Higher serum triglyceride levels in early-onset schizophrenia.
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Adolescent↗
Biomedical subjects
Matti Isohanni
Publications and source records attributed to Matti Isohanni.
Videoconferencing in child and adolescent telepsychiatry: a systematic review of the literature.
A systematic review of child and adolescent telepsychiatry was conducted. It was based on a search of the electronic databases MEDLINE and PsycINFO covering the period 1966 to June 2003. Studies were selected for review if they concerned videoconferencing for patient care or consultation, evaluated a clinical service or education, or assessed satisfaction with videoconferences. Twenty-seven articles were identified that fulfilled the selection criteria. These comprised two reports of randomized controlled experiments, 10 of descriptive questionnaire studies or observational surveys, seven case studies and eight other reports. Only three of the studies presented some calculations of cost-effectiveness. When classified by 'Quality of Evidence' criteria, only two studies were in category I (the highest), one was in II-2 and the rest fell into category III (the lowest). Most studies of child and adolescent telepsychiatry examined satisfaction with videoconferencing or described programmes or care regimens. Videoconferencing seemed to improve the accessibility of services and served an educational function. Some papers also mentioned savings in time, costs and travel. Problems with non-verbal communication and the audiovisual quality of the videoconference were mentioned as drawbacks. Telepsychiatry therefore seems to offer several benefits, at least in sparsely populated regions. Well designed and properly controlled trials are required to evaluate the clinical value of this promising method in child psychiatry, where there is a constantly increasing need for services.
Adolescent↗
Links between creativity and mental disorder.
A link between mental disorder and decreased ability is commonly assumed, but evidence to the contrary also exists. In reviewing any association between creativity and mental disorder, our aim is not only to update the literature but also to include an epidemiological and theoretical discussion of the topic. For literature retrieval, we used Medline, PsycINFO, and manual literature searches. Studies are numerous: most are empirical, many having methodological difficulties and variations in definitions and concepts. There is little consensus. However, some trends are apparent. We found 13 major case series (over 100 cases), case-control studies, or population-based studies, with valid, reliable measures of mental disorders. The results of all but one of these studies supported the association, at least when concerning particular groups of mental disorders; the findings were somewhat unclear in two studies. Most of the remainder that are not included in our more detailed examination also show a fragile association between creativity and mental disorder, but the link is not apparent for all groups of mental disorders or for all forms of creativity. In conclusion, evidence exists to support some form of association between creativity and mental disorder, but the direction of any causal link remains obscure.
Creativity↗
Hyperlipidemia in persons using antipsychotic medication: a general population-based birth cohort study.
BACKGROUND: Shortly after phenothiazines were introduced, they were found to elevate serum triglyceride and total cholesterol levels. During the past decade, an increasing body of literature has also documented this effect in atypical antipsychotics. Previous studies of antipsychotic-associated hyperlipidemias are based on clinical samples, mostly from case series. We studied the prevalence of hyperlipidemia in subjects who did and did not take antipsychotic medication in a prospective, general population-based birth cohort. METHOD: The study sample consisted of 5654 members of the unselected Northern Finland 1966 Birth Cohort who participated in the 1997-1998 clinical examination at 31 years of age. Blood samples were taken after an overnight fast, and serum total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels were determined. Health habits and other possible correlates for hyperlipidemia were assessed using a questionnaire. The sample was analyzed in 4 categories according to use of antipsychotic medication: (1) atypical, (2) typical, (3) atypical and typical (for the 3 antipsychotic categories, total N = 45), and (4) no antipsychotic medication (N = 5609). Nonparametric tests and multiple logistic regression analysis were used to measure the effect of antipsychotics on serum lipids. RESULTS: High lipid levels were found in persons treated with both atypical and typical medication (mean total cholesterol = 233 mg/dL, mean triglycerides = 163 mg/dL). Mean total cholesterol and triglycerides were also high in subjects who used only typical medication (215 mg/dL and 148 mg/dL, respectively). The prevalence of hypercholesterolemia, high LDL cholesterol, and hypertriglyceridemia was high in persons using antipsychotic medication (31.1%, 20.0%, and 22.2%, respectively) compared with persons not using such medication (12.2%, 10.2%, and 7.0%, respectively). After we adjusted for risk factors for hyperlipidemia (sex, diet, waist circumference, physical exercise, smoking, and alcohol consumption), the results of logistic regression analysis showed that in persons treated with antipsychotic medication the risk of hypercholesterolemia was 2.8 (95% CI = 1.4 to 5.6); of hypertriglyceridemia, 2.3 (95% CI = 1.0 to 5.4); and of high LDL cholesterol, 1.6 (95% CI = 0.7 to 3.5). CONCLUSION: Lipid levels in subjects who used both atypical and typical medication and those who used only typical medication were high even in young age. As these persons are at special risk of hyperlipidemia, their lipid levels should be regularly monitored, and a cholesterol-lowering diet, as well as medication, should be considered. The results indicate an elevated risk of hyperlipidemia in persons using antipsychotic medication independent of the other risk factors assessed.
Adult↗
Maternal separation at birth and schizophrenia--a long-term follow-up of the Finnish Christmas Seal Home Children.
OBJECTIVE: Problems in the early mother-infant relation pose a hypothetical risk factor of schizophrenia. We studied the association between very early separation and later development of schizophrenia or other psychoses in a unique data set. METHOD: The index cohort consisted of 3020 subjects born in 1945-1965 in Finland who were temporarily isolated from their family immediately after birth to adequate nursing homes due to tuberculosis in the family. The average separation time was 7 months. For every index subject, two reference subjects were matched for sex, year of birth and place of birth. The Finnish Hospital Discharge Register was used to identify subjects with schizophrenia and other psychoses arising from childhood to middle age, between January 1, 1971 and December 31, 1998. RESULTS: The 28-year cumulative incidence of schizophrenia was 1.6% both in the index cohort and in the reference cohort (rate ratio 1.01, 95% CI 0.75-1.37). The incidences of other psychotic disorders were 1.5% and 1.3% (RR 1.11, 95% CI 0.79-1.58), respectively. CONCLUSION: Separation at birth was not found to be associated with either schizophrenia or other psychotic illness. Temporary placement to adequate nursing homes in the first year of life is unlikely to increase the risk for schizophrenia or other psychoses.
Adult↗
Reasons for the diagnostic discordance between clinicians and researchers in schizophrenia in the Northern Finland 1966 Birth Cohort.
BACKGROUND: The diagnosis of schizophrenia by clinicians is not always accurate in terms of operational diagnostic criteria despite the fact that these diagnoses form the basis of case registers and routine statistics. This poses a challenge to psychiatric research. We studied the reasons for diagnostic discordance between clinicians and researchers. METHODS: The Northern Finland 1966 Birth Cohort (n = 11,017) was followed from mid-gestation to the end of the 31st year. Psychiatric outcome was ascertained through linkage to the national hospital discharge register containing clinical diagnoses made by the attending physician. The hospital notes of all subjects admitted to hospital during the period 1982-1997 due to psychiatric disorder were reviewed and 475 research, operational DSM-III-R diagnoses were formulated. RESULTS: Ninety-six cases met operational criteria for schizophrenia. Fifty-five (57 %) had concordant diagnoses: both the clinical and research diagnoses were schizophrenia. Forty-one (43 %) had discordant diagnoses: the clinical diagnosis was other than schizophrenia (mainly schizophreniform or other psychosis). Discordant cases were more likely to be older at onset, experience a shorter treatment duration, fewer treatment episodes, and to have a comorbid diagnosis mental retardation. CONCLUSIONS: Clinicians do not make the diagnosis of schizophrenia as often as the application of operational criteria would suggest they should. The discordance between clinical diagnosis and the research, operational diagnosis is especially likely in cases having late onset and few contacts to psychiatric hospital.
Adolescent↗
Parental separation at birth and criminal behaviour in adulthood--a long-term follow-up of the Finnish Christmas Seal Home children.
BACKGROUND: Parental absence has been connected with later criminality. We studied the association between very early separation and criminality in a unique data set. METHODS: The index cohort consisted of 2,906 subjects born between 1945 and 1965 in Finland who were temporarily isolated from their family immediately after birth and sent to adequate nursing homes due to tuberculosis in the family. The average separation time was 7 months. For every index subject, two reference subjects (matched for sex, year of birth and place of birth) were gathered. Data on criminal offences were obtained from Statistics Finland arising from adolescence to middle age, between January 1, 1977 and December 31, 1998. The association between parental separation and subcategories of non-violent and violent criminality and violent recidivism, respectively, in male and female offspring was analysed. Subjects who had committed at least two violent crimes were defined as violent recidivists. RESULTS: Of the male index subjects, 12.1% as compared with 7.1% of the reference cohort (estimated relative risk RR 1.73; 95% CI 1.42-2.11) had committed violent offences. Of the male index subjects 5.2% and of the male reference subjects 3.6% were violent recidivists (RR 1.47; 1.10-1.98). Of the male index subjects 26.3% and of the reference cohort 23.4% had committed nonviolent crimes (RR 1.14; 1.01-1.29). Among females, non-violent crimes were committed by 7.9% of the index subjects and by 5.0% of the reference subjects, respectively (RR 1.54; 1.18-2.00). Violent crimes were rare among female subjects. CONCLUSION: Criminal behaviour was more prevalent among both male and female subjects separated at birth from their families because of tuberculosis in the family than in the reference cohort. Especially violent crimes were prevalent in the male index cohort. Even so, the differences between the index and reference cohorts were rather modest. Very early separation may have some, although limited, influence on later criminality in the offspring.
Adult↗
Criminality in the offspring of antenatally depressed mothers: a 33-year follow-up of the Northern Finland 1966 Birth Cohort.
BACKGROUND: No epidemiological studies have been reported on the association between mothers' antenatal depression and criminality in their offspring. METHODS: The material consists of a general population cohort of 12059 children born in 1966 in Northern Finland and followed to the end of 1998. Mothers were asked at midgestation by a nurse at the antenatal clinic if they felt themselves to be depressed. The Finnish Ministry of Justice provided information for all descendants on criminal offences. The associations between maternal depression and subgroups of violent and non-violent, violent recidive and non-recidive criminality in male and female offspring were analysed. RESULTS: Of the mothers 14% had depressed mood during pregnancy. A total of 607 (10.9%) male and 72 (1.3%) female criminal offenders were included in the cohort. When adjusted for mother's marital status, smoking, wantedness of the pregnancy, place of residence, socioeconomic status and perinatal complications, the odds ratio (OR) for males was 1.4 (95% CI 1.0-1.9) in the association between maternal depression and non-violent offenders, 1.6 (1.1-2.4) between maternal depression and violent offenders and 1.7 (1.0-3.0) between maternal depression and violent recidivists. The adjusted OR for females involved in non-violent crimes was 1.7 (0.9-3.3) and 0.6 (0.1-6.0) for violent crimes. LIMITATIONS: Maternal depression was not checked using a standardized assessment. CONCLUSIONS: For male offspring of antenatally depressed mothers there was a significant but slight increase in criminality. The emotional state of a pregnant mother may have some, but limited, influence on later criminality in the offspring.
Adolescent↗
Persistent early childhood developmental impairment may be associated with later schizophreniform disorder.
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Comment↗
Implementation of a telepsychiatric network in northern Finland.
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Cost Savings↗
[Other mental disorders presenting together with schizophrenia].
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Anxiety Disorders↗
Weight gain and glucose and lipid metabolism disturbances during antipsychotic medication: a review.
Antipsychotic medication is the mainstay of treatment for functional psychotic illnesses. However, for some patients weight gain and the disturbances in blood-lipid levels and glucose balance associated with their use are significant disadvantages, and pose health risks that may affect prognosis. A substantial body of evidence suggests that weight gain is at least partly related to the blocking effects of antipsychotic medication on serotonin- and histamine-mediated neurotransmission. The disadvantages associated with weight gain can be reduced by an appropriate choice of antipsychotic and avoidance of polypharmacy, by regular monitoring of the patient's weight, and, if necessary, by the patient's participation in a dieting programme.
Antipsychotic Agents↗
Statistical methodology in general psychiatric journals.
Development of psychiatric research methods requires systematic review of their status. This study describes the frequency with which various statistical research designs and methods are reported in general psychiatric journals. All original research articles in four psychiatric journals in 1996 were reviewed: The American Journal of Psychiatry (AJP), The Archives of General Psychiatry (AGP), The British Journal of Psychiatry (BJP) and the Nordic Journal of Psychiatry (NJP). Evaluation included 448 regular articles, which reported original research findings based on systematic collection and statistical analysis of research data. Aspects measured were research design, statistical methodology, description of procedures and presentation of results. Percentage frequencies of reported statistical procedures were compared between the journals. The policy of determining statistical significance was still the most generally used method of conducting research. Compared to earlier reviews, readers of psychiatric reports in 1996 more frequently encountered computer-dependent multivariate techniques. There were differences in the utilization and reporting of statistical procedures among the journals. The authors of psychiatric journals might apply these results in designing their psychiatric research to present intelligible and compact analysis combined with a high quality presentation technique, thus being in line with the policy and presentation of the leading psychiatric journals.
Cross-Sectional Studies↗
How should a scientific team be effectively formed and managed.
In the research process, hypotheses, observations and raw data are systematically transformed into new knowledge and scientific rules. People and human input are essential features of the research; the intellectual process performed by the individual scientists and their team. Unplanned administration and human conflicts are the major causes of unsuccessful research. In this article, some essential organizational and psychological aspects of the scientific team are described and discussed. In addition, practical guidelines on forming, working and managing a research team are presented.
Cooperative Behavior↗
Predictors of female criminality: findings from the Northern Finland 1966 birth cohort.
OBJECTIVE: Females still commit fewer criminal offenses than males, but the percentage of female offending has been increasing during the past few decades. Thus there is a need for original studies into the perinatal contribution to the etiology of female offending. METHOD: A large, prospectively collected birth cohort database of female members (N = 5,056) was available. Information on perinatal biological and psychosocial risks as well as data from the National Crime Registers up to 32 years of age were collected and analyzed by logistic regression and a chi2 automatic interaction detection (CHAID) analysis. RESULTS: The absence of the father during childhood was the strongest risk factor in predicting female criminality (odds ratio 2.5; 95% confidence interval 1.4-4.3). Furthermore, in the families in which the father was present, maternal smoking during pregnancy together with being born unwanted correlated with an increased prevalence of criminal offending significantly up to 7.2%. CONCLUSIONS: CHAID analysis proved to be a useful statistical method in predicting female adult criminality after preceding perinatal risks. It revealed that the risk factors were mainly familial, the paternal factor being the most important one in determining the probability of daughters committing criminal offenses.
Adolescent↗
Low educational performance is associated with drunk driving: a 31-year follow-up of the northern Finland 1966 birth cohort.
AIMS: We studied the relationship between drunk driving offences, school performance and adult educational achievements. METHODS: Data from the Northern Finland 1966 Birth Cohort were linked with official criminality files and National Education registers. The cohort members were studied prospectively covering the period from pregnancy to 31 years of age. Drunk driving (one to two arrests) and recidivist drunk driving (three or more arrests) were treated as outcome variables and their relation to school performance was studied by cross-tabulation and to adult educational achievements (two levels of education) by logistic regression analysis, adjusting for parental social class and psychiatric morbidity. RESULTS: Drunk drivers had a statistically significantly worse school performance compared with controls. Male cohort members who had remained at the basic educational level had an elevated risk for drunk driving [odds ratio (OR) 3.0, 95% confidence interval (CI) 2.3-3.8]. The corresponding adjusted ORs for recidivist drunk driving and female drunk driving were 8.6 (95% CI 5.1-14.4) and 7.0 (95% CI 3.3-14.8), respectively. CONCLUSIONS: These results are unlikely to be directly causal; however, educational failures seem to be part of the complex causal pathway to drunk driving and even to alcohol-related disorders.
Achievement↗