Factors contributing to readmission in patients with psychotic disorders, with a special reference to first follow-up visit in outpatient care.

BACKGROUND: Timely outpatient follow-up and readmission after discharge are common quality indicators in psychiatric care, but their association varies in previous research. We aimed to examine whether the impact of outpatient follow-up and other factors on readmission risk evolves over time in people with non-affective psychotic disorder (NAP). METHODS: The Finnish Quality of Care Register includes all people diagnosed with NAP since January 2010. Here, we followed patients with a hospital discharge between 2017 and 2021 until readmission, death, or up to 365 days. Time of the first outpatient follow-up appointment, length of stay (LOS), number of previous hospitalizations, psychosis diagnosis, substance use disorder (SUD), residential status, economic activity, gender, age, year, and region were included. Follow-up time was divided into five periods: week 1, weeks 2-4, weeks 5-13, weeks 14-25, and weeks 26-52, and each period was analyzed separately with Cox regression. RESULTS: Of the 29 858 discharged individuals, 54.1% had an outpatient follow-up within a week. A total of 10 623 (35.6%) individuals were readmitted. Short LOS increased the readmission risk in the first four weeks, whereas lack of outpatient follow-up raised the risk (adjusted HRs between 1.15 (95% CI 1.04-1.26) and 1.53 (1.37-1.71) in weeks 5-52. The number of previous hospitalizations remained a consistent risk factor throughout the follow-up, while SUD increased risk after 4 weeks and living without family after 13 weeks. CONCLUSIONS: Risk factors of readmission vary over time. These temporal patterns must be considered when developing outpatient treatment programs.

The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment.

Comparing mental health systems across countries is difficult because of the lack of an agreed upon terminology covering services and related financing issues. Within the European Union project REFINEMENT, international mental health care experts applied an innovative mixed "top-down" and "bottom-up" approach following a multistep design thinking strategy to compile a glossary on mental health systems, using local services as pilots. The final REFINEMENT glossary consisted of 432 terms related to service provision, service utilisation, quality of care and financing. The aim of this study was to describe the iterative process and methodology of developing this glossary.

Psychoactive substance use in specialized psychiatric care patients.

Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.

Enhancing identification of nonaffective psychosis in register-based studies.

The Finnish Quality of Psychosis Care Register assesses nonaffective psychosis (NAP) care, acknowledging treatment outside specialized psychiatric services. This approach, while providing a holistic view, raises concerns about diagnostic inaccuracies. Here, we studied situations where the register-based diagnosis might be inaccurate, and whether the first episode can be reliably identified using a 14-year wash-out period. People with first register-based NAP (ICD-10 F20-F29) between years 2010 and 2018 and without NAP diagnoses in 1996-2009 were identified from the Care Register for Health Care. A diagnosis of NAP was deemed unreliable before age 7, when dementia preceded NAP diagnosis, and when a NAP diagnosis had been assigned at admission or during psychiatric hospitalization but was not confirmed by discharge diagnosis. Despite a 14-year follow-back the first register diagnosis may miss the first treatment episode in older patients. Register-based studies on psychotic disorders should pay attention to exclusion criteria and to the definition of treatment onset.

Development of sense of coherence during two group interventions.

Burnout is a serious occupational hazard. This study investigated the possibility to develop an effective salutogenic group intervention among employees suffering from severe burnout symptoms. Participants consisted of employees aged 31 to 59 years working in different public service occupations, such as police officers, tax officers, (and other public service officers), and assigned to three different groups: analytic (N = 25), psychodramatic (N = 24) and controls (N = 28). The intervention comprised 16 separate days over a nine-month period. Changes in sense of coherence (SOC) were measured four times with the 13-item Orientation to Life Questionnaire during the intervention and at six-month follow-up, and analyzed by general linear model (GLM) and using Cohen's d to estimate effect sizes. Change in SOC between the three groups was statistically significant (F(4,148) = 2.65, p = 0.036). The psychodrama group showed a higher increase in SOC than the analytic group during the intervention, while the improvement in the analytic group was significant during the six-month follow-up. Total effect size from baseline to follow-up was in the analytic group 0.71, in the psychodrama group 0.47, and in the control group from baseline to end of intervention 0.09. The results show that it is possible to improve SOC by group intervention in the occupational healthcare context. The dialogue-based analytic method and action-based psychodramatic method differ in their specific effects.

The interaction of emotion and pain in the insula and secondary somatosensory cortex.

Pain is processed in a large neural network that partially overlaps structures involved in emotion processing. Despite the fact that pain and emotion are known to share neural regions and interact in numerous clinical conditions, relatively little is known about the interaction of pain and emotion at the neural level. This study on healthy adults aimed to investigate the interaction between negative and positive emotional stimuli and experimental pain in an essential pain processing network. Sixteen healthy young adult subjects were exposed to pictures from the International Affective Picture System (IAPS) with negative, neutral or positive valence, along with laser pain stimuli. The stimuli were pseudo-randomly arranged in three 15-min experiment series comprising 49 stimuli each (picture, laser or simultaneous picture and laser stimuli). The whole-brain blood-oxygen-level-dependent (BOLD) signal was acquired using 3T functional magnetic resonance imaging (fMRI). As expected, the pain stimulus elicited activation in the secondary somatosensory cortex (SII), insula and anterior cingulate cortex (ACC) when compared to the baseline. The interaction of negative emotion and laser stimuli related to the activation of the left SII. The interaction of positive emotion and pain stimuli led to bilateral activation of the SII and left insula. These findings reveal interaction in parts of the pain processing network during simultaneous emotion and physical pain. We demonstrated a valence-independent interaction of emotion and pain in SII.

Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders.

BACKGROUND: Co-occurring borderline personality disorder (BPD) features have a marked impact on treatment of patients with mood disorders. Overall, high neuroticism, childhood traumatic experiences (TEs) and insecure attachment are plausible aetiological factors for BPD. However, their relationship with BPD features specifically among patients with mood disorders remains unclear. We investigated these relationships among unipolar and bipolar mood disorder patients. METHODS: As part of the Helsinki University Psychiatric Consortium study, the McLean Screening Instrument (MSI), the Experiences in Close Relationships-Revised (ECR-R), the Short Five (S5) and the Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n=282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, and multivariate regression (MRA) and mediation analyses were conducted. RESULTS: Spearman's correlations were strong (rho=0.58; p<0.001) between total scores of MSI and S5 Neuroticism and moderate (rho=0.42; p<0.001) between MSI and TADS as well as between MSI and ECR-R Attachment Anxiety. In MRA, young age, S5 Neuroticism and TADS predicted scores of MSI (p<0.001). ECR-R Attachment Anxiety mediated 33% (CI=17-53%) of the relationships between TADS and MSI. LIMITATIONS: Cross-sectional questionnaire study. CONCLUSIONS: We found moderately strong correlations between self-reported BPD features and concurrent high neuroticism, reported childhood traumatic experiences and Attachment Anxiety also among patients with mood disorders. Independent predictors for BPD features include young age, frequency of childhood traumatic experiences and high neuroticism. Insecure attachment may partially mediate the relationship between childhood traumatic experiences and borderline features among mood disorder patients.

Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders.

BACKGROUND: Substantial literature exists on risk factors for suicidal behaviour. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear. METHODS: The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behaviour, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated. RESULTS: Overall, 21.6% patients had no lifetime suicidal behaviour, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behaviour was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse. LIMITATIONS: Cross-sectional and retrospective study design, utilization of clinical diagnoses, and relatively low response rate. CONCLUSIONS: Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters.

Regression analysis utilizing subjective evaluation of emotional experience in PET studies on emotions.

A methodological study on subject-specific regression analysis (SSRA) exploring the correlation between the neural response and the subjective evaluation of emotional experience in eleven healthy females is presented. The target emotions, i.e., amusement and sadness, were induced using validated film clips, regional cerebral blood flow (rCBF) was measured using positron emission tomography (PET), and the subjective intensity of the emotional experience during the PET scanning was measured using a category ratio (CR-10) scale. Reliability analysis of the rating data indicated that the subjects rated the intensity of their emotional experience fairly consistently on the CR-10 scale (Cronbach alphas 0.70-0.97). A two-phase random-effects analysis was performed to ensure the generalizability and inter-study comparability of the SSRA results. Random-effects SSRAs using Statistical non-Parametric Mapping 99 (SnPM99) showed that rCBF correlated with the self-rated intensity of the emotional experience mainly in the brain regions that were identified in the random-effects subtraction analyses using the same imaging data. Our results give preliminary evidence of a linear association between the neural responses related to amusement and sadness and the self-evaluated intensity of the emotional experience in several regions involved in the emotional response. SSRA utilizing subjective evaluation of emotional experience turned out a feasible and promising method of analysis. It allows versatile exploration of the neurobiology of emotions and the neural correlates of actual and individual emotional experience. Thus, SSRA might be able to catch the idiosyncratic aspects of the emotional response better than traditional subtraction analysis.

Cortical activation in alexithymia as a response to emotional stimuli.

BACKGROUND: Alexithymia has been shown to be related to many psychiatric and somatic illnesses. Aberrant emotion processing in the brain may underlie several psychiatric disorders. However, little is known about the neurobiological underpinnings of alexithymia. AIMS: To determine the way in which the brain processes emotion in alexithymia. METHOD: The participants were 10 healthy women with alexithymia and 11 healthy women without this condition, recruited into the study on the basis of their scores on the 20-item Toronto Alexithymia Scale. Four films were projected on a video screen to induce each of three emotional conditions (neutral, amusement, sadness). The brain areas activated during emotional stimuli in the alexithymia group were compared with those activated in the non-alexithymia group. Scans of the distribution of [(15)O]H(2)O were acquired using a positron emission tomography (PET) scanner operated in three-dimensional mode. RESULTS: In response to emotional stimuli participants with alexithymia activated more parts of their sensory and motor cortices and insula, especially on the left side, and less of their anterior cingulate, compared with the control group. CONCLUSIONS: Women with alexithymia seem to over-activate their 'bodily' brain regions, implying a different mode of emotion processing. This may be related to their tendency to experience physical symptoms.

Experiencing positive affect and negative affect during stress: relationships to cardiac reactivity and to facial expressions.

We examined the relationship between experienced positive/negative affect and cardiac reactivity and facial muscle movements during laboratory tasks with different demands. Heart rate, respiratory sinus arrhythmia, pre-ejection period, and facial electromyography were measured during startle, mental arithmetic, reaction time task, and speech task. The results revealed that individuals experiencing high levels of positive affect exhibited more pronounced parasympathetic, heart rate, and orbicularis oculi reactivity than others. Individuals who experienced high levels of negative affects during the tasks showed higher corrugator supercilii responses. Men and women showed slightly different response patterns. To conclude, cardiac reactivity may be associated with positive involvement and enthusiasm in some situations and all reactivity should not automatically be considered as potentially pathological.