Brief report: validity of Finnish registry-based diagnoses of autism with the ADI-R.

AIMS: The aim of the study was to explore the validity of registry-based diagnoses of autism in Finland using the Autism Diagnostic Interview - Revised (ADI-R). This study was designed for the Finnish Prenatal Study of Autism and Autism Spectrum Disorders (FIPS-A), an ongoing research project where registry-based diagnoses will be used for epidemiological studies. METHODS: In this small pilot study, a clinical sample of 95 subjects diagnosed with childhood autism or pervasive developmental disorder/pervasive developmental disorder - not otherwise specified (PDD/PDD-NOS) or Asperger's syndrome according to the Finnish Hospital Discharge Register (FHDR) was gathered nationwide. A small control group consisting of siblings without any registered diagnoses of those being examined was also included in the study. Diagnoses were further re-evaluated by interviewing parents with the ADI-R. RESULTS: The mean scores of autistic subjects clearly exceeded cut-off limits for autism on all three ADI-R domains and 96% of the subjects with registered diagnosis of childhood autism fulfilled the criteria based on the instrument as well. CONCLUSION: These results suggest that the validity of Finnish registry-based diagnoses of childhood autism can be considered good. Our findings lay important groundwork for further population- based studies of the aetiology of autism.

Disability pensions in severely disturbed in-patient adolescents. Twenty-year prospective study.

BACKGROUND: Knowledge of working capacity from adolescence until adulthood among severely disturbed in-patients is scarce. METHOD: In a follow-up study of 61 adolescent in-patients, we studied associations between being on a disability pension 20 years after hospitalisation, and the patients' psychopathology and treatment-related factors during the hospitalisation and seven-year follow-up. RESULTS: Of the former in-patients, 27% had not been on a disability pension, 20% had short-term pension periods, and 53% were pensioned. Subjects whose overall psychosocial functioning had improved and who had not utilised in-patient services until the seven-year follow-up, had a better prognosis in terms of working capacity. Half of the subjects who had not been on pension during the follow-up had received a diagnosis of conduct disorder at discharge, and half of those pensioned had a psychotic disorder. CONCLUSIONS: The patients' level of psychosocial functioning and capability to work in young adulthood were associated with long-term prognosis in terms of working capacity. Adolescence seems to be the critical time for intensive psychiatric care combined with vocational rehabilitation programmes.

Characteristics of out-patient adolescents with suicidal tendencies.

Suicidal adolescent out-patients were compared with non-suicidal subjects with respect to background factors, psychopathology and treatment received. Data for suicidal ideation, suicide attempts, psychiatric diagnoses (DSM-III-R) and other patient-related factors were collected prospectively during treatment of 122 male and 138 female out-patients aged 12-22 years. In total, 42% of subjects displayed suicidal tendencies, and 18% had attempted suicide. According to polychotomous regression, mood disorder, previous psychiatric treatment and low level of psychosocial functioning at treatment entry were associated with suicide attempts and with suicidal ideation for both sexes. Suicidal patients were more often receiving psychotropic medication and had more total appointments (mean number 15 vs. 9) than non-suicidal patients. Suicidal and non-suicidal patients kept their scheduled appointments to the same extent (66% vs. 65%). Treatments which meet the needs of disordered suicidal adolescents need to be developed.

Excess mortality among former adolescent male out-patients.

Mortality among 156 males and 122 females referred to an out-patient adolescent psychiatric clinic in a Finnish town between 1984 and 1989 was examined. During the follow-up (mean duration 6 years; range 0-6.3 years for the deceased, 0.6-10.3 years for the survivors), 16 male subjects but no females had died. Among those who had died, the mode of death was suicide in 11 cases. The mortality for any cause for males was 10.3% and that for suicide was 7.1%. All male victims had similar high levels of individual and familial disturbances. Current suicidal ideation and suicide attempts, poor psychosocial functioning and a recommendation for psychiatric hospital treatment during the index treatment were associated with male mortality/suicidality. A high risk for mortality for several years after psychiatric treatment was found. It is concluded that, in clinical settings, perceived current suicidal tendencies should be assessed carefully.

Immunoglobulins in schizophrenics and prediction of need for hospital care.

The purpose of the study was to determine whether the total number of days spent in hospital during a 5-year follow-up period could be predicted by determining IgA, IgG and IgM concentrations in 62 schizophrenics on initial admission. A high IgA concentration on initial admission indicated less frequent need for hospital care during follow-up. A scattering diagram of this negative correlation showed that the correlation was based on a group of seven patients whose IgA concentrations markedly exceeded normal values. This group with exceedingly high IgA differed from the control group in several areas, which would indicate that these patients suffer from a "different" schizophrenia than the patients in the control group. This finding supports the idea of the heterogeneity of schizophrenia, and raises the possibility of developing biochemical methods to delineate the diagnostic category of schizophrenia.

Immunoglobulins, psychopathology and prognosis in schizophrenia.

On admission, IgA, IgG and IgM concentrations were determined in 76 schizophrenics, and the correlations of these concentrations to the variables relating to psychopathology, background and prognosis were investigated in the present study, which is a part of a more extensive unpublished study. On the basis of factorization, the highest IgM concentrations were found in withdrawn schizophrenics and the lowest in paranoid schizophrenics. Of the background variables, the patient's present age had a positive correlation and his place of birth (rural-urban) a negative correlation to IgA concentrations, both being at a statistically significant level. IgA and IgM values higher than average at the beginning of treatment predicted a short hospital stay. Earlier, these patients had also needed little hospital care in relation to the duration of the disease. A hypothesis based on the results is presented, according to which a different way of reacting to stress may explain the differences in IgM concentrations in withdrawn and paranoid schizophrenics. The connection between prognosis and immunoglobulins was considered at least partially explainable on the grounds of age at the onset of the disease.