Browsing by Subject "Schizophrenia"

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  • Robinson, Rachel; Lahti-Pulkkinen, Marius; Schnitzlein, Daniel; Voit, Falk; Girchenko, Polina; Wolke, Dieter; Lemola, Sakari; Kajantie, Eero; Heinonen, Kati; Räikkönen, Katri (2020)
    Preterm birth research is poised to explore the mental health of adults born very preterm(VP;1970) included VP/VLBW individuals with controls born at term(≥37+0 weeks) or with normal birth weight(NBW; ≥2500g). Thirteen studies were included. Studies consistently showed an increased risk for psychotropic medication use for VP/VLBW adults in comparison to NBW/term controls, but whether VP/VLBW adults have an increased risk for mental health disorders or symptoms appearing in adulthood remains uncertain. The quality of the evidence was moderate (65.8%) to high (34.2%). Further research in larger samples is needed.
  • Oksanen, Jorma K.; Vataja, Risto; Lappalainen, Jarmo; Lindberg, Nina; Koponen, Hannu (2016)
    Skitsofrenia ilmenee laaja-alaisena tunteiden, havaitsemisen, motivaation ja käyttäytymisen säätelyn häiriönä. Skitsofrenian kehittymisen ajatellaan liittyvän keskushermoston kehittymis- ja kypsymisprosessiin, johon liittyy usein häiriöitä kognitiivisissa toiminnoissa. Potilaat ovat myös herkkiä erilaisille ympäristön ­kuormitustekijöille. Varhainen psykoosioireiston tunnistaminen ja hoidon aloittaminen parantavat ennustetta. Suuressa psykoosiriskissä olevien nuorten tunnistaminen ja hoito voivat estää skitsofrenian puhkeamisen. Diagnostinen selvittely ja hoidon aloitus on usein perusteltua toteuttaa erikoissairaanhoidossa, kun kyseessä on uusi skitsofreniapotilas.
  • Suvisaari, Jaana; Eskelinen, Saana; Keinänen, Jaakko; Sailas, Eila (2019)
  • Tiihonen, Jari; Koskuvi, Marja; Lähteenvuo, Markku; Trontti, Kalevi; Ojansuu, Ilkka; Vaurio, Olli; Cannon, D. Tyrone; Lönnqvist, Jouko; Therman, Sebastian; Suvisaari, Jaana; Cheng, Lesley; Tanskanen, Antti; Taipale, Heidi; Lehtonen, Sarka; Koistinaho, Jari (2021)
    The molecular pathophysiological mechanisms underlying schizophrenia have remained unknown, and no treatment exists for primary prevention. We used Ingenuity Pathway Analysis to analyze canonical and causal pathways in two different datasets, including patients from Finland and USA. The most significant findings in canonical pathway analysis were observed for glutamate receptor signaling, hepatic fibrosis, and glycoprotein 6 (GP6) pathways in the Finnish dataset, and GP6 and hepatic fibrosis pathways in the US dataset. In data-driven causal pathways, ADCYAP1, ADAMTS. and CACNA genes were involved in the majority of the top 10 pathways differentiating patients and controls in both Finnish and US datasets. Results from a Finnish nation-wide database showed that the risk of schizophrenia relapse was 41% lower among first-episode patients during the use of losartan, the master regulator of an ADCYAP1, ADAM'S, and CACNA -related pathway, compared to those time periods when the same individual did not use the drug. The results from the two independent datasets suggest that the GP6 signaling pathway, and the ADCYAPI, ADAATTS, and CACNA-related purine, oxidative stress, and glutamatergic signaling pathways are among primary pathophysiological alterations in schizophrenia among patients with European ancestry. While no reproducible dopaminergic alterations were observed, the results imply that agents such as losartan, and ADCYAP1/PACAP -deficit alleviators, such as metabotropic glutamate 2/3 agonise MGS0028 and 5-HT7 antagonists-which have shown beneficial effects in an experimental Adcyapl(-/-) mouse model for schizophrenia - could be potential treatments even before the full manifestation of illness involving dopaminergic abnormalities. (C) 2021 The Authors. Published by Elsevier B.V.
  • Simoila, Laura; Isometsä, Erkki; Gissler, Mika; Suvisaari, Jaana; Halmesmäki, Erja; Lindberg, Nina (2018)
    Background: This national register-based study assesses obstetric and perinatal health outcomes in women with schizophrenia and their offspring. Methods: Using the Care Register for Health Care, we identified Finnish women who were born in 19651980 and diagnosed with schizophrenia. For each case, five age-and place-of-birth-matched controls were obtained from the Central Population Register of Finland. They were followed from the day when the disorder was diagnosed in specialized health-care (the index day) until 31.12.2013. Information related to births was obtained from the Medical Birth Register and the Register of Congenital Malformations. We focused on singleton pregnancies that led to a delivery after the index day. We restricted the analysis of deliveries in controls to those that occurred after the index day of the case. Maternal age, marital status, smoking status, sex of the newborn, and parity were used as covariates in adjusted models. Results: We identified 1162 singleton births among women with schizophrenia and 4683 among controls. Schizophrenic women had a 1.4-fold increased risk of induction of labor, delivery by cesarean section, and delivery by elective cesarean section. Regarding offspring, the risk of premature birth and the risk of low Apgar score at 1 min ( Conclusions: Schizophrenia associates with some specific delivery methods, but delivery complications are rare and their prevalence does not differ from that observed among community women. Maternal schizophrenia associates with some negative perinatal health outcomes of the offspring. (c) 2018 Elsevier Masson SAS. All rights reserved.
  • Frayne, Jacqueline; Nguyen, Thinh; Allen, Suzanna; Hauck, Yvonne; Liira, Helena; Vickery, Alistair (2019)
    Purpose This study aims to describe 10 years of antenatal care and outcomes for women with a severe mental illness (SMI). Methods A retrospective cohort study of 420 completed pregnancy records over the last 10 years (2007-2017). Findings were compared to the Western Australian (WA) pregnancy data. Antenatal attendance, demographic, obstetric, neonatal and psychosocial variables were analysed using t tests, chi(2)(,) ANOVA and odds ratio (OR). Results Overall, women with a SMI had high rates of comorbidity (47%), antenatal complications, and preterm birth at 12.6% compared to WA mothers (p <0.001). Those with schizophrenia were at highest risk with increased risk of threatened preterm labour OR 8.25 (95% CI 4.64-14.65), gestational diabetes OR 3.59 (95% CI 2.18-5.91) and reduced likelihood of a spontaneous vaginal birth OR 0.46 (95% CI 0.29-0.71). Late presentation and antenatal attendance for women with SMI were significantly associated with maternal substance use, psychiatric admission during pregnancy, and child welfare involvement. Women with schizophrenia had significantly lower attendance rates at scheduled antenatal care (ANC) appointments than those with bipolar disease (87.1% vs 94%, p = 0.003). Conclusion Obstetric outcomes are poorer for women with SMI compared to the general population. They have higher rates of medical comorbidities, lifestyle and psychosocial risks factors that are known to contribute to poor obstetric outcomes. Effective delivery of regular and appropriate ANC is essential in addressing these multifactorial risks. Targeted strategies addressing comprehensive medical management, preterm birth prevention, lifestyle modifications and increased psychosocial support could improve both short- and long-term outcomes for these women and their children.
  • Eskelinen, Saana; Suvisaari, Janne V. J.; Suvisaari, Jaana M. (2020)
    Background Guidelines on laboratory screening in schizophrenia recommend annual monitoring of fasting lipids and glucose. The utility and the cost effectiveness of more extensive laboratory screening have not been studied. Methods The Living Conditions and the Physical Health of Outpatients with Schizophrenia Study provided a comprehensive health examination, including a laboratory test panel for 275 participants. We calculated the prevalence of the results outside the reference range for each laboratory test, and estimated the cost effectiveness to find an aberrant test result using the number needed to screen to find one abnormal result (NNSAR) and the direct cost spent to find one abnormal result (DCSAR, NNSAR x direct cost per test) formulas. In addition, we studied whether patients who were obese or used clozapine had more often abnormal results. Results A half of the sample had 25-hydroxyvitamin D below, and almost one-fourth cholesterol, triglycerides or glucose above the reference range. One-fifth had sodium below and gamma glutamyltransferase above the reference range. NNSAR was highest for potassium (137) and lowest for 25-hydroxyvitamin D (2). DCSAR was below 5euro for glucose, all lipids and sodium, and below 10euro for creatinine and gamma glutamyltransferase. Potassium (130euro), pH-adjusted ionized calcium (33 euro) and thyroid stimulating hormone (33euro) had highest DCSARs. Several abnormal results were more common in obese and clozapine using patients. Conclusions An annual laboratory screening panel for an outpatient with schizophrenia should include fasting glucose, lipids, sodium, creatinine, a liver function test and complete blood count, and preferably 25-hydroxyvitamin D.
  • Huhtaniska, Sanna; Isohanni, Matti; Miettunen, Jouko; Koponen, Hannu; Jääskeläinen, Erika (2019)
  • Vanhala, Vasco; Junkkari, Antti; Korhonen, Ville E.; Kurki, Mitja I.; Hiltunen, Mikko; Rauramaa, Tuomas; Nerg, Ossi; Koivisto, Anne M.; Remes, Anne M.; Perälä, Jonna; Suvisaari, Jaana; Lehto, Soili M.; Viinamäki, Heimo; Soininen, Hilkka; Jääskeläinen, Juha E.; Leinonen, Ville (2019)
    BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a progressive and potentially treatable neurodegenerative disease affecting elderly people, characterized by gait impairment and ventricular enlargement in brain imaging. Similar findings are seen in some patients with schizophrenia (SCZ). OBJECTIVE To determine the prevalence of SCZ among patients suffering from probable or possible iNPH and the specific effects of comorbid SCZ on the outcome of the cerebrospinal fluid (CSF) shunting. METHODS All medical records of the 521 iNPH patients in the NPH registry were retrospectively analyzed from 1991 until 2017. The prevalence of comorbidity of SCZ was determined and compared to that of general aged (65 yr) population in Finland. RESULTS We identified a total of 16 (3.1%) iNPH patients suffering from comorbid SCZ. The prevalence of SCZ among the iNPH patients was significantly higher compared to the general population (3.1% vs 0.9%, P <.001). All iNPH patients with comorbid SCZ were CSF shunted and 12 (75%) had a clinically verified shunt response 3 to 12 mo after the procedure. The CSF shunt response rate did not differ between patients with and without comorbid SCZ. CONCLUSION SCZ seems to occur 3 times more frequently among iNPH patients compared to the general aged population in Finland. The outcome of the treatment was not affected by comorbid SCZ and therefore iNPH patients suffering from comorbid SCZ should not be left untreated. These results merit validation in other populations. In addition, further research towards the potential connection between these chronic conditions is warranted.
  • Penttilä, Matti; Huhtaniska, Sanna; Jääskeläinen, Erika; Granö, Niklas (2017)
  • Hiekkala-Tiusanen, Laura; Halunen, Minna; Mehtälä, Tuukka; Kieseppä, Tuula (2019)
  • Simoila, Laura; Isometsä, Erkki; Gissler, Mika; Suvisaari, Jaana; Sailas, Eila; Halmesmäki, Erja; Lindberg, Nina (2018)
    Background: The objectives of this study were to investigate, in women with schizophrenia or schizoaffective disorder, the number and incidence of induced abortions (= pregnancy terminations performed by a physician), their demographic characteristics, use of contraceptives, plus indications of and complications related to pregnancy termination. Methods: Using the Care Register for Health Care, we identified Finnish women born between the years 19651980 who were diagnosed with either schizophrenia or schizoaffective disorder during the follow-up period ending 31.122013. For each case, five age- and place-of-birth- matched controls were obtained from the Population Register of Finland. Information about births and induced abortions were obtained from the Medical Birth Register and the Induced Abortion Register. Results: The number and incidence of induced abortions per 1000 follow-up years did not differ between cases and their controls. However, due to fewer pregnancies, cases exhibited an over 2-fold increased risk of pregnancy termination (RR 228; 95% CI 2.20-2.36). Cases were younger, were more often without a partner at the time of induced abortion, and their pregnancies resulted more often from a lack of contraception. Among cases, the indication for pregnancy termination was more often mother-to-be's medical condition. Induced abortions after 12 weeks gestation were more common among cases. However, cases had no more complications related to termination. Conclusions: The incidence of induced abortions among Finnish women with schizophrenia or schizoaffective disorder is similar to the general population, but their risk per pregnancy over two-fold. They need effective, affordable family planning services and long-term premeditated contraception. (C) 2017 Elsevier B.V. All rights reserved.
  • Spoov, Johan; Bredbacka, Per-Erik; Stenman, Ulf-Håkan (2020)
  • Lindberg, N.; Miettunen, J.; Heiskala, A.; Kaltiala-Heino, R. (2017)
    Background: Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15-to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989-2010. Methods: The sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender-and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care. Results: Forty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53-32.39, P <0.001). Almost half of the pretrial adolescents with later schizophrenia were diagnosed within 5 years of the forensic psychiatric examination, but latency was longer among the other half of the sample, reaching up to 20.5 years. Conclusions: The study supports the previous research indicating a potential link between serious delinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquent's risk of developing later schizophrenia. (C) 2017 Elsevier Masson SAS. All rights reserved.
  • Kieseppä, Tuula; Suvisaari, Jaana (2016)
  • Koponen, Hannu; Talaslahti, Tiina; Kekkonen, Virve; Puustjärvi, Anita (2019)
  • Saarinen, Aino I. L.; Huhtaniska, Sanna; Pudas, Juho; Björnholm, Lassi; Jukuri, Tuomas; Tohka, Jussi; Granö, Niklas; Barnett, Jennifer H.; Kiviniemi, Vesa; Veijola, Juha; Hintsanen, Mirka; Lieslehto, Johannes (2020)
    Objective: We conducted a multimodal coordinate-based meta-analysis (CBMA) to investigate structural and functional brain alterations in first-degree relatives of schizophrenia patients (FRs). Methods: We conducted a systematic literature search from electronic databases to find studies that examined differences between FRs and healthy controls using whole-brain functional magnetic resonance imaging (fMRI) or voxel-based morphometry (VBM). A CBMA of 30 fMRI (754 FRs; 959 controls) and 11 VBM (885 FRs; 775 controls) datasets were conducted using the anisotropic effect-size version of signed differential mapping. Further, we conducted separate meta-analyses about functional alterations in different cognitive tasks: social cognition, executive functioning, working memory, and inhibitory control. Results: FRs showed higher fMRI activation in the right frontal gyrus during cognitive tasks than healthy controls. In VBM studies, there were no differences in gray matter density between FRs and healthy controls. Furthermore, multi-modal meta-analysis obtained no differences between FRs and healthy controls. By utilizing the BrainMap database, we showed that the brain region which showed functional alterations in FRs (i) overlapped only slightly with the brain regions that were affected in the meta-analysis of schizophrenia patients and (ii) correlated positively with the brain regions that exhibited increased activity during cognitive tasks in healthy individuals. Conclusions: Based on this meta-analysis, FRs may exhibit only minor functional alterations in the brain during cognitive tasks, and the alterations are much more restricted and only slightly overlapping with the regions that are affected in schizophrenia patients. The familial risk did not relate to structural alterations in the gray matter. (C) 2019 Elsevier B.V. All rights reserved.
  • Välimäki, Maritta; Yang, Min; Lam, Yuen Ting Joyce; Lantta, Tella; Palva, Matias; Palva, Satu; Yee, Benjamin; Yip, Siu Hung; Yu, Kin-sun Dan; Chang, Hing Chiu Charles; Cheng, Po Yee Ivy; Bressington, Daniel (2021)
    Background: Video gaming is a promising intervention for cognitive and social impairment in patients with schizophrenia. A number of gaming interventions have been evaluated in small-scale studies with various patient groups, but studies on patients with schizophrenia remain scarce and rarely include the evaluation of both clinical and neurocognitive outcomes. In this study, we will test the effectiveness of two interventions with gaming elements to improve cognitive and clinical outcomes among persons with schizophrenia. Methods: The participants will be recruited from different outpatient units (e.g., outpatient psychiatric units, day hospitals, residential care homes). The controlled clinical trial will follow a three-arm parallel-group design: 1) cognitive training (experimental group, CogniFit), 2) entertainment gaming (active control group, SIMS 4), and 3) treatment as usual. The primary outcomes are working memory function at 3-month and 6-month follow-ups. The secondary outcomes are patients' other cognitive and social functioning, the ability to experience pleasure, self-efficacy, and negative symptoms at 3-month and 6-month follow-ups. We will also test the effectiveness of gaming interventions on neurocognitive outcomes (EEG and 3 T MRI plus rs-fMRI) at a 3-month follow-up as an additional secondary outcome. Data will be collected in outpatient psychiatric services in Hong Kong. Participants will have a formal diagnosis of schizophrenia and be between 18 and 60 years old. We aim to have a total of 234 participants, randomly allocated to the three arms. A sub-sample of patients (N = 150) will be recruited to undergo an EEG. For neuroimaging assessment, patients will be randomly allocated to a subset of patients (N=126). We will estimate the efficacy of the interventions on the primary and secondary outcomes based on the intention-to-treat principle. Behavioural and EEG data will be analysed separately. Discussion: The study will characterise benefits of gaming on patients' health and well-being, and contribute towards the development of new treatment approaches for patients with schizophrenia.
  • Välimäki, Maritta; Yang, Min; Lam, Yuen T J; Lantta, Tella; Palva, Matias; Palva, Satu; Yee, Benjamin; Yip, Siu H; Yu, Kin-sun D; Chang, Hing C C; Cheng, Po Y I; Bressington, Daniel (BioMed Central, 2021)
    Abstract Background Video gaming is a promising intervention for cognitive and social impairment in patients with schizophrenia. A number of gaming interventions have been evaluated in small-scale studies with various patient groups, but studies on patients with schizophrenia remain scarce and rarely include the evaluation of both clinical and neurocognitive outcomes. In this study, we will test the effectiveness of two interventions with gaming elements to improve cognitive and clinical outcomes among persons with schizophrenia. Methods The participants will be recruited from different outpatient units (e.g., outpatient psychiatric units, day hospitals, residential care homes). The controlled clinical trial will follow a three-arm parallel-group design: 1) cognitive training (experimental group, CogniFit), 2) entertainment gaming (active control group, SIMS 4), and 3) treatment as usual. The primary outcomes are working memory function at 3-month and 6-month follow-ups. The secondary outcomes are patients’ other cognitive and social functioning, the ability to experience pleasure, self-efficacy, and negative symptoms at 3-month and 6-month follow-ups. We will also test the effectiveness of gaming interventions on neurocognitive outcomes (EEG and 3 T MRI plus rs-fMRI) at a 3-month follow-up as an additional secondary outcome. Data will be collected in outpatient psychiatric services in Hong Kong. Participants will have a formal diagnosis of schizophrenia and be between 18 and 60 years old. We aim to have a total of 234 participants, randomly allocated to the three arms. A sub-sample of patients (N = 150) will be recruited to undergo an EEG. For neuroimaging assessment, patients will be randomly allocated to a subset of patients (N=126). We will estimate the efficacy of the interventions on the primary and secondary outcomes based on the intention-to-treat principle. Behavioural and EEG data will be analysed separately. Discussion The study will characterise benefits of gaming on patients’ health and well-being, and contribute towards the development of new treatment approaches for patients with schizophrenia. Trial registration ClinicalTrials.gov NCT03133143 . Registered on April 28, 2017.