Vaasa, Finland
Vaasa, Finland

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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 | Putkonen H.,Vanha Vaasa Hospital | And 6 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.


Keski-Valkama A.,Vanha Vaasa Hospital | Sailas E.,Kellokoski Hospital | Eronen M.,Vanha Vaasa Hospital | Lonnqvist J.,Finnish National Institute for Health and Welfare | And 2 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2010

Background: To find interventions for reducing the use of restraint and seclusion, it is necessary to identify who the restrained and secluded patients are. The aim of the present study was to determine which demographic and clinical groups of psychiatric inpatients are at risk of being restrained/secluded, and whether there have been changes in the restrained/secluded patients' profiles over a 15-year period in Finland. Method: A structured postal survey concerning the demographic and clinical information of restrained/secluded patients was completed in all Finnish psychiatric hospitals during a predetermined week in 1990, 1991, 1994, 1998, and 2004. The National Hospital Discharge Register was used to gather information on all psychiatric inpatients during the study weeks. Results: Out of the variables studied (age, gender, main diagnosis, phase of hospital stay), only the main diagnosis and the phase of hospital stay were independent risk factors for restraint/seclusion, and remained constant over time. The age profile of the restrained/secluded patients was unstable over time and the risk of being restrained/secluded was not associated with gender. Conclusion: Restraint and seclusion is used mainly among the acute and the most disturbed patients. Therefore, in order to reduce the use of restraint and seclusion, resources should be targeted especially to these groups. © 2009 Springer-Verlag.


Ulla S.,University of Turku | Maritta V.,University of Turku | Riittakerttu K.-H.,University of Tampere | Riittakerttu K.-H.,Vanha Vaasa Hospital
Social Psychiatry and Psychiatric Epidemiology | Year: 2012

Purpose To evaluate the extent and trends in the use of seclusion/restraint in psychiatric inpatient treatment of adolescents aged 12-17 years in Finland. Methods The National Hospital Discharge Register data comprising all psychiatric inpatient treatment periods of 12- to 17 year-olds in Finland during the period 1996-2003 was used. Time trends, regional variation and patient characteristics related to the risk of being subjected to seclusion/restraint in psychiatric inpatient treatment are reported. Results The average prevalence of use of seclusion and restraint was 1.71/10,000/year over the study period. Use of seclusion/restraint in adolescent psychiatric inpatient care first increased, peaking in 1999-2001, and then decreased. The decrease occurred after stricter legislative control of use of seclusion/restraint was introduced in 2002, despite that involuntary treatment periods did not decrease. Considerable regional variation was seen in the use of seclusion/restraint. A greater proportion of girls than boys were secluded/restrained. Seclusion/restraint was most common in schizophrenia, mood disorders and conduct disorder. Conclusions Legislative control had the desired immediate impact on the use of seclusion/restraint in adolescent psychiatric inpatient care. Legislative control is, however, not strong enough to ensure homogenous practices across the country, as there is many-fold regional variation in figures for using seclusion and restraint. © Springer-Verlag 2011.


Kaltiala-Heino R.,University of Tampere | Kaltiala-Heino R.,Vanha Vaasa Hospital | 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.


Putkonen H.,Vanha Vaasa Hospital | Weizmann-Henelius G.,Vanha Vaasa Hospital | Lindberg N.,University of Helsinki | Rovamo T.,University of Helsinki | Hakkanen-Nyholm H.,University of Helsinki
Criminal Behaviour and Mental Health | Year: 2011

Background It is generally considered that women who kill are more likely to have a psychiatric disorder than their male counterparts, but as a relatively small group, women are much less often studied than men in this context. Aim To explore gender differences in the psychosocial history of homicide offenders. Method In this nationwide register-based study, data were extracted from the forensic psychiatric examination and crime reports of all 91 women prosecuted for homicide in Finland between 1995 and 2004 and from those of the next adjacent man convicted of a separate homicide (n = 91). Results Both female and male homicide offenders had a troubled childhood, but more women had witnessed or experienced family violence; more women had failed to complete their primary education. Men, however, were more likely to have had an offending history. Although there were no differences between the men and women in the frequencies of psychiatric diagnoses or of substance abuse, the women had more often received prior mental health treatment. The women were also more likely to have had a history of suicidal behaviour. Conclusions Both female and male homicide offenders are a troubled group of people, with slightly different criminal careers. Many use mental health services and therefore prevention could be improved. The suggestion of a special sub-group of women characterised by early educational and behavioural difficulties needs replication, as it may have implications for service development. © 2010 John Wiley & Sons, Ltd.


Kaltiala-Heino R.,University of Tampere | Eronen M.,Vanha Vaasa Hospital
Journal of Forensic Psychiatry and Psychology | Year: 2015

Ethical challenges in child and adolescent forensic psychiatry arise, on the one hand, from the dilemmas commonly faced in forensic psychiatry with adult patients, such as the dual role of the forensic psychiatrist, questions of criminal responsibility, autonomy and competence and involuntary treatment, and, on the other, from the immaturity and dependent position of the minor. Child and adolescent forensic psychiatry deals with minors involved in crime, not only as offenders, but also as victims. In this review, we attempt to describe ethical challenges in child and adolescent psychiatry using as a frame of reference the principles of biomedical ethics according to Beauchamp and Childress. © 2015 Taylor & Francis.


Keski-Valkama A.,Vanha Vaasa Hospital | Koivisto A.-M.,University of Tampere | Eronen M.,Vanha Vaasa Hospital | Kaltiala-Heino R.,University of Tampere
Journal of Forensic Psychiatry and Psychology | Year: 2010

The aim of this study was to compare the views of secluded patients in a forensic setting with the views of those in a general psychiatric setting. Subjects numbered 106 secluded patients, in the two forensic psychiatric hospitals and in the general psychiatric in-patient units of two hospital districts in Finland during a one-year recruitment period. The subjects were interviewed shortly after seclusion and re-interviewed half a year later. Regardless of more frequent and longer-term use of seclusion in the forensic group, the only difference between the two groups was that the forensic patients viewed seclusion as a form of punishment more frequently. Most of the subjects knew the reason for their seclusion, they were dissatisfied with interaction opportunities during seclusion and their opinions of seclusion as a negative experience and punishment did not change during the follow-up. Furthermore, the subjects suggested many practical improvements on the present use of seclusion. Though seclusion may not always be avoidable, its application could be done in a more therapeutic manner. © 2010 Taylor & Francis.


Gammelgard M.,Vanha Vaasa Hospital | Weizmann-Henelius G.,Vanha Vaasa Hospital | Koivisto A.-M.,University of Tampere | Eronen M.,Vanha Vaasa Hospital | Kaltiala-Heino R.,University of Tampere
Journal of Forensic Psychiatry and Psychology | Year: 2012

By contributing to the discussion concerning applicability of methods for assessing risk of violence to special groups, we studied the gender differences in violence risk profiles in 231 institutionalised adolescents. Initially, subjects were assessed for risk of violent behaviour according to the Structured Assessment of Violence Risk in Youth (SAVRY). Six months later, information regarding institutional violence was collected. Risk profiles showed that boys in general had more high-risk ratings on items regarding criminal conduct, problem-solving and ADHD, whereas girls peaked on self-destructive behaviours. The significant differences were levelled out when focusing only on youth with a SAVRY summary risk rating indicating high risk for violent behaviour. Gender interaction analysis further implied that girls' risk items were strongly connected to past violent behaviour and lifetime stress, whereas violent outcome in boys was more strongly connected to anti-social behaviours. These findings should be considered especially when estimating violence risk in young females. © 2012 Taylor and Francis Group, LLC.


Seppanen A.,Vanha Vaasa Hospital
Clinical and Developmental Immunology | Year: 2013

Collagen XVII is a nonfibril-forming transmembrane collagen, which functions as both a matrix protein and a cell-surface receptor. It is particularly copious in the skin, where it is known to be a structural component of hemidesmosomes. In addition, collagen XVII has been found to be present in the central nervous system, thus offering an explanation for the statistical association between bullous pemphigoid, in which autoimmunity is directed against dermal collagen XVII, and neurological diseases. In support of the hypothesis that collagen XVII serves as a shared antigen mediating an immune response between skin and brain, research on animal and human tissue, as well as numerous epidemiological and case studies, is presented. © 2013 Allan Seppänen.


Laakso M.P.,Kuopio University Hospital | Laakso M.P.,Vanha Vaasa Hospital | Laakso M.P.,Mikko Laakso Niuvanniemi Hospital | Jukarainen N.M.,University of Eastern Finland | Vepsalainen J.,University of Eastern Finland
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2015

Objective: To test whether the information obtained from cerebrospinal fluid (CSF) and analysed with highfield proton (1H) MR spectroscopy (MRS) would help the diagnosis of most common forms of dementia. Setting: A total of 31 metabolites from CSF from 222 controls and patients suffering from various dementias (Alzheimer's disease (AD), vascular dementia, Lewy body disease (LBD) and frontotemporal dementia (FTD)) were quantified using 1H MRS. Main outcome measure: Clinical diagnosis. Results: AD was classified with an accuracy of 85.5%. For a group of very early stage patients with AD, the result was significantly higher, 92.3%. Vascular dementia, LBD and FTD were all diagnosed with 100% accuracy in controls and from AD with an accuracy ranging between 85.5% and 93.4%. Conclusions: The results indicate that the composition of CSF contains enough information of the neurological state of a given patient with a given dementia to be diagnosed with extremely high accuracy. This approach might provide potentially a very powerful diagnostic tool to help the diagnostic process of dementias.

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