Prevalence of Schizophrenia in Idiopathic Normal Pressure Hydrocephalus.

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive and potentially treatable neurodegenerative disease affecting elderly people, characterized by gait impairment and ventricular enlargement in brain imaging. Similar findings are seen in some patients with schizophrenia (SCZ). OBJECTIVE: To determine the prevalence of SCZ among patients suffering from probable or possible iNPH and the specific effects of comorbid SCZ on the outcome of the cerebrospinal fluid (CSF) shunting. METHODS: All medical records of the 521 iNPH patients in the NPH registry were retrospectively analyzed from 1991 until 2017. The prevalence of comorbidity of SCZ was determined and compared to that of general aged (≥65 yr) population in Finland. RESULTS: We identified a total of 16 (3.1%) iNPH patients suffering from comorbid SCZ. The prevalence of SCZ among the iNPH patients was significantly higher compared to the general population (3.1% vs 0.9%, P < .001). All iNPH patients with comorbid SCZ were CSF shunted and 12 (75%) had a clinically verified shunt response 3 to 12 mo after the procedure. The CSF shunt response rate did not differ between patients with and without comorbid SCZ. CONCLUSION: SCZ seems to occur 3 times more frequently among iNPH patients compared to the general aged population in Finland. The outcome of the treatment was not affected by comorbid SCZ and therefore iNPH patients suffering from comorbid SCZ should not be left untreated. These results merit validation in other populations. In addition, further research towards the potential connection between these chronic conditions is warranted.

Associations of psychotic-like or manic-like experiences with later psychiatric disorders: An 11-year follow-up study of middle-aged adults.

Psychotic-like experiences (PLEs) and manic-like experiences (MLEs) have been found to be associated with elevated risk for future psychotic disorders. However, most follow-up studies have been conducted on adolescent and young adult samples leaving the predictive value of PLEs and MLEs among middle-aged subjects largely unknown. Here we report findings of an 11-year follow-up study of middle-aged subjects with PLEs (n=86) or MLEs (n=45) at baseline and population controls (n=62). We found that PLEs or MLEs at baseline did not predict conversion to psychosis during an 11-year follow-up in this age group. However, MLEs at baseline were associated with increased risk of nonpsychotic psychiatric disorders at follow-up whereas PLEs were not. Baseline neuropsychological performance was not associated with later psychiatric disorders in groups with PLEs or MLEs. In conclusion, our results suggest that among middle-aged subjects having PLEs or MLEs may not be a similar risk for future psychotic disorders as in younger age groups. However, studies with larger study groups and longer follow-up periods are needed in the future.

Mortality in people with psychotic disorders in Finland: A population-based 13-year follow-up study.

OBJECTIVES: We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. METHODS: In a nationally representative sample of Finns aged 30-70years (n=5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. RESULTS: No people with affective psychoses (n=36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n=106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). CONCLUSIONS: The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders.

Outcome of depressive and anxiety disorders among young adults: Results from the Longitudinal Finnish Health 2011 Study.

PURPOSE OF THE STUDY: We investigated the outcomes and outcome predictors of depressive and anxiety disorders in a general population sample of young adults with a lifetime history of these disorders. MATERIALS AND METHODS: The study sample was derived from a nationally representative two-stage cluster sample of Finns aged 19-34 years. The original study was carried out in 2003-2005, and the follow-up in 2011. We investigated participants diagnosed with a depressive or anxiety disorder based on a SCID interview (excluding those with only a single specific phobia) (DAX-group, N = 181). The control group included those with no DSM-IV- diagnosis (N = 290). They were followed up with the M-CIDI interview assessing 12-month depressive and anxiety disorders in 2011. RESULTS: In 2011, 22.8% of the DAX-group was diagnosed with a depressive or anxiety disorder compared to 9.8% of the control group. Education was lower and quality of life worse in the DAX-group than in the control group. Those participants of the DAX-group who received a diagnosis in 2011 had poorer quality of life than those in remission, which emphasizes the influence of a current disorder on the quality of life. Higher score in the Mood Disorder Questionnaire (MDQ) at baseline predicted poorer quality of life in 2011. CONCLUSIONS: Thus, depressive and anxiety disorders were persistent/recurrent in one quarter of participants, significantly affecting education and quality of life. Young adults with these disorders need support to achieve their academic goals.

Treatment adequacy of anxiety disorders among young adults in Finland.

BACKGROUND: Anxiety disorders are common in early adulthood, but general population studies concerning the treatment adequacy of anxiety disorders taking into account appropriate pharmacological and psychological treatment are scarce. The aims of this study were to examine treatments received for anxiety disorders in a Finnish general population sample of young adults, and to define factors associated with receiving minimally adequate treatment and with dropping out from treatment. METHODS: A questionnaire containing several mental health screens was sent to a nationally representative two-stage cluster sample of 1894 Finns aged 19 to 34 years. All screen positives and a random sample of screen negatives were invited to a mental health assessment including a SCID interview. For the final diagnostic assessment, case records from mental health treatments for the same sample were obtained. This article investigates treatment received, treatment adequacy and dropouts from treatment of 79 participants with a lifetime anxiety disorder (excluding those with a single specific phobia). Based on all available information, receiving antidepressant or buspirone medication for at least 2 months with at least four visits with any type of physician or at least eight sessions of psychotherapy within 12 months or at least 4 days of hospitalization were regarded as minimally adequate treatment for anxiety disorders. Treatment dropout was rated if the patient discontinued the visits by his own decision despite having an adequate treatment strategy according to the case records. RESULTS: Of participants with anxiety disorders (excluding those with a single specific phobia), 41.8 % had received minimally adequate treatment. In the multivariate analysis, comorbid substance use disorder was associated with antidepressant or buspirone medication lasting at least 2 months. Those who were currently married or cohabiting had lower odds of having at least four visits with a physician a year. None of these factors were associated with the final outcome of minimally adequate treatment or treatment dropout. Participants with comorbid personality disorders received and misused benzodiazepines more often than others. CONCLUSIONS: More efforts are needed to provide adequate treatment for young adults with anxiety disorders. Attention should be paid to benzodiazepine prescribing to individuals with personality disorders.

Treatment received and treatment adequacy of depressive disorders among young adults in Finland.

BACKGROUND: Under-treated depression may be especially harmful in early adulthood. The aims of this study are to describe treatments received for depressive disorders, to define factors associated with treatment adequacy and dropouts from treatment in a Finnish general population sample of young adults. METHODS: A nationally representative two-stage cluster sample of 1894 Finns aged 19 to 34 years was sent a questionnaire containing several mental health screens. All screen positives and a random sample of screen negatives were invited to participate in a mental health assessment including a SCID interview. Case records from mental health treatments for the same sample were obtained for the final diagnostic assessment. Based on all available information, receiving antidepressant pharmacotherapy for at least two months with at least four visits with any type of physician or at least eight sessions of psychotherapy within 12 months or at least four days of hospitalization were regarded as minimally adequate treatment. Treatment dropout was rated if the treatment strategy was assessed to be adequate according to the case records but the patient discontinued the visits. RESULTS: Of participants with depressive disorders (n = 142), 40.9% received minimally adequate treatment. In multiple logistic regression models, substance use disorder and female gender were associated with at least one visit with a physician, while having major depressive disorder was associated with visits with a physician at least 4 times a year. Women had higher odds of having received any psychotherapy and psychotherapy lasting for at least 8 sessions in a year. Low education and a history of suicide attempt were associated with increased odds of treatment dropout. None of the factors explained the final outcome of minimally adequate treatment. CONCLUSIONS: Treatment adequacy in the present study was better than previously seen, but more efforts are needed to provide adequate treatment for young adults, especially those with low education and suicidality.

Lung function and respiratory diseases in people with psychosis: population-based study.

BACKGROUND: There is little information on lung function and respiratory diseases in people with psychosis. AIMS: To compare the respiratory health of people with psychosis with that of the general population. METHOD: In a nationally representative sample of 8028 adult Finns, lung function was measured by spirometry. Information on respiratory diseases and symptoms was collected. Smoking was quantified with serum cotinine levels. Psychotic disorders were diagnosed utilising the Structured Clinical Interview for DSM-IV (SCID-I) and medical records. RESULTS: Participants with schizophrenia and other non-affective psychoses had significantly lower lung function values compared with the general population, and the association remained significant for schizophrenia after adjustment for smoking and other potential confounders. Schizophrenia was associated with increased odds of pneumonia (odds ratio (OR) = 4.9), chronic obstructive pulmonary disease (COPD, OR = 4.2) and chronic bronchitis (OR = 3.8); and with high cotinine levels. CONCLUSIONS: Schizophrenia is associated with impaired lung function and increased risk for pneumonia, COPD and chronic bronchitis.

Hearing loss in persons with psychotic disorder--findings from a population-based survey.

Hearing impairment is associated with psychotic symptoms, but has not been systematically studied in people with psychotic disorder. We used a population-based sample of 6654 persons aged 30+ to compare hearing, as measured by audiometry, in persons with schizophrenia, other non-affective psychosis and affective psychosis in the general population. The prevalence of hearing impairment did not differ in persons with psychotic disorder compared with the general population. Participants with schizophrenia and affective psychotic disorder had significantly more difficulties to hear in a noisy environment than the general population. Our results suggest that psychotic disorders are associated with minor hearing difficulties but not hearing impairment.

Prevalence and correlates of eating disorders among young adults in Finland.

BACKGROUND: This study investigated the epidemiology of eating disorders in a population-based sample of young adults. METHOD: A mental health questionnaire was sent to a nationally representative two-stage cluster sample of 1863 Finns aged 20-35 years. All screen-positives and a random sample of screen-negatives were invited to participate in a Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview. Case records from all lifetime mental health treatments were also obtained and were used to complement the diagnostic assessment. RESULTS: The lifetime prevalence of anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified and any eating disorder among women were 2.1%, 2.3%, 2.0% and 6.0%, respectively, while there was only one man with an eating disorder. Unlike other mental disorders, they are associated with high education. Of women diagnosed with lifetime eating disorder, 67.9% had at least one comorbid Axis I psychiatric disorder, most commonly depressive disorder. While 79.3% of women with lifetime eating disorder had had a treatment contact, only one third of persons with current eating disorder had a current treatment contact. Women whose eating disorder had remitted still experienced more psychological distress and had lower psychosocial functioning that women without lifetime Axis I disorders. CONCLUSION: Eating disorders are the fourth largest group of mental disorders among young women. They tend to be comorbid, often remain untreated and are associated with residual symptoms after the remission of eating disorder symptoms.

Mortality and its determinants in people with psychotic disorder.

OBJECTIVE: We investigated mortality and its determinants in people with psychotic disorder. METHODS: A nationally representative two-stage cluster sample of 8028 persons aged 30 years or older from Finland was selected for a comprehensive health survey conducted from 2000 to 2001. Participants were screened for psychotic disorder, and screen-positive persons were invited for a Structured Clinical Interview for DSM-IV. The diagnostic assessment of DSM-IV psychotic disorders was based on the Structured Clinical Interview for DSM-IV, case records from mental health treatments, or both. Mortality was followed up until September 2009 and analyzed using Cox proportional hazards model. RESULTS: People with schizophrenia (hazard ratio [HR] = 3.03; 95% confidence interval [CI] = 1.93-4.77) and other nonaffective psychoses (HR = 1.84; 95% CI = 1.17-2.91) had elevated mortality risk, whereas people with affective psychoses did not (HR = 0.61; 95% CI = 0.24-1.55). Antipsychotic medication use was associated with increased mortality (HR = 2.34; 95% CI = 1.86-2.96). There was an interaction between antipsychotic medication use and the presence of a psychotic disorder: antipsychotic medication use was only associated with elevated mortality in persons who were using antipsychotics and did not have primary psychotic disorder. In persons with psychotic disorder, mortality was predicted by smoking and Type 2 diabetes at baseline survey. CONCLUSIONS: Schizophrenia and nonaffective psychoses are associated with increased mortality risk, whereas affective psychoses are not. Antipsychotic medication use increases mortality risk in older people without primary psychotic disorder, but not in individuals with schizophrenia. Smoking and Type 2 diabetes are important predictors of elevated mortality risk in persons with psychotic disorder.

Cognitive impairments in schizophrenia and schizoaffective disorder: relationship with clinical characteristics.

The present study aimed to compare population-based familial samples of patients with schizophrenia (n = 218) and schizoaffective disorder (n = 62) and a healthy control group (n = 123). Patients with schizoaffective disorder outperformed patients with schizophrenia in verbal ability, processing speed, visual working memory, and verbal memory. When compared with controls, patients with schizoaffective disorder also had a generalized cognitive impairment. Adjusting for clinical characteristics removed significant differences between the patient groups. Irrespective of the diagnosis, patients with the most severe negative symptoms and highest dose of antipsychotics had the most severe cognitive impairments, whereas mood symptoms were not related to cognitive performance. In conclusion, people with schizoaffective disorder have severe cognitive impairments, but the impairments are milder than in schizophrenia. Mood symptoms may not explain the difference between the diagnostic groups in cognitive functions, but the difference may be related to differences in the severity of negative symptoms.

Mortality in people with depressive, anxiety and alcohol use disorders in Finland.

BACKGROUND: Mental disorders are associated with increased mortality, but population-based surveys with reliable diagnostic procedures controlling for somatic health status are scarce. AIMS: To assess excess mortality associated with depressive, anxiety and alcohol use disorders and the principal causes of death. METHOD: In a nationally representative sample of Finns aged 30-70 years, psychiatric disorders were diagnosed with the Composite International Diagnostic Interview. After an 8-year follow-up period, vital status and cause of death of each participant was obtained from national registers. RESULTS: After adjusting for sociodemographic factors, health status and smoking, depressive (hazard ratio (HR) = 1.97) and alcohol use disorders (HR = 1.72) were statistically significantly associated with mortality. Risk of unnatural death was increased among individuals diagnosed with anxiety disorders or alcohol dependence. CONCLUSIONS: Individuals with depressive and alcohol use disorders have an increased mortality risk comparable with many chronic somatic conditions, that is only partly attributable to differences in sociodemographic, somatic health status and hazardous health behaviour.

Inflammation in psychotic disorders: a population-based study.

We investigated inflammatory markers in psychotic disorders and their association with metabolic comorbidity, antipsychotic medication, smoking, alcohol use, physical condition, and mood. From the population-based Finnish Health 2000 study, we identified all persons with schizophrenia (n=45), other nonaffective psychosis (ONAP) (n=57), affective psychosis (n=37) and chose controls matched by age, sex, and region of residence. We found that persons with schizophrenia had significantly higher sIL-2Rα, IL-1RA and C-reactive protein (CRP), persons with ONAP significantly higher IL-1RA and CRP and persons with affective psychosis almost significantly higher TNF-α compared to their matched controls. Current antipsychotic use was associated with elevated IL-1RA and CRP. After taking metabolic and lifestyle-related variables that associated with inflammatory markers into account, only antipsychotic medication remained associated with elevated IL-1RA and TNF-α which are markers related to the activation of innate immune system. CRP was influenced by both antipsychotic medication and nonaffective psychosis. sIL-2Rα, a marker of T-cell activation, was associated with depressive symptoms, schizophrenia, and affective psychosis. We conclude that in persons with psychotic disorders, activation of mononuclear phagocyte system was mostly related to metabolic comorbidity and antipsychotic medication use, whereas T-cell activation had a more direct relationship with both psychotic disorders and depressive symptoms.

Metabolome in schizophrenia and other psychotic disorders: a general population-based study.

BACKGROUND: Persons with schizophrenia and other psychotic disorders have a high prevalence of obesity, impaired glucose tolerance, and lipid abnormalities, particularly hypertriglyceridemia and low high-density lipoprotein. More detailed molecular information on the metabolic abnormalities may reveal clues about the pathophysiology of these changes, as well as about disease specificity. METHODS: We applied comprehensive metabolomics in serum samples from a general population-based study in Finland. The study included all persons with DSM-IV primary psychotic disorder (schizophrenia, n = 45; other non-affective psychosis (ONAP), n = 57; affective psychosis, n = 37) and controls matched by age, sex, and region of residence. Two analytical platforms for metabolomics were applied to all serum samples: a global lipidomics platform based on ultra-performance liquid chromatography coupled to mass spectrometry, which covers molecular lipids such as phospholipids and neutral lipids; and a platform for small polar metabolites based on two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GC × GC-TOFMS). RESULTS: Compared with their matched controls, persons with schizophrenia had significantly higher metabolite levels in six lipid clusters containing mainly saturated triglycerides, and in two small-molecule clusters containing, among other metabolites, (1) branched chain amino acids, phenylalanine and tyrosine, and (2) proline, glutamic, lactic and pyruvic acids. Among these, serum glutamic acid was elevated in all psychoses (P = 0.0020) compared to controls, while proline upregulation (P = 0.000023) was specific to schizophrenia. After adjusting for medication and metabolic comorbidity in linear mixed models, schizophrenia remained independently associated with higher levels in seven of these eight clusters (P < 0.05 in each cluster). The metabolic abnormalities were less pronounced in persons with ONAP or affective psychosis. CONCLUSIONS: Our findings suggest that specific metabolic abnormalities related to glucoregulatory processes and proline metabolism are specifically associated with schizophrenia and reflect two different disease-related pathways. Metabolomics, which is sensitive to both genetic and environmental variation, may become a powerful tool in psychiatric research to investigate disease susceptibility, clinical course, and treatment response.

Cognitive functioning in severe psychiatric disorders: a general population study.

In clinical samples, patients with severe psychiatric disorders are found to have cognitive impairments. Less is known whether this applies to samples derived from the general population. We aimed to study cognitive functioning in a population-based sample comprising individuals with schizophrenia, other non-affective psychoses, bipolar disorders, major depressive disorder, and controls derived from the same population. The current analysis was based on 148 persons with severe mental disorders and 66 control subjects, derived from the Psychoses in Finland study. All subjects were interviewed with SCID, and a neuropsychological test battery was administered. Subjects with schizophrenia had a generalized cognitive impairment (d = 0.43-1.07), while those with other non-affective psychoses were impaired in verbal memory and processing speed (d = 0.43-0.59). Subjects with bipolar disorders were not impaired. Unipolar major depressive disorder associated with slowed processing speed (d = 0.64). Our findings on cognitive impairments in subjects with schizophrenia and other non-affective psychoses derived from the general population support previous findings of a generalized cognitive dysfunction in these subjects. However, our results suggest that subjects with bipolar disorders from non-clinical populations may not have significant cognitive impairments. Our results emphasize the importance of using control samples derived from the same population and studied similarly as those with disorders in evaluating cognitive functioning of subjects with severe mental disorders.

Associations of anhedonia and cognition in persons with schizophrenia spectrum disorders, their siblings, and controls.

The aim of the current study was to investigate the levels of social and physical anhedonia, as measured with the Chapman Scales for social and physical anhedonia in groups of patients with schizophrenia spectrum psychosis (n = 91), their unaffected siblings (n = 105), and control subjects drawn from a general population (n = 67). The second aim was to explore the effect of physical and social anhedonia on neuropsychological variables. Subjects with schizophrenia spectrum disorder had significantly more anhedonia than population controls, but the unaffected siblings did not differ from controls. Subjects with schizophrenia spectrum disorders had generalized cognitive deficits. Unaffected sibling status predicted impairments in executive and performance speed measures. Elevated physical anhedonia associated with deficits in verbal functions, but this was not related to genetic liability to schizophrenia. In conclusion, social and physical anhedonia did not seem to mediate neuropsychological deficits of schizophrenia family members.

Sex differences in cognition among persons with schizophrenia and healthy first-degree relatives.

Previous research suggests differences between women and men in the clinical features of schizophrenia, but studies examining sex differences in neuropsychological functioning have reached inconsistent results. In the present study, sex differences in cognition and clinical features were investigated in population-based samples of participants with schizophrenia (n=218), their healthy first-degree relatives (n=438) and controls (n=123). Sex differences in illness features were small; nevertheless, women with schizophrenia had less negative symptoms and lived independently more often than men. The schizophrenia group had impairments in all studied neuropsychological domains, and the relatives were impaired in processing speed and set-shifting. In all groups, women performed better than men in processing speed, set-shifting and verbal episodic memory, whereas men outperformed women in visual working memory. The group-by-sex interaction was significant in two variables: women outperformed men in the relatives group in immediate verbal reproduction and in the use of semantic clustering as a learning strategy, while there was no sex difference in the schizophrenia group. In conclusion, sex differences in cognition are mostly similar in schizophrenia to those among controls, despite sex differences in illness features. The preservation of sex differences also in first-degree relatives supports the conclusion.

Attempted suicide in mental disorders in young adulthood.

BACKGROUND: Nationwide general population study establishes the prevalence of suicide attempts in different mental disorders among young adults and their sociodemographic correlates. Current psychiatric symptoms are also examined. METHODS: A random sample of 1,894 young Finnish adults aged 20-34 years were approached to participate in a questionnaire containing several screens for mental health interviews. All screen positives and random sample of screen negatives were invited to an SCID interview. Altogether 546 subjects participated in the interview. Diagnostic assessment and lifetime history of suicide attempts were based on all available systematically evaluated information from the questionnaire, the interview and/or case records. RESULTS: The lifetime prevalence of suicide attempts was 5.6% in men and 6.9% in women. Both mental disorders and poor educational and occupational functioning were associated with lifetime suicide attempts. Lifetime history of suicide attempts was associated with current psychological distress, problems related to substance use and other psychiatric symptoms, even after taking current Axis I disorder into account. Suicide attempts were most common in persons with psychotic disorders (41%). CONCLUSIONS: These results suggest that continued efforts are needed to outreach and treat effectively young adults with serious mental disorders. Young people who make a suicide attempt should be offered treatment. It seems also important to prevent psychosocial alienation of young people by providing them with adequate education and work possibilities.

Cognitive functioning in relation to burnout symptoms and social and occupational functioning in a population-based sample of young adults.

BACKGROUND: There may be an association between cognitive functioning and burnout, but this has previously been investigated in only few studies, all using clinical samples. AIMS: This study aimed at examining the relationship of cognitive functioning with burnout symptoms and social and occupational functioning in a population-based sample of young adults. METHODS: Neuropsychological tests assessing verbal and visual short-term memory, verbal long-term memory, general intelligence, attention, psychomotor processing speed and executive functioning were administered to a population-based sample of working young adults aged 22-35 years (n=225). Burnout was measured with the Maslach Burnout Survey-General Survey (MBI-GS) and social and occupational functioning with examiner-rated Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS: Higher scores in the MBI-GS related to better performance in tests of verbal working memory and general intelligence. Lower SOFAS associated with poorer performance in tests assessing verbal attention, memory and learning. CONCLUSIONS: In a representative population sample of young adults, self-reported symptoms of burnout are not associated with difficulties in cognitive functioning. However, examiner-rated lower social and occupational functioning is related to problems in verbal attention, memory and learning, suggesting the importance of evaluating and enhancing cognitive functioning among those with difficulties in social and occupational functioning.