Comparing Effectiveness of Treatments for Borderline Personality Disorder in Communal Mental Health Care: The Oulu BPD Study.

The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients.

How is epilepsy treated in people with a learning disability? A retrospective observational study of 183 individuals.

Epilepsy in those with learning disability (LD) is currently managed by various health agencies with no obvious criteria for selecting particular care pathways and limited evidence-based descriptions of optimal treatment. The aim of this study was to examine relationships between management strategies and clinical outcomes in a community-based cohort of individuals with epilepsy and LD. The results may inform epilepsy management directly and contribute to an evidence base to support development of formal clinical trials. An attempt was made to recruit all individuals with epilepsy and LD known to community LD health services in one geographic area. However, those with profound LD were under-represented in the final sample. Information relating to the epilepsy, the severity of the LD, comorbidities and epilepsy management were obtained retrospectively both from the clinical notes and from interviews with carers and clinicians. We recruited 183 individuals of whom 33% had no reported seizures in the previous three months whilst 12% recorded more than 20 seizures per month. 73 individuals were receiving monotherapy, 66 were treated with two AEDs and 42 were prescribed three or more AEDs at the time of the study. In those taking monotherapy, there was no difference in the mean monthly seizure frequency between groups taking different AEDs. Similarly, for those prescribed two AEDS, no particular combination was associated with significantly lower seizure frequency. One third of the sample was receiving epilepsy management from hospital neurology services but no criteria determining choice of treatment pathway were identified. The findings suggest that more research needs to be carried out to identify both optimal care pathways and AED strategies.

Isolation, X-ray structures, and electronic spectra of reactive intermediates in Friedel-Crafts acylations.

[reaction: see text] Reactive intermediates in the Friedel-Crafts acylation of aromatic donors are scrutinized upon their successful isolation and X-ray crystallography at very low temperatures. Detailed analyses of the X-ray parameters for the [1:1] complexes of different aliphatic and aromatic-acid chlorides with the Lewis acids antimony pentafluoride and pentachloride, gallium trichloride, titanium and zirconium tetrachlorides provide unexpected insight into the activation mechanism for the formation of the critical acylium carbocations. Likewise, the X-ray-structure examinations of aliphatic and aromatic acylium electrophiles also isolated as crystalline salts point to the origins of their electrophilic reactivity. Although the Wheland intermediates (as acylium adducts to arene donors) could not be isolated in crystalline form owing to their exceedingly short lifetimes, transient (UV-vis) spectra of benzenium adducts of acylium carbocations with hexamethylbenzene can be measured and directly related to Wheland intermediates with other cationic electrophiles that have been structurally established via X-ray studies.

Isolation and X-ray structures of labile benzoic- and acetic-acidium carbocations.

New carbocationic salts (via O-protonation of substituted benzoic acids) are prepared for the first time by controlled hydration of the corresponding benzoylium salts and isolated in pure crystalline form. Precise X-ray structural analyses reveal the rather unexpected (electronic) structure of the carboxylic-acidium functionality.

Serum lipids in schizophrenia and other functional psychoses: a general population northern Finland 1966 birth cohort survey.

OBJECTIVE: To compare fasting serum lipid concentrations of subjects with schizophrenia with a comparison group. METHOD: The study sample consists of 5654 members of the northern Finland 1966 birth cohort who participated in the field study with blood samples after overnight fasting and clinical examination in 1997-98. Total cholesterol (TC), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides (TG) and glucose were analyzed. Analysis of variance were used for comparing differences in lipids means between diagnostic categories. RESULTS: Mean fasting TC in subjects with schizophrenia was 20 mg/dl higher than in the comparison group. TC and TG levels in the group of other psychoses resembled the schizophrenia group. CONCLUSION: Blood lipid levels in subjects with schizophrenia and other functional psychoses were high. As these persons are at special risk for hyperlipidemia their lipid levels should be regularly monitored, and cholesterol lowering diet, as well as medication, should be considered.

Intervalence (charge-resonance) transitions in organic mixed-valence systems. Through-space versus through-bond electron transfer between bridged aromatic (redox) centers.

Intervalence absorption bands appearing in the diagnostic near-IR region are consistently observed in the electronic spectra of mixed-valence systems containing a pair of aromatic redox centers (Ar(*)(+)/Ar) that are connected by two basically different types of molecular bridges. The through-space pathway for intramolecular electron transfer is dictated by an o-xylylene bridge in the mixed-valence cation radical 3(*)(+) with Ar = 2,5-dimethoxy-p-tolyl (T), in which conformational mobility allows the proximal syn disposition of planar T(*)(+)/T redox centers. Four independent experimental probes indicate the large through-space electronic interaction between such cofacial Ar(*)(+)/Ar redox centers from the measurements of (a) sizable potential splitting in the cyclic voltammogram, (b) quinonoidal distortion of T(*)(+)/T centers by X-ray crystallography, (c) "doubling" of the ESR hyperfine splittings, and (d) a pronounced intervalence charge-resonance band. The through (br)-bond pathway for intramolecular electron transfer is enforced in the mixed-valence cation radical 2a(*)(+) by the p-phenylene bridge which provides the structurally inflexible and linear connection between Ar(*)(+)/Ar redox centers. The direct comparison of intramolecular rates of electron transfer (k(ET)) between identical T(*)(+)/T centers in 3(*)(+) and 2a(*)(+)( )()indicates that through-space and through-bond mechanisms are equally effective, despite widely different separations between their redox centers. The same picture obtains for 3(*)(+) and 2a(*)(+)( )()from theoretical computations of the first-order rate constants for intramolecular electron transfer from Marcus-Hush theory using the electronic coupling elements evaluated from the diagnostic intervalence (charge-transfer) transitions. Such a strong coherence between theory and experiment also applies to the mixed-valence cation radical 7(*)(+), in which the aromatic redox S center is sterically encumbered by annulation.

Molecular recognition of NO/NO+ via multicenter (charge-transfer) binding to bridged diarene donors. Effect of structure on the optical transitions and complexation thermodynamics.

Bridged diarenes form very strong [1:1] complexes with nitrosonium/nitric oxide in which the NO moiety is optimally sandwiched in the cleft between a pair of cofacial aromatic rings which act as a molecular "Venus flytrap". The spectral features of these associates are generally similar to those for [1:1] and [2:1] nitrosonium complexes with mononuclear alkyl-substituted benzenes, and they are appropriately described within the LCAO molecular-orbital methodology and the Mulliken (charge-transfer) formulation of donor/acceptor electronic transitions. The thermodynamics study indicates that the efficient binding is determined by (i) the close matching of the donor/acceptor redox potentials and (ii) the ability of bridged diarenes for multicentered interactions with a single NO moiety. The best fit of the electronic and structural parameters is provided by a calixarene host that allows the interacting centers to be arranged in a manner similar to those extant in [2:1] nitrosonium complexes with analogous (nonbridged) aromatic donors; this results in its very strong noncovalent binding with nitrosonium/nitric oxide with the formation constant of K(B) approximately 10(8) M(-)(1) and free-energy change of -DeltaG degrees = 45 kJ mol(-)(1). Such strong, selective, and reversible bindings of nitrosonium/nitric oxide by (cofacial) aromatic centers thus provide the basis for the development of efficient NO sensors/absorbents and also suggest their potential relevance to biochemical systems.

Steric hindrance as a mechanistic probe for olefin reactivity: variability of the hydrogenic canopy over the isomeric adamantylideneadamantane/sesquihomoadamantene pair (a combined experimental and theoretical study).

Access to each C=C face of adamantylideneadamantane (AA) and sesquihomoadamantene (SA) is hindered by the hydrogenic canopy consisting of four beta-hydrogens; otherwise, these olefins have quite normal environments. X-ray crystallography and density functional (DFT) calculations show a 0.5 A larger annular opening in the protective cover of AA than that in SA. This contributes to the remarkable differences in reactivity toward various reagents, not only by limiting access to the olefin site in SA but also by inhibiting reactions which force these hydrogens closer together. Thus, AA is subject to typical olefin-addition reactions with bromine, sulfuryl chloride, m-chloroperbenzoic acid, dioxygen, and so forth, albeit sometimes at attenuated rates. On the other hand, SA is singularly unreactive under identical reaction conditions, except for the notable exceptions that include Brønsted (protonic) acids, a nitrosonium cation, and dichlorine. The exceptions are characterized as three sterically limited (electrophilic) reagents whose unique reactivity patterns are shown to be strongly influenced by steric access to the C=C center. As such, the different degrees of steric encumbrance in the isomeric donors AA and SA shed considerable light on the diverse nature of olefinic reactions. In particular, they evoke mechanistic features in electrophilic addition versus electron transfer, which are otherwise not readily discernible with other less hindered olefinic donors. Transient structures of the olefinic-reaction intermediates such as the protonated carbocations AA-H+ and SA-H+ as well as the cation radicals AA*+ and SA*+ are probed by the combination of X-ray crystallographic analyses and density functional theoretical computations.

Spousal resemblance for history of major depressive episode in the previous year.

BACKGROUND: There is discrepancy in findings on spousal concordance for major depression. Here we report the risk of depression and its determinants in spouses of persons with or without depression, taking into account several known risk factors for major depression. METHODS: A random sample of non-institutionalized Finnish individual aged 15-75 years was interviewed in the 1996 National Health Care Survey. The sample included 1708 male-female spouse pairs. Major depressive episode (MDE) during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Risk factors were assessed in the same interview. RESULTS: Factors associating with MDE were spouse's MDE, own alcohol intoxication at least once a week and own chronic medical conditions. In addition, there was a strong association between female's current smoking and male's MDE, independently of other risk factors and spousal MDE. The association of MDE with spouses's MDE was not affected by taking into account other assessed risk factors (own or spouse's). CONCLUSIONS: The results indicate elevated spouse concordance for MDE independent of the risk factors assessed in the present study.

Antidepressant treatment of depression in the Finnish general population.

OBJECTIVE: Antidepressant use has increased in the last decade, but whether depression continues to be undertreated is unknown. The authors investigated the prevalence of antidepressant treatment and its predictors in a recent general population sample of depressed subjects. METHOD: As part of the Finnish Health Care Survey, in 1996 a representative sample of Finns (N=5,993) aged 15-75 years underwent a standardized face-to-face interview that used the DSM-III-R criteria for major depressive episode. RESULTS: Only 13% of subjects with a major depressive episode during the preceding 12 months (70 of 557) reported current use of an antidepressant. In logistic regression models, use of psychiatric services for depression, regular use of any other medication, more than 1 month of sick leave, and smoking were associated with antidepressant treatment. CONCLUSIONS: Most depressed subjects in 1996 in Finland were not receiving antidepressant treatment despite the several-fold increase in antidepressant use in the 1990s.

Cigarette smoking, alcohol intoxication and major depressive episode in a representative population sample.

OBJECTIVE: This study investigated the associations of cigarette smoking and alcohol intoxication with major depressive episode. DESIGN: Major depressive episode during the past 12 months was assessed in a national representative cross sectional study using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). SUBJECTS: A random sample of 5993 non-institutionalised Finnish people aged 15-75 years was interviewed as a part of the 1996 Finnish Health Care Survey. RESULTS: In logistic regression models the factors associated with major depressive episode in the past 12 months were smoking 10 or more cigarettes daily (odds ratio (OR) 2.26; 95% confidence intervals (95% CI) 1.68, 3.04) and alcohol intoxication at least once a week (OR 2.99; 95%CI 1.70, 5.25). Their effects were independent of each other, and remained significant even after adjusting for other major risk factors (marital status, education, unemployment and chronic diseases). The attributable proportion (a measure of the impact of the risk factors of the disease on the population) for daily smoking of 10 or more cigarettes was 0.15, and for alcohol intoxication at least once a week 0.04. CONCLUSION: Cigarette smoking and alcohol intoxication seem to be important risk factors for major depressive episode. In this population the impact of smoking was greater.

Charge-transfer forces in the self-assembly of heteromolecular reactive solids: successful design of unique (single-crystal-to-single-crystal) Diels--Alder cycloadditions.

Electron donor/acceptor (EDA) interactions are found to be a versatile methodology for the engineering of reactive heteromolecular crystals. In this way, a series of the charge-transfer pi-complexes between bis(alkylimino)-1,4-dithiin acceptors and anthracene donors are shown to form heteromolecular (1:1) crystalline solids that spontaneously undergo stereoselective [2 + 4] Diels--Alder cycloadditions. The flexible nature of the 1,4-dithiin moiety allows this homogeneous topochemical transformation to proceed with minimal distortion of the crystal lattice. As a result, a unique (single) crystal phase of the Diels--Alder adduct can be produced anti-thermodynamically with a molecular arrangement very different from that in solvent-grown crystals. Such a topochemical reaction between bis(methylimino)-1,4-dithiin and anthracene proceeds thermally and homogeneously up to very high conversions without disintegration of the single crystal. This ideal case of the mono-phase topochemical conversion can be continuously monitored structurally (X-ray crystallography) and kinetically (NMR spectroscopy) throughout the entire range of the crystalline transformation. The resultant "artificial" crystal of the Diels--Alder adduct is surprisingly stable despite its different symmetry and packing mode compared to the naturally grown (thermodynamic) crystal.

Diels-Alder topochemistry via charge-transfer crystals: novel (thermal) single-crystal-to-single-crystal transformations.

The solid-state [4+2] cycloaddition of anthracene to bis(N-ethylimino)-1,4-dithiin occurs via a unique single-phase topochemical reaction in the intermolecular (1:1) charge-transfer crystal. The thermal heteromolecular solid-state condensation involves the entire crystal, and this rare crystalline event follows topochemical control during the entire cycloaddition. As a result, a new crystalline modification of the Diels-Alder product is formed with a crystal-packing similar to that of the starting charge-transfer crystal but very different from that of the (thermodynamically favored) product modification obtained from solution-phase crystallization. Such a single-phase transformation is readily monitored by X-ray crystallography at various conversion stages, and the temporal changes in crystallographic parameters are correlated with temperature-dependent (solid-state) kinetic data that are obtained by 1H NMR spectroscopy at various reaction times. Thus, an acceleration of the solid-state reaction over time is found which results from a progressive lowering of the activation barrier for cycloaddition in a single crystal as it slowly and homogeneously converts from the reactant to the product lattice.

The 12-month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults.

OBJECTIVE: This study reports the 12-month prevalence of major depressive episode and its risk factors in a representative nationwide sample. METHOD: A random sample of non-institutionalized Finnish individuals aged 15-75 years (N = 5993) was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). RESULTS: The population prevalence of major depressive episode was 9.3% [95% CI 8.5,10.0], and the age-adjusted prevalences for females and males were 10.9% [95% CI 9.7,12.0] and 7.2 [95% CI 6.2,8.2], respectively. In logistic regression analyses the factors associated with major depressive episode after adjustment for age were urban residency, smoking, alcohol intoxication and chronic medical conditions. In addition, being single and obese were found to be risk factors for males. CONCLUSION: The female to male risk ratio for major depressive episode was smaller than in many previous studies. The sex-specific risk factor associations warrant further investigation into sex differences in depression.

Silver(I) complexation of (poly)aromatic ligands. Structural criteria for depth penetration into cis-stilbenoid cavities.

Silver(I) complexes with aromatic donors are thoroughly analyzed (with aid of the Cambridge Crystallographic Database) to identify the basic structural factors inherent to the bonding of an arene ligand. Most strikingly, the distance parameter d (which simply measures the normal separation of Ag from the mean aromatic plane) is singularly invariant at d = 2.41 +/- 0.05 A for all silver/arene complexes, independent of the hapticity (eta 1 or eta 2), hybridization, or multiple coordination. As such, a systematic series of stilbenoid ligands has been successfully designed to precisely modulate the penetration of silver(I) into the ligand cleft, and a multicentered poly(arene) ligand (X) designed to form a one-dimensional assembly of Ag/arene units. Simply stated, the depth penetration of silver(I) into the aromatic cavities of various cis-stilbenoid donors can be precisely predicted with a single parameter gamma that measures the separation of the two cofacial aryl groups comprising the cleft. This simple geometric consideration must be taken into account in any successful design of novel (poly)aromatic ligands for silver(I) complexation to constitute new molecular architectures.

Treatment of mental disorders in seven physicians committing suicide.

Through psychological autopsy seven cases of physician suicide were studied. All seven victims received a diagnosis of current mood disorder, two of them bipolar disorder. Five had suffered a disabling physical condition. None of the victims had had adequate treatment with antidepressant or mood-stabilizing drugs, nor had they been in psychotherapy. Current adequate treatment for depression seems to be as rare among physician victims as among suicides with major depressive disorders in the population.

Photoinduced Coupling of Acetylenes and Quinone in the Solid State as Preorganized Donor-Acceptor Pairs.

Crystalline electron donor-acceptor (EDA) complexes of various diarylacetylenes (DA) and dichlorobenzoquinone (DB) are isolated and structurally characterized by X-ray crystallography. Deliberate excitation of either the DB acceptor at lambda(DB) = 355 nm or the 1:2 [DA, 2DB] complex at lambda(CT) = 532 nm in the solid state leads to [2 + 2] cycloaddition and identical (isomeric) mixtures of the quinone methide products. Time-resolved (ps) diffuse reflectance spectroscopy identifies the ion-radical pair [DA(*+), DB(*-)] as the reactive intermediate derived by photoinduced electron transfer in both photochemical procedures. The effects of crystal-lattice control on the subsequent ion-radical pair dynamics are discussed in comparison with the same photocouplings of acetylenes and quinone previously carried out in solution.

Preparation and Structures of Crystalline Aromatic Cation-Radical Salts. Triethyloxonium Hexachloroantimonate as a Novel (One-Electron) Oxidant.

Triethyloxonium hexachloroantimonate [Et(3)O(+)SbCl(6)(-)] is a selective oxidant of aromatic donors (ArH), and it allows the facile preparation and isolation of crystalline paramagnetic salts [ArH(+)(*), SbCl(6)(-)] for the X-ray structure determination of various aromatic cation radicals. The mechanistic relationship between the Meerwein salt [Et(3)O(+)SbCl(6)(-)] and the pure Lewis acid oxidant SbCl(5) is based on a prior ethyl transfer from oxygen to chlorine within the ion pair.

Suicide mortality among medical doctors in Finland: are females more prone to suicide than their male colleagues?

BACKGROUND: Suicide mortality among medical practitioners is in many countries significantly higher compared with other professionals and the general population. Differences between male and female physicians are difficult to estimate reliably because previous comparisons are mainly based on crude mortality rates. METHODS: Age-specific mortality rates were calculated for physicians, other professionals and the general population, males and females separately, as well as standardized mortality ratios (SMR) comparing physicians with the other groups. Crude mortality rates were calculated for the specialist groups. RESULTS: The SMR for male (female) physicians was 0.9 (2.4) compared with the general male (female) population and 2.4 (3.7) compared with other male (female) professionals. The SMR between male and female physicians was 1.2 (95% CI 0.9-1.7). CONCLUSIONS: Our results do not support the claim that female physicians have a greater risk of suicide than their male colleagues, but are concordant with previous observations of a higher suicide rate in female physicians compared with the general population and other female professionals.

Suicides among physicians, engineers and teachers: the prevalence of reported depression, admissions to hospital and contributory causes of death.

The number of admissions to hospital, reported diagnoses, prevalence of reported depression and contributory causes of death among Finnish physicians, engineers and teachers who committed completed suicide between 1986 and 1993 were studied. The data for hospital admissions with diagnoses were obtained from the Finnish Hospital Discharge Register. Thin-layer chromatography was used to detect drugs in the liver, a dual-column gas chromatographic method was used for screening and quantification of drugs in the blood sample, and a head-space chromatographic method was used to measure blood alcohol levels. Physicians had more somatic diagnoses than the reference groups, and the prevalence of reported depression was higher among females than males. A minority of the depressed subjects had been admitted to hospital, although depression was observed to be the most prevalent contributory cause of death in all of the groups studied. The physicians used solid or liquid substances, especially barbiturates, as the main method of suicide. It is possible that depression in physicians, especially in male subjects, is undertreated in psychiatric hospitals.