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Karpov B, Lipsanen JO, Ritola V, Rosenström T, Saarni S, Pihlaja S, Stenberg JH, Laizane P, Joffe G. The Overall Anxiety Severity and Impairment Scale as an Outcome Measure in Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders: Observational Study. J Med Internet Res 2023; 25:e45362. [PMID: 37590055 PMCID: PMC10472172 DOI: 10.2196/45362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioral therapy (iCBT) is effective in the treatment of anxiety disorders. iCBT clinical trials use relatively long and time-consuming disorder-specific rather than transdiagnostic anxiety measurements. Overall Anxiety Severity and Impairment Scale (OASIS) is a brief self-report scale that could offer a universal, easy-to-use anxiety measurement option in disorder-specific and transdiagnostic iCBT programs. OBJECTIVE We aimed to investigate relationships between OASIS and disorder-specific instruments in iCBT. We expected these relationships to be positive. METHODS We investigated patients in original nationwide iCBT programs for generalized anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, and social anxiety disorder, which were administered by Helsinki University Hospital, Finland. In each program, anxiety symptoms were measured using both disorder-specific scales (the 7-item Generalized Anxiety Disorder scale, Penn State Worry Questionnaire, revised Obsessive-Compulsive Inventory, Panic Disorder Severity Scale, and Social Phobia Inventory) and by OASIS. A general linear model for repeated measures (mixed models) and interaction analysis were used for investigating the changes and relationships in the mean scores of OASIS and disorder-specific scales from the first session to the last one. RESULTS The main effect of linear mixed models indicated a distinct positive association between OASIS and disorder-specific scale scores. Interaction analysis demonstrated relatively stable associations between OASIS and the revised Obsessive-Compulsive Inventory (F822.9=0.09; 95% CI 0.090-0.277; P=.32), and OASIS and the Panic Disorder Severity Scale (F596.6=-0.02; 95% CI -0.108 to -0.065; P=.63) from first the session to the last one, while the 7-item Generalized Anxiety Disorder scale (F4345.8=-0.06; 95% CI -0.109 to -0.017; P=.007), Penn State Worry Questionnaire (F4270.8=-0.52; 95% CI -0.620 to -0.437; P<.001), and Social Phobia Inventory (F862.1=-0.39; 95% CI -0.596 to -0.187; P<.001) interrelated with OASIS more strongly at the last session than at the first one. CONCLUSIONS OASIS demonstrates clear and relatively stable associations with disorder-specific symptom measures. Thus, OASIS might serve as an outcome measurement instrument for disorder-specific and plausibly transdiagnostic iCBT programs for anxiety disorders in regular clinical practice.
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Affiliation(s)
- Boris Karpov
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | | | - Ville Ritola
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Suoma Saarni
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Satu Pihlaja
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Grigori Joffe
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Rosenström TH, Ritola V, Saarni S, Joffe G, Stenberg JH. Measurement Invariant but Non-Normal Treatment Responses in Guided Internet Psychotherapies for Depressive and Generalized Anxiety Disorders. Assessment 2023; 30:618-632. [PMID: 34905968 PMCID: PMC9999284 DOI: 10.1177/10731911211062500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Assessment of treatment response in psychotherapies can be undermined by lack of longitudinal measurement invariance (LMI) in symptom self-report inventories, by measurement error, and/or by wrong model assumptions. To understand and compare these threats to validity of outcome assessment in psychotherapy research, we studied LMI, sum scores, and Davidian Curve Item Response Theory models in a naturalistic guided internet psychotherapy treatment register of 2,218 generalized anxiety disorder (GAD) patients and 3,922 depressive disorder (DD) patients (aged ≥16 years). Symptoms were repeatedly assessed by Generalized Anxiety Disorder Assessment-7 (GAD-7) or Beck Depression Inventory. The symptom self-reports adhered to LMI under equivalence testing, suggesting sum scores are reasonable proxies for disorder status. However, the standard LMI assumption of normally distributed latent factors did not hold and inflated treatment response estimates by 0.2 to 0.3 standard deviation units compared with sum scores. Further methodological research on non-normally distributed latent constructs holds promise in advancing LMI and mental health assessment.
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Affiliation(s)
- Tom H. Rosenström
- University of Helsinki, Finland
- Tom H. Rosenström, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PL 21 (Haartmaninkatu 3), 00014 Helsinki, Finland.
| | - Ville Ritola
- University of Helsinki, Finland
- Helsinki University Hospital, Finland
| | - Suoma Saarni
- University of Helsinki, Finland
- Helsinki University Hospital, Finland
| | - Grigori Joffe
- University of Helsinki, Finland
- Helsinki University Hospital, Finland
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Mylläri S, Saarni SE, Ritola V, Joffe G, Stenberg JH, Solbakken OA, Czajkowski NO, Rosenström T. Text Topics and Treatment Response in Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder: Text Mining Study. J Med Internet Res 2022; 24:e38911. [DOI: 10.2196/38911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background
Text mining methods such as topic modeling can offer valuable information on how and to whom internet-delivered cognitive behavioral therapies (iCBT) work. Although iCBT treatments provide convenient data for topic modeling, it has rarely been used in this context.
Objective
Our aims were to apply topic modeling to written assignment texts from iCBT for generalized anxiety disorder and explore the resulting topics’ associations with treatment response. As predetermining the number of topics presents a considerable challenge in topic modeling, we also aimed to explore a novel method for topic number selection.
Methods
We defined 2 latent Dirichlet allocation (LDA) topic models using a novel data-driven and a more commonly used interpretability-based topic number selection approaches. We used multilevel models to associate the topics with continuous-valued treatment response, defined as the rate of per-session change in GAD-7 sum scores throughout the treatment.
Results
Our analyses included 1686 patients. We observed 2 topics that were associated with better than average treatment response: “well-being of family, pets, and loved ones” from the data-driven LDA model (B=–0.10 SD/session/∆topic; 95% CI –016 to –0.03) and “children, family issues” from the interpretability-based model (B=–0.18 SD/session/∆topic; 95% CI –0.31 to –0.05). Two topics were associated with worse treatment response: “monitoring of thoughts and worries” from the data-driven model (B=0.06 SD/session/∆topic; 95% CI 0.01 to 0.11) and “internet therapy” from the interpretability-based model (B=0.27 SD/session/∆topic; 95% CI 0.07 to 0.46).
Conclusions
The 2 LDA models were different in terms of their interpretability and broadness of topics but both contained topics that were associated with treatment response in an interpretable manner. Our work demonstrates that topic modeling is well suited for iCBT research and has potential to expose clinically relevant information in vast text data.
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Stenberg JH, Ritola V, Joffe G, Saarni S, Rosenström T. Effectiveness of mobile-delivered, therapist-assisted cognitive behavioral therapy for insomnia in nationwide routine clinical care in Finland. J Clin Sleep Med 2022; 18:2643-2651. [PMID: 35929590 PMCID: PMC9622989 DOI: 10.5664/jcsm.10186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Internet-delivered cognitive behavioral therapies (iCBTs) are efficacious for insomnia. Few studies have as yet reported their effectiveness in routine care. The objective of this study was to examine the effectiveness of the new Finnish 7-session HUS Helsinki University Hospital-iCBT for Insomnia (HUS-iCBTI) program in nationwide routine care. METHODS We studied 2,464 physician-referred patients in therapist-supported iCBTI. Treatment was free of charge for patients. The primary measure was the Insomnia Severity Index (ISI); the Patient Health Questionnaire, 4-item version (PHQ-4), and the Alcohol Use Disorders Identification Test (AUDIT-C) were also administered. RESULTS As many as 75.4% completed the treatment, with the ISI scores declining, on average, by -7.04 points during treatment. Altogether, 91.1% of the completers improved in terms of having a lower ISI score in phase 7 than in phase 1 and 34.0% of the completers achieved remission by phase 7 (ISI score < 8); 46.0% responded to treatment (ISI-score reduction of ≥ 8 points from phase 1). The Cohen's effect size (ISI-score decline) was d = -1.449, showing a large effect. CONCLUSIONS We observed large benefits for this publicly funded therapist-supported treatment in its naturalistic setting as a part of routine care. Effect sizes were comparable to randomized controlled trials reported earlier. HUS-iCBTI appears to be effective as a treatment for insomnia and may also reduce the risk of other adverse health consequences associated with poor sleep. CITATION Stenberg J-H, Ritola V, Joffe G, Saarni S, Rosenström T. Effectiveness of mobile-delivered, therapist-assisted cognitive behavioral therapy for insomnia in nationwide routine clinical care in Finland. J Clin Sleep Med. 2022;18(11):2643-2651.
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Affiliation(s)
- Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Ville Ritola
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | | | - Suoma Saarni
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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Abstract
Mirtazapine has often been prescribed as add-on treatment for schizophrenia in patients with suboptimal response to conventional treatments. In this review, we evaluate the existing evidence for efficacy and effectiveness of add-on mirtazapine in schizophrenia and reappraise the practical and theoretical aspects of mirtazapine-antipsychotic combinations. In randomized controlled trials (RCTs), mirtazapine demonstrated favourable effects on negative and cognitive (although plausibly not depressive) symptoms, with no risk of psychotic exacerbation. Mirtazapine also may have a desirable effect on antipsychotic-induced sexual dysfunction, but seems not to alleviate extrapyramidal symptoms, at least if combined with second-generation antipsychotics. It is noteworthy that all published RCTs have been underpowered and relatively short in duration. In the only large pragmatic effectiveness study that provided analyses by add-on antidepressant, only mirtazapine was associated with both decreased rate of hospital admissions and number of in-patient days. Mirtazapine hardly affects the pharmacokinetics of antipsychotics. However, possible pharmacodynamic interactions (sedation and metabolic offence) should be borne in mind. The observed desired clinical effects of mirtazapine may be due to its specific receptor-blocking properties. Alternative theoretical explanations include its possible neuroprotective effect. Further well-designed RCTs and real-world effectiveness studies are needed to determine whether add-on mirtazapine should be recommended for difficult-to-treat schizophrenia.
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Ritola V, Lipsanen JO, Pihlaja S, Gummerus EM, Stenberg JH, Saarni S, Joffe G. Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care: Effectiveness Study. J Med Internet Res 2022; 24:e29384. [PMID: 35323119 PMCID: PMC8990365 DOI: 10.2196/29384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/30/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7–measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients.
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Affiliation(s)
- Ville Ritola
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jari Olavi Lipsanen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Satu Pihlaja
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eero-Matti Gummerus
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Suoma Saarni
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Seppänen M, Hämäläinen T, Joffe G, Mäkitie L. eConsultation between health care professionals in primary health care and specialized medical care. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The synchronous eConsultation is provided by a specialist in a hospital to a GP appointment either by pre-set request or without scheduling. The patient participates in the session. The eConsultation employs video or chat and the program integrated into Health Village service platform enables also sharing x-rays, still photos and other EHR material. Health Village delivers public health services for general public, digital care pathways for patients with specific diagnoses and digital tools for professionals.
The eConsultation project started in 2018, after interviewing the member municipalities (n = 24, 1 600 000 inhabitants) of the Hospital District of Helsinki and Uusimaa (HUS) in Finland. The municipalities gave a high priority to eConsultation as a way of further integration of service chains and dissemination of common practices between and within the specialized and primary health care services.
Funded by the HUS and supported by the HUS IT Department eHealth Services, eConsultation pilots started in 2018 in close collaboration between the public specialized and primary health care organizations in neurology, orthopedics and wound treatment. The pilots indicated that eConsultation are more efficient than traditional consultation methods (e.g., the time used by a neurologist in eConsultation dropped by 87% vs. a face-to-face consultation visit). Almost all of patients and 84% of primary care professionals reported high level of satisfaction. The consultants found that the presence of a patient fostered, if needed, additional clinical interview and diagnostic procedures by proxy, as well as assessment of individual needs of a GP. The primary care professionals appreciated queue-free response (45 seconds in eConsultation with no pre-set appointment time) and augmented educational validity.
Scaling of eConsultation across the whole hospital district and more specialties is going on. eConsultation will be explored in depth in two starting scientific studies.
Key messages
Synchronous eConsultation. more efficient than traditional consultation methods.
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Affiliation(s)
- M Seppänen
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - T Hämäläinen
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - G Joffe
- Helsinki University Hospital Area Administration, Helsinki University Hospital, Helsinki, Finland
| | - L Mäkitie
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
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Pihlaja S, Lahti J, Lipsanen JO, Ritola V, Gummerus EM, Stenberg JH, Joffe G. Scheduled Telephone Support for Internet Cognitive Behavioral Therapy for Depression in Patients at Risk for Dropout: Pragmatic Randomized Controlled Trial. J Med Internet Res 2020; 22:e15732. [PMID: 32706658 PMCID: PMC7413288 DOI: 10.2196/15732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/20/2019] [Accepted: 04/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficient in the treatment of depression. However, the optimal mode and intensity of therapist support remain to be identified. Scheduled telephone support (STS) may improve adherence and outcomes but, as it is time- and resource-consuming, should be reserved for patients for whom the usual support may be insufficient. Objective This paper aims to reveal whether add-on STS for patients at risk of dropping out improves treatment adherence and symptoms in iCBT for depression. Methods Among patients participating in an ongoing large observational routine clinical practice study of iCBT for depression delivered nationwide by Helsinki University Hospital (HUS-iCBT), those demonstrating a ≥14-day delay in initiation of treatment received invitations to this subsidiary STS study. A total of 100 consenting patients were randomly allocated to either HUS-iCBT as usual (control group, n=50) or HUS-iCBT plus add-on STS (intervention group, n=50). Proportions of those reaching midtreatment and treatment end point served as the primary outcome; secondary outcomes were change in Beck Depression Inventory (BDI)–measured depressive symptoms and time spent in treatment. Results Add-on STS raised the proportion of patients reaching midtreatment compared with HUS-iCBT as usual (29/50, 58% vs 18/50, 36%; P=.045) and treatment end point (12/50, 24% vs 3/50, 6%; P=.02). Change in BDI score also favored add-on STS (3.63 points vs 1.1 points; P=.049), whereas duration of treatment did not differ. Conclusions Add-on STS enhances adherence and symptom improvement of patients at risk of dropping out of iCBT for depression in routine clinical practice. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN) 55123131; http://www.isrctn.com/ISRCTN55123131.
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Affiliation(s)
- Satu Pihlaja
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Olavi Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ville Ritola
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Eero-Matti Gummerus
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Jan-Henry Stenberg
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
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Baryshnikov I, Aaltonen K, Suvisaari J, Koivisto M, Heikkinen M, Joffe G, Isometsä E. Features of borderline personality disorder as a mediator of the relation between childhood traumatic experiences and psychosis-like experiences in patients with mood disorder. Eur Psychiatry 2020; 49:9-15. [PMID: 29353179 DOI: 10.1016/j.eurpsy.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022] Open
Abstract
AbstractBackgroundPsychosis-like experiences (PEs) are common in patients with non-psychotic disorders. Several factors predict reporting of PEs in mood disorders, including mood-associated cognitive biases, anxiety and features of borderline personality disorder (BPD). Childhood traumatic experiences (CEs), often reported by patients with BPD, are an important risk factor for mental disorders. We hypothesized that features of BPD may mediate the relationship between CEs and PEs. In this study, we investigated the relationships between self-reported PEs, CEs and features of BPD in patients with mood disorders.MethodsAs part of the Helsinki University Psychiatric Consortium study, McLean Screening Instrument (MSI), Community Assessment of Psychic Experiences (CAPE-42) and Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n = 282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, multiple regression and mediation analyses were conducted.ResultsTotal scores of MSI correlated strongly with scores of the CAPE-42 dimension “frequency of positive symptoms” (rho = 0.56; p ≤ 0.001) and moderately with scores of TADS (rho = 0.4; p ≤ 0.001). Total score of MSI and its dimension “cognitive symptoms”, including identity disturbance, distrustfulness and dissociative symptoms, fully mediated the relation between TADS and CAPE-42. Each cognitive symptom showed a partial mediating role (dissociative symptoms 43% (CI = 25–74%); identity disturbance 40% (CI = 30-73%); distrustfulness 18% (CI = 12-50%)).ConclusionsSelf-reported cognitive-perceptual symptoms of BPD fully mediate, while affective, behavioural and interpersonal symptoms only partially mediate the relationships between CEs and PEs. Recognition of co-morbid features of BPD in patients with mood disorders reporting PEs is essential.
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Taiminen HM, Saraniemi S, Joffe G, Stenberg JH, Parkinson J. Reducing health inequalities trough digital options in mental health: A physician's perspective. Health Mark Q 2019; 36:93-106. [PMID: 30907260 DOI: 10.1080/07359683.2019.1575059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article explores the physicians' perspective regarding the potential of computerized cognitive behavioral therapies (cCBTs) to overcome inequalities in the context of mental health care provision. The main benefits were related to the ability of cCBTs to provide care in a convenient and efficient manner, enhancing its accessibility. These aspects were perceived more important than cost-effectivity of treatment, which is often claimed to be the key benefit of cCBTs. Age and general acceptance of CBT were the most significant individual-level separators of perceptions, while the sector in which the physician works was seen as the main structural-level separator.
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Affiliation(s)
- Heini M Taiminen
- a School of Business and Economics , Jyväskylä University , Jyväskylä , Finland
| | - Saila Saraniemi
- b Oulu Business School , University of Oulu , Oulu , Finland
| | - Grigori Joffe
- c Department of Psychiatry , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Jan-Henry Stenberg
- d Social Marketing @ Griffith , Griffith University , Nathan , Australia
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Karpov B, Joffe G, Aaltonen K, Oksanen J, Suominen K, Melartin T, Baryshnikov I, Koivisto M, Heikkinen M, Isometsä ET. Self-reported treatment adherence among psychiatric in- and outpatients. Nord J Psychiatry 2018; 72:526-533. [PMID: 30444157 DOI: 10.1080/08039488.2018.1538387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Poor adherence to psychiatric treatment is a common clinical problem, leading to unfavourable treatment outcome and increased healthcare costs. AIM The aim of this study was to investigate the self-reported adherence and attitudes to outpatient visits and pharmacotherapy in specialized care psychiatric patients. METHODS Within the Helsinki University Psychiatric Consortium (HUPC) pilot study, in- and outpatients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) were surveyed about their adherence and attitudes towards outpatient visits and pharmacotherapy. Correlates of self-reported adherence to outpatient and drug treatment were investigated using regression analysis. RESULTS The majority (78.5%) of patients reported having attended outpatient visits regularly or only partly irregularly. Most patients (79.2%) also reported regular use of pharmacotherapy. Self-reported non-adherence to preceding outpatient visits was consistently and significantly more common among inpatients than outpatients across all diagnostic groups (p < .001). Across all groups, hospital setting was the strongest independent correlate of poor adherence to outpatient visits (SSA β = -2.418, BD β = -3.417, DD β = -2.766; p < .001 in all). Another independent correlate of non-adherence was substance use disorder (SSA β = -1.555, p = .001; BD β = -1.535, p = .006; DD β = -2.258, p < .000). No other socio-demographic or clinical factor was significantly associated with poor adherence in multivariate regression models. CONCLUSIONS Irrespective of diagnosis, self-reported adherence to outpatient care among patients with schizophrenia or schizoaffective disorder, bipolar disorder, and depression is associated strongly with two factors: hospital setting and substance use disorders. Thus, detection of adherence problems among former inpatients and recognition and treatment of substance misuse are important to ensure proper outpatient care.
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Affiliation(s)
- Boris Karpov
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Grigori Joffe
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kari Aaltonen
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Jorma Oksanen
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kirsi Suominen
- b Department of Mental Health and Substance Abuse , Social Services and Health Care , Helsinki , Finland
| | - Tarja Melartin
- c Department of Psychiatry , Helsinki University Central Hospital , Helsinki , Finland
| | - Ilya Baryshnikov
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Maaria Koivisto
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Martti Heikkinen
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Erkki T Isometsä
- d Department of Psychiatry , Institute of Clinical Medicine , Helsinki , Finland
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Sadeniemi M, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, García-Alonso C, Ala-Nikkola T, Joffe G, Pirkola S, Wahlbeck K, Cid J, Salvador-Carulla L. A Comparison of Mental Health Care Systems in Northern and Southern Europe: A Service Mapping Study. Int J Environ Res Public Health 2018; 15:E1133. [PMID: 29857556 PMCID: PMC6024953 DOI: 10.3390/ijerph15061133] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022]
Abstract
Mental health services (MHS) have gone through vast changes during the last decades, shifting from hospital to community-based care. Developing the optimal balance and use of resources requires standard comparisons of mental health care systems across countries. This study aimed to compare the structure, personnel resource allocation, and the productivity of the MHS in two benchmark health districts in a Nordic welfare state and a southern European, family-centered country. The study is part of the REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care) project. The study areas were the Helsinki and Uusimaa region in Finland and the Girona region in Spain. The MHS were mapped by using the DESDE-LTC (Description and Evaluation of Services and Directories for Long Term Care) tool. There were 6.7 times more personnel resources in the MHS in Helsinki and Uusimaa than in Girona. The resource allocation was more residential-service-oriented in Helsinki and Uusimaa. The difference in mental health personnel resources is not explained by the respective differences in the need for MHS among the population. It is important to make a standard comparison of the MHS for supporting policymaking and to ensure equal access to care across European countries.
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Affiliation(s)
- Minna Sadeniemi
- Department of Social Services and Health Care, City of Helsinki, Southern Psychiatric Outpatient Clinic, Työpajankatu 14, FI-00099 Helsinki, Finland.
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Nerea Almeda
- PSICOST Research Association, Department of Psychology, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Jose A Salinas-Pérez
- PSICOST Research Association, Department of Quantitative Methods, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Mencía R Gutiérrez-Colosía
- PSICOST Research Association, Department of Psychology, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Carlos García-Alonso
- PSICOST Research Association, Department of Quantitative Methods, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences, and Tampere University Hospital, Lääkärinkatu 1, Tampere FI-33014, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Jordi Cid
- Mental Health & Addiction Research Group, Institut d'Investigacions Biomèdiques de Girona (IdibGI)-Institut d'Assistència Sanitària, 17190 Salt Girona, Spain.
| | - Luis Salvador-Carulla
- VIDEA Lab, Centre for Mental Health Research, Australian National University, 63 Eggleston Rd, Acton ACT 2601, Australia.
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Ala-Nikkola T, Pirkola S, Kaila M, Joffe G, Kontio R, Oranta O, Sadeniemi M, Wahlbeck K, Saarni SI. Identifying Local and Centralized Mental Health Services-The Development of a New Categorizing Variable. Int J Environ Res Public Health 2018; 15:ijerph15061131. [PMID: 29857540 PMCID: PMC6025394 DOI: 10.3390/ijerph15061131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/17/2018] [Accepted: 05/28/2018] [Indexed: 12/02/2022]
Abstract
The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed.
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Affiliation(s)
- Taina Ala-Nikkola
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences and Tampere University Hospital, Lääkärinkatu 1, FI-33014 Tampere, Finland.
| | - Minna Kaila
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland.
| | - Grigori Joffe
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
| | - Raija Kontio
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- University of Turku, FI-20014 Turku, Finland.
- Lohja Hospital Area, Sairaalakatu 8, 08200 Lohja, Finland.
| | - Olli Oranta
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, FI-20520 Turku, Finland.
| | - Minna Sadeniemi
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
- Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
| | - Samuli I Saarni
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, FI-20520 Turku, Finland.
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Pihlaja S, Stenberg JH, Joutsenniemi K, Mehik H, Ritola V, Joffe G. Therapeutic alliance in guided internet therapy programs for depression and anxiety disorders - A systematic review. Internet Interv 2018; 11:1-10. [PMID: 30135754 PMCID: PMC6084872 DOI: 10.1016/j.invent.2017.11.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/11/2017] [Accepted: 11/15/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The role of internet therapy programs for mental disorders is growing. Those programs employing human support yield better outcomes than do those with no such support. Therapeutic alliance may be a critical element in this support. Currently, the significance of therapeutic alliance in guided, internet-delivered cognitive behavioral therapy programs (iCBT) remains unknown. This review aims to determine whether the therapeutic alliance influences outcome of iCBTs and if it does, what plausible factors underlie this association. METHOD Towards that goal searches were made in PubMed, PsycINFO, SCOPUS, The Cochrane Library and CINAHL in May 2016 and January 2017. RESULTS From the 1658 relevant studies, only six studied the relationship of therapeutic alliance and outcome. All six studies showed a high level of client-therapist alliance; in the three most recent studies, the alliance was directly associated with outcome. No studies reported alliance-adherence associations. CONCLUSIONS Alliance research in iCBT for mental disorders is scarce. Therapeutic alliance seems to associate with outcomes. More studies are necessary to define the optimal support to strengthen alliance. iCBT is a feasible environment for alliance research both practically and theoretically. The impact of alliance on adherence to iCBT requires study.
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Affiliation(s)
| | | | | | | | | | - Grigori Joffe
- Hospital District of Helsinki and Uusimaa, Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, 00029 HUS, Finland
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Karpov B, Joffe G, Aaltonen K, Suvisaari J, Baryshnikov I, Koivisto M, Melartin T, Suominen K, Näätänen P, Heikkinen M, Oksanen J, Isometsä E. Psychoactive substance use in specialized psychiatric care patients. Int J Psychiatry Med 2017; 52:399-415. [PMID: 29179661 DOI: 10.1177/0091217417738937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.
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Affiliation(s)
- Boris Karpov
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grigori Joffe
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari Aaltonen
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- 2 Department of Mental Health and Substance Abuse Services, 3837 Terveyden ja hyvinvoinnin laitos , National Institute for Health and Welfare, Helsinki, Finland
| | - Ilya Baryshnikov
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maaria Koivisto
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tarja Melartin
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Suominen
- 3 Department of Social Services and Health Care, 3834 Helsingin Kaupunki , Helsinki, Finland
| | - Petri Näätänen
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martti Heikkinen
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Oksanen
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Mental Health and Substance Abuse Services, 3837 Terveyden ja hyvinvoinnin laitos , National Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Isometsä
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Mental Health and Substance Abuse Services, 3837 Terveyden ja hyvinvoinnin laitos , National Institute for Health and Welfare, Helsinki, Finland
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16
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Aaltonen K, Rosenström T, Baryshnikov I, Karpov B, Melartin T, Näätänen P, Heikkinen M, Koivisto M, Suominen K, Joffe G, Isometsä E. A Mediation Analysis of Childhood Maltreatment and Suicidal Behavior among Patients with Depressive or Bipolar Disorders. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionSubstantial evidence supports association between childhood maltreatment and suicidal behaviour, however, a limited number of studies have examined psychological mechanisms mediating the relationship among patients with mood disorders.ObjectiveTo investigate directly the potential intermediating mechanisms between childhood maltreatment and suicidal behaviour among patients with mood disorders.AimsWe examine by formal mediation analyses, if:– the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits;– the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.MethodsDepressive disorder and bipolar disorder (ICD-10-DCR) patients (n = 287) from the Helsinki university psychiatric consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts.ResultsThe influence of childhood maltreatment on lifetime suicidal ideation and lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only 21% of the total effect on lifetime suicide ideation. The mediation effect was stronger for lifetime suicide attempts compared to ideation (P = 0.002) and independent of current depressive symptoms.ConclusionsThe mechanisms of the effect of childhood maltreatment on suicidal ideation and attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicide ideation.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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17
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Baryshnikov I, Suvisaari J, Aaltonen K, Koivisto M, Melartin T, Näätänen P, Suominen K, Karpov B, Heikkinen M, Oksanen J, Paunio T, Joffe G, Isometsä E. Self-reported psychosis-like experiences in patients with mood disorders. Eur Psychiatry 2017; 51:90-97. [PMID: 28797561 DOI: 10.1016/j.eurpsy.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Self-reported psychosis-like experiences (PEs) may be common in patients with mood disorders, but their clinical correlates are not well known. We investigated their prevalence and relationships with self-reported symptoms of depression, mania, anxiety, borderline (BPD) and schizotypal (SPD) personality disorders among psychiatric patients with mood disorders. METHODS The Community Assessment of Psychic Experiences (CAPE-42), Mood Disorder Questionnaire (MDQ), McLean Screening Instrument (MSI), The Beck Depressive Inventory (BDI), Overall Anxiety Severity and Impairment Scale (OASIS) and Schizotypal Personality Questionnaire-Brief form (SPQ-B) were filled in by patients with mood disorders (n=282) from specialized care. Correlation coefficients between total scores and individual items of CAPE-42 and BDI, SPQ-B, MSI and MDQ were estimated. Hierarchical multivariate regression analysis was conducted to examine factors influencing the frequency of self-reported PE. RESULTS PEs are common in patients with mood disorders. The "frequency of positive symptoms" score of CAPE-42 correlated strongly with total score of SPQ-B (rho=0.63; P<0.001) and moderately with total scores of BDI, MDQ, OASIS and MSI (rho varied from 0.37 to 0.56; P<0.001). Individual items of CAPE-42 correlated moderately with specific items of BDI, MDQ, SPQ-B and MSI (rφ varied from 0.2 to 0.5; P<0.001). Symptoms of anxiety, mania or hypomania and BPD were significant predictors of the "frequency of positive symptoms" score of CAPE-42. CONCLUSIONS Several, state- and trait-related factors may underlie self-reported PEs among mood disorder patients. These include cognitive-perceptual distortions of SPD; distrustfulness, identity disturbance, dissociative and affective symptoms of BPD; and cognitive biases related to depressive or manic symptoms.
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Affiliation(s)
- I Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, 00271 Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - K Suominen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - B Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Oksanen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, 00271 Helsinki, Finland.
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18
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Terevnikov V, Stenberg JH, Joffe G. Should patients with schizophrenia receive antidepressants? Duodecim 2017; 133:465-471. [PMID: 29205993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Antipsychotics play a key role in the pharmacological treatment of schizophrenia, and monotherapy is effective for most patients. Achieving an optimal treatment response is, however, often difficult. Combining an antidepressant drug to the antipsychotic regimen could potentially improve treatment outcomes, although the evidence supporting the use of such combinations is limited and contradictory. Positive evidence has mostly been obtained from the efficacy of antidepressants acting on monoamine receptors on the negative symptoms of schizophrenia. These receptor-active drugs may also improve cognition in schizophrenic patients. In the light of current knowledge, antidepressants do not appear to potentiate the psychotic symptoms of schizophrenic patients. However, there is no robust evidence of the efficacy of antidepressants in the treatment of schizophrenia-related depression, and thus monotherapy with an antipsychotic drug is recommended for treating it. If using antidepressants in addition to antipsychotics is deemed necessary, the risk of pharmacodynamic and pharmacokinetic interactions should be kept in mind.
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Terevnikov V, Stenberg JH, Tiihonen J, Burkin M, Joffe G. Add-on mirtazapine improves orgasmic functioning in patients with schizophrenia treated with first-generation antipsychotics. Nord J Psychiatry 2017; 71:77-80. [PMID: 27701952 DOI: 10.1080/08039488.2016.1233996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM Sexual dysfunction, common in schizophrenia, may be further exaggerated by antipsychotics, especially those of First Generation (FGAs), and antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRs). Mirtazapine, an antidepressant characterized by its different action mechanism compared with that of the majority of other antidepressants, may improve SSRI-induced sexual dysfunction in patients with depression. It is unknown, however, whether mirtazapine improves sexual functioning in schizophrenia. METHODS This study randomly assigned FGA-treated patients with schizophrenia to receive either an add-on mirtazapine (n = 20) or a placebo (n = 19) for 6 weeks. Sexual functioning was prospectively measured using five relevant items from the Udvalg for Kliniske Undersogelser side-effect rating scale (UKU-SERS). RESULTS Orgasmic function improved with statistical significance in the mirtazapine group (p = .03), with no changes in any other sexual functions in either group. CONCLUSION Add-on mirtazapine appears to relieve orgasmic dysfunction in FGA-treated patients with schizophrenia.
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Affiliation(s)
| | - Jan-Henry Stenberg
- b Department of Psychiatry , Helsinki University Central Hospital, and University of Helsinki , Helsinki , Finland
| | - Jari Tiihonen
- c Department of Forensic Psychiatry , University of East Finland, Niuvanniemi Hospital , Finland.,d Department of Mental Health and Alcohol Research , National Institute for Health and Welfare , Helsinki , Finland.,e Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Mark Burkin
- f Department of Psychiatry , University of Petrozavodsk , Petrozavodsk , Russia
| | - Grigori Joffe
- b Department of Psychiatry , Helsinki University Central Hospital, and University of Helsinki , Helsinki , Finland
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Ala-Nikkola T, Pirkola S, Kaila M, Saarni SI, Joffe G, Kontio R, Oranta O, Sadeniemi M, Wahlbeck K. Regional Correlates of Psychiatric Inpatient Treatment. Int J Environ Res Public Health 2016; 13:ijerph13121204. [PMID: 27929403 PMCID: PMC5201345 DOI: 10.3390/ijerph13121204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/13/2016] [Accepted: 11/30/2016] [Indexed: 11/16/2022]
Abstract
Current reforms of mental health and substance abuse services (MHS) emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources) and indicators of service need (mental health index, education, single household, and alcohol sales) correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R) tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years). The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components.
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Affiliation(s)
- Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, Helsinki FI-000014, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences, and Tampere University Hospital, Lääkärinkatu 1, Tampere FI-33014, Finland.
| | - Minna Kaila
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, Helsinki FI-000014, Finland.
| | - Samuli I Saarni
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, Turku FI-20520, Finland.
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
| | - Raija Kontio
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- University of Turku, Turku FI-20014, Finland.
| | - Olli Oranta
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, Turku FI-20520, Finland.
| | - Minna Sadeniemi
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
- Department of Social Services and Health Care, City of Helsinki, Helsinki FI-00099, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
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21
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Ala-Nikkola T, Sadeniemi M, Kaila M, Saarni S, Kontio R, Pirkola S, Joffe G, Oranta O, Wahlbeck K. How size matters: exploring the association between quality of mental health services and catchment area size. BMC Psychiatry 2016; 16:289. [PMID: 27520368 PMCID: PMC4983042 DOI: 10.1186/s12888-016-0992-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size. METHODS To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors. RESULTS The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units. CONCLUSIONS Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.
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Affiliation(s)
- Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Psychiatry, Välskärinkatu 12, FI-00029, Helsinki, Finland. .,Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland.
| | - Minna Sadeniemi
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland ,Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland ,Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Minna Kaila
- Department of Public Health, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland
| | - Samuli Saarni
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Raija Kontio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Sami Pirkola
- University of Tampere and Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-33014 Tampere, Finland
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, FI-00029 Helsinki, Finland
| | - Olli Oranta
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Kristian Wahlbeck
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland
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Karpov B, Joffe G, Aaltonen K, Suvisaari J, Baryshnikov I, Näätänen P, Koivisto M, Melartin T, Oksanen J, Suominen K, Heikkinen M, Paunio T, Isometsä E. Anxiety symptoms in a major mood and schizophrenia spectrum disorders. Eur Psychiatry 2016; 37:1-7. [PMID: 27447101 DOI: 10.1016/j.eurpsy.2016.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Comorbid anxiety symptoms and disorders are present in many psychiatric disorders, but methodological variations render comparisons of their frequency and intensity difficult. Furthermore, whether risk factors for comorbid anxiety symptoms are similar in patients with mood disorders and schizophrenia spectrum disorders remains unclear. METHODS The Overall Anxiety Severity and Impairment Scale (OASIS) was used to measure anxiety symptoms in psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n=113), bipolar disorder (BD, n=99), or depressive disorder (DD, n=188) in the Helsinki University Psychiatric Consortium Study. Bivariate correlations and multivariate linear regression models were used to examine associations of depressive symptoms, neuroticism, early psychological trauma and distress, self-efficacy, symptoms of borderline personality disorder, and attachment style with anxiety symptoms in the three diagnostic groups. RESULTS Frequent or constant anxiety was reported by 40.2% of SSA, 51.5% of BD, and 55.6% of DD patients; it was described as severe or extreme by 43.8%, 41.4%, and 41.2% of these patients, respectively. SSA patients were significantly less anxious (P=0.010) and less often avoided anxiety-provoking situations (P=0.009) than the other patients. In regression analyses, OASIS was associated with high neuroticism, symptoms of depression and borderline personality disorder and low self-efficacy in all patients, and with early trauma in patients with mood disorders. CONCLUSIONS Comorbid anxiety symptoms are ubiquitous among psychiatric patients with mood or schizophrenia spectrum disorders, and in almost half of them, reportedly severe. Anxiety symptoms appear to be strongly related to both concurrent depressive symptoms and personality characteristics, regardless of principal diagnosis.
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Affiliation(s)
- B Karpov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - I Baryshnikov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, Helsinki University Central Hospital, PO Box 590, 00029 Helsinki, Finland
| | - J Oksanen
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - K Suominen
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland.
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23
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Aaltonen K, Näätänen P, Heikkinen M, Koivisto M, Baryshnikov I, Karpov B, Oksanen J, Melartin T, Suominen K, Joffe G, Paunio T, Isometsä E. Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders. J Affect Disord 2016; 193:318-30. [PMID: 26774520 DOI: 10.1016/j.jad.2015.12.033] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Substantial literature exists on risk factors for suicidal behaviour. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear. METHODS The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behaviour, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated. RESULTS Overall, 21.6% patients had no lifetime suicidal behaviour, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behaviour was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse. LIMITATIONS Cross-sectional and retrospective study design, utilization of clinical diagnoses, and relatively low response rate. CONCLUSIONS Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters.
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Affiliation(s)
- Kari Aaltonen
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Näätänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martti Heikkinen
- Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maaria Koivisto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilya Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Boris Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Oksanen
- Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tarja Melartin
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Suominen
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Paunio
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Oshukova S, Kaltiala-Heino R, Hillege S, de Ruiter C, Joffe G, Miettunen J, Marttila R, Marttunen M, Kaivosoja M, Lindberg N. Short report: self-reported psychopathic traits in Finnish and Dutch samples of non-referred adolescents: exploration of cultural differences. Child Adolesc Psychiatry Ment Health 2016; 10:3. [PMID: 26858774 PMCID: PMC4745156 DOI: 10.1186/s13034-015-0090-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/22/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Culture-related differences in psychopathic traits have been reported for adults, but for adolescents such knowledge is lacking. The aim of this cross-national study was to compare self-reported psychopathic traits between Finnish and Dutch samples of mid-adolescent community youth. METHODS The Youth Psychopathic traits Inventory (YPI) was filled in by 372 Finnish and 474 Dutch 15- to 16-year-old pupils. As gender-specific differences exist in psychopathic traits, we analyzed the data separately for boys and girls. RESULTS Dutch boys scored significantly higher than Finnish boys on total and all dimensional scores of the YPI as well as on most sub-dimensional scores. Dutch girls scored significantly higher than Finnish girls on the Affective dimension and on the two corresponding sub-dimensions: remorselessness and callousness. Finnish girls scored significantly higher on grandiosity, which loads to the Interpersonal dimension of the YPI. CONCLUSIONS Our findings suggest that culture influences the manifestation of psychopathic traits already in adolescence and that this relation is more prominent in boys.
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Affiliation(s)
- Svetlana Oshukova
- Psychiatry, Helsinki University and Helsinki University Hospital, P.O. Box 282, 00029 HUS, Helsinki Finland
| | - Riittakerttu Kaltiala-Heino
- School of Medicine, University of Tampere, 33014 Tampere, Finland ,Department of Adolescent Psychiatry, Tampere University Hospital, 33380 Pitkäniemi, Finland
| | - Sanne Hillege
- Child and Adolescent Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Corine de Ruiter
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Grigori Joffe
- Psychiatry, Helsinki University and Helsinki University Hospital, P.O. Box 282, 00029 HUS, Helsinki Finland
| | - Jouko Miettunen
- Research Unit of Clinical Neuroscience, Department of Psychiatry, Oulu University and Oulu University Hospital, Oulu, Finland ,Medical Research Center Oulu, Oulu University Hospital and Oulu University, Oulu, Finland ,Center for Life Course Health Research, Oulu University, Oulu, Finland
| | - Riikka Marttila
- Research Unit of Clinical Neuroscience, Department of Psychiatry, Oulu University and Oulu University Hospital, Oulu, Finland ,Medical Research Center Oulu, Oulu University Hospital and Oulu University, Oulu, Finland ,Center for Life Course Health Research, Oulu University, Oulu, Finland
| | - Mauri Marttunen
- Adolescent Psychiatry, Helsinki University and Helsinki University Hospital, P.O. Box 590, 00029 HUS, Helsinki Finland ,Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Matti Kaivosoja
- Department of Child Psychiatry, Turku University, 20014 Turku, Finland ,Hospital District of Central Ostrobothnia, Mariankatu, 16-20, 67200 Kokkola, Finland
| | - Nina Lindberg
- Forensic Psychiatry, Helsinki University and Helsinki University Hospital, 04500 Kellokoski, Finland
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25
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Baryshnikov I, Suvisaari J, Aaltonen K, Koivisto M, Näätänen P, Karpov B, Melartin T, Oksanen J, Suominen K, Heikkinen M, Paunio T, Joffe G, Isometsä E. Self-reported symptoms of schizotypal and borderline personality disorder in patients with mood disorders. Eur Psychiatry 2016; 33:37-44. [PMID: 26854985 DOI: 10.1016/j.eurpsy.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Distinguishing between symptoms of schizotypal (SPD) and borderline personality disorders (BPD) is often difficult due to their partial overlap and frequent co-occurrence. We investigated correlations in self-reported symptoms of SPD and BPD in questionnaires at the levels of both total scores and individual items, examining overlapping dimensions. METHODS Two questionnaires, the McLean Screening Instrument (MSI) for BPD and the Schizotypal Personality Questionnaire Brief (SPQ-B) for SPD, were filled in by patients with mood disorders (n=282) from specialized psychiatric care in a study of the Helsinki University Psychiatric Consortium. Correlation coefficients between total scores and individual items of the MSI and SPQ-B were estimated. Multivariate regression analysis (MRA) was conducted to examine the relationships between SPQ-B and MSI. RESULTS The Spearman's correlation between total scores of the MSI and SPQ-B was strong (rho=0.616, P<0.005). Items of MSI reflecting disrupted relatedness and affective dysregulation correlated moderately (rφ varied between 0.2 and 0.4, P<0.005) with items of SPQ. Items of MSI reflecting behavioural dysregulation correlated only weakly with items of SPQ. In MRA, depressive symptoms, sex and MSI were significant predictors of SPQ-B score, whereas symptoms of anxiety, age and SPQ-B were significant predictors of MSI score. CONCLUSIONS Items reflecting cognitive-perceptual distortions and affective symptoms of BPD appear to overlap with disorganized and cognitive-perceptual symptoms of SPD. Symptoms of depression may aggravate self-reported features of SPQ-B, and symptoms of anxiety features of MSI. Symptoms of behavioural dysregulation of BPD and interpersonal deficits of SPQ appear to be non-overlapping.
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Affiliation(s)
- I Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, Mannerheimintie 166, 00271 Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - B Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, 00029 Helsinki, Finland
| | - J Oksanen
- Department of Social Services and Health Care, Helsinki, Finland
| | - K Suominen
- City of Helsinki, Social Services and Healthcare, Helsinki, Finland; Aurora Hospital, P.O. Box 6800, 00099 Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, Mannerheimintie 166, 00271 Helsinki, Finland.
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Chukhin E, Terevnikov V, Takala P, Hakko H, Putkonen H, Räsänen P, Stenberg JH, Eronen M, Joffe G. Is there an interrelationship between the effects of antipsychotics on psychopathology and on metabolism? Nord J Psychiatry 2016; 70:190-4. [PMID: 26450657 DOI: 10.3109/08039488.2015.1074283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Increased body weight and hyperlipidemia caused by antipsychotics may be associated with improved antipsychotic efficacy in schizophrenia. If this association has a causal interrelationship via a genuine pathophysiological mechanism, then body weight loss in antipsychotic-treated patients would be accompanied by worsened psychopathology. This could have clinical implications. AIM To explore whether the decreased body weight in these patients is associated with a worsened psychopathology. METHODS In our previously published study, a 16 week treatment period with add-on orlistat (but not placebo) resulted in body weight loss in male (but not female) clozapine- or olanzapine-treated overweight or obese patients. In the current study, we investigated whether body weight loss in those male patients could worsen psychosis. Changes in the Positive and Negative Syndrome Scale (PANSS) scores within groups and body weight changes and lipid profiles over the treatment period were analysed by the paired samples t-test. Between-group comparisons were analysed by the independent samples t-test. RESULTS Over the treatment period body weight decreased by 2.56 ± 3.25 kg from initial 106.02 ± 12.61 kg (p = 0.04) for the orlistat group, with no statistically significant changes for the placebo group. Lipid levels did not change in either group. The orlistat-induced weight decrease was not associated with worsening in the PANSS scores. CONCLUSIONS Weight loss was not associated with a worsening of psychosis. The interrelationship between the antipsychotic-induced weigh gain and improved schizophrenia psychopathology observed in earlier studies appears to be indirect. Orlistat treatment in our study did not worsen psychopathology in this population.
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Affiliation(s)
- Evgeny Chukhin
- a Department of Psychiatry , Helsinki University Central Hospital , Finland.,b Department of Psychiatry , University of Helsinki , Finland
| | - Viacheslav Terevnikov
- b Department of Psychiatry , University of Helsinki , Finland.,c Department of Psychiatry , Kellokoski Hospital , Finland
| | - Pirjo Takala
- d Department of Psychiatry , Vanha Vaasa Hospital , Finland
| | - Helinä Hakko
- e Department of Psychiatry , Oulu University Hospital , Finland
| | - Hanna Putkonen
- c Department of Psychiatry , Kellokoski Hospital , Finland .,f National Institute for Health and Welfare , Finland , and
| | - Pirkko Räsänen
- g Department of Psychiatry , University of Oulu , Finland
| | - Jan-Henry Stenberg
- a Department of Psychiatry , Helsinki University Central Hospital , Finland
| | - Markku Eronen
- d Department of Psychiatry , Vanha Vaasa Hospital , Finland
| | - Grigori Joffe
- a Department of Psychiatry , Helsinki University Central Hospital , Finland
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Terevnikov V, Joffe G, Stenberg JH. Randomized Controlled Trials of Add-On Antidepressants in Schizophrenia. Int J Neuropsychopharmacol 2015; 18:pyv049. [PMID: 25991654 PMCID: PMC4576515 DOI: 10.1093/ijnp/pyv049] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 04/27/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Despite adequate treatment with antipsychotics, a substantial number of patients with schizophrenia demonstrate only suboptimal clinical outcome. To overcome this challenge, various psychopharmacological combination strategies have been used, including antidepressants added to antipsychotics. METHODS To analyze the efficacy of add-on antidepressants for the treatment of negative, positive, cognitive, depressive, and antipsychotic-induced extrapyramidal symptoms in schizophrenia, published randomized controlled trials assessing the efficacy of adjunctive antidepressants in schizophrenia were reviewed using the following parameters: baseline clinical characteristics and number of patients, their on-going antipsychotic treatment, dosage of the add-on antidepressants, duration of the trial, efficacy measures, and outcomes. RESULTS There were 36 randomized controlled trials reported in 41 journal publications (n=1582). The antidepressants used were the selective serotonin reuptake inhibitors, duloxetine, imipramine, mianserin, mirtazapine, nefazodone, reboxetin, trazodone, and bupropion. Mirtazapine and mianserin showed somewhat consistent efficacy for negative symptoms and both seemed to enhance neurocognition. Trazodone and nefazodone appeared to improve the antipsychotics-induced extrapyramidal symptoms. Imipramine and duloxetine tended to improve depressive symptoms. No clear evidence supporting selective serotonin reuptake inhibitors' efficacy on any clinical domain of schizophrenia was found. Add-on antidepressants did not worsen psychosis. CONCLUSIONS Despite a substantial number of randomized controlled trials, the overall efficacy of add-on antidepressants in schizophrenia remains uncertain mainly due to methodological issues. Some differences in efficacy on several schizophrenia domains seem, however, to exist and to vary by the antidepressant subgroups--plausibly due to differences in the mechanisms of action. Antidepressants may not worsen the course of psychosis. Better designed, larger, and longer randomized controlled trials are needed.
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Affiliation(s)
- Viacheslav Terevnikov
- Kellokoski Hospital, Kellokoski, Finland (Dr Terevnikov); Department of Psychiatry, Helsinki University Central Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland (Drs Joffe and Stenberg).
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Kontio R, Pitkänen A, Joffe G, Katajisto J, Välimäki M. eLearning course may shorten the duration of mechanical restraint among psychiatric inpatients: a cluster-randomized trial. Nord J Psychiatry 2014; 68:443-9. [PMID: 24274836 DOI: 10.3109/08039488.2013.855254] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible. AIMS The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients. METHODS In a cluster-randomized intervention trial, the nursing personnel on 10 wards were randomly assigned to eLearning (intervention) or training-as-usual (control) groups. The eLearning course comprised six modules with specific topics (legal and ethical issues, behaviour-related factors, therapeutic relationship and self-awareness, teamwork and integrating knowledge with practice) and specific learning methods. The rates (incidents per 1000 occupied bed days) and durations of the coercion incidents were examined before and after the course. RESULTS A total of 1283 coercion incidents (1143 seclusions [89%] and 140 incidents involving the use of mechanical restraints [11%]) were recorded on the study wards during the data collection period. On the intervention wards, there were no statistically significant changes in the rates of seclusion and mechanical restraint. However, the duration of incidents involving mechanical restraints shortened from 36.0 to 4.0 h (median) (P < 0.001). No statistically significant changes occurred on the control wards. CONCLUSIONS After our eLearning course, the duration of incidents involving the use of mechanical restraints decreased. However, more studies are needed to ensure that the content of the course focuses on the most important factors associated with the seclusion-related elements. The eLearning course deserves further development and further studies. The duration of coercion incidents merits attention in future research.
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Affiliation(s)
- Raija Kontio
- Raija Kontio, Ph.D., Assistant Chief of Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital , Finland
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Kontio R, Anttila M, Lantta T, Kauppi K, Joffe G, Välimäki M. Toward a safer working environment on psychiatric wards: service users' delayed perspectives of aggression and violence-related situations and development ideas. Perspect Psychiatr Care 2014; 50:271-9. [PMID: 24405057 DOI: 10.1111/ppc.12054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/20/2013] [Accepted: 11/04/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To explore service users' (n = 9) delayed perceptions of and suggestions for improvement of management of aggression/violence in psychiatry. DESIGN AND METHOD Focus group interviews, inductive content analysis. FINDINGS Participants reported aggression/violence-related negative perceptions (including loneliness, boredom, excessive control, and fear) but also memories of humane and caring personnel. The suggestions included meaningful activities and humane, interactive nursing. PRACTICE IMPLICATIONS Delayed perceptions and proposals resembled the proximate ones. Perceptions may persist for years. Such perceptions and proposals, if taken into account from the beginning of treatment, may prevent negative long-term consequences of witnessed or experienced aggression/violence. Humane, interactive nursing models should be studied and disseminated.
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Affiliation(s)
- Raija Kontio
- Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Kellokoski, Tuusula, Finland
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Soininen P, Putkonen H, Joffe G, Korkeila J, Välimäki M. Methodological and ethical challenges in studying patients' perceptions of coercion: a systematic mixed studies review. BMC Psychiatry 2014; 14:162. [PMID: 24894162 PMCID: PMC4051960 DOI: 10.1186/1471-244x-14-162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/16/2014] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Päivi Soininen
- Department of Nursing Science, University of Turku, Turku, Finland
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Kellokoski Hospital, Tuusula, Finland
| | - Hanna Putkonen
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Kellokoski Hospital, Tuusula, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
| | - Grigori Joffe
- Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland
| | - Jyrki Korkeila
- Faculty of Medicine, University of Turku, Turku, Finland
- Hospital District of Satakunta, Pori, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
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Laiho T, Lindberg N, Joffe G, Putkonen H, Hottinen A, Kontio R, Sailas E. Psychiatric staff on the wards does not share attitudes on aggression. Int J Ment Health Syst 2014; 8:14. [PMID: 24778708 PMCID: PMC4002577 DOI: 10.1186/1752-4458-8-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022] Open
Abstract
Background The concept of ward culture has been proposed as a reason for the often reported differences in treatment decisions when managing inpatient aggression. We therefore studied whether staff on wards actually shares similar perceptions and attitudes about aggression and whether the specialty of the ward on which the staff members work influences these opinions. Methods The Attitudes Towards Aggression Scale was used to assess attitudes towards aggression in 31 closed psychiatric wards. Altogether 487 staff members working on the study wards were asked to fill in the scale. Respondent’s gender, age, educational level, working experience on the current ward, and specialty of this ward (acute, forensic, rehabilitation) served as background variables. Results Most of the variance found was due to differences between individuals. Belonging to the personnel of a particular ward did not explain much of the variance. Conclusions Psychiatric staff on the wards does not share attitudes on aggression. As each staff member has his/her own opinion about aggression, training for dealing with aggression or violent incidents should be done, at least partly, on an individual level. We also suggest caution in using the concept of ward culture as an explanation for the use of restrictive measures on psychiatric wards.
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Affiliation(s)
- Tero Laiho
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Nina Lindberg
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland ; Faculty of Medicine, Forensic Psychiatry, University of Helsinki, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Hanna Putkonen
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland ; Vanha Vaasa Hospital, Vaasa, Finland
| | - Anja Hottinen
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Raija Kontio
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland
| | - Eila Sailas
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland
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Soininen P, Putkonen H, Joffe G, Korkeila J, Puukka P, Pitkänen A, Välimäki M. Does experienced seclusion or restraint affect psychiatric patients' subjective quality of life at discharge? Int J Ment Health Syst 2013; 7:28. [PMID: 24308388 PMCID: PMC4174906 DOI: 10.1186/1752-4458-7-28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 12/02/2013] [Indexed: 11/20/2022] Open
Abstract
Background In Finland major effort has been invested in reducing the use of coercion in psychiatric treatment, and the goal is to diminish the use of coercion by 40% by 2015. Improving patients’ quality of life (QoL) has gained prominence in psychiatric treatment during the past decade. Numerous studies have shown that most secluded or restrained patients (S/R patients) would prefer not to have had this experience. Experience of S/R could affect negatively patients’ QoL, but empirical data on this issue are lacking. Aim The study aimed to explore the effect of experienced S/R on the subjective QoL of psychiatric in-patients. Method This study explored subjective QoL of the S/R patients. At discharge, S/R patients completed the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). Results We found that S/R patients’ (n = 36) subjective QoL was significantly better than that of non-S/R patients’ (n = 228). Most non-S/R patients were diagnosed with mood disorders (mostly depression). Most of S/R patients were diagnosed with schizophrenia, schizotypal and delusional disorders. The mean duration of S/R was 2.3 days, median was one day and mean length of the hospitalization after S/R episode was 2.5 months. Conclusion Our cross-sectional findings suggest that S/R does not considerably influence patients’ QoL or that the influence is short-lived. Because baseline QoL was not measured this remains uncertain. There are also many other factors, such as negative mood, which decrease the patients’ QoL ratings. These factors may either mask the influence of S/R on QoL or modify the experience of QoL to such an extent that no independent association can be found at the time of discharge.
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Affiliation(s)
- Päivi Soininen
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland.
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Noda T, Sugiyama N, Sato M, Ito H, Sailas E, Putkonen H, Kontio R, Joffe G. Influence of patient characteristics on duration of seclusion/restrain in acute psychiatric settings in Japan. Psychiatry Clin Neurosci 2013; 67:405-11. [PMID: 23941159 DOI: 10.1111/pcn.12078] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 12/06/2012] [Accepted: 12/08/2012] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study was to investigate the current state of duration of seclusion/restraint in acute psychiatric settings in Japan and the effect of patient characteristics on duration of seclusion/restraint. METHODS During an 8-month period starting from November 2008, duration of seclusion/restraint and patient characteristics were investigated in 694 psychiatric inpatients who experienced seclusion/restraint in three emergency and three acute wards at four psychiatric hospitals. Reasons for starting seclusion/restraint were also assessed. Analysis was performed using generalized linear models, with the duration of seclusion/restraint as the dependent variable and patient characteristics and reasons for starting seclusion/restraint as independent variables. RESULTS Of the patients secluded/restrained, 58.6% had a primary diagnosis of schizophrenia (F20-F29) and a large proportion (37.9%) were secluded/restrained due to hurting others. Median hours ofseclusion/restraint were 204 and 82 h, respectively. The duration of seclusion was longer for patients with F20-F29 than those with disorders due to psychoactive substance use (F10-F19) or other diagnoses (F40-F99), and when the reason was danger of hurting others. In contrast, the duration of restraint in female patients and in patients with F10-F19 diagnosis was shorter. CONCLUSION The duration of seclusion/restraint at acute psychiatric care wards in Japan are much longer than those reported by previous overseas studies. Although Japanese structure issues such as more patients per ward and a lower ratio of nurses need to be considered, skills for dealing with patients with primary diagnosis of F20-F29 secluded due to danger posed to others should be improved.
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Affiliation(s)
- Toshie Noda
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
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Kontio R, Hätönen H, Joffe G, Pitkänen A, Lahti M, Välimäki M. Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: 9-month follow-up results of a randomized controlled study (ISRCTN32869544). J Psychiatr Ment Health Nurs 2013; 20:411-8. [PMID: 22672441 DOI: 10.1111/j.1365-2850.2012.01933.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
eLearning may facilitate continuing vocational education, but data on the long-term effects of an eLearning course are lacking. The aim of this study was to explore the long-term impact of an eLearning course entitled ePsychNurse.Net on psychiatric nurses' professional competence in practicing seclusion and restraint and on their job satisfaction and general self-efficacy at 9-month follow-up. In a randomized controlled study, 12 wards were randomly assigned to the ePsychNurse.Net (intervention) or training as usual (control). Baseline and 9-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 137 completers (those who participated in the 9-month follow-up assessment). No between-group differences were found on any variable, with the exception of a change in attitude to seclusion in favour of the control group. The findings of the long-term effects did not differ from the immediate outcomes (3-month follow-up) and the improved level of knowledge acquired and further consolidation of that knowledge did not take place in the 6-month period after the 3-month ePsychNurse.Net course. The ePsychNurse.Net should be further developed and its future modifications will require additional studies, probably with some new outcome measures.
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Affiliation(s)
- R Kontio
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland.
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Hottinen A, Välimäki M, Sailas E, Putkonen H, Joffe G, Puukka P, Noda T, Lindberg N. Mechanical restraint in adolescent psychiatry: a Finnish Register study. Nord J Psychiatry 2013; 67:132-9. [PMID: 22762210 DOI: 10.3109/08039488.2012.699552] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known of the use of mechanical restraint in adolescent psychiatry. AIMS To investigate the frequency and features of mechanical restraint in the field of Finnish adolescent psychiatry. METHODS The data were collected in the metropolitan area of Helsinki, Finland, with seven closed and eight open wards for Finnish-speaking 13-17-year-old adolescents. The official restraint reports and the hospital files of the restraint patients from January 2009 to December 2009 were collected and analyzed. RESULTS Among adolescents hospitalized in closed wards, the 1-year prevalence of mechanical restraint was 9.5%. Among all hospitalized adolescents, the prevalence was 6.9%. The number of mechanically restrained individuals per 100,000 13 to 17-year -old Finnish-speaking inhabitants was 57.1. The median duration of the restraint episode was 4 h and 50 min, but almost half of the mechanical restraint episodes lasted 8 h or more. A quarter of restraint episodes were not based on reasons mentioned in the Finnish Mental Health Act. The most frequent diagnostic categories of mechanically restrained adolescents were mood disorders followed by schizophrenia-related as well as behavioral and emotional disorders. Suicidality preceded 40% and violence 61% of restraint episodes. Boys were restrained during the first days of hospital treatment significantly more often than were girls, whereas one in four girls experienced her first episode of restraint after 1 month of hospitalization. CONCLUSIONS Reducing the number and shortening the length of mechanical restraint episodes requires education of staff as well as projects focusing on reducing coercion. The clinical guidelines must be followed at grassroots level.
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Affiliation(s)
- Anja Hottinen
- Department of Nursing Science, University of Turku, Finland.
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Abstract
Though some empirical and anecdotal accounts can be located in the extant literature, it remains the case that little is known about how secluded/restrained (S/R) patients perceive their overall treatment. The purpose of this study was to explore patients' perceptions of their hospital treatment measured after S/R. The data were collected with a Secluded and Restrained Patients' Perceptions of their Treatment (S/R-PPT) questionnaire from S/R patients aged 18-65 years. Ninety completed questionnaires were analysed. Patients perceived that they received enough attention from staff, and they were able to voice their opinions, but their opinions were not taken into account. Patients denied the necessity and beneficence of S/R. Women and older patients were more critical than men and younger patients regarding the use of restrictions. There were also statistically-significant differences in responses among patients at different hospitals. It is concluded that patients' opinions need more attention in treatment decisions. To achieve this, psychiatric treatment needs genuine dialogue between patients and staff, and individual care should have alternatives and no routine decisions. Therefore, the treatment culture must improve towards involving patients in treatment planning, and giving them a say when S/R is considered.
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Affiliation(s)
- Päivi Soininen
- Hospital District of Helsinki and Uusimaa, Kellokoski Hospital, Tuusula, Finland.
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Stenberg JH, Terevnikov V, Joffe M, Tiihonen J, Chukhin E, Burkin M, Joffe G. Predictors and mediators of add-on mirtazapine-induced cognitive enhancement in schizophrenia – A path model investigation. Neuropharmacology 2013; 64:248-53. [DOI: 10.1016/j.neuropharm.2012.06.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/11/2012] [Accepted: 06/14/2012] [Indexed: 12/31/2022]
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Hottinen A, Välimäki M, Sailas E, Putkonen H, Joffe G, Noda T, Lindberg N. Underaged patients' opinions toward different containment measures: a questionnaire survey in Finnish adolescent psychiatry. J Child Adolesc Psychiatr Nurs 2012; 25:219-23. [PMID: 23121144 DOI: 10.1111/jcap.12006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PROBLEM The current literature does not provide an understanding of adolescent patients' opinions toward various containment measures and how these are related to the opinions of the staff who are caring for them. METHODS The study population comprised 81 inpatients and 128 staff members in an inpatient setting in Finland. Their opinions were studied using the Attitude to Containment Measures Questionnaire. FINDINGS The adolescents were more critical toward most containment measures compared to the staff. Exactly as reported in previous studies among adult service users, the containment measures most accepted by the adolescents were as-needed medication, intermittent observation, and time out. They were considered as helpful, safe, and respectful methods. Net bed, which has never been used in Finland, was most disapproved. It was considered as a distressing, inhuman, and cruel method. Opinions toward mechanical restraint, which is commonly used in Finnish adolescent psychiatry, were noticeable: adolescents rated mechanical restraint among the three least accepted, staff among the three most accepted containment methods. Adolescents considered it as distressing and not consistent of human dignity. CONCLUSIONS Adolescents disapprove of containment measures some of which are widely used in psychiatric practice. Their opinions differ significantly from those of the staff. New ways to manage crisis situations should be developed. Where containment cannot be avoided, information, explanation about the procedures involved, and debriefing should be offered to an underaged patient in a manner which takes account of his/her developmental level.
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Affiliation(s)
- Anja Hottinen
- Department of Nursing Science, University of Turku and Hospital District of Southwest Finland, Turku, Finland
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Noda T, Nijman H, Sugiyama N, Tsujiwaki K, Putkonen H, Sailas E, Kontio R, Ito H, Joffe G. Factors affecting assessment of severity of aggressive incidents: using the Staff Observation Aggression Scale - Revised (SOAS-R) in Japan. J Psychiatr Ment Health Nurs 2012; 19:770-5. [PMID: 22070849 DOI: 10.1111/j.1365-2850.2011.01838.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study is to investigate factors associated with overall judgements of aggression severity as provided by ward nurses, using the Japanese-language version of the Staff Observation Aggression Scale - Revised (SOAS-R). Nurses who observed 326 aggressive incidents involving psychiatric inpatients at five mental health facilities in Japan provided their assessments of the incident severity both on the established rating scale, the SOAS-R, and on a visual analogue scale (VAS), a one-item scale to indicate overall aggression severity. To evaluate the factors influencing the VAS severity scores, a multiple regression analysis was performed, in which consumer, nurse and ward characteristics were added consecutively, along with SOAS-R severity scores as independent variables. SOAS-R scores explained 17.6% of the VAS severity scores. Independently from the SOAS-R scores, the gender and age of the aggressive consumers (adjusted R(2) = 10.0%), as well as the gender of the nurses who reported the aggression (adjusted R(2) = 4.1%), each explained VAS severity score to a significant degree. Apart from the SOAS-R scores, consumer and nurse characteristics appeared to influence the overall judgements of severity of aggressive incidents, which may be connected to decisions about the use of coercive measures, such as seclusion/restraint or forced medication.
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Affiliation(s)
- T Noda
- Department of Social Psychiatry, National Institute of Mental Health, Tokyo, Japan.
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Noda T, Sugiyama N, Ito H, Soininen P, Putkonen H, Sailas E, Joffe G. Secluded/restrained patients' perceptions of their treatment: validity and reliability of a new questionnaire. Psychiatry Clin Neurosci 2012; 66:397-404. [PMID: 22726202 DOI: 10.1111/j.1440-1819.2012.02350.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To develop a standardized self-reporting questionnaire to evaluate patients' perceptions of their overall treatment in specific relation to the use of seclusion and/or restraint (SR) measures as part of the treatment program. METHODS A 17-item self-rating questionnaire was given to 56 patients with experience of SR-related treatment to develop a new scale, the Secluded/Restrained Patients' Perceptions of their Treatment (SR-PPT). Concurrent validity was examined against the Client Satisfaction Questionnaire-8 Japanese Version (CSQ-8J). In addition, Patient burden induced by answering the SR-PPT was evaluated. RESULTS On factor analysis, two factors named as Cooperation with Staff (nine items) and Perceptions of SR (two items) were derived. Cronbach's coefficient alphas were 0.928 and 0.887, and correlation coefficients against the CSQ-8J were 0.838 and 0.609, respectively. Answering the SR-PPT was found to induce little burden on the patients. CONCLUSION Adequate internal consistency and concurrent validity of the final version of the SR-PPT, which consists of 11 items, indicate that it is acceptable as a measurement scale. Use of this questionnaire will add the patient's view to the assessment of overall treatment involving SR.
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Affiliation(s)
- Toshie Noda
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.
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Hottinen A, Välimäki M, Sailas E, Putkonen H, Joffe G, Noda T, Lindberg N. Attitudes towards different containment measures: a questionnaire survey in Finnish adolescent psychiatry. J Psychiatr Ment Health Nurs 2012; 19:521-7. [PMID: 22093236 DOI: 10.1111/j.1365-2850.2011.01820.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Use of containment measures in the treatment of underage patients is controversial, and empirical evidence about which containment methods are preferred is lacking. This study aimed to investigate attitudes of staff towards various containment measures in the field of adolescent psychiatry. The sample comprised 128 Finnish nurses and doctors working in closed wards with 13- to 17-year-old patients. The attitudes were studied using the Attitude to Containment Measures Questionnaire. The three methods with the most approval were as-needed medication, transfer to specialist locked wards and mechanical restraint. The method with the least approval was the net bed. Total approval scores for the various containment measures were very similar among nurses and doctors. The differences appeared in attitudes towards mechanical restraint and constant observation, doctors showing a more critical attitude. Women tended to be more critical than men, but only intramuscular medication and mechanical restraint reached statistical significance. The results emphasize the importance of wide-ranging and in-depth training as well as the difficulty of changing practices in psychiatric wards while attitudes are so strongly pro-containment.
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Affiliation(s)
- A Hottinen
- Department of Nursing Science, University of Turku and Hospital District of Southwest Finland, Turku, Finland.
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Kontio R, Joffe G, Putkonen H, Kuosmanen L, Hane K, Holi M, Välimäki M. Seclusion and restraint in psychiatry: patients' experiences and practical suggestions on how to improve practices and use alternatives. Perspect Psychiatr Care 2012; 48:16-24. [PMID: 22188043 DOI: 10.1111/j.1744-6163.2010.00301.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland. METHODS The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis. RESULTS Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient-staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted. PRACTICE IMPLICATIONS Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development.
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Affiliation(s)
- Raija Kontio
- Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland.
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Kontio R, Lahti M, Pitkänen A, Joffe G, Putkonen H, Hätönen H, Katajisto J, Välimäki M. Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: a randomized controlled study (ISRCTN32869544). J Psychiatr Ment Health Nurs 2011; 18:813-21. [PMID: 21985684 DOI: 10.1111/j.1365-2850.2011.01729.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Education on the care of aggressive and disturbed patients is fragmentary. eLearning could ensure the quality of such education, but data on its impact on professional competence in psychiatry are lacking. The aim of this study was to explore the impact of ePsychNurse.Net, an eLearning course, on psychiatric nurses' professional competence in seclusion and restraint and on their job satisfaction and general self-efficacy. In a randomized controlled study, 12 wards were randomly assigned to ePsychNurse.Net (intervention) or education as usual (control). Baseline and 3-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 158 completers. Knowledge (primary outcome) of coercion-related legislation improved in the intervention group, while knowledge of physical restraint improved and knowledge of seclusion remained unchanged in both groups. General self-efficacy improved in the intervention group also attitude to seclusion in the control group. In between-group comparison, attitudes to seclusion (one of secondary outcomes) favoured the control group. Although the ePsychNurse.Net demonstrated only slight advantages over conventional learning, it may be worth further development with, e.g. flexible time schedule and individualized content.
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Affiliation(s)
- R Kontio
- Department of Psychiatry, University of Turku, Turku, Finland.
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Stenberg JH, Terevnikov V, Joffe M, Tiihonen J, Tchoukhine E, Burkin M, Joffe G. More evidence on proneurocognitive effects of add-on mirtazapine in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1080-6. [PMID: 21402120 DOI: 10.1016/j.pnpbp.2011.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/01/2011] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
Abstract
Enhancement of neurocognition is essential in the treatment of schizophrenia. In our previously reported six-week randomized controlled trial (RCT) mirtazapine added to conventional antipsychotics improved not only negative, but also positive symptoms and neurocognition in difficult-to-treat schizophrenia. The present study aimed to explore whether a prolonged exposure to mirtazapine could further improve neurocognition. Completers of the RCT who were able and willing to proceed to the extension phase received open label mirtazapine for an additional 6 weeks. During the extension phase, both groups (i.e., patients who previously received mirtazapine and those who received placebo) and the whole population showed improvement on a number of neurocognitive tests. Patients who shifted to open label mirtazapine from placebo achieved in the six following weeks similar results as their initially mirtazapine-treated counterparts did during their first 6 weeks of mirtazapine exposure. Middle-term mirtazapine treatment (12 weeks) demonstrated an advantage over short-term mirtazapine treatment (6 weeks) on Stroop Dots time and Trail Making Test, part B, number of mistakes (t = -2.562, p = 0.035 and t = -2.42, p = 0.043, correspondingly). Mirtazapine added to antipsychotics consistently shows desirable effects on neurocognition. Lengthy treatment seems worthwhile. Mirtazapine may become a safe and cost-saving neurocognitive enhancer in schizophrenia, yet more studies are needed.
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Affiliation(s)
- Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
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Terevnikov V, Stenberg JH, Tiihonen J, Joffe M, Burkin M, Tchoukhine E, Joffe G. Add-on mirtazapine improves depressive symptoms in schizophrenia: a double-blind randomized placebo-controlled study with an open-label extension phase. Hum Psychopharmacol 2011; 26:188-93. [PMID: 21469215 DOI: 10.1002/hup.1189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Depression is common in schizophrenia and worsens its course. The role of antidepressants for schizophrenic depression remains unclear. In this study, the efficacy of add-on mirtazapine on depression in schizophrenia was explored in a subsidiary arm of a recent randomized controlled trial. Patients (n = 41) with chronic but stable schizophrenia and inadequate response to stable doses of different first-generation antipsychotics were treated with add-on mirtazapine 30 mg or placebo during a 6-week double-blind phase and with open-label add-on mirtazapine during a 6-week extension phase. Efficacy measures were the Calgary Depression Scale for Schizophrenia (CDSS) and the Positive and Negative Syndrome Scale depression item. During the double-blind phase, both measures' scores decreased significantly in the mirtazapine group but not in the placebo group (for the CDSS, 52.0% vs 19.6%, respectively). During the open‐label phase, both groups demonstrated significant improvements. In between‐group comparison, a trend favoring mirtazapine did not reach statistical significance. The changes in the CDSS correlated positively with those in the Positive and Negative Syndrome Scale negative, positive and total (sub)scales for mirtazapine‐treated patients during the double‐blind phase. Depressed patients with schizophrenia may benefit from mirtazapine–first‐generation antipsychotics combination, with no increased risk for psychosis. However, more studies are needed.
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Tchoukhine E, Takala P, Hakko H, Raidma M, Putkonen H, Räsänen P, Terevnikov V, Stenberg JH, Eronen M, Joffe G. Orlistat in clozapine- or olanzapine-treated patients with overweight or obesity: a 16-week open-label extension phase and both phases of a randomized controlled trial. J Clin Psychiatry 2011; 72:326-30. [PMID: 20816037 DOI: 10.4088/jcp.09m05283yel] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 09/03/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore long-term effects of orlistat in adult clozapine- or olanzapine-treated patients with DSM-IV-diagnosed schizophrenia and overweight or obesity who tolerate orlistat. METHOD Orlistat or placebo was added to clozapine or olanzapine in stable doses in a 16-week randomized controlled trial. Open-label orlistat was added to the antipsychotics during a 16-week extension phase for those completing the double-blind phase. No low-calorie diet or participation in behavioral programs was required. Body weight (primary outcome) and some metabolic parameters were measured prospectively. Analyses were performed for those completing both phases (ie, population differing from that reported earlier). The study was conducted from 2004 through 2005. RESULTS During the open-label phase, the 44 patients experienced mean ± SD body weight loss of -1.29 ± 3.04 kg, P = .007. During both phases, men (but not women) showed a weight loss of -2.39 ± 5.45 kg, P = .023. Some subgroups showed desirable changes in several metabolic parameters. Prolonged (32 weeks) orlistat treatment yielded no additional benefits as compared to short (16 weeks) treatment. CONCLUSIONS In clozapine- or olanzapine-treated overweight or obese patients able to take orlistat on a long-term basis, the drug, with no concomitant hypocaloric diet or behavioral interventions, caused moderate weight loss only in men. However, some metabolic benefits may be achieved independently of weight changes. In patients who do not respond to orlistat within the first 16 weeks, continuation treatment may provide no additional benefits. TRIAL REGISTRATION controlled-trials.com Identifier: ISRCTN65731856.
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Affiliation(s)
- Evgueni Tchoukhine
- Helsinki University Central Hospital, Peijas Hospital, 01400 Vantaa, Helsinki, Finland
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Terevnikov V, Stenberg JH, Joffe M, Tiihonen J, Burkin M, Tchoukhine E, Joffe G. More evidence on additive antipsychotic effect of adjunctive mirtazapine in schizophrenia: an extension phase of a randomized controlled trial. Hum Psychopharmacol 2010; 25:431-8. [PMID: 20737516 DOI: 10.1002/hup.1137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Adjunctive mirtazapine improved negative symptoms of schizophrenia in several studies. Recently, we found an improvement also in positive symptoms when mirtazapine was added to first generation antipsychotics (FGAs) in a 6 week randomized controlled trial (RCT). The short duration of that trial was its limitation. This study aimed to explore whether longer treatment is worthwhile. METHOD Completers of the RCT (n = 39) received open-label add-on mirtazapine for additional 6 weeks. The Positive and Negative Syndrome Scale (PANSS) total score (primary outcome) and several other clinical parameters were measured prospectively. RESULTS During the open-label phase, significant improvement was achieved in all parameters, with an effect size of 0.94 (CI 95% = 0.45-1.43) on the primary outcome and an impressive additive antipsychotic effect. Patients who received mirtazapine during both phases demonstrated greater improvement in positive symptoms (29.6% versus 21.2%, p = 0.027) than those who received mirtazapine during open-label extension phase only. CONCLUSIONS These findings support our previous data on the additive antipsychotic effect of mirtazapine in FGAs-treated schizophrenia. Mirtazapine may be effective in other symptom domains, too. Longer duration of mirtazapine treatment may yield additional benefits. If these results will be confirmed in larger studies, add-on mirtazapine may become a feasible option in difficult-to-treat schizophrenia.
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Kontio R, Välimäki M, Putkonen H, Kuosmanen L, Scott A, Joffe G. Patient restrictions: are there ethical alternatives to seclusion and restraint? Nurs Ethics 2010; 17:65-76. [PMID: 20089626 DOI: 10.1177/0969733009350140] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses' (n = 22) and physicians' (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The participants believed that the decision-making process for managing patients' aggressive behaviour contains some in-built ethical dilemmas. They thought that patients' subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients' aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent.
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Affiliation(s)
- Raija Kontio
- University of Turku, Turku, Finland, and Kellokoski Hospital, Tuusula, Finland.
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Kontio R, Välimäki M, Putkonen H, Cocoman A, Turpeinen S, Kuosmanen L, Joffe G. Nurses' and physicians' educational needs in seclusion and restraint practices. Perspect Psychiatr Care 2009; 45:198-207. [PMID: 19566692 DOI: 10.1111/j.1744-6163.2009.00222.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to explore nurses' (N= 22) and physicians' (N= 5) educational needs in the context of their perceived seclusion and restraint-related mode of action and need for support. METHOD The data were collected by focus group (N= 4) interviews and analyzed with inductive content analysis. RESULTS Participants recognized a need for on-ward and problem-based education and infrastructural and managerial support. The declared high ethical principles were not in accordance with the participants' reliance on manpower and the high seclusion and restraint rates. PRACTICE IMPLICATIONS Future educational programs should bring together written clinical guidelines, education on ethical and legal issues, and the staff's support aspect.
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Affiliation(s)
- Raija Kontio
- University of Turku, Department of Nursing Science, Turku, Finland.
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Joffe G, Eskelinen S, Sailas E. Add-on filgrastim during clozapine rechallenge in patients with a history of clozapine-related granulocytopenia/agranulocytosis. Am J Psychiatry 2009; 166:236. [PMID: 19188296 DOI: 10.1176/appi.ajp.2008.08081295] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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