derived from 1518 subjects in 16 European centres. Local district data on suicide were available from 10 of the collaborating centres. RESULTS: Stockholm (Sweden), Pontoise (France) and Oxford (UK) had the highest suicide attempts rates. In most centres, the majority of elderly who attempted suicide were widow(er)s, often living alone, who used predominantly voluntary drug ingestion. Non-fatal suicidal behaviour decreased with increasing age, whereas suicide rates rose. The ratio between fatal and non-fatal behaviours was 1:2, that for males/females almost 1:1. In the years considered, substantial stability in suicide and attempted suicide rates was observed. As their age increased, suicidal subjects displayed only a limited tendency to repeat self-destructive acts. Moreover, there was little correlation between attempted suicide and suicide rates, which carries different clinical implications for non-fatal suicidal behaviour in the elderly compared with younger subjects in the same WHO/EURO study.

Age Distribution↗

PubMed2000

The inheritance of neuropsychological dysfunction in twins discordant for schizophrenia.

While genetic influences in schizophrenia are substantial, the disorder's molecular genetic basis remains elusive. Progress has been hindered by lack of means to detect nonpenetrant carriers of the predisposing genes and by uncertainties concerning the extent of locus heterogeneity. One approach to solving this complexity is to examine the inheritance of pathophysiological processes mediating between genotype and disease phenotype. Here we evaluate whether deficits in neurocognitive functioning covary with degree of genetic relationship with a proband in the unaffected MZ and DZ co-twins of patients with schizophrenia. Twin pairs discordant for schizophrenia were recruited from a total population cohort and were compared with a demographically balanced sample of control twin pairs, on a comprehensive neuropsychological test battery. The following four neuropsychological functions contributed uniquely to the discrimination of degree of genetic loading for schizophrenia and, when combined, were more highly correlated within MZ pairs than within DZ pairs, in both discordant and control twins: spatial working memory (i.e., remembering a sequence of spatial locations over a brief delay), divided attention (i.e., simultaneous performance of a counting and visual-search task), intrusions during recall of a word list (i.e., "remembering" nonlist items), and choice reaction time to visual targets. Together with evidence from human and animal studies of mediation of these functions by partially distinct brain systems, our findings suggest that there are multiple independently inherited dimensions of neural deficit in schizophrenia and encourage a search for genes contributing to quantitative variation in discrete aspects of disease liability. On tests of verbal and visual episodic memory, but not on the liability-related measures, patients were more impaired than their own MZ co-twins, suggesting a preferential impact of nongenetic influences on long-term memory systems.

Adult↗

PubMed1999

Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPSIS/WHO-EURO).

OBJECTIVE: The aim of this research was to identify psychosocial characteristics which might predict future suicidal behavior in parasuicidal subjects in Europe. METHOD: The interview utilized for the survey (European Parasuicide Study Interview Schedule--EPSIS) was administered to 1269 parasuicides aged fifteen years and over, within one week of hospital admission after a suicide attempt, and is part of a longitudinal multicenter study. EPSIS included a brief medical questionnaire, scales rating depression, hopelessness, self-esteem, suicide intention, questions on sociodemographic characteristics, an interview on life events and social support, a description of the parasuicidal act, and an evaluation of factors precipitating the index parasuicide. RESULTS: Physical illness proved to be very frequent among suicide attempters. One in two subjects suffered from an acute, chronic, or chronic disorder in relapse at the time of the parasuicide. Subjects with a physical illness were significantly more depressed, particularly subjects from the intermediate age band and ones affected by a chronic physical disease in relapse. Forty-two percent of patients with physical illness rated their somatic problem as a factor precipitating the attempt and 22 percent judged it to be major one. Furthermore, subjects with physical illnesses considered psychiatric symptoms and disorders to be relevant factors in triggering suicidal behavior, to a greater extent than non-sufferers. The importance of physical illness in contributing to suicidal behavior increased with advancing age. CONCLUSIONS: More careful attention to somatic conditions and their subjective implications would probably augment chances of effectively preventing suicide.

Adolescent↗

PubMed1998

Antidepressants and suicide mortality.

BACKGROUND: This paper presents a nationwide analysis of suicide mortality in Finland from 1990 to 1995, when the total use of antidepressants, especially that by selective serotonin reuptake inhibitors (SSRIs) expanded in the country. METHODS: Suicide rate was analysed by various methods including that by intake of antidepressants. Various antidepressants were compared by calculating fatal toxicity indices (FTI) by relating number of fatal poisonings by a drug to its consumption. RESULTS: The expanded use of antidepressants coincided with an increased number of deaths caused by these drugs. The proportion of suicides committed by use of antidepressants among all suicides increased from 5.6% to 8.4%. The total suicide rate, however, declined significantly. This was mainly accounted for by the reduced suicide rates by hanging and carbomonoxide poisoning, which outnumbered the increased figures of suicides by poisoning. On the whole, 82% of suicides by antidepressants were committed by use of tricyclics. Use of doxepin and amitriptyline remained steady, and their FTIs were constantly high. The lowest FTIs were associated with fluoxetine, citalopram, mianserin and moclobemide. LIMITATIONS: The method ignores causality between the increased use of SSRIs and suicide mortality. Various factors affecting risk of suicide or choice of a method remain outside the scope of the data. CONCLUSION: The increased use of SSRIs coincided with a significant decline in suicide mortality. However, suicides by use of antidepressants showed an upward trend. Therefore, in suicide prevention, risks and benefits of antidepressants should be considered in choosing treatment for depressive patients.

Antidepressive Agents, Tricyclic↗

PubMed1998

LEIPAD, an internationally applicable instrument to assess quality of life in the elderly.

A questionnaire to assess quality of life in the elderly was developed under the auspices of the European office of the World Health Organization. Stages in construction of the instrument, which was designed for international application, particularly at the primary level, are described. The latest version of the questionnaire is composed of 49 self-assessment item, 31 of which can be grouped into 7 subscales: Physical Function, Self-Care, Depression and Anxiety, Cognitive Functioning, Sexual Functioning, and Life Satisfaction. The remaining 18 items serve as moderators for assessing the influence of social desirability factors and personality characteristics on the individual scores for the 7 core instrument subscales. The questionnaire has been administered to 586 individuals aged 65 years and over recruited in communities in Italy (Padua and Brescia), the Netherlands (Leiden), and Finland (Helsinki). The main psychometric characteristics of the instrument, together with its concurrent validity with the Rotterdam Questionnaire, are illustrated.

Aged↗

PubMed1998

Suicides hidden among undetermined deaths.

The research phase of the National Suicide Prevention Project in Finland (from 1 April 1987 to 31 March 1988) included medico-legal investigation and psychological autopsy of all deaths suspected of being suicides, including 1397 official suicides and 61 undetermined deaths. In later analyses on suicide, undetermined cases were excluded. This paper presents an analysis of all officially classified undetermined deaths (n = 139) over the study period, consisting of all the initially suspected suicides (n = 61) and the remaining undetermined deaths (n = 78) where suicide could not be excluded. Poisoning by solids or liquids and drowning were the most common causes of all undetermined deaths. Suicidal intent was observed in 87% of undetermined deaths initially suspected of being suicides. In addition, 31% of these subjects had previously attempted suicide, and 34% had made suicidal threats. Depression was diagnosed in 23% of cases and alcohol dependence or abuse in 31% of cases. Undetermined deaths resembled suicides and appeared to reduce the suicide rate by 10%.

Adult↗

PubMed1997

A repetition-prediction study of European parasuicide populations: a summary of the first report from part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC concerted action on attempted suicide.

One of the aims of the European Study on Parasuicide, which was initiated by the Regional Office for the European Region of the World Health Organization in the mid-1980s, was to try to identify social and personal characteristics that are predictive of future suicidal behaviour. A follow-up interview study (the Repetition-Prediction Study) was designed, and to date 1145 first-wave interviews have been conducted at nine research centres, representing seven European countries. The present paper provides an abridged version of the first report from the study. The design and the instrument used (The European Parasuicide Study Interview Schedules, EPSIS I and II) are described. Some basic characteristics of the samples from the various centres, such as sex, age, method of suicide attempt, and history of previous attempts, are presented and compared. The male/female sex ratio ranged from 0.41 to 0.85; the mean age range for men was 33-45 years and that for women was 29-45 years. At all of the centres, self-poisoning was the most frequently employed method. On average, more than 50% of all respondents had attempted suicide at least once previously. The representativeness of the samples is discussed. There were differences between the centres in several respects, and also in some cases the representativeness of the different samples varied. Results obtained from analyses based on pooled data should therefore be treated with caution.

Adolescent↗

PubMed1997

Driver suicides.

BACKGROUND: To study driver suicides, all motor vehicle driver fatalities in Finland from 1987 to 1991 were analysed. METHOD: Cases were collected from all driver fatalities (n = 1419), as those that accident investigation teams considered possible suicides (n = 99). Drivers committing suicide classified according to ICD-9 by two forensic pathologists were selected as cases (n = 84). Drivers of unintentional motor vehicle fatalities served as the control group. RESULTS: While 5.9% of all driver fatalities were classified as suicides, the figure given in the official statistics was 2.6%. Driver suicides accounted for 1.2% of all suicides. Fifty per cent of driver suicides were committed by men aged between 15 and 34 years. The victims had often suffered from life-event stress, mental disorders and had alcohol misuse problems. The cases were usually head-on collisions between two vehicles with a large weight disparity. CONCLUSIONS: Misclassification of driver suicides does not significantly influence the total suicide rate. However, people who commit suicide by this method could often be recognised, and prevention of these events would improve traffic safety.

Accidents, Traffic↗

PubMed1997

Autosomal dominant progressive external ophthalmoplegia with multiple deletions of mtDNA: clinical, biochemical, and molecular genetic features of the 10q-linked disease.

Autosomal dominant progressive external ophthalmoplegia (adPEO) is a mitochondrial disease characterized by accumulation of multiple large deletions of mtDNA in patients' tissues. We previously showed that the disease is genetically heterogeneous by assigning two nuclear loci predisposing to mtDNA deletions: one on chromosome 10q 23.3-24.3 in a Finnish family and one on 3p 14.1-21.2 in three Italian families. To reveal any locus-specific disease features, we report here the clinical, biochemical, and molecular genetic characteristics of the 10q-linked disease in the single family reported to date. All seven patients and four asymptomatic subjects had ragged-red fibers and multiple deletions of mtDNA in their muscle. Ptosis and external ophthalmoplegia were the major clinical findings, and depression or avoidant personality traits were frequently, but not consistently, present in the subjects carrying mutant mtDNA. In six of the subjects with mutant mtDNA, the activities of the respiratory chain complexes I or IV, or both, were below or within the low normal range. Two autopsy studies revealed the characteristic distribution of mutant mtDNA in these patients: highest proportion of mutant mtDNA is found in different parts of the brain, followed by the skeletal and ocular muscle, and the heart.

Adult↗

PubMed1996

Effects of bright light on sleepiness, melatonin, and 25-hydroxyvitamin D(3) in winter seasonal affective disorder.

Sixteen patients with winter seasonal affective disorder and 13 healthy controls were exposed to 3300 lx of cool-white fluorescent light for either 1 hour or 15 min in the morning for 2 weeks during the winter. Subjective sleepiness, melatonin concentration in saliva, and serum 25-hydroxyvitamin D(3) concentration were measured before and after the 2-week trial as well as the following summer when the patients were well. There were no significant differences in the baseline values between the patients and healthy subjects. No significant differences in the outcome measures were observed in the patients or the controls in the two groups of each after the trial. The exposure to bright light resulted in a significant decrease in subjective sleepiness early in the evening in the patients but not in the control subjects. The reduction of depressive symptoms was associated with the decrease in subjective sleepiness but not with the changes in the melatonin or vitamin D concentrations.

Adult↗

PubMed1996

Violent methods associated with high suicide mortality among the young.

OBJECTIVE: To present rates and trends in suicide methods, and associations between these, in male and female adolescents in the age groups 15 through 19 years and 20 through 24 years in Finland from 1947 through 1991. METHOD: Suicide rates were calculated on the basis of the mean same-age population, and suicide trends by each method were analyzed by using the Poisson regression model. For the rates and trends, 95% confidence intervals based on the Poisson distribution were calculated. RESULTS: The suicide rate revealed a sharp and significant increase between 1965 and 1975 for both male age groups. Firearms and hanging accounted for the majority of that increase. These figures, however, were not accompanied by similar changes in the availability of firearms during that period. Moreover, an increased total suicide rate as well as that by automobile exhaust fumes in young adults after 1982 coincided with a widely presented Finnish movie which featured this method of committing suicide. In young women, however, intake of solids and liquids remained the most common suicide method. CONCLUSION: Suicide rates increased, especially by violent methods, which contributed to the high suicide mortality rate among the young. These methods, except firearms, however, are often difficult to restrict. This fact underlines the importance of the integration of various preventive measures of cooperation between mental health professionals and other authorities and of the recognition and care of young people at high suicide risk.

Adolescent↗

PubMed1996

A systematic review on gender-specific suicide mortality in medical doctors.

BACKGROUND: So far no comprehensive systematic review has been published about epidemiologic studies on suicides among medical practitioners. The aim here is to describe the variation of published estimates of relative risk of doctors to die from suicide. METHOD: A systematic review of published original articles on population-based studies, registered mainly in MEDLINE and fulfilling specific methodological requirements. Incidence rates and standardised mortality ratios were calculated for male and female doctors in relation to the reference groups. RESULTS: The estimated relative risk varied from 1.1 to 3.4 in male doctors, and from 2.5 to 5.7 in female doctors, respectively, as compared with the general population, and from 1.5 to 3.8 in males and from 3.7 to 4.5 in females, respectively, as compared with other professionals. The crude suicide mortality rate was about the same in male and female doctors. CONCLUSION: In all studies the suicide rates among doctors were higher than those in the general population and among other academic occupational groups.

Female↗

PubMed1995

Moclobemide and fluoxetine in the prevention of relapses following acute treatment of depression.

The efficacy of moclobemide (378 mg +/- 76 mg/day) and fluoxetine (36 mg +/- 8 mg/day) in preventing relapse was studied during 12 weeks of continuation treatment after a 6-week initial trial. Fifty-nine patients with Hamilton Depression Rating Scale (HDRS) scores of 16 or less were enrolled; 29 continued to receive moclobemide and 30 fluoxetine. Efficacy was measured using a 17-item HDRS, the Montgomery-Asberg Depression Rating Scale and the Clinical Global Impression. Improvement in quality of life was measured using a Medical Outcome Study Short-form General Health Survey and the 15D Measure of Quality of Life. Twenty-three per cent of the patients in the fluoxetine group dropped out of the study and 10% in the moclobemide group. Two patients (7%) in the moclobemide group and one (3%) in the fluoxetine group suffered a relapse. Health status and quality of life improved in both drug groups during a 12-week continuation period. The reports of adverse events fell to one third during the continuation phase. The results indicate that benefits may be gained from extending acute treatment.

Acute Disease↗

PubMed1995

Trends and availability of suicide methods in Finland. Proposals for restrictive measures.

BACKGROUND: Trends and availability of the methods used for suicide in Finland were analysed in order to base proposals for prevention of access to methods. METHODS: Finnish suicides from 1947 to 1990 were analysed by sex, age, time period and suicide method using confidence intervals for rates, chi 2 test for trends and suicide risks for different medicines. RESULTS: Suicide rate by parathion, a highly lethal pesticide and commonly used for suicide in the 1950s, decreased after its availability was restricted, but this was offset by an increased rate by other methods. Since 1982, the suicide risk for antidepressants and neuroleptics increased coincident with their availability, although that for barbiturates remained stable but high despite a reduction in availability. Suicide risk for antidepressants other than tricyclics decreased despite increased availability. CONCLUSION: Restriction of a method reduces its use for suicide, but other methods tend to replace it. Restrictive measures should focus on some specific situations. Antidepressants other than tricyclics are recommended for the treatment of suicidal depressive patients.

Adolescent↗

PubMed1994

Moclobemide and fluoxetine in atypical depression: a double-blind trial.

The effectiveness of moclobemide or fluoxetine in the treatment of atypical (n = 53) and other depressive patients (n = 156) was compared in a 6-week double-blind randomized trial. HDRS, MARDS, GCI and the Atypical Depression Diagnostic Scale were used in clinical assessment. Significant differences were seen in MADRS and GCI scores in favour of moclobemide in the treatment of atypical depression, but not with HDRS. No major differences were seen between the two drugs in the treatment of other depressive patients. A positive response, defined by a > 50% decrease in HDRS score and a GCI Improvement Score of 1 or 2, was seen among 67% of atypical patients treated with moclobemide and among 55% treated with fluoxetine and in 60 and 48% of other depressive patients, respectively. Both drugs gave results with atypical patients at least as good as with other depressive patients. Our results suggest that patients suffering from atypical depression may respond more favourably to moclobemide than to fluoxetine treatment.

Adult↗

PubMed1994

Antidepressant efficacy and quality of life in depression: a double-blind study with moclobemide and fluoxetine.

The efficacy of moclobemide (300-450 mg/day) was compared with fluoxetine (20-40 mg/day) in a double-blind, multicentre study in 209 patients with new episodes of depression selected from 612 consecutive depressed patients representative of those consulting psychiatric services in Finland. Antidepressant efficacy was assessed with the Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale and Clinical Global Impression (CGI). The Medical Outcome Study Short-form General Health Survey (SF-20) and 15D Measure of Quality of Life were used to measure effectiveness in terms of health-related quality of life. Efficacy was evident with both drug treatments, with 67% in the moclobemide group and 57% in the fluoxetine group having a reduction in HDRS of more than 50%. Similarly, 77% of the patients in the moclobemide group and 67% in the fluoxetine group were assessed on the CGI as much better or very much better after 6 weeks of treatment. The most commonly reported adverse events were nausea, other gastrointestinal symptoms, nervousness, dizziness and sleep disorders. Nausea was significantly more common in the fluoxetine group and was found especially in women. Premature terminations of treatment were 18% in the moclobemide and 21% in the fluoxetine group. A significant change for the better in quality of life was found in both treatment groups, even at week 2 but especially after 6 weeks of treatment. Improvement was not only seen in dimensions measuring depression or mental health but also in other dimensions.

Adult↗

PubMed1992

Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989.

The WHO/EURO multicentre study on parasuicide is a new, coordinated, multinational, European study that covers two broad areas of research: monitoring trends in the epidemiology of parasuicide (epidemiological monitoring study); and follow-up investigations of parasuicide populations, with a view to identifying the social and personal characteristics predictive of future suicidal behaviour (repetition prediction project). This article provides background information on the development and organization of the multicentre study, and presents selected findings from the epidemiological monitoring project, based on a preliminary examination of data collected in 15 centres on parasuicides aged 15 years and over treated in health facilities in defined catchment areas during the year 1989. The overall parasuicide incidence varied considerably across the centres, from a high (event) rate of 414 per 100,000 males in Helsinki to a low of 61 among males in Leiden. The highest female event rate was 595 in Pontoise, and the lowest 95 in Guipuzcoa. The mean event rate across all centres was 167 among males and 222 among females. Parasuicide incidence tended to be elevated among 15- to 34-year-olds, with lowest rates among those aged 55 years and over. With one exception (Helsinki), the female parasuicide rate was higher than the male rate, the F:M ratio ranging from 0.71:1 to 2.15:1, with a median of 1.5:1 (events). Short-term repetition rates (as measured by the event:person ratio) differed between centres, from 1.03 to 1.30 (median = 1.12) among males, and from 1.07 to 1.26 (median = 1.13) among females. Although we warn against generalizing from our findings to make statements about differences in parasuicide between countries, we argue that the differences between centres are valid and should be addressed in further research.

Adolescent↗