Biomedical subjects

Kirsi Suominen

Publications and source records attributed to Kirsi Suominen.

At least 19 recordsLinked to original sources

PubMed2007

Impaired functional connectivity at EEG alpha and theta frequency bands in major depression.

Recent reports on functional brain imaging in major depression have lead to an assumption that observed psychopathology might be related to an altered brain functional connectivity. Our hypothesis was that an increase in brain functional connectivity occurs in major depression. As a measure of functional connectivity, the electroencephalogram (EEG) structural synchrony approach was used in 12 medication-free depressive outpatients and 10 control subjects. Differences in the number and strength of structurally synchronized EEG patterns were compared between groups. In depressive patients the number and strength of short cortex functional connections were significantly larger for the left than for the right hemisphere, while the number and strength of long functional connections were significantly larger for the right than for the left hemisphere. Some of the functional connections were positively correlated with the severity of depression, thus being predictive. These were short-range anterior, posterior, and left hemisphere functional connections for the alpha frequency band and short-range anterior functional connections for the theta frequency band. The topology of the most representative functional connections among all patients with major depression indicated that the right anterior and left posterior brain parts may discriminate depressive patients from healthy controls. The obtained data support our hypothesis that there is an increase in brain functional connectivity in major depression. This finding was interpreted within the semantic framework, where different specialization of left (monosemantic context) and right (polysemantic context) hemispheres is functionally insufficient in patients with depression.

Adult↗

PubMed2006

Composition of brain oscillations in ongoing EEG during major depression disorder.

In the present study, we examined the composition of electroencephalographic (EEG) brain oscillations in 12 unmedicated major depressive outpatients and 10 healthy subjects during resting conditions (closed eyes). The exact composition of brain oscillations was assessed by the probability-classification analysis of short-term EEG spectral patterns. In contrast to previous studies of depression, the current study found that major depression affects brain activity in nearly the whole cortex and manifests itself in considerable reorganization of the composition of brain oscillations in a broad frequency range: 0.5-30 Hz. At the same time, the magnitude of the effect of depression was maximal in the posterior cortex of the brain. Interhemisphere asymmetry during major depression was also observed in the whole cortex with right hyperactivity in frontal, parietal and occipital brain areas. It is suggested that depressive brain is manifested in the superposition of distributed multiple oscillations. Our findings provide new insight on the relationship between major depressive disorder and cortical oscillatory activity.

Adult↗

PubMed2006

Suicidal behaviour during different phases of bipolar disorder.

BACKGROUND: There are no previous studies comparing the prevalence and risk factors for suicidal behaviour during different phases of bipolar disorder. METHODS: In the Jorvi Bipolar Study (JoBS), 1630 psychiatric in- and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire. Using SCID I and II interviews, 191 patients were diagnosed with bipolar disorders (90 bipolar I, 101 bipolar II). Suicidal ideation was measured using the Scale for Suicidal Ideation (SSI). Prevalence and risk factors for ideation and attempts during different phases (depressive, mixed, depressive mixed and hypomanic/manic phases) were investigated. RESULTS: There were marked differences between phases regarding suicide attempts and level of suicidal ideation. Hopelessness predicted suicidal behaviour during the depressive phase, whereas a subjective rating of severity of depression and younger age predicted suicide attempts during mixed phases. LIMITATIONS: The relatively small sample size in some phases. CONCLUSIONS: Suicidal behaviour varied markedly between different phases of BD. Suicide attempts and suicidal ideation were related to phases which are associated with depressive aspects of the illness. Hopelessness and severity of depression were key indicators of risk in all phases.

Adolescent↗

PubMed2006

Affective flattening and alogia associate with the familial form of schizophrenia.

Family history of schizophrenia has been associated with negative symptoms in the clinical picture. Our aim was to examine the signs and symptoms of schizophrenia in a genetically homogeneous isolate and a nationwide multiplex family sample, and to investigate the symptom dimensions and their association with the degree of familial loading for psychotic disorders and with consanguinity. For factor analysis of the Scales for the Assessment of Negative and Positive Symptoms, we included 290 patients with a DSM-IV diagnosis of schizophrenia: 63 multiplex family and 133 singleton patients from the isolate, and 94 nationwide multiplex family patients. The factor analysis yielded four factors. There was a significant difference between the multiplex and singleton patients, the former having more severe affective flattening and alogia. Further, the patients in isolate groups had fewer delusions and hallucinations compared with the whole country multiplex patients regardless of their familial loading for schizophrenia. This may be related to genetic homogeneity in the isolate. We conclude that patients with first-degree relatives with psychotic disorder have more severe negative symptoms.

Adult↗

PubMed2006

Time patterns of attempted suicide.

BACKGROUND: The association of mental disorders with time patterns of attempted suicide is poorly understood. METHODS: The study material consisted of all consecutive suicide attempts admitted to health care in Helsinki during a one-year period from 15 January 1997 to 14 January 1998. Clinical diagnosis was made according to ICD-10. RESULTS: Overall, the rate of suicide attempts varied markedly during the study period, peaking in autumn and being lowest during winter. Substance use disorders best explained suicide attempts occurring at weekends. There was considerable temporal variation among patients with mood disorders, compared to only slight variation among patients with schizophrenia spectrum disorders. Study subjects tended to contact health services in the late evening and around midnight. Those contacting health services outside normal hours received psychiatric consultation less frequently than others and were referred to aftercare less often. LIMITATIONS: Structured Clinical Interviews for DSM-IV Axis I and II Disorders were not used. CONCLUSIONS: There were marked time patterns of attempted suicide, especially among patients with mood disorders and substance use disorders. This contrasted with the limited fluctuation among patients with schizophrenia spectrum disorders. Contacts with the health care system occurred most often in the late evening and around midnight. The findings question the adequacy of staff numbers for psychiatric consultations and of time to plan aftercare.

Adolescent↗

PubMed2006

Prospective study of risk factors for attempted suicide among patients with bipolar disorder.

OBJECTIVE: There are few prospective studies on risk factors for attempted suicide among representative samples of psychiatric patients with bipolar I and II disorders. We conducted a prospective study to investigate risk for suicide attempts among a secondary-level sample of psychiatric in- and outpatients with bipolar disorder (BD). METHODS: In the Jorvi Bipolar Study (JoBS), 1,630 psychiatric in- and outpatients from three Finnish cities were screened for BDs with the Mood Disorder Questionnaire (MDQ). Using the Structured Clinical Interview for DSM-IV Disorders (SCID)-I and -II, 191 patients were diagnosed with BDs (90 bipolar I and 101 bipolar II). Information on suicide attempts during the follow-up was obtained for 176 patients (92%) at the 6-month follow-up and for 160 patients (84%) at the 18-month follow-up. RESULTS: During the 18-month follow-up 20% of patients (35/176) attempted suicide. In a Cox regression model, baseline previous suicide attempts (OR 3.8, 95% CI 1.7-8.8; p = 0.001), hopelessness (OR 1.2, 95% CI 1.1-1.3; p < 0.001), depressive phase at index episode (OR 2.4, 95% CI 1.1-5.3; p = 0.03) and younger age at intake (OR 0.94, 95% CI 0.91-0.97; p < 0.001) were independent risk factors for suicide attempts during follow-up, whereas factors such as bipolar I or II, or comorbidity did not reach statistical significance. CONCLUSIONS: During a medium-term follow-up, as many as one-fifth of random psychiatric patients with BD attempted suicide, which highlights the public health importance of suicidal behavior in BD. Previous suicide attempts, hopelessness and depressive phase were the key indicators of risk.

Adult↗

PubMed2006

Differences in Axis I and II comorbidity between bipolar I and II disorders and major depressive disorder.

OBJECTIVE: To obtain a comprehensive view of differences in current comorbidity between bipolar I and II disorders (BD) and (unipolar) major depressive disorder (MDD), and Axis I and II comorbidity in BD in secondary-care psychiatric settings. METHOD: The psychiatric comorbidity of 90 bipolar I and 101 bipolar II patients from the Jorvi Bipolar Study and 269 MDD patients from the Vantaa Depression Study were compared. We used DSM-IV criteria assessed by semistructured interviews. Patients were inpatients and outpatients from secondary-care psychiatric units. Comparable information was collected on clinical history, index episode, symptom status, and patient characteristics. RESULTS: Bipolar disorder and MDD differed in prevalences of current comorbid disorders, MDD patients having significantly more Axis I comorbidity (69.1% vs. 57.1%), specifically anxiety disorders (56.5% vs. 44.5%) and cluster A (19.0% vs. 9.9%) and C (31.6% vs. 23.0%) personality disorders. In contrast, BD had more single cluster B personality disorders (30.9% vs. 24.6%). Bipolar I and bipolar II were similar in current overall comorbidity, but the prevalence of comorbidity was strongly associated with the current illness phase. CONCLUSIONS: Major depressive disorder and BD have somewhat different patterns in the prevalences of comorbid disorders at the time of an illness episode, with differences particularly in the prevalences of anxiety and personality disorders. Current illness phase explains differences in psychiatric comorbidity of BD patients better than type of disorder.

Adolescent↗

PubMed2005

Breakdown of long-range temporal correlations in theta oscillations in patients with major depressive disorder.

Neuroimaging has revealed robust large-scale patterns of high neuronal activity in the human brain in the classical eyes-closed wakeful rest condition, pointing to the presence of a baseline of sustained endogenous processing in the absence of stimulus-driven neuronal activity. This baseline state has been shown to differ in major depressive disorder. More recently, several studies have documented that despite having a complex temporal structure, baseline oscillatory activity is characterized by persistent autocorrelations for tens of seconds that are highly replicable within and across subjects. The functional significance of these long-range temporal correlations has remained unknown. We recorded neuromagnetic activity in patients with a major depressive disorder and in healthy control subjects during eyes-closed wakeful rest and quantified the long-range temporal correlations in the amplitude fluctuations of different frequency bands. We found that temporal correlations in the theta-frequency band (3-7 Hz) were almost absent in the 5-100 s time range in the patients but prominent in the control subjects. The magnitude of temporal correlations over the left temporocentral region predicted the severity of depression in the patients. These data indicate that long-range temporal correlations in theta oscillations are a salient characteristic of the healthy human brain and may have diagnostic potential in psychiatric disorders. We propose a link between the abnormal temporal structure of theta oscillations in the depressive patients and the systems-level impairments of limbic-cortical networks that have been identified in recent anatomical and functional studies of patients with major depressive disorder.

Adult↗

PubMed2005

Chronic alcohol problems among suicide attempters--post-mortem findings of a 14-year follow-up.

This study set out to describe the clinical characteristics of a subgroup of suicide attempters with clear post-mortem evidence of long-term alcohol misuse, and to investigate the risk factors predicting chronic alcohol misuse/dependence using survival analysis. Data were collected over 14 years on all unselected deliberate self-poisoning patients (n=1018) treated in the emergency unit of Helsinki University Central Hospital. Of the 222 (22.7%) who had died by the end of the follow-up period, 85 (38.5%) showed clear post-mortem evidence of long-term alcohol misuse. Seventy-four per cent of misusers were men. The risk factors for chronic alcohol misuse/dependence among deceased suicide attempters were: male sex, numerous previous suicide attempts, non-impulsive suicide attempts, certain intention to die and subjective motive of the index attempt other than "wish to die". The findings emphasize that more attention should be focused on evaluating alcohol use and the risk of alcohol dependence in suicide attempters encountered in the emergency room of general hospitals.

Adult↗

PubMed2005

Suicidal ideation and attempts in bipolar I and II disorders.

OBJECTIVE: Few studies have investigated the prevalence of and risk factors for suicidal ideation and attempts among representative samples of psychiatric patients with bipolar I and II disorders. METHOD: In the Jorvi Bipolar Study (JoBS), psychiatric inpatients and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire from January 1, 2002, to February 28, 2003. According to Structured Clinical Interviews for DSM-IV Axis I and II Disorders, 191 patients were diagnosed with bipolar disorders (bipolar I, N = 90; bipolar II, N = 101). Suicidal ideation was measured using the Scale for Suicidal Ideation. Prevalence of and risk factors for ideation and attempts were investigated. RESULTS: During the current episode, 39 (20%) of the patients had attempted suicide and 116 (61%) had suicidal ideation; all attempters also reported ideation. During their lifetime, 80% of patients (N = 152) had had suicidal behavior and 51% (N = 98) had attempted suicide. In nominal regression models, severity of depressive episode and hopelessness were independent risk factors for suicidal ideation, and hopelessness, comorbid personality disorder, and previous suicide attempt were independent risk factors for suicide attempts. There were no differences in prevalence of suicidal behavior between bipolar I and II disorder; the risk factors were overlapping but not identical. CONCLUSION: Over their lifetime, the vast majority (80%) of psychiatric patients with bipolar disorders have either suicidal ideation or ideation plus suicide attempts. Depression and hopelessness, comorbidity, and preceding suicidal behavior are key indicators of risk. The prevalence of suicidal behavior in bipolar I and II disorders is similar, but the risk factors for it may differ somewhat between the two.

Adult↗

PubMed2004

Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study.

BACKGROUND: The aim of this study was to comprehensively examine clinical risk factors, including suicide intent and hopelessness, for suicide and risk of death from all causes after attempted suicide over a 12-year follow-up period. METHODS: A systematic sample of 224 patients from consecutive cases of attempted suicide referred to health care in four Finnish cities between 1 January and 31 July 1990 was interviewed. RESULTS: After 12 years of follow-up 22% of these patients had died, 8% by committing suicide. The only statistically significant risk factor for eventual suicide was high scores on Beck's Suicidal Intention Scale. Male gender, older age, physical illness or disability and high scores on Beck's Suicidal Intention Scale predicted death overall. CONCLUSIONS: Following attempted suicide, high intention to kill oneself is a significant risk factor for both death from all causes and suicide.

Adolescent↗

PubMed2004

Clinical phenotype of schizophrenia in a Finnish isolate.

We identified all cases in Finland (population of 5 million) with a diagnosis of schizophrenia born between 1940 and 1969, using four national computerised registers with high reliability. A sample of 397 families was identified in a genetically homogeneous internal isolate (population of 18,000) in northeastern Finland with high prevalence for schizophrenia and an LOD score of 3.8 in chromosome 1. Our aim was to examine with Operational Criteria Checklist for Psychotic Illness (OCCPI) factor analysis the psychotic and affective signs and symptoms of schizophrenia in this genetically homogeneous population, and compare them with findings from individuals with schizophrenia from multiplex families from the whole country. After collecting all original case notes, we made DSM-IV consensus diagnoses and completed OCCPI ratings on a lifetime basis. For the factor analysis, we accepted 190 patients with a diagnosis of schizophrenia. In addition, 466 schizophrenia patients from 147 multiplex families from the whole country were included in the analysis. The OCCPI factor analysis resulted in four factors: "delusions and hallucinations" and "negative" factors, plus two affective ("manic" and "depressive") factors. We compared the pattern of symptoms among three patient groups: isolate patients who were the only affected individuals in their family, isolate patients who had affected family members, and patients from the whole country with affected family members. We found no clear differences among these groups. However, there were significant differences in the frequency of individual OCCPI items between the study groups. Findings in this schizophrenia OCCPI phenotype study suggest that the clinical picture of schizophrenia in a genetically isolated and homogeneous population closely resembles our nationwide findings in Finland.

Alleles↗

PubMed2004

Elderly suicide attempters with depression are often diagnosed only after the attempt.

OBJECTIVE: No previous study has comprehensively investigated the pattern of health care contacts among elderly subjects attempting suicide. The present study compared elderly suicide attempters with younger attempters, before and after attempted suicide, in terms of health care contacts, clinical diagnoses of mental disorders, and characteristics predicting lack of treatment contact after the index attempt. METHODS: All consecutive 1198 suicide attempters treated in hospital emergency rooms in Helsinki, Finland, from 15.1.1997 to 14.1.1998 were identified and divided into two age groups: (1) elderly suicide attempters aged 60 years or more (n = 81) and (2) suicide attempters aged under 60 years (n = 1117). RESULTS: During the final 12 months before the attempt, the majority of elderly suicide attempters had a contact with primary health care, but their mood disorders were likely to have remained undiagnosed before the index attempt. In primary health care, only 4% had been diagnosed with a mood disorder before the attempt, but 57% after (p < 0.001). After the suicide attempt, most elderly suicide attempters were referred for aftercare, two thirds having contact with psychiatric care. CONCLUSIONS: For purposes of preventing suicidal behaviour, screening for depression, plus further education on recognition, diagnosis and treatment of mood disorders among the elderly in primary health care setting are needed.

Aftercare↗

PubMed2004

Substance use and male gender as risk factors for deaths and suicide--a 5-year follow-up study after deliberate self-harm.

OBJECTIVE: The aim of this study was to determine the mortality by suicide and other causes of death in a cohort of suicide attempters and identify predictive factors, including contact to healthcare after the attempt. METHOD: All consecutive 1198 deliberate self-harm patients treated in hospital emergency rooms in Helsinki during a 12-month period were identified. Data were gathered on healthcare contacts preceding and following the index attempt, and cause-specific mortality over a 5-year period. RESULTS: By the end of the 5-year follow-up period, 171 (14%) of the patients had died. A total of 57 (5%) had committed suicide. The age- and sex-adjusted risk for suicide among deliberate self-harm patients was 40-fold, and for death overall tenfold, compared to general population during the 5-year follow-up period. Risk factors for subsequent suicide were a diagnosis of substance use disorder, male gender and previous suicide attempts. A diagnosis of substance use disorder and male gender predicted death. Furthermore, male gender and substance use disorders had a strong interaction for both classes of death. CONCLUSIONS: The findings of this study suggest that deliberate self-harm patients have a high risk for both suicide and other causes of death. Male gender and substance use disorders are significant risk factors for both later suicide and other causes of death. Male suicide attempters with substance use disorders have remarkably high total and suicide mortality.

Adult↗

PubMed2004

Self-inflicted burns: an eight year retrospective study in Finland.

The aim of this study was to investigate differences in characteristics of burn patients who had attempted suicide, as compared with other burn patients admitted to the Helsinki Burn Centre during 1989-97. Burn patients were first drawn from a computerised register, after which a psychiatrist examined their medical records and ascertained the suicide attempters. Of the total of 811 burn patients, 46 (5.7%) had attempted suicide. The median total body surface area (TBSA) of suicide attempters (24.0%) was markedly higher than in the other patients (6.0%, P < 0.001). Flame was a much more common cause of burns among suicide attempters (82.1%) than among the remainder (44.5%, P < 0.001). Suicide attempters were also more often unemployed (28.2 versus 12.9%) or on disability pension (30.8 versus 7.1%) before the injury (P < 0.001). Although the proportion with self-inflicted burns among all burn patients was not high, the markedly higher severity of their burns makes them an important clinical subgroup for further study.

Adult↗

PubMed2004

Patients' evaluation of their psychiatric consultation after attempted suicide.

Few studies have previously investigated patients' evaluation of their psychiatric consultation after attempted suicide. The aim of the present study was to examine the patients' view of their psychiatric consultation after a suicide attempt. Of a systematic sample of 114 suicide attempters in Helsinki, 73 subjects were referred to psychiatric consultation at an emergency room or department, and 53 of these evaluated the consultation received. Half of these suicide attempters considered their psychiatric consultation had occurred too soon after the attempt. Those whose prior attitude toward the consultation was indifferent had higher Hopelessness Scale (HS) and Beck Depression Inventory (BDI) scores than those who were positive. Psychiatric assessment should not take place before the patient has recovered from toxic effects caused by any overdose attempt. Suicide attempters with severe depression and hopelessness are likely to be those most indifferent to the prospect of psychiatric consultation. The presence of severe depression or hopelessness should not deter active evaluation and treatment.

Adult↗

PubMed2004

The clinical characteristics of DSM-IV bipolar I and II disorders: baseline findings from the Jorvi Bipolar Study (JoBS).

OBJECTIVE: To obtain a comprehensive view of the clinical epidemiology of bipolar I and II disorder in secondary-level psychiatric settings. METHODS: In the Jorvi Bipolar Study (JoBS), 1630 non-schizophrenic psychiatric in- and outpatients in three Finnish cities were screened for bipolar I and II disorders with the Mood Disorder Questionnaire. Diagnoses were made using semistructured SCID-I and -II interviews. Information collected included clinical history, current episode, symptom status, and other characteristics. RESULTS: A total of 191 patients with bipolar disorder (90 bipolar I and 101 bipolar II) were included in the JoBS. The majority of bipolar II (50.5%) and many bipolar I (25.6%) patients were previously undiagnosed; the remainder had a median 7.8 years delay from first episode to diagnosis. Despite several lifetime episodes, 26 and 58% of bipolar I and II patients, respectively, had never been hospitalized. A polyphasic episode was current in 51.3%, rapid cycling in 32.5%, and psychotic symptoms in 16.2% of patients. Mixed episodes occurred in 16.7% of bipolar I, and depressive mixed states in 25.7% of bipolar II patients. CONCLUSION: Even in psychiatric settings, bipolar disorders usually go undetected, or recognized only after a long delay. A significant proportion of not only bipolar II, but also bipolar I patients are never hospitalized. Polyphasic episodes and rapid cycling are prevalent in both types. Depressive mixed states are at least as common among bipolar II patients as mixed episodes among bipolar I.

Adolescent↗

PubMed2004

Completed suicide after a suicide attempt: a 37-year follow-up study.

OBJECTIVE: Attempted suicide is the strongest known predictor of completed suicide. However, suicide risk declines over time after an attempt, and it is unclear how long the risk persists. Risk estimates are almost exclusively based on studies of less than 10 years of follow-up. METHOD: The authors followed a cohort of 100 consecutive self-poisoned patients in Helsinki in 1963, for whom forensically classified causes of death during the following 37 years were investigated. RESULTS: They found that suicides continued to accumulate almost four decades after the index suicide attempt. CONCLUSIONS: A history of a suicide attempt by self-poisoning indicates suicide risk over the entire adult lifetime.

Adolescent↗