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Niemi-Pynttari J.A.,Helsinki City Health Center | Sund R.,Service Systems Research Unit | Putkonen H.,Hospital District of Helsinki and Uusimaa | Vorma H.,University of Helsinki | And 3 more authors.
Journal of Clinical Psychiatry | Year: 2013

Background: Despite the clinical importance of substance-induced psychosis (SIP), few studies have examined the course of this condition after its acute manifestation. Objective: To investigate the rate of SIP conversion to a schizophrenia spectrum disorder and the length of followup needed to catch the majority of these patients whose diagnoses change. In addition to the conversion rate and pattern, we wanted to look for possible related factors. Method: Using the nationwide Finnish Hospital Discharge Register, we followed all patients (N = 18,478) since their first inpatient hospital admission with a diagnosis of SIP (codes 2921 and 2928 in DSM-III-R and codes F10-F19 in ICD-10 with a third digit of 4, 5, or 7) between January 1987 and December 2003 in Finland. Patients (mean age = 43.7 years, standard deviation = 13.5 years) were followed until first occurrence of schizophrenia spectrum disorder, death, or the end of December 2003, whichever took place first. Conversions of discharge diagnoses into schizophrenia spectrum disorders (codes 2951-2959 and 2971 in DSM-III-R and codes F20, F22, and F23 in ICD-10) were recorded at follow-up. Results: Eight-year cumulative risk to receive a schizophrenia spectrum diagnosis was 46% (95% CI, 35%-57%) for persons with a diagnosis of cannabisinduced psychosis and 30% (95% CI, 14%-46%) for those with an amphetamine-induced psychosis. Although alcohol-induced psychosis was the most common type of SIP, 8-year cumulative risk for subsequent schizophrenia spectrum diagnosis was only 5.0% (95% CI, 4.6%-5.5%). No differences were detected with regard to gender, except for amphetamine-induced psychosis, which converted into a schizophrenia spectrum disorder significantly more often in men (P = .04). The majority of conversions to a schizophrenia spectrum diagnosis occurred during the first 3 years following the index treatment period, especially for cannabis-induced psychosis. Conclusion: Substance-induced psychotic disorders predict schizophrenia spectrum disorders to a greater extent than previously thought. The intensity of clinical attention focused on substance-induced psychotic disorders should be increased. © Copyright 2013 Physicians Postgraduate Press, Inc. Source

Tuuri A.L.,Hospital District of Helsinki and Uusimaa | Jauhiainen M.S.,Finnish National Institute for Health and Welfare | Tikkanen M.J.,University of Helsinki | Kaaja R.J.,University of Turku
Placenta | Year: 2014

INTRODUCTION: The insulin-sensitivity regulator adipocyte fatty acid-binding protein 4 (FABP4) integrates metabolic and inflammatory responses. We hypothesize that there is relationship between FABP4 and factors related to metabolic syndrome in pregnancy-induced hypertension (PIH).METHODS: In this prospective observational study, among the 72 relatively overweight (BMI ≥24 kg/m2) nulliparous women, 14 developed non-proteinuric PIH and 12 developed proteinuric PIH (preeclampsia), whereas 46 had normotensive pregnancies. Insulin sensitivity was assessed via the whole-body insulin sensitivity index (ISI) and the homeostatic model of assessment - insulin resistance (HOMA-IR) at 24 weeks of gestation. Maternal serum levels of FABP4, high-sensitive C-reactive protein (hs-CRP), total testosterone, and non-protein-bound calculated free testosterone (cfT) were determined at 24 and 32 weeks.RESULTS: Measures of ISI, HOMA-IR, hs-CRP, testosterone and lipids did not differ at 24 and/or at 32 weeks in women who were subsequently hypertensive. SBP was higher at all time points and FABP4 levels tended to be higher at 24 and 32 weeks in patients compared to controls. In logistic regression analysis, baseline FABP4 (OR [95% CI] 1.069 [1.020-1.121], P = 0.006) and SBP after 10 min standing (OR [95% CI] 1.087 [1.029-1.149], P = 0.003) were associated with the development of PIH. FABP4 levels at 24 weeks did not correlate with insulin sensitivity. Neither was correlation seen between FABP4 levels at 24 and 32 weeks, vs. those of hs-CRP and testosterone.DISCUSSION AND CONCLUSIONS: Serum FABP4 concentration and SBP after 10 min standing in an orthostatic test at 24 weeks are associated with subsequent development of PIH. Copyright © 2014 Elsevier Ltd. All rights reserved. Source

Torvinen S.,University of Helsinki | Torvinen S.,Glaxosmithkline | Farkkila N.,University of Helsinki | Farkkila N.,Glaxosmithkline | And 4 more authors.
Acta Oncologica | Year: 2013

Background. With new treatment options, the prognosis of prostate cancer (PCa) has improved in recent decades, and health-related quality of life (HRQoL) has become an important outcome of treatment. HRQoL scores are also essential for health economic analyses concerning treatment options for the disease. This study assesses HRQoL scores in different health states of PCa, compares the results obtained by different HRQoL instruments, compares the HRQoL of PCa patients with that of the general population, and explores factors associated with the resultant HRQoL scores. Material and methods. An observational cross-sectional study among PCa patients in the Helsinki and Uusimaa Hospital District between September 2009 and December 2010. A total of 630 PCa patients (aged 43-92) assessed their HRQoL with the generic 15D and EQ-5D, as well as the cancer-specific EORTC QLQ-C30 questionnaires. Patients were divided into five mutually exclusive groups based on disease state: Loc1 (local disease, first six months after diagnosis; n = 47), Loc2 (local disease, 0.5-1.5 years after diagnosis or recurrence; n = 158), Loc3 (local disease, more than 1.5 years after diagnosis; n = 317), Metastatic (after detection of metastases; n = 89) and Palliative care (n = 19). Multivariate analysis served to evaluate the factors associated with the HRQoL scores. Results. The utility scores were highest at baseline. Markedly impaired HRQoL was seen first at the more advanced states of the disease. All HRQoL instruments studied were consistent in all states of the disease, yet the HRQoL scores obtained varied widely. Symptoms of fatigue and pain, and background variables of financial difficulties and age were the most important factors associated with poor HRQoL. Conclusions. All instruments provided valuable insight into PCa patients' overall HRQoL. Management of cancer-related symptoms is important in maintaining patients' HRQoL, but more attention should also focus on financial difficulties. © 2013 Informa Healthcare. Source

Kontio R.,Hospital District of Helsinki and Uusimaa | Pitkanen A.,University of Tampere | Joffe G.,University of Helsinki | Katajisto J.,University of Turku | Valimaki M.,University of Turku
Nordic Journal of Psychiatry | Year: 2014

Background: The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible. Aims: The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients. Methods: In a cluster-randomized intervention trial, the nursing personnel on 10 wards were randomly assigned to eLearning (intervention) or training-as-usual (control) groups. The eLearning course comprised six modules with specific topics (legal and ethical issues, behaviour-related factors, therapeutic relationship and self-awareness, teamwork and integrating knowledge with practice) and specific learning methods. The rates (incidents per 1000 occupied bed days) and durations of the coercion incidents were examined before and after the course. Results: A total of 1283 coercion incidents (1143 seclusions [89%] and 140 incidents involving the use of mechanical restraints [11%]) were recorded on the study wards during the data collection period. On the intervention wards, there were no statistically significant changes in the rates of seclusion and mechanical restraint. However, the duration of incidents involving mechanical restraints shortened from 36.0 to 4.0 h (median) (P < 0.001). No statistically significant changes occurred on the control wards. Conclusions: After our eLearning course, the duration of incidents involving the use of mechanical restraints decreased. However, more studies are needed to ensure that the content of the course focuses on the most important factors associated with the seclusion-related elements. The eLearning course deserves further development and further studies. The duration of coercion incidents merits attention in future research. © 2014 Informa Healthcare. Source

Kaltiala-Heino R.,University of Tampere | Eronen M.,Vanha Vaasa Hospital | Putkonen H.,Hospital District of Helsinki and Uusimaa
Journal of Forensic Psychiatry and Psychology | Year: 2014

Background: Most research on violent perpetrators is based on male samples. Aims: To compare girls and boys admitted to an adolescent forensic unit due to physically violent and/or sexually coercive behavior. Methods: On an adolescent forensic ward, demographics, family, treatment, crime and victimization histories, diagnose, psychiatric symptoms and violent behaviors during care of all adolescents are collected in a cumulative database. These were compared between girls and boys admitted due to violent behaviors. Results: Girls were more often diagnosed with schizophrenia group psychoses. The symptom profiles and violence risk ratings did not differ by sex. The girls were less antisocial in general. They were more suicidal and displayed more promiscuous behaviors, and they had more commonly been victims of sexual abuse. During inpatient care they displayed much more often violent and uncontrollable behaviors than the boys. Conclusion: Treatment approaches that respond to the special needs of aggressive girls are required. © 2014 Taylor & Francis. Source

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