Deficits in adolescent social functioning, dysfunctional family processes and genetic risk for schizophrenia spectrum disorders as risk factors for later psychiatric morbidity of adoptees.

Social functioning deficits during adolescence are associated with later psychiatric morbidity, particularly in offspring at high genetic risk for schizophrenia spectrum disorders. However, a shortcoming of earlier study findings is the lack of control of the impact of the family rearing environment. The study was aimed to examine the association of adoptees' social functioning during adolescence, adoptive family functioning, and adoptees' high (HR) or low (LR) genetic risk for schizophrenia spectrum disorders with adoptees' later psychiatric morbidity. The present subsample from the nationwide Finnish Adoptive Family Study of Schizophrenia included 57 HR and 60 LR adoptees. Adolescent social functioning was assessed using UCLA Social Attainment Survey (UCLA SAS). Adoptive family functioning was based on Global Family Ratings (GFRs) and psychiatric disorders on DSM-III-R criteria. The results indicated that, after controlling for adoptive family functioning and genetic risk for schizophrenia spectrum disorders, deficits in peer relationships during adolescence were associated with an increased likelihood of psychiatric morbidity of adoptees. Our findings highlight social functioning deficits during adolescence, specifically in peer relationships, as plausible independent risk factors for later psychiatric disorders. These results can be utilized in identifying possible at-risk groups and targets for prevention and in developing preventive strategies.

Associations of Duration of Preadoption Out-of-home Care, Genetic Risk for Schizophrenia Spectrum Disorders and Adoptive Family Functioning with Later Psychiatric Disorders of Adoptees.

The objective was to examine the impacts of duration of preadoption out-of-home care and adoptive family functioning on later psychiatric morbidity of adoptees with high (HR) and low (LR) genetic risk for schizophrenia spectrum disorders. The study uses nationwide data from the Finnish Adoptive Family Study of Schizophrenia. The study population in this substudy consisted of 43 h adoptees and 128 LR adoptees. Of these adoptees, 90 had spent 0-6 months and 81 over 6 months in preadoption out-of-home care. The family functioning of adoptive families was assessed based on Global Family Ratings and psychiatric disorders on DSM-III-R criteria. The results showed that among the adoptees with over 6 months in preadoption out-of-home care, the likelihood for psychiatric disorders was significantly increased in HR adoptees compared to LR adoptees. In adoptees with 6 months or less in preadoption out-of-home care, an increased likelihood for psychiatric disorders was found among those living in adoptive families with dysfunctional processes. These findings indicate that especially for HR children, a well-functioning early caregiving environment is crucial in terms of subsequent mental wellbeing. The results emphasize that when adoption is necessary, early placement and well-functioning adoptive family environment are beneficial to children.

Adolescent Social Functioning Deficits in Association With Adoptive Family Functioning and Genetic Risk for Schizophrenia Spectrum Disorders: The Finnish Adoptive Family Study of Schizophrenia.

ABSTRACT: Social functioning deficits (SFDs) during adolescence represent potential vulnerability indicators to schizophrenia spectrum disorders, but little is known about how both family environmental and genetic factors contribute to SFDs. The aim of this study was to examine the association of adoptees' adolescent social functioning with adoptive family functioning and adoptees' high (HR) or low (LR) genetic risk for schizophrenia spectrum disorders. The present subsample from the nationwide Finnish Adoptive Family Study of Schizophrenia included 88 HR and 83 LR adoptees. Adolescent social functioning was assessed using UCLA Social Attainment Survey. Assessment of adoptive family functioning was based on Global Family Ratings. Results indicated that dysfunctional family processes and high genetic risk for schizophrenia spectrum disorders contributed approximately equally to adoptees' adolescent social functioning. Our findings underscore the importance of functional family processes in adolescent social functioning, particularly in individuals at high genetic risk for severe psychiatric disorder.

Dysfunctional family functioning in high socioeconomic status families as a risk factor for the development of psychiatric disorders in adoptees: the Finnish Adoptive Family Study of Schizophrenia.

PURPOSE: Earlier findings indicate that socioeconomic status (SES) of family associates with family functioning. This study examined the impacts of family functioning and genetic risk for schizophrenia on psychiatric morbidity of adoptees in families of high SES (HSES) and low SES (LSES). METHODS: The study population is a subgroup of the Finnish Adoptive Family Study of Schizophrenia. Of the adoptees, 152 had high genetic risk for schizophrenia spectrum disorders (HR) and 151 adoptees had low risk (LR). Of the adoptees, 185 (HR = 94, LR = 91) were raised in high-SES (HSES) families and 118 (HR = 58, LR = 60) in low-SES (LSES) families. The family SES was determined by the occupational status of the main provider of the family. The functioning of adoptive families was assessed based on Global Family Ratings (GFRs) and psychiatric disorders on DSM-III-R criteria. RESULTS: In the HSES families, the psychiatric morbidity of the adoptees was emphasized by HR (OR = 4.28, CI 2.14-8.56) and dysfunctional family processes (OR = 6.44, CI 2.75-15.04). In the LSES families, the adoptees´ psychiatric morbidity was almost significantly increased by HR (OR = 2.10, CI 0.99-4.45), but not by dysfunctional family processes (OR = 1.33, CI 0.53-3.34). CONCLUSIONS: This study showed that in HSES families, dysfunctional family processes and HR for schizophrenia increased the likelihoods for the development of psychiatric disorders in adoptees. The results can be utilized in identifying risk factors in the development of psychiatric disorders and focusing preventative strategies on risk groups with acknowledging the importance of family functioning.

Adolescent social functioning in offspring at high risk for schizophrenia spectrum disorders in the Finnish Adoptive Family Study of Schizophrenia.

BACKGROUND: Children and adolescents with a genetic risk for schizophrenia are often found to have poorer social functioning compared to their controls. However, less is known about high-risk offspring who have not been reared by a biological parent with schizophrenia. The purpose of this study was to examine deficits in social functioning in adolescence as a possible factor related to genetic vulnerability to schizophrenia spectrum disorders, and also to examine possible gender differences in these associations. METHOD: The present sample consisted of 88 genetic high-risk (HR) adoptees whose biological mothers were diagnosed with schizophrenia spectrum disorders and 83 genetic low-risk (LR) adoptees with biological mothers with non-schizophrenia spectrum disorders or no psychiatric disorders. Adoptees' social functioning at ages 16-20 was assessed using the UCLA Social Attainment Survey. RESULTS: Compared to LR adoptees, HR adoptees displayed statistically significant deficits in their peer relationships, involvement in activities and overall social functioning during adolescence. HR males were distinguished from LR males by their significantly poorer overall social functioning. Compared to HR females, HR males showed significant deficits in their romantic relationships. Of marginal significance was that HR females displayed more social functioning deficits relative to LR females, mainly in the areas of peer relationships, involvement in activities and overall social functioning. CONCLUSIONS: These results from the adoption and high-risk study design suggest that deficits in social functioning in adolescence may be related to genetic vulnerability to schizophrenia spectrum disorders and that some of these deficits may be gender-specific.

Interaction of genetic vulnerability to schizophrenia and family functioning in adopted-away offspring of mothers with schizophrenia.

OBJECTIVE: The aim of this study was to examine the association of family functioning to psychiatric disorders of adoptees with and without genetic vulnerability to schizophrenia. METHODS: The data is based on the Finnish Adoptive Family Study of Schizophrenia. The study sample consisted of 346 adoptive families, of which 175 adoptees had high (HR) and 171 low (LR) genetic risk for schizophrenia. DSM-III-R was used for diagnostic criteria. Family functioning was assessed using the Global Family Ratings. Childhood adversities covered early parental divorce and death occurring before 18 years of age of the adoptees. RESULTS: Approximately two thirds of the adoptees had lived in families with mildly dysfunctional processes (30%) or dysfunctional processes (28.4%). An increased likelihood for psychiatric disorders of the adoptees was related to dysfunctional family processes both in HR (OR = 4.8, 95% CI 2-11.4) and LR (OR = 2.6, 95% CI 1.1-6.3) adoptees, but not to early parental death or divorce. CONCLUSIONS: The risk for psychiatric disorders was increased for adoptees in families with dysfunctional processes, especially for those adoptees with genetic vulnerability to schizophrenia. These results emphasize the importance of policies and practices that aim to strengthen and support family functioning.

[Somatization disorder - an overdiagnosed but underestimated illness]. / Somatisaatiohäiriö - ylidiagnosoitu mutta aliarvioitu sairaus.

Physical symptoms often occur in the absence of physical illness. This is termed somatization when the symptoms are caused by psychic factors. When abundant symptoms affect the functional capacity and cause subjective harm and seeking healthcare services, a psychic disorder may be in question. Somatization may be associated with numerous psychic disorders. It may, however, also be a question of a somatoform disorder having a physical symptom picture. Somatization disorder is one of the somatoform disorders. Recognition of the disorder is often the problem in its treatment. Establishing a long-term treatment relationship actually forms the basis for therapy.

Enhancing sense of coherence via early intervention among depressed occupational health care clients.

BACKGROUND: Research on interventions improving psychological adjustment has suggested that sense of coherence (SOC) could be improved. AIMS: In the present study, we measured the impact of an intervention on the SOC among adults with first-episode depression. We also examined whether rehabilitation, depression, occupational stressors, life situation stressors and socio-demographic characteristics are associated with a change in the SOC. METHODS: Occupational health care clients were screened for depression using the Beck Depression Inventory (BDI) and a structured clinical interview (the The Structured Clinical Interview for DSM-IV: SCID-I). The participating subjects were randomized into a rehabilitation group (n = 134) and control group (n = 100) receiving treatment as usual. The Sense of Coherence Scale (SOC-13) was used at the baseline and in a 1-year follow-up to compare the change of the SOC between the groups. RESULTS: The increase in the mean SOC score was statistically significant both in the rehabilitation group (54.91 compared with 62.85, P < 0.001) and in the control group (55.29 compared with 61.64, P < 0.001). There was no significant difference in the mean SOC scores between the groups at the follow-up. The improved SOC was associated with less severe depression (P = 0.003) and greater decreasing in BDI (P = 0.041) in the rehabilitation group. CONCLUSIONS: The results suggest that both rehabilitation and conventional depression treatment in a first episode of depression may enhance the SOC and that rehabilitation itself enhances the SOC more effectively among those with less severe depression or those whose BDI scores had further decreased at the 1-year follow-up.

The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People.

Objective. To evaluate the effect of an early vocational-orientated eclectic intervention on beck depression inventory (BDI) scores compared to treatment as usual in first ever depressive episode among employed people. Design. A randomized controlled trial comparing the rehabilitative intervention and the conventional treatment. Subjects. The subjects came from occupational health care units. Methods. Employees were sent to a rehabilitation center after being screened for depression using the BDI. They were diagnosed using the structured clinical interview for DSM-IV. The participating subjects (N = 283) were randomized into intervention and control groups. The intervention group received eclectic early depression intervention treatment (N = 134) and the control group was treated in the conventional way (N = 100). They were followed for one year. Results. The mean decrease in BDI scores within the intervention group was from 20.8 to 11.6 and within the control group from 19.3 to 10.8. BDI score decreased by 10 or more points in 64% of the participants in the intervention group and in 53% of the control group (P = 0.013). Conclusions. There was some evidence that early eclectic intervention in first ever episode depression may be more effective than conventional treatments among working age people in employment.

Obsessive-compulsive personality disorder is common among occupational health care clients with depression.

OBJECTIVE: To study how common personality disorders (PDs) are among employed subjects with first-episode depression. Depression is the single most common cause of working disability in Finland. Personality disorders are associated with depression. METHODS: Subjects were screened using the Beck Depression Inventory scale, with a cutoff point greater than 9. The structured clinical interview for Diagnostic and Statistical Manual, fourth revision, was used to assess mental disorders. Inclusion criterion was major depressive disorder. RESULTS: Most of the 272 participants were female (83%) and the majority (74%) were older than 40 years. The main finding was that one third of the participants had obsessive-compulsive PD. The prevalence of obsessive-compulsive PD was 50% among men and 28% in women. CONCLUSION: It is important to recognize comorbid PDs when assessing working-age persons experiencing depression.

Five-year follow-up study of disability pension rates in first-onset schizophrenia with special focus on regional differences and mortality.

OBJECTIVE: To evaluate the rate and regional determinants of disability pension in first-admission schizophrenia. In addition, we investigated whether patients with disability pension had increased mortality rates during follow-up. METHOD: A nationwide register-based 5-year follow-up study of all patients with onset of schizophrenia between 1998 and 2001 (n=3,875). RESULTS: A total of 1944 (50.2%) first-onset schizophrenia patients retired on disability pension during the 5-year follow-up. Males retired on pension at an earlier age and more often than females. Regional disability pension rates and retirement times for schizophrenia varied between hospital districts. Patients on disability pension had lower overall and suicide mortality, and they had less physical illness, depression and more psychotropic medication use than patients without disability pension. In regions with a short median time from onset time to retirement, there was significantly higher regional overall mortality and suicide mortality. Disability pension rates were also higher in regions with high involuntary treatment rate. CONCLUSION: Half of the schizophrenia patients were pensioned off in 5 years. Lower mortality, especially suicide mortality among disability pensioners, suggests that the decision on a permanent disability pension, indicating for its part the activation of the service system, might be a relief to schizophrenic patients, helping them cope with illness. The retirement process has regional differences, which may be caused by the regional nature of treatment and resources.

Temperament profiles in personality disorders among a young adult population.

The objective of this study was to describe the temperament dimension profiles assessed by the Temperament and Character Inventory (TCI) among young adults with the DSM-III-R personality disorder (PD). Our hypothesis was that PD clusters and separate PDs can be distinguished from one another by their specific temperament profiles. As a part of the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort, the cohort members living in the city of Oulu at the age of 31 years (n=1609) were invited to participate in a two-phase field study. The Structured Clinical Interview for DSM-III-R for PDs (SCID-II) was used as diagnostic instrument. The final study sample consisted of the 1311 subjects who had completed the Hopkins Symptom Check List-25 questionnaire for screening and had given a written informed consent. Of the 321 SCID interviewed subjects, 74 met the criteria for at least one PD and had completed the TCI. The mean TCI scores of subjects with PD and control subjects without PD (n=910) were compared. Low Novelty Seeking, high Harm Avoidance and low Reward Dependence characterized cluster A and C PDs. Subjects with a cluster B PD did not differ from controls, except for Novelty Seeking, which was high. The temperament dimensions could not distinguish different PDs very well, with the only exception of persons with obsessive-compulsive PD. PD clusters were associated with different profiles of temperament, lending some support for Cloninger's typology.

Birth measures and depression at age 31 years: the Northern Finland 1966 Birth Cohort Study.

The aim of the study was to explore whether there is an association between body size at birth measured by birth weight and ponderal index and later depression at the age of 31 years. The analyses were based on 4,007 males and 4,332 females born in 1966 in the two northernmost provinces of Finland with data on current depression measured by the Hopkins Symptom Checklist-25 questionnaire (HSCL-25) and self-reported physician-diagnosed lifetime depression at 31 years and childhood characteristics. The associations between birth measures and later depression were analysed with several confounding factors including maternal depression during pregnancy. Low birth measures did not associate with adult depression in men or women. Women with high birth weight (>or=4,500 g) had a higher risk for current depression compared to women with birth weight 3,000 g-3,499 g. Women with high ponderal index (the highest 90-95 percentiles and >or=95 percentiles) had a 1.53-1.55 higher likelihood for current depression compared with women with normal ponderal index. Based on this study, large body size at birth may be a risk factor for later depression.

MMPI measures as signs of predisposition to mental disorder among adoptees at high risk for schizophrenia.

The DSM-III-R diagnoses of a group of adoptees were predicted by the MMPI (Minnesota Multiphasic Personality Inventory) schizophrenia-related scales in the Finnish Adoptive Family Study. The sample consisted of 60 high-risk (HR) adopted-away offspring of biologic mothers with a diagnosis of broad schizophrenia spectrum and 76 low-risk (LR) control adoptees. They were assessed with the MMPI before the onset of any psychiatric disorder at a mean age of 24 years. High scores on the Psychopathic Deviate scale predicted psychiatric disorder at 11-year follow-up. Furthermore, LR adoptees', but not HR adoptees', mental disorders could be predicted with the MMPI scales Psychopathic Deviate and Golden-Meehl Indicators. These scales measure schizophrenia-related personality traits, including a social behavior, anhedonia, ambivalence, interpersonal aversiveness, and formal thought disturbances.

Somatization symptoms in young adult Finnish population--associations with sex, educational level and mental health.

We assessed somatization symptoms and their associations among a 31-year-old Finnish population sample (n=1598). Data on somatization symptoms were gathered from a review of all medical public outpatient records. Subjects with four or more somatization symptoms according to the DSM-III-R criteria were classified as somatizers. Ninety-seven (83 females) DSM-III-R somatizers (6.1%) were found. Somatization associated with female sex, lower educational level and increased psychiatric morbidity. Roughly half of the somatizers had a comorbid psychiatric disorder. Mood disorders did not associate specifically with somatization--in fact, after adjusting for sex and educational level only anxiety disorders and personality disorders associated with somatization. It may be concluded that it is important to recognize psychiatric disorders in subjects with somatization symptoms, especially as these symptoms have been shown to be treatable with both psychotherapy and psychiatric medication.

Interaction of genetic vulnerability to schizophrenia and Communication Deviance of adoptive parents associated with MMPI schizophrenia vulnerability indicators of adoptees.

The aim of this study was to establish possible genotype-environment interaction in high-risk and low-risk adoptees' vulnerability to schizophrenia. The study population consisted of a subgroup of 41 adoptive families with a high genetic risk adoptee and 58 families with a low genetic risk adoptee from the Finnish Adoptive Family Study of Schizophrenia. Communication style was assessed based on the Communication Deviance (CD) of the adoptive parents, and the adoptees' vulnerability indicators were measured with the Minnesota Multiphasic Personality Inventory (MMPI). Taken separately, only the genetic liability to schizophrenia, but not the communication style of the adoptive parents, was significantly associated with the Lie, Correction and Hostility scales in the MMPI of the adoptees. Analyses of the genotype-environment interactions showed that the high-risk adoptees with high-CD rearing parents had an increased risk of vulnerability on the MMPI Social Maladjustment scale compared with the corresponding low-risk adoptees. Genetic vulnerability to schizophrenia and genotype-environment interaction are manifested in adoptees' MMPI.

Temperament profiles and somatization--an epidemiological study of young adult people.

OBJECTIVE: We assessed the temperament profiles of young adult somatizers in an epidemiological setting. We hypothesized that somatizers would have a characteristic temperament profile. METHODS: The sample consisted of 984 subjects at the age of 31 years. Data on somatization were gathered from a review of all public health outpatient records. Subjects with four or more somatization symptoms according to the DSM-III-R criteria were classified as somatizers. Temperament profiles were assessed using the Temperament and Character Inventory (TCI). RESULTS: Six males (1.3%) and 61 females (11.5%) met our criteria for somatization. Harm avoidance and reward dependence of the TCI profiles were associated with somatization symptoms in the whole sample. In logistic regression analysis, sex and psychological distress were associated with somatization but not with temperament profiles. CONCLUSION: We did not find a characteristic temperament profile for somatizers. This finding is in contrast to suggestions that somatization is associated with temperament profiles.

Co-occurrence of personality disorders with mood, anxiety, and substance use disorders in a young adult population.

The purpose of this study was to determine the co-occurrence of DSM- III-R personality disorders (PDs) with mood, anxiety, and substance use disorders in a young adult population. The members of the Northern Finland 1966 Birth Cohort Project, living in the city of Oulu with an age of 31 years (N = 1,609) were invited to participate in a two-phase field study. The SCID I and II were used as diagnostic instruments. One hundred and seventy-seven out of 321 interviewed subjects met the criteria for mood, anxiety, or substance use disorders. Altogether 72 (41%) of the subjects with an Axis I disorder met the criteria for at least one PD. The weighted co-occurrence rate of any PD varied from 28% for mood disorders to 47% for anxiety disorders. PDs, especially those in Cluster C, are highly associated with Axis I psychiatric disorders in population.

Differentiation of adoptees at high versus low genetic risk for schizophrenia by adjusted MMPI indices.

The aim of this study was to find potential signs of genetic vulnerability to schizophrenia. The differences between adoptees at high genetic risk for schizophrenia (their biological mother had a schizophrenia spectrum disorder) and control adoptees of non-schizophrenia spectrum biological mothers were assessed. The comparisons between these groups were based on the Minnesota Multiphasic Personality Inventory (MMPI) test's subscale scores adjusted by gender, age at MMPI assessment, age at placement into the adoptive family and social class. The subjects were a subsamples of a total of 182 tested adoptees and 136 mentally healthy adoptees in the Finnish Adoptive Family Study. The high-risk group was found to be distinguishable from the low-risk group based on deviant scores on the Hostility, Hypomania and Lie scales. These scales may measure genetic vulnerability and also possibly be indicative of psychometric deviance predicting future onset of schizophrenia.

Co-occurrence of metabolic syndrome with depression and anxiety in young adults: the Northern Finland 1966 Birth Cohort Study.

OBJECTIVE: Only a few studies have dealt with the association of metabolic syndrome with depression and anxiety. We studied whether metabolic syndrome and its components are associated with depressive and anxiety symptoms in a young adult population cohort. METHODS: This study forms part of the Northern Finland 1966 Birth Cohort Study. The study sample consists of 5,698 members of the cohort who participated in the field study in 1997 to 1998. Metabolic syndrome was defined according to the five criteria of the National Cholesterol Education Program. Depressive and anxiety symptoms were defined by the Hopkins Symptom Checklist-25 questionnaire. RESULTS: Metabolic syndrome was not associated with depression or anxiety. The correlations between the components of the metabolic syndrome and psychological distress as continuous measures were low. High waist circumference (>102 cm in males and >88 cm in females) associated with depression (odds ratio, 1.30; 95% confidence interval, 1.05-1.61), but this association vanished when adjusted for gender, smoking, alcohol consumption, marital status, level of education, and physical activity. CONCLUSION: No clear association was found between the metabolic syndrome and psychological distress.