Browsing by Subject "Psychosis"

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  • Karjula, Salla; Arffman, Riikka K.; Morin-Papunen, Laure; Franks, Stephen; Järvelin, Marjo-Riitta; Tapanainen, Juha S.; Miettunen, Jouko; Piltonen, Terhi T. (2022)
    Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% of women. Besides metabolic and fertility aspects, attention has lately been directed towards the detrimental effect of PCOS on psychological health. The objective of the study was to investigate whether women with PCOS are at higher risk for psychotic disorders. The study population derives from the Northern Finland Birth Cohort 1966 (N = 5889 women). The women with PCOS were identified by two simple questions on oligo-amenorrhea and hirsutism at age 31. Women reporting both symptoms were considered PCOS (N = 124) and asymptomatic women as controls (N = 2145). The diagnosis of psychosis was traced using multiple national registers up to the year 2016. Symptoms of psychopathology were identified using validated questionnaires at age 31. Women with PCOS showed an increased risk for any psychosis by age 50 (HR [95% CI] 2.99, [1.52-5.82]). Also, the risk for psychosis after age 31 was increased (HR 2.68 [1.21-5.92]). The results did not change after adjusting for parental history of psychosis, nor were they explained by body mass index or hyperandrogenism at adulthood. The scales of psychopathology differed between women with PCOS and non-PCOS controls showing more psychopathologies among the affected women. PCOS cases were found to be at a three-fold risk for psychosis, and they had increased psychopathological symptoms. PCOS should be taken into consideration when treating women in psychiatric care. More studies are required to further assess the relationship between PCOS and psychotic diseases.
  • Schwarz, Emanuel; Maukonen, Johanna; Hyytiäinen, Tiina; Kieseppä, Tuula; Oresic, Matej; Sabunciyan, Sarven; Mantere, Outi; Saarela, Maria; Yolken, Robert; Suvisaari, Jaana (2018)
    The effects of gut microbiota on the central nervous system, along its possible role in mental disorders, have received increasing attention. Here we investigated differences in fecal microbiota between 28 patients with first-episode psychosis (FEP) and 16 healthy matched controls and explored whether such differences were associated with response after up to 12 months of treatment. Numbers of Lactobacillus group bacteria were elevated in FEP-patients and significantly correlated with severity along different symptom domains. A subgroup of FEP patients with the strongest microbiota differences also showed poorer response after up to 12 months of treatment. The present findings support the involvement of microbiota alterations in psychotic illness and may provide the basis for exploring the benefit of their modulation on treatment response and remission. (C) 2017 Elsevier B.V. All rights reserved.
  • Bosqui, Tania; Väänänen, Ari; Koskinen, Aki; Buscariolli, Andre; O'reilly, Dermot; Airila, Auli; Toivanen, Minna; Kouvonen, Anne (2020)
    Aims: Higher incidence of psychotic disorders in high-income countries for migrants compared with the settled majority has been well established. However, it is less clear to what extent different migrants groups have accessed and utilised mental health care. This study aimed to identify the hazard of antipsychotic medication use in the largest migrant groups in Finland, compared with a Finnish-born comparison group, using high quality datasets maintained by Statistics Finland and Social Insurance Institution Finland, and linking socio-demographic and -economic characteristics to antipsychotic prescription purchases. Methods: The study draws on a representative sample of 33% of the adult working-age population of Finland in 2005 (n = 1,059,426, 50.2% male, 2.5% migrant). The use of antipsychotic drugs was followed-up from 2005 to 2014. Results: The results show that the hazard of antipsychotic medication purchases differed between migrant groups, with a higher hazard for migrants from North Africa and the Middle East before socio-economic adjustment (men HR 1.19, 95% CI 1.04-1.37; women HR 1.37, 95% CI 1.12-1.66), and a lower hazard for all migrant groups after adjustment for socio-economic characteristics compared with the Finland-born population. Conclusions: The findings suggest that attention should be paid to the lower use of medication for psychotic disorders in some migrant groups, as well as the potential role of social disadvantage for migrants from North Africa and Middle East.
  • Rikandi, Eva; Mantyla, Teemu; Lindgren, Maija; Kieseppa, Tuula; Suvisaari, Jaana; Raij, Tuukka T. (2018)
    Background: Functional connectivity is altered in psychotic disorders. Multiple findings concentrate on the default mode network, anchored on the precuneus-posterior cingulate cortex (PC-PCC). However, the nature of the alterations varies between studies and connectivity alterations have not been studied during an ecologically valid natural stimulus. In the present study, we investigated the functional and structural connectivity of a PC-PCC region, where functioning differentiated first-episode psychosis patients from control subjects during free viewing of a movie in our earlier study. Methods: 14 first-episode psychosis patients and 12 control subjects were imaged with GE 3T, and 29 patients and 19 control subjects were imaged with a Siemens Skyra 3T scanner while watching scenes from the movie Alice in Wonderland. Group differences in functional connectivity were analysed for both scanners separately and results were compared to identify any overlap. Diffusion tensor measures of 26 patients and 19 control subjects were compared for the related white matter tracts, identified by deterministic tractography. Results: Functional connectivity was increased in patients across scanners between the midline regions of the PC-PCC and the anterior cingulate cortex-medial prefrontal cortex (ACC-mPFC). We found no group differences in any of the diffusion tensor imaging measures. Conclusions: Already in the early stages of psychosis functional connectivity between the midline structures of the PC-PCC and the ACC-mPFC is consistently increased during naturalistic stimulus. (c) 2018 Elsevier B.V. All rights reserved.
  • Stenlund, Mari; Slotte, Pamela Paulina (2018)
    Human rights theory generally conceptualizes freedom of thought, conscience, religion, and belief as well as freedom of opinion and expression, as offering absolute protection in what is called the forum internum. At a minimum, this is taken to mean the right to maintain thoughts in one’s own mind, whatever they may be and independently of how others may feel about them. However, if we adopt this stance, it seems to imply that there exists an absolute right to hold psychotic delusions. This article takes the position that this conclusion is ethically problematic from the perspective of psychiatric treatment and the rights of persons with psychosis. The article reflects on this particular challenge and sets forth an understanding of freedom in the forum internum that might apply to situations where for various reasons it is not, necessarily accurate to maintain that persons have an absolute right to their own thoughts. For the purpose of proposing such an understanding, the article engages with current debates within human rights theory and political philosophy and analyzes discussions about psychotic delusions and the way in which involuntary treatment is justified. Based on this analysis, this article in turn conceptualizes freedom in the forum internum as ‘negative liberty’, ‘authenticity’, and ‘capability’. This article suggests that when forum internum is redefined as encompassing a right to certain internal capabilities, the right remains meaningful for persons with psychotic delusions as well.
  • Rikandi, Eva; Mäntylä, Teemu; Lindgren, Maija; Kieseppä, Tuula; Suvisaari, Jaana; Raij, Tuukka T. (2022)
    Background: Psychotic disorders have been suggested to derive from dysfunctional integration of signaling between brain regions. Earlier studies have found several changes in functional network synchronization as well as altered network topology in patients with psychotic disorders. However, studies have used mainly resting-state that makes it more difficult to link functional alterations to any specific stimulus or experience. We set out to examine functional connectivity as well as graph (topological) measures and their association to symptoms in first-episode psychosis patients during movie viewing. Our goal was to understand whole-brain functional dynamics of complex naturalistic information processing in psychosis and changes in brain functional organization related to symptoms. Methods: 71 first-episode psychosis patients and 57 control subjects watched scenes from the movie Alice in Wonderland during 3 T fMRI. We compared functional connectivity and graph measures indicating integration, segregation and centrality between groups, and examined the association between topology and symptom scores in the patient group. Results: We identified a subnetwork with predominantly decreased links of functional connectivity in firstepisode psychosis patients. The subnetwork was mainly comprised of nodes of and links between the cinguloopercular, sensorimotor and default-mode networks. In topological measures, we observed between-group differences in properties of centrality. Conclusions: Functional brain networks are affected during naturalistic information processing already in the early stages of psychosis, concentrated in salience- and cognitive control-related hubs and subnetworks. Understanding these aberrant dynamics could add to better targeted cognitive and behavioral interventions in the early stages of psychotic disorders.
  • Sabe, Michel; Pillinger, Toby; Kaiser, Stefan; Chen, Chaomei; Taipale, Heidi; Tanskanen, Antti; Tiihonen, Jari; Leucht, Stefan; Correll, Christoph U.; Solmi, Marco (2022)
    Changes over 50 years of research on antipsychotics in schizophrenia have occurred. A scientometric synthesis of such changes over time and a measure of researchers' networks and scientific productivity is currently lacking. We searched Web of Science Core Collection from inception until November 5, 2021, using the appropriate key. Our primary objective was to conduct systematic mapping with CiteSpace to show how clusters of keywords have evolved over time and obtain clusters' structure and credibility. Our secondary objective was to measure research network performance (countries, institutions, and authors) using CiteSpace, VOSviewer, and Bibliometrix. We included 32,240 studies published between 1955 and 2021. The co-cited reference network identified 25 clusters with a well-structured network (Q=0.8166) and highly credible clustering (S=0.91). The main trends of research were: 1) antipsychotic efficacy; 2) cognition in schizophrenia; 3) side effects of antipsychotics. Last five years research trends were: 'ultra-resistance schizophrenia' (S=0.925), 'efficacy/dose-response' (S=0.775), 'evidence synthesis' (S=0.737), 'real-world effectiveness' (S=0.794), 'cannabidiol' (S=0.989), and 'gut microbiome' (S=0.842). These results can inform funding agencies and research groups' future directions.
  • Stenlund, Mari (2013)
    The analysis presented in this article reveals an ambiguity and tension in human rights theory concerning the delusional person’s freedom of belief and thought. Firstly, it would appear that the concepts ‘opinion’ and ‘thought’ are defined in human rights discussion in such a way that they do include delusions. Secondly, the internal freedom to hold opinions and thoughts is defined in human rights discussion and international human rights covenants as an absolute human right which should not be restricted in any situation for any reason. These views, if understood literally, imply that a person has an absolute right to hold a delusion. However, this kind of conclusion has not been made in mental health laws, the ethical principles guiding psychiatric care or the practice of psychiatry. Instead, they assume that the use of involuntary antipsychotic medication is justified even thought its purpose is to influence delusions. The ambiguity and tension in human rights theory concerning the freedom of belief and thought challenge us to develop this theory within an interdisciplinary discussion so that people with delusions are taken into account properly.
  • Uljas, Max (Helsingin yliopisto, 2021)
    Suomessa psykoosisairauksien kognitiivinen psykoterapia ei ole vielä vakiintunut hoitomuoto, vaikka on jo muualla maailmalla käytössä ja osana hoitosuosituksia. Tutkimuksen tavoitteena on seurata psykoosipotilaiden kognitiivista psykoterapiaa avohoidossa, miten potilaiden subjektiivinen kärsimys, toimintakyky ja psykiatriset oireet muuttuvat hoidon aikana, ja onko lähtötilanteella merkitystä. Tutkittavat (N=60) ovat Helsingin kaupungin psykoosipalveluihin päätyneitä potilaita jotka käyneet läpi psykoterapiajakson. Psykoterapiat alkaneet aikavälillä 3/2016–2/2019. Potilaista tehtiin VAS, SOFAS ja BPRS arviot hoidon alku- ja loppuvaiheessa. Hoitojakson aikana havaittiin kliinisesti merkittävää paranemista toimintakyvyssä (SOFAS +6,9 eli +10,8 % alkuvaiheeseen verrattuna) ja lievittymistä kärsimyksessä (VAS -21,2 eli -31,3 %) ja oireissa (BPRS -7,4 eli -15,7 %). Eniten lievittyivät potilaiden masennus-ahdistus oireet (BPRS -0,70 eli -22,6 %) ja epäluuloisuus (BPRS -0,66 eli 17,6 %). Myös negatiiviset (BPRS -0,42 eli -18,3 %) ja positiiviset psykoosioireet (BPRS -0,27 eli 12,5 %) sekä mania (BPRS -0,22 eli 12,8 %) lievittyivät jonkin verran. Diagnoosi, ikä, klotsapiinilääkitys, aiempien sairaalahoitojen lukumäärä ja työ- tai opiskelutilanne eivät vaikuttaneet muutoksiin. Sukupuolten välillä havaittiin, että naisten epäluuloisuus ei lievittynyt yhtä paljon kuin miesten. Tutkimuksen tulokset osoittavat, että subjektiivinen vointi ja työkyky kohenivat ja psykiatrinen oireilu lievittyi psykoterapian aikana, ja etenkin hyvinvoinnin ja masentuneisuuden kannalta nähtiin selviä muutoksia. Työkyvyn koheneminen ennusti hyvinvointia, oireet sen sijaan eivät. Ilman vertailuryhmää ei voida kuitenkaan varmasti sanoa johtuuko voinnin koheneminen itse terapiasta.
  • Husa, Anja P.; Moilanen, Jani; Murray, Graham K.; Marttila, Riikka; Haapea, Marianne; Rannikko, Irina; Barnett, Jennifer H.; Jones, Peter B.; Isohanni, Matti; Remes, Anne M.; Koponen, Hannu; Miettunen, Jouko; Jaaskelainen, Erika (2017)
    This naturalistic study analysed the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia after an average of 16.5 years of illness. Sixty participants with schizophrenia and 191 controls from the Northern Finland Birth Cohort 1966 were assessed at age 43 years with a neurocognitive test battery. Cumulative lifetime antipsychotic dose-years were collected from medical records and interviews. The association between antipsychotic dose-years and a cognitive composite score based on principal component analysis was analysed using linear regression. Higher lifetime antipsychotic dose-years were significantly associated with poorer cognitive composite score, when adjusted for gender, onset age and lifetime hospital treatment days. The effects of typical and atypical antipsychotics did not differ. This is the first report of an association between cumulative lifetime antipsychotic dose and global cognition in midlife schizophrenia. Based on these data, higher lifetime antipsychotic dose-years may be associated with poorer cognitive performance at age 43 years. Potential biases related to the naturalistic design may partly explain the results; nonetheless, it is possible that large antipsychotic doses harm cognition in schizophrenia in the long-term.
  • Latvala, Reetta (Helsingin yliopisto, 2014)
    Objective. Based on previous studies, foster care adolescents placed due to behavioral problems have an elevated risk to psychosis. In this large register based longitudinal study we aimed to investigate the prevalence of psychosis among Finnish reform school adolescents compared to matched peers in general population. We also intended to assess the possible differences in psychosis liability among five cohorts of reform school adolescents and examined the possible correlation between instability of out-of-home placements or the age at the time of first out-of-home placement with later psychosis. It was hypothesized that reform school adolescents had greater risk for psychosis, the number of adolescents with psychosis in reform schools was increasing and that instability of placements and early age at the time of fist out-of-home placement would be associated with an elevated risk for psychosis. Methods. The subjects (N=1159, M/F=749/410) were chosen from the Finnish welfare registry by status "placement in reform school" the last day of the years 1991, 1996, 2001, 2006 or (/and?) 2011. A control group (N=5676) matched on age, gender and place of birth was obtained from the Population Register Centre, Finland. The information about child's involvement in child welfare services and out-of-home placements was collected from the Finnish welfare register, and the data from schizophrenia spectrum disorders was collected from the Finnish hospital discharge register. Results. Prevalence of psychosis among reform adolescents was 7.1%, which was significantly higher than among general population controls (0.8%) (χ² = 205.550, df =1, P<.000). After controlling for gender and cohort, reform school adolescents had a 9.44 fold risk for psychosis compared to controls (OR=9.440, p<.000). There was no difference in psychosis liability between the five study cohorts after controlling for the difference in cohorts' follow-up times. The instability of out-of-home placements and the age at the time of first out-of-home placement were not associated with an elevated risk to psychosis. Conclusions. Results of this study show clearly that psychosis is a common problem among reform school adolescents, and indicates that reform school adolescents are a population, where the identification of early psychosis should be readily and reliable accessible. Only by recognizing early psychotic symptoms it is possible to offer intervention procedures, which in turn might prevent psychosis from becoming a chronic illness, decrease other mental health and substance abuse problems and thus enhance the overall functioning and quality of life of reform school adolescents.
  • Lindgren, Maija; Numminen, Linda; Holm, Minna; Therman, Sebastian; Tuulio-Henriksson, Annamari (2022)
    Psychotic-like experiences (PLEs) have been identified as risk markers for psychotic disorders and may indicate an individual's susceptibility to mental disorders in general. We examined whether 23 PLEs (assessed with MCIDI questionnaire) reported in young adulthood (n = 1313) predict subsequent psychotic or any mental disorders in the general population. We also investigated whether these possible associations are explained by general psychological distress assessed with the General Health Questionnaire-12 (GHQ-12). The register follow-up period spanned 10-12 years. In Cox regression models, PLEs predicted subsequent psychotic disorders (n = 12) when the effects of age, sex, education, and marital status were adjusted for, but not when general psychological distress was added to the model. Having any mental disorders during follow-up (n = 91) was predicted by PLEs reported at a younger age, when controlling for age, sex, education, marital status, and general psychological distress. In line with earlier results in other age groups, PLEs can be seen as a sign of vulnerability to not just psychotic but all mental disorders during the following years also among young adults in the general population. PLEs were a predictive marker of general psychopathology independently from general psychological distress.
  • 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.
  • Hakulinen, Christian; McGrath, John J.; Timmerman, Allan; Skipper, Niels; Mortensen, Preben Bo; Pedersen, Carsten Bøcker; Agerbo, Esben (2019)
    Purpose Individuals with schizophrenia have been reported to have low employment rates. We examined the associations of schizophrenia with employment, income, and status of cohabitation from a work life course perspective. Methods Nationwide cohort study including all individuals (n = 2,390,127) born in Denmark between 1955 and 1991, who were alive at their 25th birthday. Diagnosis of schizophrenia (yes/no) between ages 15 and 25 was used as an exposure. Employment status, annual wage or self-employment earnings, level of education, and cohabitant status from the age of 25–61 (years 1980–2016) were used as outcomes. Results Schizophrenia diagnosis between ages 15 and 25 (n = 9448) was associated with higher odds of not being employed (at the age of 30: OR 39.4, 95% CI 36.5–42.6), having no secondary or higher education (7.4, 7.0–7.8), and living alone (7.6, 7.2–8.1). These odds ratios were two-to-three times lower and decreasing over time for those individuals who did not receive treatment in a psychiatric inpatient or outpatient clinic for schizophrenia after the age of 25. Between ages 25–61, individuals with schizophrenia have cumulative earning of $224,000, which is 14% of the amount that the individuals who have not been diagnosed with schizophrenia earn. Conclusions Individuals with schizophrenia are at high risk of being outside the labour market and living alone throughout their entire life, resulting in an enormous societal loss in earnings. Individuals with less chronic course of schizophrenia had a gradual but substantial improvement throughout their work life.
  • Saarinen, Aino; Lieslehto, Johannes; Kiviniemi, Vesa; Tuovinen, Timo; Veijola, Juha; Hintsanen, Mirka (2020)
    Previously, schizophrenia is found to be related to the variability of the functional magnetic resonance imaging (fMRI) signal in the white matter. However, evidence about the relationship between genetic vulnerabilities and physiological fluctuation in the brain is lacking. We investigated whether familial risk for psychosis (FR) and polygenic risk score for schizophrenia (PRS) are linked with physiological fluctuation in fMRI data. We used data from the Oulu Brain and Mind study (n. = 140-149, aged 20-24 years) that is a substudy of the Northern Finland Birth Cohort 1986. The participants underwent a resting-state fMRI scan. Coefficient of variation (CV) of blood oxygen level dependent (BOLD) signal (CVBOLD) was used as a proxy of physiological fluctuation in the brain. Familial risk was defined to be present if at least one parent had been diagnosed with psychosis previously. PRS was computed based on the results of the prior GWAS by the Schizophrenia Working Group. FR or PRS were not associated with CVBOLD in cerebrospinal fluid, white matter, or grey matter. The findings did not provide evidence for the previous suggestions that genetic vulnerabilities for schizophrenia become apparent in alterations of the variation of the BOLD signal in the brain.