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AIMS: To investigate urban-rural differences in male suicide mortality between 1988 and 1997 in the province of Kuopio in eastern Finland. METHODS: Male suicide mortality between 1988 and 1997 was studied in eastern Finland. The data were collected from official autopsy reports. Age, marital status, household type, place of death, method of suicide and the region within the county were analysed. RESULTS: The age-adjusted male suicide mortality remained quite constant at 67 and 65/100,000 (> 15 years of age) in 1988 and 1997, respectively. In urban areas, a decline in suicide rates was noted in all age groups of men, whereas in rural areas, after an initial decline, a marked increase took place during the last years of the study period, especially among middle-aged and elderly men. This coincided with the time of recovery from an economic recession in Finland that particularly affected rural areas. CONCLUSION: Male suicide mortality may be regionally diverging in Finland. [ABSTRACT FROM AUTHOR]

Abstract Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophenia patients.

Abstract Background Results obtained from brain imaging studies indicate that serotonin transporter (SERT) and dopamine transporter (DAT) densities are altered in major depression. However, no such studies have been published on current mania or hypomania. Case presentation In this single photon emission computed tomography (SPECT) study with [123I]nor-β-CIT we present a case with simultaneous symptoms of major depression and hypomania. She had an elevated serotonin transporter availability (SERT) in the midbrain and elevated dopamine transporter availability (DAT) in the striatum, which normalised in a one-year follow-up period during which she received eight months of psychodynamic psychotherapy. Conclusions To our knowledge, this is the first report on SERT and DAT associated with mania. In our case the availability of both SERT in the midbrain and DAT in the striatum were elevated at baseline and declined during psychotherapy, while the SERT and DAT of the depressed controls increased during psychotherapy. Symptoms of hypomania in the case were alleviated during psychotherapy. Clinical recovery was also reflected in the Hamilton Depression Rating Scale (HDRS) scores.

Aim and Objectives: The aims of this study were (1) to identify which nurses benefitted most from clinical supervision and (2) to explore whether they were healthier and more satisfied with their work than their peers who did not attend clinical supervision., Background: To maintain quality nursing, there is currently a social call to improve the well-being of nurses at work. Restoring nurses' well-being is one of the main purposes of clinical supervision. However, research evidence on the effects of clinical supervision is scarce., Design: Survey., Methods: Questionnaires were distributed to female hospital nurses (n=304), about a half of whom (48.7%) had attended clinical supervision. Perceptions of work and health among the nurses who gave the best evaluations of clinical supervision (n=74) were compared with those of their peers who gave the worst evaluations (n=74) or who had not attended clinical supervision (n=156)., Results: The nurses who received efficient clinical supervision reported more job and personal resources and were more motivated and committed to the organisation than their peers. However, professional inefficacy was the only burnout dimension on which they scored lower than other nurses., Conclusions: Clinical supervision can be conceptualised as an additional job resource associated with other job and personal resources, which mutually reinforce each other, promoting well-being at work. Efficient clinical supervision is probably both an antecedent as well as a consequence of well-being at work., Relevance to Clinical Practice: The results of this study advocate management planning to provide formal support for health care providers. Medical-surgical nurses are interested in clinical supervision. Reflecting on practice in clinical supervision generates new ideas about how to improve the quality of care and the psychosocial work environment. However, clinical supervision may be viewed as a preventive method rather than a treatment for burnout., (© 2012 Blackwell Publishing Ltd.)

Aim: The aim of the present paper is to report results of a quasi-experimental study exploring the effects of clinical supervision (CS) on the development of medical-surgical nurses' well-being at work over a 4-year period., Background: Effective workplace interventions are needed to prevent stress and burnout. More robust scientific evidence is needed to confirm the restorative effects of CS in nursing., Methods: A questionnaire survey on the perceptions of work and health was conducted in 2003 and 2007 on 14 units of a Finnish university hospital where 19 CS group processes had been completed between 2004 and 2007., Results: Improvement in job resources as well as reduction in professional inefficacy and psychological distress were found among nurses who received effective CS (n = 41), but were not present among the nurses who found their CS less effective (n = 43) or who did not attend CS (n = 82)., Conclusions: The results provide robust evidence for the positive effects of CS on medical-surgical nurses' well-being at work., Implications for Nursing Management: Stress is a developmental challenge in the professional growth of individual nurses. One option for management to sustain nurses' well-being at work is to develop a learning organization in the workplace making use of CS., (© 2012 Blackwell Publishing Ltd.)

Aim: The aim of the present study was to explore the differences in the uptake of clinical supervision on the medical and surgical units of an acute hospital relating to the nurses' background and perceptions of their work and health., Background: Considering the varied challenges of nursing in different specialities, the reasons for attending clinical supervision may also vary., Methods: In 2003, a survey on work and health issues was conducted in a Finnish university hospital with a 3-year follow-up of the uptake of clinical supervision by the respondents. The nurses who subsequently undertook clinical supervision and their peers who decided not to undertake it were compared in five medical (n=96) and nine surgical units (n=232)., Results: On the medical units, stress management motivated the uptake of clinical supervision, whereas on the surgical units, reasons relating to practice development predominated., Conclusions: The reasons for attending clinical supervision can be quite different depending on the basic tasks and organizational culture of the hospital unit., Implications for Nursing Management: If clinical and managerial supervision are meant to support and complement each other, the nurse manager should be involved in discussions about the needs and goals of clinical supervision provided for staff., (© 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.)

Aim: The aim of the present study was to identify which nurses decide to participate in clinical supervision (CS) when it is provided for all nursing staff., Background: Clinical supervision is available today for health care providers in many organisations. However, regardless of evidence showing the benefits of CS, some providers decide not to participate in the sessions., Methods: A baseline survey on work and health issues was conducted in 2003 with a 3-year follow-up of the uptake of CS by the respondents. Background characteristics and perceptions of work and health were compared between medical and surgical nurses who had undertaken CS (n=124) and their peers who decided not to undertake it (n=204)., Results: Differences in the perceptions of work and dimensions of burnout were found between the two groups., Conclusions: Nurses attracted to CS form a distinctive group in the unit, standing out as self-confident, committed and competent professionals supported by empowering and fair leadership., Implications for Nursing Management: Facilitating clinical supervision for committed and innovative nurses may be seen as part of the empowering leadership of the nurse manager., (© 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.)

The perceptions of patients (n = 25) and their therapists about psychodynamic psychotherapy for depression were assessed during the first treatment year using 23 scales. Patients and therapists independently evaluated the impact of depression on the therapeutic experience of the patients. The estimations of the impact of depression by the patients and therapists were concordant in the majority of the subjects, reflecting mutual tuning and a working alliance. The roles of affects and frustrating subjects in the treatment relationship were evaluated as significantly different by the patients and the therapists. The results highlight the importance of working on the expression of affects in the psychotherapy of depression.

Aims: Both the serotonin transporter and its genetic regulation by the serotonin-transporter-linked polymorphic region have a role in the pathophysiology of depression. Most of the previous studies have found no influence of serotonin-transporter-linked polymorphic region allelic variation on serotonin transporter binding in healthy controls or patients with major depression. Due to the inconsistency of the previous findings, we compared single photon emission computed tomography imaging with the serotonin-transporter-linked polymorphic region genotype in patients with major depressive disorder., Methods: A total of 23 drug-naïve patients with major depressive disorder were genotyped and brain imaged with ([123I])nor-beta-CIT single photon emission computed tomography. The severity of depression was evaluated with the 17-item Hamilton depression rating scale., Results: Depressed patients homozygous for the short allele had lower ([123I])nor-beta-CIT binding in the medial prefrontal cortex, but not in the midbrain, compared with the other genotypes., Conclusion: The decreased medial prefrontal cortical serotonin transporter binding in the patients homozygous for the short allele may be linked to altered function of the serotonin-transporter-linked polymorphic region gene expressed in these patients, especially in the medial prefrontal cortex.

Data on neurobiological differences between major depression (MD) and double depression (DD) are scarce. We examined the striatum dopamine (DAT) and midbrain serotonin transporter (SERT) binding of [123I] nor-beta-CIT in DD patients (n=8) and compared it to that in MD patients (n=11) and healthy controls (n=19). Drug-naïve patients and controls were imaged by single-photon emission computed tomography at baseline, and the patients also after one year of psychodynamic psychotherapy. Both DD and MD groups had lower midbrain [123I] nor-beta-CIT binding compared with the controls. Baseline 17-item Hamilton Depression Rating Scale (HAM-D-17) scores significantly decreased in both groups after one year of psychotherapy (DD: t=3.55, p=0.009; MD: t=5.86, p<0.001). No differences between the DD and MD groups were observed in age-adjusted baseline striatum or midbrain [123I] nor-beta-CIT binding or its change during psychotherapy. Age-adjusted baseline striatum [123I] nor-beta-CIT binding correlated inversely with the duration of both dysthymia (rho=-0.76, p=0.03) and MD (rho=-0.83, p=0.01) in the DD group. No such finding was observed in the MD group (rho=0.26, p=0.44). Baseline HAM-D-17 did not correlate with the change in striatum or midbrain [123I] nor-beta-CIT binding in either group. In conclusion, our findings suggest that when using midbrain [123I] nor-beta-CIT binding as a marker of SERT binding, no differences are detectable between patients with DD and MD. However, low striatum [123I] nor-beta-CIT binding, a marker of DAT binding, may be associated with a longer illness duration in dysthymia.

Background: Psychotherapy is an effective treatment method for depression, but no differences in the psychotherapy response have been found between the subtypes of depression. The effect of psychotherapy on neurotransmitter transporter functions has never been recorded in depressed subjects., Methods: Depressive outpatients (N=19) received psychodynamic psychotherapy for 12 months. All subjects fulfilled the DSM-IV criteria for depression, and 8 were classified as having atypical depression. The severity of depression was assessed with the 29-item Hamilton Depression Rating Scale (HAM-D-29). Midbrain serotonin transporter (SERT) and striatum dopamine transporter (DAT) densities were recorded using single photon emission computed tomography (SPECT) brain imaging with the [123I]nor-beta-CIT radioligand before and after psychotherapy., Results: Midbrain SERT density significantly increased during psychotherapy in atypicals but not in nonatypicals. There were no changes in the levels of DAT., Conclusions: The psychotherapy-related SERT elevation of atypically depressed subjects may be due to some unknown adaptive mechanisms inducing an increase in either the levels of SERT or serotonergic nerve terminals and therefore enhancing serotonergic activity and improving mood.

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5-13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the result of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophrenia patients.

Earlier results have indicated that serotonin transporter (SERT) availability is altered in major depression. We examined SERT density with a more serotonin-specific ligand and with a larger number of patients than in previous studies. Twenty-nine antidepressant-naïve patients with major depressive disorder (MDD) and 19 healthy age- and sex-matched controls were studied with SPECT using [(123)I] nor-beta-CIT as a ligand. The patients had a significantly lower (-10%) binding potential in the midbrain region than controls. No correlation with depression severity was found. These findings indicate that SERT availability in the midbrain area is reduced in depression, and that interindividual variation is considerable in both patients and controls.

Background: Altered serotonin (SERT) and dopamine transporter (DAT) densities have been recorded in major depression. Atypical depression (ATD) has been suggested to be connected to decreased serotonergic transmission, but no studies have been published on the association between brain serotonin transporter density and ATD., Methods: PATIENTS with depression (n=29) were divided into three groups according to DSM-IV criteria: atypically depressed, melancholic patients, and "undifferentiated" patients. Depressive symptoms were evaluated with the 29-item Hamilton Depression Rating Scale (HAM-D-29). Single photon emission computed tomography (SPECT) with [(123)I]nor-beta-CIT was used to evaluate serotonin transporter density (SERT) in the midbrain and dopamine transporter density (DAT) in the striatum of patients and healthy controls (n=18)., Results: All subgroups except those with undifferentiated depression had lower SERT densities compared to controls. No significant differences were found in the densities between the subgroups. Atypical scores of HAM-D-29 were associated with SERT densities in the midbrain (beta=-0.40, t=-2.3, p=0.03), even after adjustment for age, gender and HAM-D-21 scores (beta=-0.39, t=-2.32, p=0.03)., Conclusions: The association between atypical scores of HAM-D-29 and midbrain SERT densities suggests a relationship between serotonergic dysfunction and ATD.

We explored the outcome of psychodynamic psychotherapy of a female patient with major depression using clinical evaluation and serotonin transporter (SERT) binding assessed with [123I]nor-beta-CIT SPECT. The psychotherapy process was analyzed with special emphasis on the change that was recognized in the dreaming process. The activation of the dream screen in transference seemed to form a turning point during the psychotherapy. Normalization of SERT binding at the midbrain level was found on 12-month follow-up. Major alleviation of depressive symptoms assessed by rating scales was evident only six months after SERT normalization.

Background: Results obtained from brain imaging studies indicate that serotonin transporter (SERT) and dopamine transporter (DAT) densities are altered in major depression. However, no such studies have been published on current mania or hypomania., Case Presentation: In this single photon emission computed tomography (SPECT) study with [123I]nor-beta-CIT we present a case with simultaneous symptoms of major depression and hypomania. She had an elevated serotonin transporter availability (SERT) in the midbrain and elevated dopamine transporter availability (DAT) in the striatum, which normalised in a one-year follow-up period during which she received eight months of psychodynamic psychotherapy., Conclusions: To our knowledge, this is the first report on SERT and DAT associated with mania. In our case the availability of both SERT in the midbrain and DAT in the striatum were elevated at baseline and declined during psychotherapy, while the SERT and DAT of the depressed controls increased during psychotherapy. Symptoms of hypomania in the case were alleviated during psychotherapy. Clinical recovery was also reflected in the Hamilton Depression Rating Scale (HDRS) scores.

Background: Our aim was to study the frequency of metabolic syndrome and associated factors in patients with schizophrenia., Method: The study group consisted of 35 outpatients with long-term schizophrenia defined by DSM-IV criteria. Patients were assessed for the presence of metabolic syndrome, which was defined by the criteria of the National Cholesterol Education Program. All patients were on antipsychotic medication. Data were collected from Jan. 1, 2001, to Aug. 30, 2001., Results: Metabolic syndrome was found in 37% (N = 13) of the patients, and it was associated inversely with the total daily dose of, but not with any specific type of, antipsychotic drug., Conclusion: The results suggest that metabolic syndrome is common among patients with schizophrenia, and it may be far more common than in general populations.

The aim of this article is to offer a point on the meaning of the dream screen phenomenon in psychotherapy and artistic work. Some current theories of early ego development, the formation of the dream screen and dream imagery seem to match the theories of symbol formation, artistic and literary creativity. In actual dreaming, the dream screen can exist in the form of empty sheets of paper, but also in the form of a landscape, hills or mountains. The activation of the dream screen is presented in the light of the psychotherapy of two depressed patients. Dreams implying activation of the dream screen have been interpreted to signify a turning point during psychotherapy. Dream screen can be considered as a phenomenon with different elements. Examples of dream screen symbols in Aleksis Kivi's poems and in Paul Cézanne's paintings are presented.

We conducted a prospective ten-year follow-up study on the consequences of a suicide among relatives or other individuals close to the suicide victim. Baseline interviews (n = 104) were carried out during the National Suicide Prevention Project in Finland from 1987 to 1988. Semi-structured follow-up interviews including the 12-item General Health Questionnaire and the 21-item Beck Depression Inventory were carried out ten years later (n = 64, 64% of those still alive). Mental symptoms were reported to have been common after suicide but they had subsided during three years. Mental symptoms had been common especially among children after their parent's suicide. At baseline mothers had had depressive symptoms more often than others, but at follow-up there was no statistical difference. Life changes associated with the suicide were common, and they could be unfavourable as well as favourable. At the time of the follow-up study, half of the interviewees felt that baseline interviews had helped them to adjust to the suicide.

This is a study on associations between suicide mortality, unemployment, divorce rate and mean alcohol consumption during an economic cycle in Finland, from 1985 to 1995. Data on annual suicide mortality, gross domestic product, unemployment, divorce rate and mean alcohol consumption were collected from official Finnish statistics. Regression analyses using a correction for serial autocorrelation were performed. Suicide mortality in both males and females increased during an economic upswing from 1985 to 1990 and decreased during an economic recession from 1990 to 1995. Suicide mortality was not associated with unemployment or divorce rate. These results are opposed to those of many previous studies. However, a significant association was found between male suicide mortality and mean alcohol consumption, in accord with other studies. In conclusion, the results suggest diversity in associations between suicide mortality, socioeconomic factors and alcohol consumption.

The aim of this study was to investigate interactional factors related to the recognition of suicide risk in patients with schizophrenia. The study focused on 17 schizophrenia patients who had committed suicide during the National Suicide Prevention Project in Finland between April 1, 1987, and March 31, 1988, in the province of Kuopio. Consensus case reports were assembled by using the psychological autopsy method. Study methods included structured and in-depth interviews of next of kin and interviews of health care or social services workers who had treated the suicide victims. Male and female patients with schizophrenia committed suicide in equal proportions. Most had suffered from schizophrenia for more than 15 years; all but one had been receiving psychiatric treatment at the time of suicide. Retrospective assessment indicated that 59 percent of the patients were clinically depressed at the time of suicide. In 76 percent of the cases, the mental health professionals involved in treatment had not believed that there was a risk of suicide during their last contact with the patient. In 29 percent of the cases, the patient's paranoid ideas concerning treatment personnel had increased. Patients' withdrawal from human relationships because of depression was related to loss of the treatment professionals' concern for the patients. The findings in this descriptive study suggest that withdrawal by a patient with schizophrenia and an increase in the patient's paranoid behavior should be regarded as signals of risk of suicide.