Physical ill health and risk of psychosis

Patients with psychosis have been found to suffer from physical illnesses more commonly than the general population. In this report, self-reported physical ill health and its correlates among subjects with and without vulnerability to psychosis in a sample of first-degree relatives, help-seekers and controls were investigated. Perceived physical health was statistically significantly poorer among subjects with minor symptoms on the Structured Interview for Prodromal Symptoms and those vulnerable to psychosis than among those without symptoms measured by 13 somatoform symptom sum scores of the Symptom Checklist-90. Those at current risk of psychosis had a significantly higher mean sum score on the 13 somatic items (mean=21.1) than others (mean=9.6). Having physical symptoms or a self-reported physician-diagnosed illness was significantly associated with vulnerability to psychosis (odds ratio=3.05). The subjects with a mood disorder (odds ratio=4.33) had significantly more commonly physician-diagnosed illnesses than those who had no diagnosis or any other diagnosis. Physical ill health seems to be common among those vulnerable to psychosis.

Substance abuse and related diagnoses in early psychosis

Substance abuse seems to be common among those with early signs of evolving psychosis. This article seeks to determine the prevalence of substance abuse and substance use disorders (SUDs) and the association of abuse and SUD with vulnerability psychosis among a sample of first-degree relatives of schizophrenic patients (n = 70), help-seekers (n = 29), and control subjects (n = 34). The Structured Interview for Prodromal Symptoms (SIPS) 1.0 was used to define the vulnerability status and the Structured Clinical Interview for DSM-IV Axis I to diagnose the subjects. Data on various other measures, including premorbid adjustment, personality disorder symptoms, psychological distress, and abuse of substances, were collected. Those who were identified as vulnerable to psychosis reported significantly more lifetime alcohol abuse and had more commonly an SUD than controls. Substance use disorder, as well as alcohol and drug abuse, correlated significantly with personality disorder symptoms and current positive SIPS score and both types of abuse also with disorganization SIPS score. The odds ratio for having an SUD among those vulnerable to psychosis was 6.33 (95% confidence interval, 1.77-22.73). Early psychosis and substance abuse frequently occur together.

Burnout and self-perceived health among Finnish psychiatrists and child psychiatrists: a national survey

AIMS

This study investigated burnout and related health matters among a sample of Finnish physicians working within the field of psychiatry.

METHODS

A postal questionnaire was sent to one in three licensed physicians randomly selected from the register of the Finnish Medical Association (FMA). The response rate was 74% (n = 3133).

RESULTS

Psychiatrists and child psychiatrists reported burnout, threat of severe burnout, depression, and mental disorder more commonly than other physicians. Moreover, psychiatrists and child psychiatrists reported less often "good" or "rather good" self-perceived health. Depression had a moderate positive correlation with overall MBI score. Lack of possibilities to consult a colleague, and supervision of work, experience of threat of violence, and self-reported depression were significantly associated with overall burnout level and emotional exhaustion.

CONCLUSIONS

Emotional exhaustion as a symptom of burnout was common among psychiatrists, especially among those working in community care, and child psychiatrists. Problems of general health, as well as mental health, among psychiatrists and child psychiatrists are in need of attention.

Predicting use of coercive measures in Finland

The prevalence of use of seclusion and restraints in psychiatric treatment has varied dramatically among institutions, according to previous studies. We investigated the factors predicting overall and "heavy use" of restrictive measures and differences in the population-based rates of use of seclusion and restraints in three university psychiatric centres in Finland (Turku, Tampere and Oulu) using a retrospective chart review. The material comprised all civil admissions to the study hospitals of working-aged people during a period of 6 months in 1996. There were significant differences among the studied centres as to the population-based level of use of seclusion and restraints. Oulu used significantly less seclusion but had a significantly higher level of use of restraints than Turku and Tampere. The individual institutions best predicted the overall use of restrictive interventions, whereas previous commitments and involuntary legal status on admission were factors predicting "heavy use" of these measures. Our results suggest that the implementation and monitoring of restrictive measures could be further harmonized.

Frequently hospitalised psychiatric patients: a study of predictive factors

The purpose of this study was to investigate the factors predicting readmission and the interval between readmissions to psychiatric hospital during the early 1990s in Finland. Data were retrieved using the national register of all discharges from psychiatric hospitals during the early 1990s. Frequently admitted patients were an identifiable group. The factors associated with an increased risk of multiple readmissions were: previous admissions, long length of stay (LOS) and diagnosis of psychosis or personality disorder. Patients with psychosis or personality disorder were also readmitted more rapidly than patients with an organic disorder. There seemed to be a small proportion of psychiatric patients in need of frequent or lengthy hospital treatment. The expansion of community care did not as such seem to have diminished the need and use of psychiatric hospital care. However, the differences between the years 1990 and 1993 were less important than the other factors that predicted readmission, namely LOS and diagnosis.

Regional differences in the use of psychiatric hospital beds in Finland: a national case-register study

We investigated the possible differences in the utilization of psychiatric hospital beds among five social security areas in Finland, and the association between the variables related to the psychiatric services and the use of hospital beds. The use of hospital beds varied quite distinctly among these areas, as did the total rate of in-patients, readmissions, and rates of in-patients with psychotic and affective disorders. The treatment practices appeared to vary as the length of stay (LOS) and the rate of committal differed regionally in a significant manner. There was a significant positive correlation between the total rate of in-patients and the rate of readmitted patients (r=0.92, P<0.001), and a significant negative correlation between the number of visits per worker in out-patient care and the rate of readmissions (r=-0.94, P<0.001).

Readmitted nonpsychotic patients and their eventual diagnoses. A retrospective study on 64 first-timers of inpatient care in the Psychiatric Clinic of Turku, Finland

This longitudinal study was performed to characterise frequently readmitted patients in a sample of 64 first-timers of inpatient care. Half of the 12 revolving door patients were psychotic at last discharge. The relative risk for diagnostic change in the Axis I group was nine times higher than in the personality disorder group.

Patterns of psychiatric hospital service use in Finland: a national register study of hospital discharges in the early 1990s

We were interested in studying the possible concurrent changes in the psychiatric inpatient population during a rapid phase of deinstitutionalisation, and severe economic recession with a record level unemployment rate, and after the amendment of the mental health legislation. Although there were 4540 fewer beds in the psychiatric hospitals in 1993 compared to 1990, the rate of patient admissions remained the same. There was a significant increase in readmissions (P < 0.001) to the psychiatric hospitals, and particularly in multiple (three or more) readmissions among new inpatients (P < 0.001). The prevalence of inpatients with major depression increased by 0.2/1000 in the whole cohort and by 0.12/1000 among first-timers from 1990 to 1993 (P < 0.001). In addition, the rate of involuntary admissions decreased significantly (P < 0.001).

Factors predicting readmissions in personality disorders and other nonpsychotic illnesses. A retrospective study on 64 first-ever admissions to the Psychiatric Clinic of Turku, Finland

A retrospective study of factors predicting readmissions and follow-up treatment was undertaken of all first-ever episodes of inpatient care (age under 65), excluding psychotic and organic mental disorders, during 1987 and 1988 in University Psychiatric Clinic in Turku City Hospital, Finland. The cohort consisted of 64 subjects, 24 men and 40 women. The study was carried out in the end of 1993, thus allowing about 5 years of follow-up. The diagnosis of personality disorder did not predict readmission. The only factor predicting readmission nearly significantly was not having a relationship. The incidence of the revolving door syndrome, defined as 4 or more admissions within 5 years, was 12.5%. Women had a greater risk of readmission, but not that of the revolving door. Patients who had psychotherapy as follow-up treatment showed a frequency of 8% for 4 or more admissions, whereas patients who had no follow-up treatment had a frequency of 21% for 4 or more readmissions. The only factor significantly predicting follow-up treatment arrangement was previous treatment contact.