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Objective: Impulsiveness is a tendency to act quickly based on a whim without reflection or consideration of consequences. We studied its correlations with burn variables and mental disorders among burn patients., Methods: Consecutive acute burn patients (N=107) admitted to the Helsinki Burn Center were assessed with the Structured Clinical Interview for DSM-IV mental disorders (SCID) at baseline and at 6 months. All patients filled out the 30-item Barratt Impulsiveness Scale (BIS-11), the most commonly administered self-report measure and a standard point of reference in research on impulsiveness., Results: The mean total score of BIS-11 was 64.5 (range 41.0-87.8, SD±6.9). There was not a significant correlation between impulsiveness and a range of characteristics of burn injury (all p-values>0.05). We found a significant correlation between some pre-burn mental disorders and impulsiveness, alcohol dependence and attentional impulsiveness (OR=1.22, p=0.022), any personality disorder and non-planning impulsiveness (OR=1.21, p=0.005), and antisocial personality disorder and motor impulsiveness (OR=1.35, p=0.043). Patients with high impulsiveness (total score >65) more often than those with low impulsiveness (≤65), had pre-burn mental disorders such as major depressive disorder (22.6% vs. 8.6%, p=0.046), alcohol dependence (46.9% vs. 25.9%, p=0.023), or other substance dependence (12.2% vs. 1.7%, p=0.028)., Conclusion: Impulsiveness had a significant correlation with mental disorders but not with burn-related variables. Therefore the role of impulsiveness in burn injuries should not be investigated independently without first accounting for the role of mental disorders., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

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.

Objective: We investigated alcohol use and smoking at time of burn and their relationships with severity of burn and presence of mental disorders., Methods: Consecutive acute burn patients (N=107) admitted to the Helsinki Burn Center were assessed with the structured clinical interview for mental disorders (SCID) at baseline and after 6 months. Information regarding being under the influence of alcohol and having smoking-related activity at burn as well as about hazardous drinking (Alcohol Use Disorders Identification Test) and heavy smoking before the burn was recorded., Results: Around half (52%) of the acute burn patients were under the influence of alcohol and 19% had been both drinking and smoking at the time of the burn. Patients under the influence at the time of burn had significantly higher prevalence of lifetime mental disorders compared to those patients who were not under the influence of alcohol (73.2% vs. 45.1%, p=0.003), especially alcohol dependence (55.4% vs. 13.7%, p<0.001) and anxiety disorders (28.6% vs. 9.8%, p=0.015). Patients who had both alcohol use and smoking at burn had even more often at least one mental disorder (95.0% vs. 51.7%, p<0.001), in specific alcohol dependence (90.0% vs. 23.0%, p<0.001), or psychotic disorder (25.0% vs. 6.9%, p=0.016). The main characteristics of the burns themselves did not differ significantly between these groups., Conclusion: Half of the burn patients were under the influence of alcohol at the time of the burn in this study. In almost all patients where alcohol and smoking contributed to the burn a diagnosable alcohol use disorder was present. Interventions for those with alcohol use disorders and the associated risk behaviors are important for the prevention of burns., (Copyright © 2017. Published by Elsevier Ltd.)

Rationale: Major burns are likely to have a strong impact on health-related quality of life (HRQoL). We investigated the level of and predictors for quality of life at 6 months after acute burn., Methods: Consecutive acute adult burn patients (n=107) admitted to the Helsinki Burn Centre were examined with a structured diagnostic interview (SCID) at baseline, and 92 patients (86%) were re-examined at 6 months after injury. During follow-up 55% (51/92) suffered from at least one mental disorder. The mean %TBSA was 9. TBSA of men did not differ from that of women. Three validated instruments (RAND-36, EQ-5, 15D) were used to evaluate the quality of life at 6 months., Results: All the measures (RAND-36, EQ-5, 15D) consistently indicated mostly normal HRQoL at 6 months after burn. In the multivariate linear regression model, %TBSA predicted HRQoL in one dimension (role limitations caused by physical health problems, p=0.039) of RAND-36. In contrast, mental disorders overall and particularly major depressive disorder (MDD) during follow-up (p-values of 0.001-0.002) predicted poor HRQoL in all dimensions of RAND-36. HRQoL of women was worse than that of men., Conclusion: Self-perceived HRQoL among acute burn patients at 6 months after injury seems to be mostly as good as in general population studies in Finland. The high standard of acute treatment and the inclusion of small burns (%TBSA<5) in the cohort may partly explain the weak effect of burn itself on HRQoL. Mental disorders strongly predicted HRQoL at 6 months., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

Previous suicide attempt signifies an almost 40-fold suicidal risk. When assessing the danger of suicide the patient should always be asked directly about possible suicidal thoughts or plans. Since most persons having committed or attempted suicide have a psychiatric illness, the diagnosis and treatment of these illnesses are important means to prevent self-destructive behavior. Besides active and intensive therapy, the mediation of hope in all engagements is essential. The mental status of a person having attempted suicide must be assessed, and appropriate follow-up care should be arranged.

Objective: Although 70-80% of panic disorder patients use primary care to obtain mental health services, relatively few studies have examined panic patients in this setting. This study aimed to examine both the lifetime and current comorbid psychiatric disorders associated with panic disorder in primary care, the duration and severity of the disorder, and the sociodemographic factors associated with it., Design: Patients were screened for panic disorder. Panic disorder and the comorbid disorders were determined using the Structured Clinical Interview for DSM-IV Axis I and II., Setting: Eight different health care centers in primary care in the city of Espoo., Subjects: Finnish-speaking, between 18 and 65 years of age., Main Outcome Measures: Comorbid psychiatric disorders, the duration and severity of the disorder, and the sociodemographic factors., Results: A sample of 49 panic disorder patients and 44 patients with no current psychiatric diagnosis were identified; 98% of panic disorder patients had at least one comorbid lifetime DSM-IV Axis I disorder. Major depressive disorder and other anxiety disorders were most common comorbid disorders. Lifetime alcohol use disorders also showed marked frequency. Interestingly, the remission rates of alcohol use disorders were notable. The panic symptoms appeared to persist for years. Panic disorder was associated with low education and relatively low probability of working full time., Conclusions: Also in primary care panic disorder is comorbid, chronic, and disabling. It is important to recognize the comorbid disorders. High remission rates of comorbid alcohol use disorders encourage active treatment of patients also suffering from these disorders.

Background: Nationwide general population study establishes the prevalence of suicide attempts in different mental disorders among young adults and their sociodemographic correlates. Current psychiatric symptoms are also examined., Methods: A random sample of 1,894 young Finnish adults aged 20-34 years were approached to participate in a questionnaire containing several screens for mental health interviews. All screen positives and random sample of screen negatives were invited to an SCID interview. Altogether 546 subjects participated in the interview. Diagnostic assessment and lifetime history of suicide attempts were based on all available systematically evaluated information from the questionnaire, the interview and/or case records., Results: The lifetime prevalence of suicide attempts was 5.6% in men and 6.9% in women. Both mental disorders and poor educational and occupational functioning were associated with lifetime suicide attempts. Lifetime history of suicide attempts was associated with current psychological distress, problems related to substance use and other psychiatric symptoms, even after taking current Axis I disorder into account. Suicide attempts were most common in persons with psychotic disorders (41%)., Conclusions: These results suggest that continued efforts are needed to outreach and treat effectively young adults with serious mental disorders. Young people who make a suicide attempt should be offered treatment. It seems also important to prevent psychosocial alienation of young people by providing them with adequate education and work possibilities.

Objective: To prospectively investigate variations in prevalences of mental disorders after burn, and correlation between burn severity and mental disorders among hospitalized burn patients., Method: A cohort of 107 consecutive acute adult burn patients was examined with structured diagnostic interview (SCID-I) at baseline, and 92 patients (86%) at 6 months after injury. Prevalences of mental disorders for the whole 6-month follow-up period, plus 1-month point prevalences in acute care and in a second 6-month interview were assessed, and the two point prevalences were compared. Burn severity was estimate by %TBSA., Results: During the 6-month follow-up 55% (51/92) of burn patients had at least one mental disorder, including 12% (11/92) with post-traumatic stress disorder (PTSD). In a multinomial regression, %TBSA exposure independently and strongly predicted risk for mental disorders, especially for anxiety disorders and delirium. The overall point prevalence of mental disorders decreased significantly (p=0.036) from acute care (45%) to 6 months (33%)., Conclusions: After burn, more than half of the patients suffer from some type of mental disorder, but the prevalence declines over time after the acute phase. The disorders are not limited to depression and PTSD. A strong relationship likely exists between burn severity and some post-burn mental disorders., (Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To investigate mental disorders among acute hospitalized burn patients., Method: Consecutive acute adult burn patients (n=107) admitted to Helsinki Burn Centre were interviewed by an experienced psychiatrist with the Structured Clinical Interview for DSM-IV-TR for Axis I and II mental disorders assessed in three time frames (lifetime, the month prior to burn, and in acute care). Information on clinical features, psychiatric symptoms, personality traits, and burn severity (total body surface area, TBSA) was gathered., Results: The mean TBSA was 9%. Most (61%) acute burn patients had at least one lifetime Axis I or II mental disorder. Prevalences of lifetime substance-related disorders (47%), psychotic disorders (10%), and Axis II personality disorders (23%) were high. The overall prevalence of Axis I mental disorders increased significantly (Q=6.40, df=1, p=0.011) from the month prior to burn (40%) to acute care (48%). The prevalence of delirium for this period was significantly higher (0.9% vs. 13%; Q=13.00, df=1, p<0.001) in acute care., Conclusions: Mental disorders, particularly substance use disorders, psychotic disorders, and personality disorders are common among acute burn patients before injury. These disorders may predispose to burns. Burn itself may also predispose to mental disorders, particularly delirium., (Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To test two hypotheses of psychiatric comorbidity in bipolar disorder (BD): (i) comorbid disorders are independent of BD course, or (ii) comorbid disorders associate with mood., Methods: In the Jorvi Bipolar Study (JoBS), 191 secondary-care outpatients and inpatients with DSM-IV bipolar I disorder (BD-I) or bipolar II disorder (BD-II) were evaluated with the Structured Clinical Interview for DSM-IV Disorders, with psychotic screen, plus symptom scales, at intake and at 6 and 18 months. Three evaluations of comorbidity were available for 144 subjects (65 BD-I, 79 BD-II; 76.6% of 188 living patients). Structural equation modeling (SEM) was used to examine correlations between mood symptoms and comorbidity. A latent change model (LCM) was used to examine intraindividual changes across time in depressive and anxiety symptoms. Current mood was modeled in terms of current illness phase, Beck Depression Inventory (BDI), Young Mania Rating Scale, and Hamilton Depression Rating Scale; comorbidity in terms of categorical DSM-IV anxiety disorder diagnosis, Beck Anxiety Inventory (BAI) score, and DSM-IV-based scales of substance use and eating disorders., Results: In the SEM, depression and anxiety exhibited strong cross-sectional and autoregressive correlation; high levels of depression were associated with high concurrent anxiety, both persisting over time. Substance use disorders covaried with manic symptoms (r = 0.16-0.20, p < 0.05), and eating disorders with depressive symptoms (r = 0.15-0.32, p < 0.05). In the LCM, longitudinal intraindividual improvements in BDI were associated with similar BAI improvement (r = 0.42, p < 0.001)., Conclusions: Depression and anxiety covary strongly cross-sectionally and longitudinally in BD. Substance use disorders are moderately associated with manic symptoms, and eating disorders with depressive mood.

Objective: This study investigated the characteristics of suicide attempters referred to psychiatric hospitals and the factors affecting such referral., Method: All 1198 consecutive suicide attempters treated in general hospital emergency rooms in Helsinki during a 12-month period were identified. Data on all health care contacts 1 year before the index attempt and on referrals to psychiatric hospitals after the attempt were gathered., Results: We found that a quarter of patients were referred to psychiatric hospitals as inpatients after index suicide attempts. Factors predicting referral to psychiatric hospitals, compared to nonreferral, were older age, psychotic disorder, mood disorder, lack of alcohol consumption preceding the attempt, somatic illness, suicide attempt on a weekday, previous psychiatric treatment, psychiatric consultation and the hospital treating the suicide attempt., Conclusion: Although the clinical characteristics of patients attempting suicide are a major determinant of whether they are subsequently referred to psychiatric hospitals, the treatment practices of emergency room hospitals also influence treatment decisions.

Objective: To obtain a comprehensive view of differences in current comorbidity between bipolar I and II disorders (BD) and (unipolar) major depressive disorder (MDD), and Axis I and II comorbidity in BD in secondary-care psychiatric settings., Method: The psychiatric comorbidity of 90 bipolar I and 101 bipolar II patients from the Jorvi Bipolar Study and 269 MDD patients from the Vantaa Depression Study were compared. We used DSM-IV criteria assessed by semistructured interviews. Patients were inpatients and outpatients from secondary-care psychiatric units. Comparable information was collected on clinical history, index episode, symptom status, and patient characteristics., Results: Bipolar disorder and MDD differed in prevalences of current comorbid disorders, MDD patients having significantly more Axis I comorbidity (69.1% vs. 57.1%), specifically anxiety disorders (56.5% vs. 44.5%) and cluster A (19.0% vs. 9.9%) and C (31.6% vs. 23.0%) personality disorders. In contrast, BD had more single cluster B personality disorders (30.9% vs. 24.6%). Bipolar I and bipolar II were similar in current overall comorbidity, but the prevalence of comorbidity was strongly associated with the current illness phase., Conclusions: Major depressive disorder and BD have somewhat different patterns in the prevalences of comorbid disorders at the time of an illness episode, with differences particularly in the prevalences of anxiety and personality disorders. Current illness phase explains differences in psychiatric comorbidity of BD patients better than type of disorder.

Background: The association of mental disorders with time patterns of attempted suicide is poorly understood., Methods: The study material consisted of all consecutive suicide attempts admitted to health care in Helsinki during a one-year period from 15 January 1997 to 14 January 1998. Clinical diagnosis was made according to ICD-10., Results: Overall, the rate of suicide attempts varied markedly during the study period, peaking in autumn and being lowest during winter. Substance use disorders best explained suicide attempts occurring at weekends. There was considerable temporal variation among patients with mood disorders, compared to only slight variation among patients with schizophrenia spectrum disorders. Study subjects tended to contact health services in the late evening and around midnight. Those contacting health services outside normal hours received psychiatric consultation less frequently than others and were referred to aftercare less often., Limitations: Structured Clinical Interviews for DSM-IV Axis I and II Disorders were not used., Conclusions: There were marked time patterns of attempted suicide, especially among patients with mood disorders and substance use disorders. This contrasted with the limited fluctuation among patients with schizophrenia spectrum disorders. Contacts with the health care system occurred most often in the late evening and around midnight. The findings question the adequacy of staff numbers for psychiatric consultations and of time to plan aftercare.

Objective: Older adults comprise a fifth of all suicides. Elders are the fastest growing part of the population, thus the number of persons needing nursing home care will increase dramatically in the near future. Little information has been available about suicides in nursing homes. The present study described all suicides among older adults in nursing homes in Finland during a 12-month period emphasizing the factors that have been found to be associated with suicide in the general elderly population., Methods: Drawing on data from a psychological autopsy study of all suicides (n=1397) in Finland during one year, all suicides committed by patients in nursing homes were identified. Retrospective DSM-IV consensus diagnoses were assigned., Results: Twelve elderly (aged 60 years or more) nursing home residents who died by suicide, 0.9% of all suicides, were identified. The primary finding of the present study was that nursing home residents who died by suicide had suffered from highly comorbid somatopsychiatric disorders. One or more diagnoses on Axis I were made for all who died by suicide in nursing home. Depressive syndrome was diagnosed in three-quarters of subjects. Only a third of these were identified to have suffered from depressive symptoms before their death., Conclusions: Early recognition and adequate treatment of both somatic diseases and mental disorders, particularly depression, as well as early recognition of suicide risk among nursing home residents, are needed in order to prevent suicide., (Copyright 2003 John Wiley & Sons, Ltd.)

The present study examined the prevalence and comorbidity of mental disorders according to DSM-III-R among male and female suicide attempters. A systematic sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki between 1 January and 31 July 1990 was interviewed. In 98% of the cases at least one Axis I diagnosis was made. Depressive syndromes were more common among females (85%) than males (64%), and alcohol dependence was more common among males (64%) than females (21%). A high proportion of suicide attempters (82%) suffered from comorbid mental disorders. Comorbidity appears to play an important role in parasuicide.