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11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study).

https://arctichealth.org/en/permalink/ahliterature149701
Source
Lancet. 2009 Aug 22;374(9690):620-7
Publication Type
Article
Date
Aug-22-2009
Author
Jari Tiihonen
Jouko Lönnqvist
Kristian Wahlbeck
Timo Klaukka
Leo Niskanen
Antti Tanskanen
Jari Haukka
Author Affiliation
Department of Forensic Psychiatry, University of Kuopio and Niuvanniemi Hospital, Department of Clinical Physiology, Kuopio University Hospital, Kuopio, Finland. jari.tiihonen@niuva.fi
Source
Lancet. 2009 Aug 22;374(9690):620-7
Date
Aug-22-2009
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Antipsychotic Agents - adverse effects
Case-Control Studies
Cause of Death
Clozapine - adverse effects
Dibenzothiazepines - adverse effects
Drug Utilization - trends
Female
Finland - epidemiology
Follow-Up Studies
Health Status Disparities
Humans
Life expectancy
Male
Middle Aged
Patient Readmission - statistics & numerical data
Perphenazine - adverse effects
Proportional Hazards Models
Registries
Risk factors
Schizophrenia - drug therapy - mortality
Sex Distribution
Time Factors
Abstract
The introduction of second-generation antipsychotic drugs during the 1990s is widely believed to have adversely affected mortality of patients with schizophrenia. Our aim was to establish the long-term contribution of antipsychotic drugs to mortality in such patients.
Nationwide registers in Finland were used to compare the cause-specific mortality in 66 881 patients versus the total population (5.2 million) between 1996, and 2006, and to link these data with the use of antipsychotic drugs. We measured the all-cause mortality of patients with schizophrenia in outpatient care during current and cumulative exposure to any antipsychotic drug versus no use of these drugs, and exposure to the six most frequently used antipsychotic drugs compared with perphenazine use.
Although the proportional use of second-generation antipsychotic drugs rose from 13% to 64% during follow-up, the gap in life expectancy between patients with schizophrenia and the general population did not widen between 1996 (25 years), and 2006 (22.5 years). Compared with current use of perphenazine, the highest risk for overall mortality was recorded for quetiapine (adjusted hazard ratio [HR] 1.41, 95% CI 1.09-1.82), and the lowest risk for clozapine (0.74, 0.60-0.91; p=0.0045 for the difference between clozapine vs perphenazine, and p
Notes
Comment In: Lancet. 2009 Nov 7;374(9701):1591; author reply 1592-319897117
Comment In: Lancet. 2009 Nov 7;374(9701):1591; author reply 1592-319897118
Comment In: Lancet. 2009 Aug 22;374(9690):590-219595448
Comment In: Lancet. 2009 Nov 7;374(9701):1592; author reply 1592-319897121
Comment In: Lancet. 2009 Nov 7;374(9701):1592; author reply 1592-319897120
PubMed ID
19595447 View in PubMed
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Antidepressants and the risk of suicide, attempted suicide, and overall mortality in a nationwide cohort.

https://arctichealth.org/en/permalink/ahliterature166258
Source
Arch Gen Psychiatry. 2006 Dec;63(12):1358-67
Publication Type
Article
Date
Dec-2006
Author
Jari Tiihonen
Jouko Lönnqvist
Kristian Wahlbeck
Timo Klaukka
Antti Tanskanen
Jari Haukka
Author Affiliation
Department of Forensic Psychiatry, University of Kuopio and Niuvanniemi Hospital, Kuopio University Hospital, Kuopio, Finland. Jari.Tiihonen@niuva.fi
Source
Arch Gen Psychiatry. 2006 Dec;63(12):1358-67
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antidepressive Agents - adverse effects - therapeutic use
Cause of Death
Child
Cohort Studies
Depressive Disorder - drug therapy - epidemiology - mortality
Female
Finland - epidemiology
Follow-Up Studies
Hospitalization
Humans
Male
Middle Aged
Proportional Hazards Models
Registries
Risk factors
Serotonin Uptake Inhibitors - adverse effects - therapeutic use
Suicide - psychology - statistics & numerical data
Suicide, Attempted - psychology - statistics & numerical data
Abstract
It is unknown if antidepressant treatment is associated with either increased or decreased risk of suicide.
To estimate the risk of suicide, attempted suicide, and overall mortality during antidepressant treatments in a real-life setting with high statistical power.
A cohort study in which all subjects without psychosis, hospitalized because of a suicide attempt from January 1, 1997, to December 31, 2003, in Finland, were followed up through a nationwide computerized database.
A total of 15 390 patients with a mean follow-up of 3.4 years.
The propensity score-adjusted relative risks (RRs) during monotherapy with the most frequently used antidepressants compared with no antidepressant treatment.
In the entire cohort, fluoxetine use was associated with the lowest risk (RR, 0.52; 95% confidence interval [CI], 0.30-0.93), and venlafaxine hydrochloride use with the highest risk (RR, 1.61; 95% CI, 1.01-2.57), of suicide. A substantially lower mortality was observed during selective serotonin reuptake inhibitor use (RR, 0.59; 95% CI, 0.49-0.71; P
Notes
Comment In: Evid Based Ment Health. 2007 Aug;10(3):9017652572
PubMed ID
17146010 View in PubMed
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Antidepressant use and violent crimes among young people: a longitudinal examination of the Finnish 1987 birth cohort.

https://arctichealth.org/en/permalink/ahliterature289550
Source
J Epidemiol Community Health. 2017 01; 71(1):12-18
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2017
Author
Elina Hemminki
Marko Merikukka
Mika Gissler
Kristian Wahlbeck
Jukka Savolainen
Tiina Ristikari
Mikko Aaltonen
Author Affiliation
THL, Health and Social Care Systems, Helsinki, Finland.
Source
J Epidemiol Community Health. 2017 01; 71(1):12-18
Date
01-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Antidepressive Agents - therapeutic use
Crime - psychology - statistics & numerical data
Female
Finland - epidemiology
Humans
Longitudinal Studies
Male
Risk factors
Violence - psychology - statistics & numerical data
Abstract
The use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), has been questioned due to poor efficacy and safety. We examined whether young violent offenders were more likely antidepressant users prior to their first violent offence than other young persons.
The study is a follow-up of children born in Finland in 1987 (n=59 120), linking national registers to each other using personal identity codes. Data on psychotropic drug use came from a register of reimbursed drugs and data on crimes from a register on court convictions (after the age of 14 years). Participants were followed until the age of 18 years, and for some analyses until the end of the follow-up (mean 21 years). To adjust for differences in background characteristics, regression analyses for antidepressant use were made, using the no-conviction group as the reference.
Proportions of young people convicted by the age of 18 years were: 5% of boys (1.7% for violent crimes) and 1% (0.5%) of girls. Antidepressant use (both overall and for SSRIs) prior to violent crime was more common among those convicted than among those without convictions. Among boys with repeated violent crimes, it was also more common than among boys with non-violent crimes. Adjustment for differences in background characteristics decreased the associations between antidepressant use and violent crime, but did not eliminate them.
The results add further evidence for caution in prescribing antidepressants among young persons. It also calls for a reanalysis of violence measures in the original trial data.
PubMed ID
27354489 View in PubMed
Less detail

Antidepressant use and violent crimes among young people: a longitudinal examination of the Finnish 1987 birth cohort.

https://arctichealth.org/en/permalink/ahliterature289708
Source
J Epidemiol Community Health. 2017 01; 71(1):12-18
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2017
Author
Elina Hemminki
Marko Merikukka
Mika Gissler
Kristian Wahlbeck
Jukka Savolainen
Tiina Ristikari
Mikko Aaltonen
Author Affiliation
THL, Health and Social Care Systems, Helsinki, Finland.
Source
J Epidemiol Community Health. 2017 01; 71(1):12-18
Date
01-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Antidepressive Agents - therapeutic use
Crime - psychology - statistics & numerical data
Female
Finland - epidemiology
Humans
Longitudinal Studies
Male
Risk factors
Violence - psychology - statistics & numerical data
Abstract
The use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), has been questioned due to poor efficacy and safety. We examined whether young violent offenders were more likely antidepressant users prior to their first violent offence than other young persons.
The study is a follow-up of children born in Finland in 1987 (n=59 120), linking national registers to each other using personal identity codes. Data on psychotropic drug use came from a register of reimbursed drugs and data on crimes from a register on court convictions (after the age of 14 years). Participants were followed until the age of 18 years, and for some analyses until the end of the follow-up (mean 21 years). To adjust for differences in background characteristics, regression analyses for antidepressant use were made, using the no-conviction group as the reference.
Proportions of young people convicted by the age of 18 years were: 5% of boys (1.7% for violent crimes) and 1% (0.5%) of girls. Antidepressant use (both overall and for SSRIs) prior to violent crime was more common among those convicted than among those without convictions. Among boys with repeated violent crimes, it was also more common than among boys with non-violent crimes. Adjustment for differences in background characteristics decreased the associations between antidepressant use and violent crime, but did not eliminate them.
The results add further evidence for caution in prescribing antidepressants among young persons. It also calls for a reanalysis of violence measures in the original trial data.
PubMed ID
27354489 View in PubMed
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Attitudes towards people with mental disorders: the psychometric characteristics of a Finnish questionnaire.

https://arctichealth.org/en/permalink/ahliterature151023
Source
Soc Psychiatry Psychiatr Epidemiol. 2010 Feb;45(2):265-73
Publication Type
Article
Date
Feb-2010
Author
Esa Aromaa
Asko Tolvanen
Jyrki Tuulari
Kristian Wahlbeck
Author Affiliation
Vaasa Hospital District, Psychiatric Unit of Vaasa Central Hospital, Sarjakatu 2, Vaasa 65320, Finland. esa.aromaa@vshp.fi
Source
Soc Psychiatry Psychiatr Epidemiol. 2010 Feb;45(2):265-73
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Attitude to Health
Depressive Disorder - diagnosis - epidemiology - psychology
Female
Finland - epidemiology
Health Surveys
Humans
Mental Disorders - diagnosis - epidemiology - psychology
Mental Health Services - statistics & numerical data - utilization
Middle Aged
Personality Inventory - statistics & numerical data
Principal Component Analysis
Psychometrics
Public Opinion
Questionnaires - standards
Reproducibility of Results
Sampling Studies
Stereotyping
Abstract
The prevalence of mental disorders, especially depression, increasingly creates concern for our mental, social and economic well-being. The public has insufficient knowledge about mental disorders and their treatment. A stigma is attached to mental disorders, which has a multifaceted impact on the lives of patients and their families. A Finnish general population survey studied knowledge of and attitudes towards mental health problems. This study examines the background dimensions of the attitude items used in the survey.
An eight-page health survey questionnaire with 16 items on attitudes to mental health and depression was sent to a randomly selected sample of 10,000 persons aged 15-80 years. The overall response rate was 55.2%. The data were submitted to a principal component analysis (PCA). Two components were extracted by means of this analysis and submitted to further reliability analyses as well as to a preliminary validity analysis.
The PCA identified four components: (1) depression is a matter of will, (2) mental problems have negative consequences, (3) one should be careful with antidepressants and (4) you never recover from mental problems.
The internal consistencies of the first two components were sufficient to build dimension scales for future analyses. The extracted components fit consistently with the leading stigma theories and earlier studies measuring public attitudes.
PubMed ID
19436925 View in PubMed
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The characteristics of suicides within a week of discharge after psychiatric hospitalisation - a nationwide register study.

https://arctichealth.org/en/permalink/ahliterature68238
Source
BMC Psychiatry. 2005 Aug 25;5:32
Publication Type
Article
Date
Aug-25-2005
Author
Sami Pirkola
Britta Sohlman
Kristian Wahlbeck
Author Affiliation
Mental Health Group, Health and Social Services Division, National Research and Development Centre for Welfare and Health (STAKES), Lintulahdenkuja 4, FIN-00530, Helsinki Finland. Sami.Pirkola@stakes.fi
Source
BMC Psychiatry. 2005 Aug 25;5:32
Date
Aug-25-2005
Language
English
Publication Type
Article
Abstract
BACKGROUND: The characteristics of victims of immediate post-discharge suicides are not well known. We explored these characteristics for the purposes of better recognition and preventive efforts of potential immediate post-discharge suicides. METHODS: Suicides from a Finnish nationwide register were linked with preceding periods of psychiatric inpatient treatment. Characteristics of suicides within a week of discharge were compared to those occurring later after discharge. RESULTS: Compared to other previously hospitalised suicide victims, those committing suicide within a week of discharge were more often female, unmarried, had a higher grade of education and a diagnosis of schizophrenia spectrum or affective disorder, tended to use more drowning and jumping from heights as the methods for suicide and had gained a smaller improvement in psychological functioning during hospitalization. CONCLUSION: These characteristics indicate a more severe psychopathology, relatively poorer level of functioning, less global response to hospitalisation, and a more frequent choice of lethal and easily available method for suicide. Potentially suicidal psychiatric patients should be better recognized and an immediate follow-up arranged if it is decided they be discharged.
PubMed ID
16120228 View in PubMed
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Community mental-health services and suicide rate in Finland: a nationwide small-area analysis.

https://arctichealth.org/en/permalink/ahliterature153558
Source
Lancet. 2009 Jan 10;373(9658):147-53
Publication Type
Article
Date
Jan-10-2009
Author
Sami Pirkola
Reijo Sund
Eila Sailas
Kristian Wahlbeck
Author Affiliation
Mental Health Group, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland.
Source
Lancet. 2009 Jan 10;373(9658):147-53
Date
Jan-10-2009
Language
English
Publication Type
Article
Keywords
Adult
Bayes Theorem
Community Mental Health Services - organization & administration - statistics & numerical data
Female
Finland
Humans
Male
Socioeconomic Factors
Suicide - prevention & control - statistics & numerical data
Abstract
In many countries, psychiatric services have been reformed by reducing the size of hospitals and developing community mental-health services. We investigated this reform by assessing the relation between suicide risk and different ways of organising mental-health services.
We did a nationwide comprehensive survey of Finnish adult mental-health service units between Sept 1, 2004, and March 31, 2005. From health-care or social-care officers of 428 municipalities, we asked for information, classified according to the European service mapping schedule, about adult mental-health services. For each municipality, we measured age-adjusted and sex-adjusted suicide risk, pooled between 2000 and 2004, and then adjusted for register-derived socioeconomic factors.
A wide variety of outpatient services (relative risk [RR] 0.92, 95% CI 0.87-0.96), prominence of outpatient versus inpatient services (0.93, 0.89-0.97), and 24-h emergency services (0.84, 0.75-0.92) were associated with decreased death rates from suicide. However, after adjustment for socioeconomic factors, only the prominence of outpatient services was associated with low suicide rate (0.94, 0.90-0.98). We replicated this finding even after adjustment for organisational changes and inpatient treatment.
Well-developed community mental-health services are associated with lower suicide rates than are services oriented towards inpatient treatment provision. These data are consistent with the idea that population mental health can be improved by use of multifaceted, community-based, specialised mental-health services.
Academy of Finland.
Notes
Comment In: Lancet. 2009 Jan 10;373(9658):99-10019097637
PubMed ID
19097638 View in PubMed
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Differential response to right unilateral ECT in depressed patients: impact of comorbidity and severity of illness [ISRCTN39974945].

https://arctichealth.org/en/permalink/ahliterature191499
Source
BMC Psychiatry. 2002;2:2
Publication Type
Article
Date
2002
Author
Pertti Heikman
Heikki Katila
Seppo Sarna
Kristian Wahlbeck
Kimmo Kuoppasalmi
Author Affiliation
Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland. pertti.heikman@hus.fi
Source
BMC Psychiatry. 2002;2:2
Date
2002
Language
English
Publication Type
Article
Keywords
Comorbidity
Depressive Disorder - diagnosis - epidemiology - therapy
Electroconvulsive Therapy - methods
Female
Finland - epidemiology
Functional Laterality - physiology
Humans
Male
Mental Disorders - epidemiology
Middle Aged
Psychiatric Status Rating Scales
Severity of Illness Index
Treatment Outcome
Abstract
Recent electroconvulsive therapy (ECT) efficacy studies of right unilateral (RUL) ECT may not apply to real life clinics with a wide range of patients with major depressive episodes.
The study included two groups of patients. In addition to a homogeneous group of patients with major depression according to DSM-IV criteria with severity of the major depressive episode > 16 scores on 17-item Hamilton Rating Scale for Depression (HDRS) (Group 1, n = 16), we included a heterogeneous group of patients with less severe major depressive episodes or with a variety of comorbid conditions (Group 2, n = 24). We randomly assigned the patients to an RUL ECT treatment dosed at 5 or 2.5 times seizure threshold with an intent-to-treat design. The outcomes measured blindly were HDRS, number of treatments, and Mini-Mental State Examination (MMSE). The patients were considered to have responded to treatment if the improvement in HDRS score was at least 60% and they had a total score of less than ten.
The Group 2 patients responded poorer (8% vs. 63%), and had more often simultaneous worsening in their MMSE scores than Group 1 patients. The differences in the outcomes between the two different doses of RUL ECT treatment were not statistically significant.
ECT effectiveness seems to be lower in real-life heterogeneous patient groups than in homogeneous patient samples used in experimental efficacy trials.
Notes
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PubMed ID
11846888 View in PubMed
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Does primary care mental health resourcing affect the use and costs of secondary psychiatric services?

https://arctichealth.org/en/permalink/ahliterature266345
Source
Int J Environ Res Public Health. 2014 Sep;11(9):8743-54
Publication Type
Article
Date
Sep-2014
Author
Minna Sadeniemi
Sami Pirkola
Maiju Pankakoski
Grigori Joffe
Raija Kontio
Maili Malin
Taina Ala-Nikkola
Kristian Wahlbeck
Source
Int J Environ Res Public Health. 2014 Sep;11(9):8743-54
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Finland
Health Care Costs
Health Resources - economics - organization & administration
Health Services Needs and Demand - economics - organization & administration
Hospitalization
Humans
Mental Disorders - therapy
Mental Health Services - economics - organization & administration
Primary Health Care - economics - organization & administration
Secondary Care Centers - utilization
Abstract
Collaborative care models for treatment of depression and anxiety disorders in primary care have been shown to be effective. The aim of this study was to investigate at the municipal level to what extent investment in mental health personnel at primary care health centres in the study area is reflected in the costs and use of secondary psychiatric services. Furthermore, we analysed whether the service provision and use of secondary psychiatric care correlates with the socioeconomic indicators of need. We found significant variation in the amount of mental health personnel provided at the health centres, uncorrelated with the indicators of need nor with the costs of secondary psychiatric care. The amount of mental health nurses at the health centres correlated inversely with the number of secondary psychiatric outpatient visits, whereas its relation to inpatient days and admission was positive. The costs of secondary psychiatric care correlated with level of psychiatric morbidity and socioeconomic indicators of need. The results suggest that when aiming at equal access of care and cost-efficiency, the primary and secondary care should be organized and planned with integrative collaboration.
Notes
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PubMed ID
25162710 View in PubMed
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Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study.

https://arctichealth.org/en/permalink/ahliterature168429
Source
BMJ. 2006 Jul 29;333(7561):224
Publication Type
Article
Date
Jul-29-2006
Author
Jari Tiihonen
Kristian Wahlbeck
Jouko Lönnqvist
Timo Klaukka
John P A Ioannidis
Jan Volavka
Jari Haukka
Author Affiliation
Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, FIN-70240 Kuopio, Finland. jari.tiihonen@niuva.fi
Source
BMJ. 2006 Jul 29;333(7561):224
Date
Jul-29-2006
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - therapeutic use
Cohort Studies
Community Mental Health Services - statistics & numerical data
Female
Finland - epidemiology
Humans
Length of Stay
Male
Patient Readmission - statistics & numerical data
Prospective Studies
Psychotic Disorders - drug therapy - mortality
Risk factors
Schizophrenia - drug therapy - mortality
Treatment Outcome
Treatment Refusal
Abstract
To study the association between prescribed antipsychotic drugs and outcome in schizophrenia or schizoaffective disorder in the community.
Prospective cohort study using national central registers.
Community care in Finland.
Nationwide cohort of 2230 consecutive adults hospitalised in Finland for the first time because of schizophrenia or schizoaffective disorder, January 1995 to December 2001.
Rates of discontinuation of drugs (all causes), rates of rehospitalisation, and mortality associated with monotherapy with the 10 most commonly used antipsychotic drugs. Multivariate models and propensity score methods were used to adjust estimates of effectiveness.
Initial use of clozapine (adjusted relative risk 0.17, 95% confidence interval 0.10 to 0.29), perphenazine depot (0.24, 0.13 to 0.47), and olanzapine (0.35, 0.18 to 0.71) were associated with the lowest rates of discontinuation for any reason when compared with oral haloperidol. During an average follow-up of 3.6 years, 4640 cases of rehospitalisation were recorded. Current use of perphenazine depot (0.32, 0.22 to 0.49), olanzapine (0.54, 0.41 to 0.71), and clozapine (0.64, 0.48 to 0.85) were associated with the lowest risk of rehospitalisation. Use of haloperidol was associated with a poor outcome among women. Mortality was markedly raised in patients not taking antipsychotics (12.3, 6.0 to 24.1) and the risk of suicide was high (37.4, 5.1 to 276).
The effectiveness of first and second generation antipsychotics varies greatly in the community. Patients treated with perphenazine depot, clozapine, or olanzapine have a substantially lower risk of rehospitalisation or discontinuation (for any reason) of their initial treatment than do patients treated with haloperidol. Excess mortality is seen mostly in patients not using antipsychotic drugs.
Notes
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Comment In: BMJ. 2006 Jul 29;333(7561):212-316873834
Comment In: BMJ. 2006 Aug 12;333(7563):35316902223
PubMed ID
16825203 View in PubMed
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46 records – page 1 of 5.