Clinicians' experiences on patients' demands and shared decision making in Finnish specialized mental health care.

PURPOSE: Psychiatric patients' awareness of treatments options and their possibilities to influence their care has increased. For the clinicians, the management of evidence-based care, as well as organizational and resource aspects, set different goals for the clinical encounter. In this article we are focusing on the clinicians' experiences and ask: How do the clinicians view situations in which there is a conflict between patients' individual needs and goals and other aspects in decision-making? MATERIALS AND METHODS: We implemented a qualitative study of 13 thematic semi-structured interviews with clinicians working in psychiatry. We used discourse analysis to investigate how the clinician view the doctor-patient interaction. RESULTS: We identified three discources which were termed the medical standpoint, the psychodynamic standpoint and the standpoint of the patient's experience. CONCLUSIONS: In their talk, the clinicians use the three discources to make sense of the diverse expectations from both the patient and the mental health care system. The three discources also reflect different aspects in psychiatric treatment cultures, such as evidence-based medicine, the ideal of patient-centeredness, therapeutic interaction and organizational requirements.

Early childhood and adolescent risk factors for psychotic depression in a general population birth cohort sample.

BACKGROUND AND PURPOSE: In the group of severe mental disorders, psychotic depression (PD) is essentially under-researched. Knowledge about the risk factors is scarce and this applies especially to early risk factors. Our aim was to study early childhood and adolescent risk factors of PD in a representative birth cohort sample with a follow-up of up to 50 years. METHODS: The study was carried out using the Northern Finland Birth Cohort 1966 (NFBC 1966). We used non-psychotic depression (NPD) (n = 746), schizophrenia (SZ) (n = 195), psychotic bipolar disorder (PBD) (n = 27), other psychoses (PNOS) (n = 136) and healthy controls (HC) (n = 8200) as comparison groups for PD (n = 58). We analysed several potential early risk factors from time of birth until the age of 16 years. RESULTS: The main finding was that parents' psychiatric illness [HR 3.59 (1.84-7.04)] was a risk factor and a high sports grade in school was a protective factor [HR 0.29 (0.11-0.73)] for PD also after adjusting for covariates in the multivariate Cox regression model. Parental psychotic illness was an especially strong risk factor for PD. The PD subjects had a parent with psychiatric illness significantly more often (p < 0.05) than NPD subjects. Differences between PD and other disorder groups were otherwise small. CONCLUSIONS: A low sports grade in school may be a risk factor for PD. Psychiatric illnesses, especially psychoses, are common in the parents of PD subjects. A surprisingly low number of statistically significant risk factors may have resulted from the size of the PD sample and the underlying heterogeneity of the etiology of PD.

Awareness of hypertension and depressive symptoms: a cross-sectional study in a primary care population.

OBJECTIVE: To investigate the association of hypertension awareness and depressive symptoms, and to analyse factors predisposing aware hypertensives to depressive symptoms. DESIGN: Cross-sectional study in a primary care population. SETTING: Cardiovascular risk factor survey in two semi-rural towns in Finland. SUBJECTS: Two thousand six hundred seventy-six middle-aged risk persons without an established cardiovascular or renal disease or type 2 diabetes. MAIN OUTCOME MEASURES: Depressive symptoms, previous and new diagnosis of hypertension. RESULTS: Hypertension was diagnosed in 47.9% of the subjects, of whom 34.5% (442/1 282) had previously undetected hypertension. Depressive symptoms were reported by 14% of the subjects previously aware of their hypertension, and by 9% of both unaware hypertensives and normotensive subjects. In the logistic regression analysis, both the normotensive (OR 0.62, 95% CI 0.45-0.86) (p = 0.0038) and the unaware hypertensive subjects (OR 0.54, 95% CI 0.35-0.84) (p = 0.0067) had lower risk for depressive symptoms than the previously diagnosed hypertensives. Among these aware hypertensives, female gender (OR 3.61, 95% CI 2.06-6.32), harmful alcohol use (OR 2.55, 95% CI 1.40-4.64) and obesity (OR 2.50, 95% CI 1.01-6.21) predicted depressive symptoms. Non-smoking (OR 0.57, 95% Cl 0.33-0.99) and moderate leisure-time physical activity compared to low (OR 0.53, 95% CI 0.33-0.84) seemed to buffer against depressive symptoms. CONCLUSION: Depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle associated factors may contribute to the association of hypertension and depressive symptoms. Key Points Hypertension and depressive symptoms are known to form a toxic combination contributing even to all-cause mortality. Comorbidities or the labelling effect of the diagnosis of hypertension can confound their association. Our study shows that depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle-associated factors may contribute to the association of hypertension and depressive symptoms. When treating hypertensive patients, consideration of depressive symptoms is important in order to promote favorable lifestyle and control of hypertension.

Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Randomized Clinical Feasibility Study.

BACKGROUND: Traumatic brain injury (TBI) is a major health problem that often requires intensive and long-term rehabilitation. OBJECTIVE: The aim of this study was to determine whether rehabilitative digital gaming facilitates cognitive functioning and general well-being in people with TBI. METHODS: A total of 90 Finnish-speaking adults with TBI (18-65 years) were recruited from an outpatient neuroscience clinic. The participants were randomly allocated to one of the three groups: a rehabilitation gaming group (n=29, intervention), an entertainment gaming group (n=29, active control), or a passive control group (n=32). The gaming groups were instructed to engage in gaming for a minimum of 30 min per day for 8 weeks. Primary and secondary outcomes were measured at three time points: before the intervention, after the intervention, and 3 months following the intervention. The primary outcome was cognitive status measured by processing speed and visuomotor tasks (The Trail Making Test; Wechsler Adult Intelligence Scale-Fourth Edition, WAIS-IV, symbol search, coding, and cancellation tasks). Secondary outcomes were attention and executive functions (Simon task), working memory (WAIS-IV digit span and Paced Auditory Serial Addition Test, PASAT), depression (Patient Health Questionnaire-9), self-efficacy (General Self-efficacy Scale), and executive functions (Behavior Rating Inventory of Executive Function-Adult Version). Feasibility information was assessed (acceptability, measurement instruments filled, dropouts, adherence, usability, satisfaction, and possible future use). Cognitive measurements were conducted in face-to-face interviews by trained psychologists, and questionnaires were self-administered. RESULTS: The effects of rehabilitation gaming did not significantly differ from the effects of entertainment gaming or being in a passive control group. For primary outcomes and PASAT tests, the participants in all three groups showed overall improvement in test scores across the three measurement points. However, depression scores increased significantly between baseline and after 8 weeks and between baseline and after 3 months in the rehabilitative gaming group. No differences were found in patients' self-efficacy between the three measuring points in any of the groups. Participants did use the games (rehabilitation group: 93%, 27/29; entertainment group 100%, 29/29). Games were seen as a usable intervention (rehabilitation group: 70%, 14/29; entertainment group: 83%, 20/29). The rehabilitation group was less satisfied with the gaming intervention (68%, 13/29 vs 83%, 20/29), but they were more willing to use the game after the intervention period (76%, 16/29 vs 63%, 15/29). Total time spent on gaming during the intervention period was low (15.22 hour rehabilitation gaming group, 19.22 hour entertainment gaming group). CONCLUSIONS: We did not find differences between the groups in improvement in the outcome measures. The improvements in test performance by all three groups may reflect rehearsal effects. Entertainment gaming had elements that could be considered when rehabilitative games are designed for, implemented in, and assessed in larger clinical trials for persons with TBI. TRIAL REGISTRATION: ClinicalTrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH).

Maternal Smoking During Pregnancy and the Risk of Psychiatric Morbidity in Singleton Sibling Pairs.

INTRODUCTION: Maternal smoking during pregnancy has been associated with an increased risk for psychiatric morbidity. We further studied this with Finnish siblings to control for genetic/familial factors. METHODS: From the Finnish Medical Birth Register, sibling pairs were selected as the first two children born 1987-1995 to the same mother (n = 150 168 pairs), along with information on maternal smoking (no smoking/smoking). Information on the children's psychiatric diagnoses related to outpatient care visits (1998-2013) and inpatient care (1987-2013), and the mothers' psychiatric morbidity (1969-2013) was derived from the Finnish Hospital Discharge Register. The first pair analysis compared siblings of mothers who only smoked in the first pregnancy (Quitters, 4.7%) and mothers who smoked in both pregnancies (Smokers, 9.6%); the second analysis included mothers who smoked only in the second pregnancy (Starters, 3.3%) and mothers who did not smoke in either pregnancy (Nonsmokers, 77.5%). Smoking information was missing for 5.0% of pairs. Psychiatric morbidity of the siblings and mother was included in the statistical analyses. RESULTS: The risk of psychiatric diagnoses was significantly lower for the second child of quitters (adjusted OR 0.77, 95% CI 0.72-0.83) compared to the risk among smokers. A higher risk for psychiatric diagnoses was found for the second child of starters (1.39, 1.30-1.49) compared to the risk among nonsmokers. The effect of smoking was more robust for externalizing diagnoses. CONCLUSIONS: Maternal smoking was independently associated with a higher risk for psychiatric morbidity in children, even when controlling thoroughly for genetic and familial factors. IMPLICATIONS: Maternal smoking during pregnancy has an independent effect on the risk of psychiatric morbidity in children, even after controlling for non-measurable genetic/familial factors by using a sibling pair design. The effect of maternal smoking was robust for externalizing diagnoses. Maternal smoking during pregnancy had an effect on diagnoses both in outpatient and inpatient care.

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders.

BACKGROUND: Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. METHODS: The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). RESULTS: The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant. CONCLUSIONS: An elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders.

Health mind in a health brain.

The last few years have seen an increase in the research of psychic well-being and positive mental health. A positive point of view refers not only to pleasure but also to the ability to act in a constructive manner in challenging situations, and effectively regulate negative feelings and stress. Although a positive state of mind is often a passing experience, it can also be developed. Analogously, effective methods tested in a controlled manner have been established for the development of positive capabilities. It is furthermore possible to promote psychic well-being through exercise, healthy diet and practicing mindfulness.

Catatonia.

Catatonia is associated with psychomotor symptoms and severe disturbances of executive functioning. While the prognosis is good in most cases, malignant catatonia still continues to occur. The first-line choice for drug therapy is lorazepam, which usually results in a good response. In catatonic stupor, i.e. immobility and stupor, the first-line therapy is electrotherapy, preferably at an earliest possible stage. In mania, catatonia may become manifest also as psychomotor excitement. Electrotherapy can be used primarily in malignant catatonia, with dantrolene and bromocriptin also finding use in a critical situation.

Smoking during pregnancy affects foetal brain development.

UNLABELLED: Environmental factors such as maternal smoking can significantly modulate genetically programmed brain development during foetal life. This review looks at how prenatal smoking exposure modulates brain development, including new evidence on the effects of smoking on foetal brain development and function. CONCLUSION: Smoking during pregnancy exposes the foetus to thousands of health-threatening chemicals, restricting foetal body and head growth. Alterations in brain structure and function have been seen in children exposed to prenatal smoking.

[Update on Current Care Guideline: Borderline personality disorder]. / Epävakaa persoonallisuus.

Borderline personality disorder is a severe disorder that increases disability to a considerable extent. Emotional instability, difficulties in regulating behavior and interpersonal relationships are essential features of the disorder. Borderline personality disorder has a more favorable course than previously thought. Dialectic behavioral therapy, cognitive therapy, mentalization therapy and transference-focused psychotherapy seem to be effective. Hospital treatment should be carried out primarily in day hospital settings. Antipsychotics and mood stabilizers may be used for a range of symptoms. SSRIs may be useful in the treatment of impulsivity and aggression. Benzodiazepines should be avoided.

Methodological and ethical challenges in studying patients' perceptions of coercion: a systematic mixed studies review.

BACKGROUND: Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients' perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay. METHODS: Systematic mixed studies review was the study method. Studies reporting patients' perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out. RESULTS: Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient's refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22). CONCLUSIONS: The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants' informed consent and respecting ethical procedures.

Association of stigma resistance with emotion regulation - functional magnetic resonance imaging and neuropsychological findings.

BACKGROUND: [corrected] Personal characteristics contribute to whether negative attitudes in society are internalized as deteriorating self-stigma. Studies in healthy subjects suggest that resilience is associated with the regulation of amygdala activation by the medial prefrontal cortex (mPFC), but little is known about the factors that contribute to individual stigma resistance in psychiatric patients. METHODS: We assessed stigma (by measuring association strengths between social inferiority and schizophrenia by an implicit association test) in 20 patients with schizophrenia and in 16 age- and sex-matched healthy control subjects. The brain activation strengths were measured by functional magnetic resonance imaging during evaluation of schizophrenia-related statements and of control statements. RESULTS: Association strengths between social inferiority and schizophrenia were inversely related to the strength of the activation of the rostro-ventral mPFC. This inverse correlation survived adjustment for global functioning, depression symptom scores, and insight. Activation of the rostro-ventral mPFC was negatively correlated with activation of the amygdala. The association strengths between social inferiority and schizophrenia correlated with the compromised performance in a Stroop task, which is a measure of cognitive regulation. DISCUSSION: Our findings suggest that individual stigma resistance is associated with emotion regulation. These findings may help to understand better stigma resistance and thereby aid the development of patient interventions that add to the public anti-stigma work in reducing devastating effects of stigma.

Trends and risk groups for smoking during pregnancy in Finland and other Nordic countries.

BACKGROUND: Reductions in maternal smoking can prevent pregnancy complications and adverse effects to foetus. Our objective was to study how the prevalence of maternal smoking differs between Nordic countries, and to identify target groups for smoking-cessation interventions. METHODS: Information on maternal smoking and background factors was requested from the Nordic countries (the Danish National Board of Health, the Finnish National Institute for Health and Welfare, the Public Health Institute in Iceland, the Norwegian Institute of Public Health and the Swedish National Board of Health and Welfare). Data on maternal smoking were received from 1991 to 2010 in Denmark, 1987 to 2010 in Finland, 1999 to 2009 in Norway and 1983 to 2008 in Sweden. Trends in smoking were studied by using test for relative proportion. RESULTS: The prevalence of maternal smoking in early pregnancy has declined in the countries during the past 20 years (Denmark: from 30.6 to 12.5%; Norway: 20.6 to 16.5% and Sweden: 31.4 to 6.9%), except in Finland (a steady prevalence at 15%). The highest rates of smoking in early pregnancy were among teenagers (24% in Sweden and 49% in Finland and Norway). Single women were 2-3 times more likely to smoke than married women. The women in the lowest socioeconomic group were 6-7 times more likely to smoke than women in the highest group in Finland and Norway. CONCLUSION: Maternal smoking and its trends differed between the Nordic countries. The highest smoking rates during pregnancy were observed among teenagers, single women and women with a low socioeconomic position.

Can social support alleviate inflammation associated with childhood adversities?

OBJECTIVE: Childhood adversities have been linked to elevated high-sensitivity C-reactive protein (hsCRP), which has been associated with increased morbidity. Low social support has been reported to worsen the prognosis in heart disease and cancer, and high social support has been linked to lower hsCRP. We hypothesized that social support could be a mediating factor between childhood adversities and hsCRP. METHODS: The sample was drawn from the data of the nationwide Health and Social Support Study (HeSSup Study) to which 25,898 Finns had responded in 1998. The cohort was stratified into groups of high and low social support, and the study group consisted of 100 women in both groups. Additionally, we invited a randomly drawn group of 50 subjects and a group of 62 women who had reported depressive symptoms. Of the 312 women, 116 participated in the study. RESULTS: Social support score (Social Support Questionnaire, SSQ) was lower when the number of adverse experiences in childhood was high (r = - 0.251, P = 0.007). hsCRP and SSQ were inversely associated (r = - 0.188, P = 0.046). In the adjusted general linear model, the level of social support was significantly associated with hsCRP and there was a statistically significant interactive effect of small effect size of childhood adversities and the level of social support on hsCRP (ES = 0.123, P = 0.004). CONCLUSION: This finding suggests that childhood adversity may affect social relationships and that high social support may attenuate the health risks caused by childhood adverse experience.

[Investments of research and treatment of brain diseases will pay of time]. / Aivosairaudet ovat kalleimmat kansantautimme.

In 2010, a quarter of direct healthcare cost in Europe were spent on brain diseases. The importance of preventing and treating brain diseases and maintaining of functional capacity of the brain will increase in our society with ageing population and with increasing cognitive requirements of modern working life. Public funding of basic and clinical neuroscience has, however, frozen to levels achieved years ago, clinical research of brain diseases being at a particular risk. Research projects directed to prevention, treatment, and rehabilitation of brain diseases will pay off, also when assessed by economic measures.

[Internet addiction]. / Internetriippuvuus--milloin haitalliseen käyttöön pitää puuttua?

Internet addiction is defined as uncontrolled and harmful use of Internet, which manifests in three forms: gaming, various sexual activities and excessive use of emails, chats or SMS messaging. Several studies have found that abuse of alcohol and other substances, depression and other health problems are associated with Internet addiction. In boys and men depression may be more a consequence of the addiction than a cause for it. ADHD seems to be a significant background factor for developing the condition. Because it is almost impossible to lead a life without Internet and computers nowadays, it is unrealistic to aim towards full abstinence. Treatment has generally followed the guidelines adapted for pathological gambling.

Effects of gender and psychiatric comorbidity on the age of illness onset and the outcome of psychotic depression-A birth cohort study.

BACKGROUND: Psychotic depression (PD) is an under-researched disorder with severe symptoms and course of illness. Little is known about gender differences relating to this condition and possible variation of prognosis based on comorbid pathology. Our aim was to analyze the effects of gender and psychiatric comorbidities on the age of illness onset and on the outcome of psychotic depression. METHODS: The study was carried out in the Northern Finland Birth Cohort 1966. We utilized register data to acquire information about lifetime psychiatric diagnoses, hospitalization, age of illness onset, rate of disability pensions and mortality. The PD group (n = 58) was defined based on a lifetime register diagnosis. We compared outcome variables in sub-groups based on gender and comorbid alcohol use or personality disorder. RESULTS: The prevalence of comorbid personality disorders was 38% (22/58) and comorbid alcohol use disorders 41% (24/58). PD patients with a personality disorder diagnosis had an earlier onset age (p<0.01) and a higher mortality rate (p = 0.03). Male gender (p = 0.03), comorbid alcohol use disorder (p<0.01) and personality disorder (p < 0.01) were all associated with more psychiatric hospitalization. Comorbid alcohol use disorder was more common among men (males: 61%; females: 29%; p = 0.03). LIMITATIONS: National registers were the main source of diagnostic information. CONCLUSIONS: Gender and psychiatric comorbidity have significant implications for the course of illness in PD in naturalistic settings, which is an important message for all clinicians. More research into the heterogeneity of PD is needed in order to guide research and clinical practice.

Impaired long-term outcomes of patients with schizophrenia spectrum disorder after coronary artery bypass surgery: nationwide case-control study.

BACKGROUND: Patients with schizophrenia spectrum disorder have increased risk of coronary artery disease. AIMS: To investigate long-term outcomes of patients with schizophrenia spectrum disorder and coronary artery disease after coronary artery bypass grafting surgery (CABG). METHOD: Data from patients with schizophrenia spectrum disorder (n = 126) were retrospectively compared with propensity-matched (1:20) control patients without schizophrenia spectrum disorder (n = 2520) in a multicentre study in Finland. All patients were treated with CABG. The median follow-up was 7.1 years. The primary outcome was all-cause mortality. RESULTS: Patients with diagnosed schizophrenia spectrum disorder had an elevated risk of 10-year mortality after CABG, compared with control patients (42.7 v. 30.3%; hazard ratio 1.56; 95% CI 1.13-2.17; P = 0.008). Schizophrenia spectrum diagnosis was associated with a higher risk of major adverse cardiovascular events during follow-up (49.9 v. 32.6%, subdistribution hazard ratio 1.59; 95% CI 1.18-2.15; P = 0.003). Myocardial infarction (subdistribution hazard ratio 1.86; P = 0.003) and cardiovascular mortality (subdistribution hazard ratio 1.65; P = 0.017) were more frequent in patients with versus those without schizophrenia spectrum disorder, but there was no difference for stroke. Psychiatric ward admission, antipsychotic medication, antidepressant use and benzodiazepine use before CABG were not associated with outcome differences. After CABG, patients with schizophrenia spectrum disorder received statin therapy less often and had lower doses; the use of other cardiovascular medications was similar between schizophrenia spectrum and control groups. CONCLUSIONS: Patients with schizophrenia spectrum disorder have higher long-term risks of death and major adverse cardiovascular events after CABG. The results underline the vulnerability of these patients and highlight the importance of intensive secondary prevention and risk factor optimisation.

Relation of prenatal smoking exposure and use of psychotropic medication up to young adulthood.

The study objective was to determine the relation of prenatal smoking exposure to the use of psychotropic medication up to young adulthood by using population-based longitudinal register data consisting of all singletons born in Finland from 1987 to 1989 (n = 175,869). Information on maternal smoking was assessed during antenatal care and received from the Finnish Medical Birth Register. Information on the children's psychotropic medication (1994-2007) was received from the Drug Prescription Register, and the children's psychiatric diagnoses related to outpatient (1998-2007) and inpatient (1987-2007) care were derived from the Finnish Hospital Discharge Register. A total of 15.3% (n = 26,083) of the children were exposed to prenatal smoking. The incidence of psychotropic medication use was 8.3% in unexposed children, 11.3% in children exposed to <10 cigarettes per day (adjusted odds ratio = 1.36, 95% confidence interval: 1.29, 1.43), and 13.6% in children exposed to >10 cigarettes per day (odds ratio = 1.63, 95% confidence interval: 1.53, 1.74). The exposure was significantly associated with the risk for all medication use and for both single- and multiple-drug consumption even after adjustment (e.g., mothers' severe psychiatric illnesses). These findings show that exposure to smoking during pregnancy is linked to both mild and severe psychiatric morbidity.

[Revision of psychiatric classification]. / Psykiatrian häiriöluokitus uudistuu.

Revisions of both psychiatric classifications, ICD and DSM are in progress. The ICD-11 is scheduled to be published at the earliest in 2011 and the DSM-V in 2013. The scientific basis for a criteria-based psychiatric classification was created in the 1950's when the concept of construct validity was outlined. Additionally, revision of classification of psychiatric disorders was dealt with in several international meetings that made efforts to increase the reliability of psychiatric diagnoses. Central issues in revisions have been, e.g., utility, heterogeneity and overlapping of the categories. Presently, one of the main themes is incorporating dimensional assessment into diagnostics. However, mere dimensionality as grounds for classification, would lead to too much complexity. It is liable that category disorders will be used also in the future in psychiatric classifications.