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Biomedical subjects

M Joukamaa

Publications and source records attributed to M Joukamaa.

At least 37 records · Page 2Linked to original sources
PubMed1998

The mortality of released Finnish prisoners; a 7 year follow-up study of the WATTU project.

OBJECTIVE: The aim was to compare the mortality of released prisoners and the general population. METHOD: The study forms a part of the Health Survey of Finnish Prisoners (the WATTU Project). A sample (N = 903), representing all Finnish male prisoners, underwent a thorough health survey in 1985. A 7 year follow-up study was performed by means of gathering register data (deaths, hospital care, diseases leading to working incapacity). A population-based age-selected control group was formed for comparison. RESULTS: During the follow-up, 13.2% of the sample died (natural deaths 5.2%, accidental deaths 4.1%, suicides 2.0%), whereas the corresponding figure in the control group was 3.4%. Overmortality among released prisoners, when compared to the general population, was also found in different death categories. CONCLUSION: The high somatic and psychiatric morbidity and mortality due to prisoner suicide, when imprisoned, has been reported in many earlier studies. This is probably the first study to confirm the high mortality in different death categories of a representative sample of released prisoners compared to a control group representing the general population. It is important to try to help released prisoners to get a new grip on normal life, especially if they also have somatic or mental health problems. More effort should be made to improve the collaboration between different health care systems.

Adult↗
PubMed1998

Schizophrenia among patients treated for rheumatoid arthritis and appendicitis.

The widely accepted negative association between schizophrenia and rheumatoid arthritis (RA) is based on the results of investigations which sought RA in large samples of schizophrenic patients. Using a discharge register, we examined the frequency of schizophrenia in a sample of 5626 RA patients. Appendicitis patients (n = 5330) were used as a comparison group. The cumulative incidence of hospital care with the diagnosis of schizophrenia during 8 years was higher in the RA group (0.64%) than in the appendicitis group (0.47%). Schizophrenia was significantly more common in the RA group than in the appendicitis group among the young. The age-adjusted prevalence of schizophrenia was 0.96% in the RA group and 0.51% in the appendicitis group. Because of this unexpected finding, we examined the incidence of RA and appendicitis among a birth cohort born in 1966. The frequencies of RA and appendicitis among schizophrenic cohort members (n = 76), cohort members with psychiatric diagnosis other than schizophrenia (n = 438), and members without psychiatric diagnosis (n = 10503) were similar. These findings do not support the negative association between schizophrenia and RA. Prolonged institutionalization per se may have been the protective factor against RA in the previous studies. The findings also raise the hypothesis that genes that predispose to schizophrenia provide protection from appendicitis, historically a common cause of mortality.

Adolescent↗
PubMed1998

Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 northern Finland general population birth cohort.

We studied the comorbidity of psychiatric and physical disorders in a sample (n = 11,017) from the unselected, general population, Northern Finland 1966 Birth Cohort. During the period 1982-1994, hospital-treated psychiatric patients were more likely than people without psychiatric diagnoses to have been treated for physical disease in hospital wards, 298 out of 387 (77%) vs 6687 out of 10,630 (62.9%) (OR = 2.0, 95% CI = 1.6-2.5). Injuries, poisonings and indefinite symptoms were a more common reason for hospital treatment in people with schizophrenia or other psychiatric disorder as compared with people without a psychiatric disorder. Men with psychiatric disorder had more than a 50-fold risk for poisoning by psychotropic drugs (OR = 52.6, 95% CI = 27.7-99.8), women with psychiatric disorder a 20-fold risk (OR = 19.0, 95% CI = 9.5-38.1) and schizophrenics more than a 30-fold (OR = 37.5, 95% CI = 19.1-73.8). Men with psychiatric disorders were more commonly hospitalised for a variety of gastrointestinal disorders and circulatory diseases (OR = 2.3, 95% CI = 1.2-4.4), as compared with men with no psychiatric disorder. Respiratory diseases (OR = 2.2, 95% CI = 1.2-4.2, vertebral column disorders (OR = 4.2, 95% CI = 1.8-9.9), gynaecological disorders (OR = 2.1, 95% CI = 1.2-3.6) and induced abortions (OR = 1.8, 95% CI = 1.2-2.7) were more prevalent in women with psychiatric disorder than in other women. Epilepsy was strongly associated with schizophrenia (OR = 11.1, 95% CI = 4.0-31.6). Nervous and sensory organ diseases in general (OR = 2.5, 95% CI = 1.1-5.8) and inflammatory diseases of the bowel (OR = 12.8, 95% CI = 3.8-42.7) were also overrepresented in schizophrenia when compared with people without a psychiatric disorder. Our results indicate that physicians must be alert for psychiatric disorder, and mental health professionals must be aware of the considerable morbidity in their patients.

Adolescent↗
PubMed1998

Repeated use of psychiatric emergency out-patient services among new patients: a 3-year follow-up study.

The aim of this study was to examine repeated use of psychiatric emergency out-patient services during the second and third years after the first contact. A 1-year treated incidence cohort of 537 new patients was studied in the Department of Psychiatry in Oulu, Finland. Repeat users were defined as patients belonging to the upper 10th percentile of the emergency out-patient contacts. The median of emergency out-patient contacts among repeaters was 4. The repeaters constituted 8% of the cohort and they used 65% of the cohort's emergency contacts. They were more likely to be male and living alone, and they tended to have more serious diagnoses than non-repeaters. Having hospital admissions, planned out-patient contacts and repeated emergency out-patient contacts also during the first year of follow-up was associated with an increased probability of repeatedly using emergency services during the second and third years. Living alone and having hospital admissions during the follow-up period were associated with being a continuous repeat visitor during the whole follow-up period. It is concluded that the extended repeated use of emergency services is associated with inadequate social support and serious psychiatric problems.

Adult↗
PubMed1998

Risk factors and prognosis for psychiatric morbidity in children and adolescents.

Because of the new epidemiological studies during the past two decades our knowledge concerning child and adolescent psychiatric disorders has grown up. There exists data concerning the distribution of different disorders in the community. The development in the methodology of child psychiatric investigation has made it possible to study also the risk factors and prognostic features of child psychiatric disorders. In this paper risk and prognostic factors of various child psychiatric disorders are reviewed. All the findings from studies made in different countries are not suitable as such in Finland. No large scale epidemiological studies concerning the risk and prognostic factors of various child psychiatric disorders are available in Finland. The cohort-66 study offers a possibility to elucidate also these factors.

Adolescent↗
PubMed1998

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.

Adolescent↗
PubMed1997

Prison suicide in Finland, 1969-1992.

BACKGROUND: All prisoners' suicides in Finland during 1969-1992 (n = 184) were studied. METHOD: The data were collected from official documents. RESULTS: Of all prisoners' deaths, 47% were suicides. The rate of suicide among male prisoners was three-fold compared to the normal adult Finnish male population. More than half of those committing suicide had a psychiatric disturbance and one half of them had visited the prison health services because of a psychiatric problem not more than one week before the suicide. Almost one third of the suicides were committed in isolation rooms. Contrary to the findings of many previous studies, there was no concentration of suicides at weekends, on religious holidays, in different seasons nor at the beginning of the confinement. CONCLUSIONS: The most important finding of this study was the common use of health care facilities in the prison just before the suicide. It is important to try to develop the means to recognize suicidal ideation among all prisoners seeking psychiatric care. The surveillance of prisoners in isolation cells needs to tighten up and should probably be continuous.

Adult↗
PubMed1997

Frequent attender profiles: different clinical subgroups among frequent attender patients in primary care.

Psychiatric and physical morbidity among frequently attending patients in primary care is high. However, very few efforts have been made to sort out the complex patterns of problems these patients have. We developed a clinical grouping of these patients. Our sample consisted of 67 frequent attenders. The measures included physical and psychiatric illnesses, presenting symptoms, sociodemographic data, psychosocial situation, level of distress, global functioning, experienced life satisfaction, illness attribution, and current psychiatric treatment. We identified five groups with different profiles: (1) patients with entirely physical illnesses; (2) patients with clear psychiatric illnesses; (3) crisis patients; (4) chronically somatizing patients; and (5) patients with multiple problems. The grouping was based on multidimensional operational criteria. The majority in all groups attended for solely physical illnesses or symptoms suggesting different forms of somatization. Only a few patients were undergoing any psychiatric treatment. Differences between groups were found regarding sociodemographic factors, physical illnesses, global functioning, and satisfaction.

Adolescent↗
PubMed1997

Psychiatric morbidity in primary public health care: a multicentre investigation. Part II. Hidden morbidity and choice of treatment.

A total of 1,281 patients were examined during consultation with their GP in a Nordic multicentre study focusing on the prevalence of psychiatric illness, hidden psychiatric morbidity, treatment and pathways to specialized care. The methodology and prevalence were reported in an accompanying paper. The present paper presents results concerning the variables hidden psychiatric morbidity, treatment and pathways to specialized care. The GPs detected 44% of the psychiatric cases compared with the result of a diagnostic interview (PSE). The distinction between psychosis and non-psychosis did not influence the GPs' ability to detect a mental illness. According to the GPs' assessment the majority of patients suffering from a mental disorder consulted their GP about physical complaints. The GPs treated the patients themselves, and only a limited number of cases were referred to psychiatrists or psychologists.

Adolescent↗
PubMed1996

Recognition and management of major depression in psychiatric outpatient care: a questionnaire survey.

We studied the ability of psychiatric practitioners to recognize and treat major depression in standard clinical practice in Finland. A questionnaire with 18 items (including, e.g. physicians characteristics, two case reports and diagnostic and treatment proposals for both of them) was sent to 255 physicians in communal psychiatric outpatient care, 216 physicians responded (85%). Results suggest that diagnostic accuracy was good. Treatment proposals showed high sensitivity and lower specificity when the use of antidepressive medication was examined. This may reflect increased education concerning the illness and the effect of the new antidepressants, which are probably considered easier to initiate, or may be partly due to systematic error. Physicians characteristics determined neither diagnostic nor treatment decisions.

Adult↗
PubMed1996

Alexithymia and psychological distress among frequent attendance patients in health care.

BACKGROUND: The aim of the present study was to find out whether alexithymia is common in frequently attending primary health care patients and whether alexithymia and psychological distress are associated in these patients. METHODS: Alexithymia was measured by the TAS-26 and psychological distress by the SCL-25 in a random sample of 394 working-age primary health care patients. Frequent attendance was defined as a minimum of 11 visits during 1 year to different kinds of outpatient health care services, excluding specialized psychiatric care. RESULTS: Frequently attending patients with psychological distress were found to be alexithymic more commonly than other patients, but this was not the case with other frequently attending patients. In other words, frequent attendance and alexithymia had an association mediated by psychological distress. CONCLUSIONS: There is a subgroup of frequently attending patients, who are alexithymic and have psychological distress, too. They usually visit health-care services because of a somatic complaint. We hypothesize that their expression of psychological distress was masked and somatized just because of alexithymia.

Adolescent↗
PubMed1995

Psychiatric morbidity among Finnish prisoners with special reference to socio-demographic factors: results of the Health Survey of Finnish Prisoners (Wattu Project).

The present study is part of the Health Survey of Finnish Prisoners (Wattu Project). The project dealt with a sample of 1099 Finnish prisoners, of which 82% participated in the study. Because of the representativeness of the sample the results can be generalized to all Finnish prisoners. The methods used consisted of questionnaires, interviews, a clinical examination by prison physicians and gathering of register data. The total prevalence rate of psychiatric cases was 56%. This is much higher than the rate for the Finnish population in general. The high number of mental disorders was due to alcoholism (43%) and personality disorders (18%). These disorders became even more prevalent as the number of prison sentences increased. There was no difference between the prisoners and the general population in the prevalence of psychoses and neuroses. Alcoholism is the most important mental disorder in Finnish prisoners, while drug abuse is rarely found among them in comparison to prisoners in many other countries.

Adolescent↗
PubMed1995

Alexithymia in primary health care patients.

Although many studies have been published about the relationship between alexithymia and different somatic diseases, little is known about the occurrence of alexithymia in primary health care patients. The aim of the present study was to shed light on this problem. The study forms part of a larger project dealing with psychiatric morbidity in primary health care patients. The original material consisted of 1,000 randomly selected adult patients in Turku in 1989-90. As part of a follow-up study (N = 748) three years later, alexithymia was measured using the Toronto Alexithymia Scale (TAS). Primary care patients seemed to have commonly alexithymic features: The mean of the TAS-score was 64.41 +/- 11.71 for male and 63.51 +/- 11.86 for female patients. The results indicated that alexithymia was associated with psychological distress, age, educational level, and socioeconomic status. The nature of alexithymia is discussed.

Adolescent↗
PubMed1995

Psychiatric morbidity among frequent attender patients in primary care.

In this study, 96 frequent attender patients in primary care were compared with 466 other primary care patients. The focus was on psychiatric morbidity, current and former psychiatric treatment, and self-perceived need for treatment. The prevalence of psychiatric illness was much greater among frequent attender patients than other patients (54.0% vs. 24.0%, p < 0.001), and subclinical symptoms were common in both groups (34.0% vs. 43.2%). Depression and anxiety were the most common clinical entities among frequent attender patients. However, very few patients had psychiatric treatment and the self-perceived need for treatment was low. The significance of these findings is discussed in the paper.

Attitude to Health↗
PubMed1995

Education, gender and cognitive performance in a 62-year-old normal population: results from the Turva Project.

Four WAIS (Wechsler Adult Intelligence Scale) subtests, and tasks of memory and cognitive control were administered to a population sample of 143 men and 179 women. Subjects with a minor advantage in years of education out-performed those with only primary schooling. Gender-related effects were also remarkable. Whereas the general abilities were equal in the genders, women out-performed men on recall of word pairs and objects, on verbal cognitive control and on Digit Symbol. In contrast, men excelled on Trail Making A, and on Block Design. The findings emphasize the need for age norms by gender and education for cognitive tests.

Aging↗
PubMed1995

The prescription of psychotropic drugs in primary health care.

We followed the prescription of psychotropic drugs by primary health care physicians over a 3-year period. The material consisted of 1000 randomly selected adult primary health care patients. At least one psychotropic drug was prescribed to one third (n = 307) of the sample during the follow-up period. The most commonly used drug category was that of benzodiazepines, which was prescribed to 24% of the sample. An antidepressive was prescribed to 8%, a neuroleptic to 2% and "other psychotropic drugs" to 10% of the sample. The most important predictor for prescribing psychotropic drugs was recognition of mental problems at the initial survey, but age and marital status also had an association with the prescription. No gender difference was found after controlling for mental problems. Psychotropic medication was also prescribed to 13% of the patients who had no sign of mental disorder.

Adolescent↗
PubMed1995

Psychiatric morbidity in primary public health care: a Nordic multicentre investigation. Part I: method and prevalence of psychiatric morbidity.

The prevalence of mental illness in five different Scandinavian primary care populations was investigated in this study. Patients consecutively consulting their general practitioner a particular week-day were included in the study. Initially the SCL-25 was applied and next the high scores and a sample of the low scores were interviewed by the PSE. In the analysis the screening procedure was first validated. The internal validity of the SCL was tested by means of Rasch latent structure analysis and the external validity tested by ROC/QROC analysis. Based on this, a short 8-item version of the SCL was developed. The prevalence of mental illness in all centres was 0.26 with a minimum of 0.14 in Nacka and a maximum of 0.34 in Turku.

Adolescent↗