IntroductionDepression, anxiety and lack of impulse control are common neuropsychiatric symptoms in neurocognitive disorders and have been strongly associated with suicidality.ObjectivesThe aim of ...this study was to explore suicide rates in three major neuropsychiatric conditions including various degenerative neurocognitive disorders (DND), alcohol related neurocognitive disorders (ARND), and traumatic brain injuries (TBI).MethodsThe register cohort data of 231 817 patients with a diagnosis of degenerative dementias, ARND, or TBI, and their mortality data were collected from Finnish nationwide registers between 1998 and 2018. We calculated incidences of suicides, types of suicides, and suicide rates compared with the age- and sex matched general population (Standardized Mortality Ratio, SMR).ResultsIn fifteen years since diagnosis, 0.3% (95% CI: 0.2 to 0.5) of patients with DND, 1.1% (0.7 to 1.8) of patients with ARND, and 1.0% (0.7 to 1.3) of patients with TBI died from suicide (Figure). Men died from suicide more often than women 58.9 (51.3 to 67.4) vs. 9.8 (7.5 to 12.5) per 100 000 person-years. Of all three groups of patients, the highest number of suicides per 100 000 was in ARND (98.8; 65.1 to 143.8), then in TBI (82.0; 62.4 to 105.8), and then in DND (21.2; 18.3 to 24.5). The most common cause of death per 100 000 person-years was self-inflicted injury by hanging, strangulation or suffocation and drowning (12.4, 10.3 to 14.8), the second highest incidence self-inflicted poisoning (5.7, 4.3 to 7.4), and then self-inflicted injury by firearms, explosives, smoke, fire, flames, steam, hot vapours or hot objects (4.7, 3.4 to 6.2). The SMRs (95% CI) in the DND group were 1.31 (1.13 to 1.51) for the whole group, 1.21 (0.90-1.62) for women, and 1.34 (1.14-1.58) for men. The SMRs in the ARND group were 3.69 (2.53-5.38), 5.05 (1.90 to 13.46), and 3.52 (2.34 to 5.30), and in the TBI group 2.99 (2.31 to 3.86), 5.68 (3.22 to 10.00), and 2.66 (2.00 to 3.55), respectively.Image:ConclusionsSuicide rates were higher in all three patient groups compared with the same-aged general population. Risk for death from suicide remained elevated for more than ten years after the initial diagnosis. Men committed more suicides than women, but there was no difference between sexes in comparison with the age-matched general population. The suicide methods were mostly violent.Disclosure of InterestT. Talaslahti Grant / Research support from: Helsinki University Hospital, grant no 212 9003, M. Ginters: None Declared, H. Kautiainen: None Declared, R. Vataja: None Declared, A. Palm: None Declared, H. Elonheimo: None Declared, J. Suvisaari: None Declared, H. Koponen: None Declared, N. Lindberg: None Declared
Introduction
Off-label use of antipsychotics has increased in many countries. In adult populations antipsychotics off-label prescriptions varied from 40 to 75% of all AP users.
Objectives
To examine ...the off-label prescribing practices and experiences of antipsychotic medication in Finland.
Methods
An electronic questionnaire on physicians’ prescription practices of antipsychotics, especially for off-label use, was sent in 2019 for physicians (n=1195) in different health care facilities including primary health care, occupational health care, in- and outpatient mental health services and services for substance abuse. The sample was selected by systematic and convenience sampling covering five university hospital areas in Finland.
Results
In total, 216 physicians (18% of the target sample) participated in the study, and 94% had prescribed antipsychotics for off-label use. The most common off-label indications were insomnia and anxiety. The most common antipsychotic used was quetiapine. Off-label antipsychotics was not prescribed as a first-choice medication: 99% of the physicians reported that the patients with off-label use have previously had other medications for the corresponding symptoms. In all, 88% of clinicians monitored the patients’ clinical condition, whereas metabolic values were followed more rarely. About 68% of physicians reported more benefit than harm from the antipsychotics off-label
use.
Conclusions
Antipsychotics are often prescribed for off-label use, most commonly for insomnia and anxiety. Most of the physicians see more benefits than harms for the patient in off-label use. There is a need to analyse the long-term benefits and harms of off-label use of antipsychotics and create more detailed treatment algorithms and clinical recommendations for such use.
Disclosure
No significant relationships.
Objective: Our aim was to present recent studies of alcohol use disorders (AUDs) in patients with schizophrenia, estimate overall prevalence and characteristics affecting the prevalence of AUDs.
...Method: We conducted a search using three literature databases and a manual search on articles published in 1996–2008. Meta‐regression was used to study how prevalence is affected by different study characteristics. Articles that reported diagnoses according to DSM or ICD diagnostic systems were included.
Results: Altogether 60 studies met our criteria. The median of current AUD prevalence was 9.4% (inter‐quartile range, IQR 4.6–19.0, 18 studies) and median of lifetime AUD prevalence 20.6% (IQR 12.0–34.5, 47 studies). In studies using DSM‐III‐R median prevalence was higher than that in studies using DSM‐IV, ICD‐9 or ICD‐10 (32/17/11/6%).
Conclusion: Approximately every fifth patient with schizophrenia had lifetime AUD diagnosis. When contrasted with the most recent review, there might be a descending trend in AUD prevalence in patients with schizophrenia.
Recent findings on large nitrous oxide (N₂O) emissions from permafrost peatlands have shown that tundra soils can support high N₂O release, which is on the contrary to what was thought previously. ...However, field data on this topic have been very limited, and the spatial and temporal extent of the phenomenon has not been known. To address this question, we studied N₂O dynamics in two types of subarctic permafrost peatlands, a peat plateau in Russia and three palsa mires in Finland, including also adjacent upland soils. The peatlands studied have surfaces that are uplifted by frost (palsas and peat plateaus) and partly unvegetated as a result of wind erosion and frost action. Unvegetated peat surfaces with high N₂O emissions were found from all the studied peatlands. Very high N₂O emissions were measured from peat circles at the Russian site (1.40±0.15 g N₂O m⁻² yr⁻¹). Elevated, sparsely vegetated peat mounds at the same site had significantly lower N₂O release. The N₂O emissions from bare palsa surfaces in Northern Finland were highly variable but reached high rates, similar to those measured from the peat circles. All the vegetated soils studied had negligible N₂O release. At the bare peat surfaces, the large N₂O emissions were supported by the absence of plant N uptake, the low C : N ratio of the peat, the relatively high gross N mineralization rate and favourable moisture content, together increasing availability of mineral N for N₂O production. We hypothesize that frost heave is crucial for high N₂O emissions, since it lifts the peat above the water table, increasing oxygen availability and making it vulnerable to the the physical processes that may remove the vegetation cover. In the future, permafrost thawing may change the distribution of wet and dry surfaces in permafrost peatlands, which will affect N₂O emissions.
Objective: To evaluate the risk for developing metabolic syndrome when having depressive symptoms.
Method: The prevalence of depressive symptoms and metabolic syndrome at baseline, and after a ...7‐year follow‐up as measured with Beck depression inventory (BDI), and using the modified National Cholesterol Education Program – Adult Treatment Panel III criteria for metabolic syndrome (MetS) were studied in a middle‐aged population‐based sample (n = 1294).
Results: The logistic regression analysis showed a 2.5‐fold risk (95% CI: 1.2–5.2) for the females with depressive symptoms (BDI ≥10) at baseline to have MetS at the end of the follow‐up. The risk was highest in the subgroup with more melancholic symptoms evaluated with a summary score of the melancholic items in BDI (OR 6.81, 95% CI: 2.09–22.20). In men, there was no risk difference.
Conclusion: The higher risks for MetS in females with depressive symptoms at baseline suggest that depression may be an important predisposing factor for the development of MetS.
Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and ...frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics.
The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people.
The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity).
Overall, 11.4 % (n = 69) of the study participants were frail and 49.4 % (n = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people (p < 0.001). In multivariate analyses, frailty was positively associated with analgesic use (odds ratio 2.96; 95 % CI 1.38-6.36). However, frail analgesic users (46.7 %) were more likely to want their physicians to pay greater attention to pain management than robust (23.2 %) analgesic users. The most prevalent analgesic was acetaminophen (paracetamol) among frail (78.7 %) and pre-frail (63.2 %), and NSAIDs among robust (60.4 %) analgesic users. Frail (60.3 %) and pre-frail (58.1 %) participants were more likely to report musculoskeletal pain than robust (44.7 %) participants. Of robust, pre-frail and frail older people 33.0 %, 23.1 % and 4.9 % (respectively) did not use any analgesics to treat their pain.
Frailty was associated with a higher prevalence of analgesic use. As frail older people may be more susceptible to adverse events, careful selection of analgesics is warranted. Clinicians should pay more attention to pain management to ensure adequate pain relief.
Due to the paucity of previous studies, we wanted to elucidate the pharmacoepidemiology of antipsychotics in schizophrenia in a general population sample, and the association between long-term ...antipsychotic use and outcomes.
The sample included 53 schizophrenia subjects from the Northern Finland Birth Cohort 1966 with at least ten years of follow-up (mean 18.6 years since illness onset). Data on lifetime medication and outcomes (remission, Clinical Global Impression CGI, Social and Occupational Functioning Assessment Scale SOFAS) were collected from medical records, interviews, and national registers.
During the first two years 22 (42%), between two to five years 17 (32%), and between five to ten years 14 (26%) subjects had used antipsychotics less than half of the time. Drug-free periods became rarer during the follow-up. The mean lifetime daily dose of antipsychotics was 319mg in chlorpromazine equivalents. A high lifetime average and cumulative dose and antipsychotic polypharmacy were associated with a poorer outcome in all measures, whereas having no drug-free periods was associated with a better SOFAS score and a low proportion of time on antipsychotics with a better CGI score.
In our population-based sample, the use of antipsychotics increased during the first five years of illness and was relatively stable after that. Our results suggest that both low dose and proportion of use, and having no drug-free periods, are associated with better outcomes, which concords with current treatment recommendations and algorithms. High long-term doses and polypharmacy may relate to poor outcomes.
To estimate the prevalence of non-medicated subjects having schizophrenia spectrum disorder and to study how they differ from medicated subjects in terms of sociodemographic and illness-related ...variables. We also aim to find the predictors for successful antipsychotic withdrawal.
Data of 70 subjects with schizophrenic psychoses (mean duration of illness 10.4 years) from the Northern Finland 1966 Birth Cohort were gathered by interview at the age of 34 and from hospital records. The stability of remission was assessed by comparing hospitalization rates between non-medicated and medicated subjects over an 8.7-year additional follow-up period.
Twenty-four (34%) subjects were currently not receiving medication. They were more often males, less often on a disability pension, more often in remission, and had better clinical outcomes. Relapses during the follow-up were equally frequent between non-medicated and medicated subjects (47% vs. 56%). Not having been hospitalised during previous 5 years before the interview predicted long-term successful antipsychotic withdrawal without relapse.
Despite a lack of precise predictors, there might be subgroup of schizophrenia spectrum subjects who do not need permanent antipsychotic medication, and a fewer previous psychiatric treatments may indicate such a subgroup.
Urban air particulate pollution is a known cause for adverse human health effects worldwide. China has encountered air quality problems in recent years due to rapid industrialization. Toxicological ...effects induced by particulate air pollution vary with particle sizes and season. However, it is not known how distinctively different photochemical activity and different emission sources during the day and the night affect the chemical composition of the PM size ranges and subsequently how it is reflected to the toxicological properties of the PM exposures. The particulate matter (PM) samples were collected in four different size ranges (PM10-2.5; PM2.5-1; PM1-0.2 and PM0.2) with a high volume cascade impactor. The PM samples were extracted with methanol, dried and thereafter used in the chemical and toxicological analyses. RAW264.7 macrophages were exposed to the particulate samples in four different doses for 24 h. Cytotoxicity, inflammatory parameters, cell cycle and genotoxicity were measured after exposure of the cells to particulate samples. Particles were characterized for their chemical composition, including ions, element and PAH compounds, and transmission electron microscopy (TEM) was used to take images of the PM samples. Chemical composition and the induced toxicological responses of the size segregated PM samples showed considerable size dependent differences as well as day to night variation. The PM10-2.5 and the PM0.2 samples had the highest inflammatory potency among the size ranges. Instead, almost all the PM samples were equally cytotoxic and only minor differences were seen in genotoxicity and cell cycle effects. Overall, the PM0.2 samples had the highest toxic potential among the different size ranges in many parameters. PAH compounds in the samples and were generally more abundant during the night than the day, indicating possible photo-oxidation of the PAH compounds due to solar radiation. This was reflected to different toxicity in the PM samples. Some of the day to night difference may have been caused also by differing wind directions transporting air masses from different emission sources during the day and the night. The present findings indicate the important role of the local particle sources and atmospheric processes on the health related toxicological properties of the PM. The varying toxicological responses evoked by the PM samples showed the importance of examining various particle sizes. Especially the detected considerable toxicological activity by PM0.2 size range suggests they're attributable to combustion sources, new particle formation and atmospheric processes.
•Chemical composition of size segregated PM displayed day to night variation.•PM10-2.5 and PM0.2 samples showed higher toxicological responses during daytime.•Toxicological responses were dependent on PM size range.•Atmospheric processes and emission sources are likely causes of differences.
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