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Biomedical subjects

Mauri Marttunen

Publications and source records attributed to Mauri Marttunen.

At least 19 recordsLinked to original sources
PubMed2007

Differences in the clinical characteristics of adolescent depressive disorders.

Our objective was to analyze differences in clinical characteristics and comorbidity between different types of adolescent depressive disorders. A sample of 218 consecutive adolescent (ages 13-19 years) psychiatric outpatients with depressive disorders was interviewed for DSM-IV Axis I and Axis II diagnoses. We obtained data by interviewing the adolescents themselves and collecting additional background information from the clinical records. Lifetime age of onset for depression, current episode duration, frequency of suicidal behavior, psychosocial impairment, and the number of current comorbid psychiatric disorders varied between adolescent depressive disorder categories. The type of co-occurring disorder was mainly consistent across depressive disorders. Minor depression and dysthymia (DY) presented as milder depressions, whereas bipolar depression (BPD) and double depression [DD; i.e., DY with superimposed major depressive disorder (MDD)] appeared as especially severe conditions. Only earlier lifetime onset distinguished recurrent MDD from first-episode MDD, and newly emergent MDD appeared to be as impairing as recurrent MDD. Adolescent depressive disorder categories differ in many clinically relevant aspects, with most differences reflecting a continuum of depression severity. Identification of bipolarity and the subgroup with DD seems especially warranted. First episode MDD should be considered as severe a disorder as recurring MDD.

Adolescent↗
PubMed2006

Improvement in cognitive and psychosocial functioning and self image among adolescent inpatient suicide attempters.

BACKGROUND: Psychiatric treatment of suicidal youths is often difficult and non-compliance in treatment is a significant problem. This prospective study compared characteristics and changes in cognitive functioning, self image and psychosocial functioning among 13 to 18 year-old adolescent psychiatric inpatients with suicide attempts (n = 16) and with no suicidality (n = 39) METHODS: The two-group pre-post test prospective study design included assessments by a psychiatrist, a psychologist and medical staff members as well as self-rated measures. DSM-III-R diagnoses were assigned using the SCID and thereafter transformed to DSM-IV diagnoses. Staff members assessed psychosocial functioning using the Global Assessment Scale (GAS). Cognitive performance was assessed using the Wechsler Adult Intelligence Scale, while the Offer Self-Image Questionnaire (OSIQ) was used to assess the subjects' self-image. ANCOVA with repeated measures was used to test changes from entry to discharge among the suicide attempters and non suicidal patients. Logistic regression modeling was used to assess variables associated with an improvement of 10 points or more in the GAS score. RESULTS: Among suicide attempter patients, psychosocial functioning, cognitive performance and both the psychological self and body-image improved during treatment and their treatment compliance and outcome were as good as that of the non-suicidal patients. Suicidal ideation and hopelessness declined, and psychosocial functioning improved. Changes in verbal cognitive performance were more pronounced among the suicide attempters. Having an improved body-image associated with a higher probability of improvement in psychosocial functioning while higher GAS score at entry was associated with lower probability of functional improvement in both patient groups. CONCLUSION: These findings illustrate that a multimodal treatment program seems to improve psychosocial functioning and self-image among severely disordered suicidal adolescent inpatients. There were no changes in familial relationships, possibly indicating a need for more intensive family interventions when treating suicidal youths. Multimodal inpatient treatment including an individual therapeutic relationship seems recommendable for severely impaired psychiatric inpatients tailored to the suicidal adolescent's needs.

Adolescent↗
PubMed2006

Adolescent adjustment disorder: precipitant stressors and distress symptoms of 89 outpatients.

OBJECTIVE: Research on adolescent adjustment disorder (AD) is scarce. We characterized adolescent outpatients with AD in psychosocial background and treatment received compared with patients with other non-psychotic disorders (OND). Furthermore, we explored precipitant stressors, distress symptoms and behavioral problems among males and females with AD. METHOD: Data were collected prospectively on 290 consecutive psychiatric outpatients, aged 12-22 yrs, at a secondary care clinic in Finland. DSM-III-R diagnoses were assigned, based on all available information, at the end of treatment. RESULTS: AD was the second most common diagnosis among non-psychotic patients (31% of 290). Compared to OND-patients, those with AD were predominantly female and had less severe psychosocial impairment. In multivariate comparisons school-related stressors, problems with law and restlessness characterized males, and parental illness and internalizing symptoms females with AD. Intensity and duration of treatment of AD-patients varied widely. CONCLUSIONS: Adjustment disorder comprised a common clinical entity among adolescent outpatients. Psychiatric assessment and treatment should be individually targeted by taking into account gender-specific stressors and distress symptoms among young people with AD.

Adjustment Disorders↗
PubMed2006

Minor depression in adolescence: phenomenology and clinical correlates.

BACKGROUND: Depressions that fail to meet the diagnostic criteria for major depressive disorder (MDD) may be underdiagnosed and undertreated in adolescent population. Traditionally, they are not considered as serious conditions and the phenomenological nature and clinical correlates of these disorders are largely unknown. In the present study, we used a large, representative and age-standardized sample of adolescents to examine the phenomenology and clinical correlates of minor depression, a poorly understood condition included in the category of Depressive Disorder Not Otherwise Specified in Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revised (DSM-IV-TR). METHODS: 909 girls and 945 boys, with mean age of 14, were interviewed by professionals using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). RESULTS: Although clearly milder condition than MDD, minor depression was associated with marked suicidal thoughts, plans and attempts, recurrences and a high degree of comorbidity. At this early age, despite that 14% of adolescents under 15 had suffered from depressive conditions with severe clinical implications, most of them failing to meet the diagnostic threshold for MDD, only 1.7% had received any psychiatric treatment. 40% of depressive adolescents who had attempted suicide had no contact with mental health services. LIMITATIONS: Analyzed in a cross-sectional setting, no conclusions about long-term implications could be made. CONCLUSIONS: The results highlight the clinical and public health significance of non-MDD depressions, e.g. minor depression, which need to be more carefully identified and treated at early age.

Adolescent↗
PubMed2006

Perceived financial difficulties and maladjustment outcomes in adolescence.

BACKGROUND: Studies using traditional SES indicators in strictly adolescent populations have usually failed to find class differences in adolescent mental health. The present study aimed to find out whether there is an association between adolescent perceived financial difficulties of the family and adolescent maladjustment, and to explore the possible sex differences in this association. METHODS: School-based survey on 3278 ninth grade students (15-16 years old) in two economically well developed Finnish cities. RESULTS: One-fifth of the adolescents reported that their family had financial difficulties in the previous 12 months. Perceiving financial difficulties was significantly more common among girls than boys. Perceived financial difficulties were associated with known risk factors of poverty and with depression and harmful drinking patterns in both sexes. Adjusting for parental educational levels, parental unemployment and family structure did not change the significant association with maladjustment outcomes. Additional adjustment with comorbidity, however, levelled out the significance of the association of perceived financial difficulties and harmful drinking patterns in boys. CONCLUSION: While adolescent perception of financial difficulties is probably associated with the objective financial situation of the family it may also be an indicator of the psychological meaning attached to the situation and should thus be considered a possible risk factor for adolescent maladjustment in clinical practice.

Adolescent↗
PubMed2006

Suicidal ideation, deliberate self-harm behaviour and suicide attempts among adolescent outpatients with depressive mood disorders and comorbid axis I disorders.

OBJECTIVE: We aimed to analyse and compare prevalence and associated clinical features of suicidal ideation, self-harm behaviour with no suicidal intent and suicide attempts among adolescent outpatients with depressive mood disorders with or without comorbidity. METHOD: A sample of 218 consecutive adolescent outpatients aged 13-19 years with depressive mood disorders was interviewed using K-SADS-PL for DSM-IV Axis I diagnoses. They filled out self-report questionnaires assessing depressive and anxiety symptoms. Suicidal behaviour was assessed by K-SADS-PL suicidality items. RESULTS: Half of the subjects reported suicidal ideation or behaviour. There was no difference in prevalence of suicidal behaviour between non-comorbid and comorbid mood disorder groups. Multivariate logistic regression analyses produced the following associations: (1) suicidal ideation with self-reported depressive symptoms and poor psychosocial functioning, (2) deliberate self-harm behaviour with younger age and poor psychosocial functioning, and (3) suicide attempts with self-reported depressive symptoms and poor psychosocial functioning. CONCLUSIONS: Depressed mood disorders, whether comorbid or not, are associated with suicidal ideation and suicide attempts. Diagnostic assessment should be supplemented by self-report methods when assessing suicidal behaviour in depressed adolescents.

Adolescent↗
PubMed2006

Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders.

OBJECTIVE: To compare selected characteristics (age, sex, age of onset for depression, impairment, severity of depression, somatic comorbidity, and treatment status) of adolescents with currently comorbid and non-comorbid depression. METHOD: A sample of 218 consecutive adolescent (13-19 years) psychiatric outpatients with depressive disorders, and 200 age- and sex-matched school-attending controls were interviewed for DSM-IV Axis I and Axis II diagnoses. RESULTS: Current comorbidity, most commonly with anxiety disorders, was equally frequent (>70%) in outpatients and depressed controls. Younger age (OR 0.20; 95% CI 0.08, 0.51) and male gender (OR 0.02; 95% CI 0.09, 0.55) were associated with concurrent disruptive disorders. Current comorbidity with substance use disorders (SUD) was independent of age (OR 1.13; 95% CI 0.51, 2.49) and sex (OR 0.51; 95% CI 0.22, 1.17). Personality disorders associated with older age (OR 2.06; 95% CI 1.10, 3.86). In multivariable logistic regression analysis, impairment (GAF <or=60) was associated with current comorbidity (OR 3.13; 95% CI 1.53, 6.45), while severity of depression and lifetime age of onset for depression were not. CONCLUSIONS: Adolescent depression presents with age- and sex-dependent patterns of multiple co-occurring problem areas. While many clinical characteristics of adolescent depression are not affected by comorbidity, comorbidity associates with increased impairment.

Adolescent↗
PubMed2006

Familial risks, conduct disorder and violence: A Finnish study of 278 adolescent boys and girls.

OBJECTIVE: The aim was to investigate the impact of familial risk factors on the development of violent behaviour and conduct disorder (CD) by gender in a sample of adolescent psychiatric patients. METHODS: The study sample consisted of 278 adolescents (age 12-17) consecutively admitted to psychiatric inpatient care between April 2001 and January 2004. DSMIV psychiatric diagnoses were obtained from the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime (K-SADS-PL). RESULTS: Logistic regression analyses revealed that girls who had been physically abused at home had a 4.2-fold risk of having conduct disorder with violent behaviour (95% CI 1.4-12.2) compared to those not exposed to domestic violence. A broken primary family also increased the risk for having both violent CD (OR 7.8 95 % CI 1.7-36.4) and non-violent CD (OR 7.0 95% CI 1.5-33.5) among girls. Among boys, no statistically significant association was found between any familial risk factors and later CD. CONCLUSIONS: The results suggest that being physically abused by parents may influence the development of conduct disorder including violent behaviour among girls. This emphasizes the importance of early recognition of domestic violence. In girls, the absence of primary family seems to associate strongly with the development of CD, and should be taken into consideration by physicians and other professionals working with young people.

Conduct Disorder↗
PubMed2006

Psychometric properties of the defense style questionnaire (DSQ-40) in adolescents.

This study examined the psychometric properties of the Defense Style Questionnaire (DSQ-40) in adolescents. Internal consistency, factor structure, and discriminant and concurrent validity of the DSQ-40 were studied in 211 adolescent psychiatric outpatients aged 13 to 19 years and 199 age-matched and sex-matched controls. Principal components analysis yielded four internally consistent components: mature, neurotic, image-distorting, and immature defense styles. The outpatients reported more immature, image-distorting, and neurotic styles and less mature style than did the controls, suggesting adequate discriminant validity. As a demonstration of convergent and concurrent validity, the severity of psychiatric symptoms assessed by the General Health Questionnaire and psychosocial adjustment assessed by the Global Assessment of Functioning Scale correlated theoretically meaningfully with the different defense styles. The DSQ-40 appears to be a reliable and valid instrument for adolescents.

Adaptation, Psychological↗
PubMed2006

Good working alliance and psychotherapy are associated with positive changes in cognitive performance among adolescent psychiatric inpatients.

The effects of therapeutic relationships on the treatment outcome in 45 adolescent inpatients, aged 14 to 18 years, were assessed using the Working Alliance Inventory, the Wechsler Adult Intelligence Scale, the Global Assessment Scale, and The Offer Self-Image Questionnaire at entry and on discharge. Multivariate analysis revealed that a better quality of working alliance and a greater number of therapy sessions were significantly associated with positive change in cognitive performance during treatment.

Adolescent↗
PubMed2005

Major depressive episode and physical health in adolescents and young adults: results from a population-based interview survey.

BACKGROUND: This paper aimed to investigate associations between major depressive episode (MDE) and chronic illness, disability, self-perceived health and number of sick-days among adolescents and young adults in the general population. METHODS: The Finnish Health Care Survey 1996 was a cross-sectional nationwide epidemiological study. A random sample of 509 adolescents and 433 young adults was interviewed in 1996. DSM-III-R MDE during the past 12 months was defined using The University of Michigan Composite International Diagnostic Interview Short-Form algorithm. Data on physical health were gathered in the interview. RESULTS: In multivariable logistic regression, chronic illness [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.03, 3.05], poor self-rated health (OR 2.26; 95% CI 1.01, 5.07), more than three sick-days in the past 6 months (OR 1.72; 95% CI 1.02, 2.92) and respiratory allergies (OR 2.40; 95% CI 1.00, 5.75) were associated with MDE. Among 15- to 19-year-olds, disabling chronic illness was related to MDE (OR 2.59; 95% CI 1.06, 6.36), and thoughts of death were more prevalent in the presence of chronic illness among those with MDE [35.2% versus 65.7%; F(1,67) P = 0.024]. Migraine was associated with MDE among young adults (OR 6.18; 95% CI 1.14, 30.8). CONCLUSIONS: Symptoms of depression should be investigated among adolescents with chronic illness or frequent sick-days. The degree of reported disability should be noted. Young people with both chronic illness and depressive symptoms should be assessed for thoughts of death and possible suicidality.

Adolescent↗
PubMed2005

Psychometric properties and clinical utility of the Scale for Suicidal Ideation (SSI) in adolescents.

BACKGROUND: Accurate assessment of suicidality is of major importance in both clinical and research settings. The Scale for Suicidal Ideation (SSI) is a well-established clinician-rating scale but its suitability to adolescents has not been studied. The aim of this study was to evaluate the reliability and validity, and to test an appropriate cutoff threshold for the SSI in a depressed adolescent outpatient population and controls. METHODS: 218 adolescent psychiatric outpatient clinic patients suffering from depressive disorders and 200 age- and sex-matched school-attending controls were evaluated by the SSI for presence and severity of suicidal ideation. Internal consistency, discriminative-, concurrent-, and construct validity as well as the screening properties of the SSI were evaluated. RESULTS: Cronbach's alpha for the whole SSI was 0.95. The SSI total score differentiated patients and controls, and increased statistically significantly in classes with increasing severity of suicidality derived from the suicidality items of the K-SADS-PL diagnostic interview. Varimax-rotated principal component analysis of the SSI items yielded three theoretically coherent factors suggesting construct validity. Area under the receiver operating characteristic (ROC) curve was 0.84 for the whole sample and 0.80 for the patient sample. The optimal cutoff threshold for the SSI total score was 3/4 yielding sensitivity of 75% and specificity of 88.9% in this population. CONCLUSIONS: SSI appears to be a reliable and a valid measure of suicidal ideation for depressed adolescents.

Adolescent↗
PubMed2005

Suicidality in adjustment disorder--clinical characteristics of adolescent outpatients.

OBJECTIVE: Although a remarkable proportion of adolescents suffering from adjustment disorder (AD) are suicidal, few studies have documented the characteristics of suicidal AD patients. We examined background, psychopathology and treatment-related factors among suicidal adolescent AD outpatients. METHOD: Data on 302 consecutively referred psychiatric outpatient adolescents, aged 12-22 years, were collected. DSM-III-R diagnoses were assigned at the end of treatment based on all available data. Of the patients 89 received a diagnosis of AD, 25% of whom showed suicide attempts, suicidal threats or ideation. RESULTS: Compared with non-suicidal AD patients, suicidal AD patients were characterized by previous psychiatric treatment (OR = 6.1), poor psychosocial functioning at treatment entry (OR = 16.2), suicide as a stressor (OR = 33.3), dysphoric mood (OR = 6.9) and psychomotor restlessness (OR = 3.7). CONCLUSIONS: Common risk factors for suicidality in major psychiatric disorders characterized suicidal AD patients. Psychiatric assessment of AD patients should include careful monitoring of both symptomatology and exposure to suicide of significant others.

Adjustment Disorders↗
PubMed2005

Adolescent outpatients with depressive disorders: clinical characteristics and treatment received.

Depressive disorders constitute a common clinical problem. However, research on psychosocial impairment and treatment-related factors among adolescent outpatients with different diagnoses of depression is scarce. This study aimed at investigating consecutively referred outpatient adolescents with depressive syndrome compared with psychiatric controls. We also compared those with major depression (MDD), other depressive disorders (OD), or adjustment disorder with depressed mood (ADDM) in terms of psychosocial impairment and treatment received in a sample of 302 consecutively referred adolescent outpatients. Psychosocial impairment was most severe in MDD. Comorbidity with anxiety disorders characterized those with MDD, whereas antisocial disorders were common among those with OD. Psychosocial treatment was more intensive and psychotropic medication more prevalent in patients with MDD compared with those with OD or ADDM. All the depressed patients receiving psychotropic medication had additional psychosocial treatments. Psychosocial functioning improved in all three groups (MDD, OD, ADDM), whether their treatment involved only psychotherapeutic treatments or additional psychotropic medication. Adolescents with different diagnoses of depression have specific psychosocial impairments that have to be taken into account in developing psychiatric treatments for them.

Adolescent↗
PubMed2004

Fear of nuclear war increases the risk of common mental disorders among young adults: a five-year follow-up study.

BACKGROUND: Evidence on the relation between fear of war and mental health is insufficient. We carried out a prospective cohort study to find out whether fear of nuclear war is related to increased risk of common mental disorders. METHODS: Within two months preceding the outbreak of Persian Gulf War in January 1991, 1518 adolescents [mean age 16.8 years, SD 0.9] filled in a self-administered questionnaire. Of the 1493 respondents, 47% gave their written informed consent to participate in the follow-up study. There were no material differences between those who chose to respond anonymously and those who volunteered to give their name and address for the follow-up study. In 1995, the response to the follow-up questionnaire was 92%. Common mental disorders were assessed by 36-item version of the General Health Questionnaire [GHQ]. A score 5 or higher was considered to indicate caseness. We excluded 23 cases which had used mental health services in the year 1991 or earlier and two cases with deficient responses to GHQ. This left 626 subjects for analysis [400 women]. RESULTS: After adjusting for significant mental health risk factors in logistic regression analysis, the risk for common mental disorders was found to be significantly related to the increasing frequency of fear for nuclear war, high scores of trait anxiety and high scores of immature defense style. Elevated risk was confined to the group reporting fear of nuclear war once a week or more often [odds ratio 2.05; 95% confidence interval 1.29-3.27]. CONCLUSION: Frequent fear of nuclear war in adolescents seems to be an indicator for an increased risk for common mental disorders and deserves serious attention.

Adolescent↗
PubMed2004

Mirtazapine in the treatment of adolescents with major depression: an open-label, multicenter pilot study.

This multicenter, open-label study with a duration of 85 days was performed to evaluate the antidepressant efficacy and safety of mirtazapine (dose range, 30-45 mg) in 12-18-year-old adolescents diagnosed with major depression. Twenty-four (24) patients (15 female patients and 9 male patients) meeting the DSM-IV criteria for major depression and the Hamilton Rating Scale for Depression (HAM-D-17) score of 18 at baseline were enrolled in the study. The primary outcome measures were HAM-D-17, Beck Depression Inventory (BDI), and Clinical Global Impression (CGI) scales. Any changes in symptoms of anxiety were measured using the Hamilton Anxiety Rating Scale (HAM-A). The average age of the 23 subjects, who were eligible for analysis, was 16.3 years (standard deviation (SD) 6.11, median 17.3). The mean daily dose of mirtazapine was 32.9 mg. Mirtazapine showed a marked efficacy on all rating scales and was well tolerated. Mirtazapine had a beneficial effect on sleep. A rapid onset of sleep and pattern of action was seen. No dropouts due to adverse events were recorded. The most common treatment-emergent adverse events were tiredness, increased appetite, and dizziness. The results of this study suggest that mirtazapine may be an effective treatment for major depression in adolescents.

Adolescent↗