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Funding Information: We want to thank all the participants, and Eva Rikandi, Marita Kattelus, Tuula Mononen, Laura Hietapakka, and Sanna Leppänen for their help with the collection of the data. This work was supported by the Sigrid Jusélius Foundation (J.S.), the Finnish Cultural Foundation (T.M. and J.S.), the Jalmari and Rauha Ahokas Foundation (T.M.), the Doctoral Program Brain and Mind of the University of Helsinki (T.M.), the Paulo Foundation (T.M.), the Finnish Association of Psychiatric Research (T.M.), the Academy of Finland (grants # 278171 and # 323035 to J.S. and # 315861 to T.T.R.), the Finnish Medical Foundation (T.T.R.), State funding for university-level health research ( Hospital District of Helsinki and Uusimaa # TYH2013332 , # TYH2014228 , # TYH2017128 to T.K.), and the European Union's Seventh Framework Programme for project METSY (# 602478 to J.S.). Publisher Copyright: © 2021 ; Poor insight is a central characteristic of psychotic disorders, and it has been suggested to result from a general dysfunction in self-reflection. However, brain processing of clinical insight and more general self-reflection has not been directly compared. We compared tasks on (1) self-reflection on psychosis-related mental functioning (clinical insight, in patients only), (2) self-reflection on mental functioning unrelated to psychosis (general metacognition), and (3) semantic control during blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging with 19 first-episode psychosis patients and 24 control participants. Arterial-spin-labeling (ASL) images were collected at rest. Clinical insight was evaluated with the Schedule for the Assessment of Insight. In patients, posterosuperior precuneus showed stronger activation during the insight task than during the semantic control task, while anteroinferior precuneus and posterior cingulate cortex (PCC) showed stronger activation during the insight task than during the general metacognition task. No significant group differences in brain activation emerged during the general metacognition task. Although the BOLD measures did not correlate with clinical insight measures, ASL-measured cerebral blood flow (CBF) values did correlate when extracted from the task-selective precuneus/PCC areas: higher CBF correlated with higher clinical insight scores. These results suggest that regions in the posteromedial cortex are selective for clinical insight. ; Peer reviewed

INTRODUCTION: Multimorbidity, defined as the co-occurrence of two or more long-term medical conditions, is an increasing public health concern worldwide causing enormous burden to individuals, healthcare systems and societies. The most effective way of decreasing the burden caused by multimorbidity is to find tools for its successful prevention but gaps in research evidence limit capacities to develop prevention strategies. The aim of the MOLTO study (Multimorbidity - identifying the most burdensome patterns, risk factors and potentials to reduce future burden) is to provide novel evidence required for cost-effective prevention of multimorbidity by defining the multimorbidity patterns causing the greatest burden at the population level, by examining their risk and protective factors and by estimating the potentials to reduce the future burden. METHODS AND ANALYSIS: The MOLTO study is based on the data from the Finnish population-based cross-sectional (FINRISK 2002–2012, FinHealth 2017 the Migrant Health and Well-being Study 2010–2012) and longitudinal (Health 2000/2011) health examination surveys with individual-level link to administrative health registers, allowing register-based follow-up for the study participants. Both cross-sectional and longitudinal study designs will be used. Multimorbidity patterns will be defined using latent class analysis. The burden caused by multimorbidity as well as risk and protective factors for multimorbidity will be analysed by survival analysis methods such as Cox proportional hazards and Poisson regression models. ETHICS AND DISSEMINATION: The survey data have been collected following the legislation at the time of the survey. The ethics committee of the Hospital District of Helsinki and Uusimaa has approved the data collection and register linkages for each survey. The results will be published as peer-reviewed scientific publications.

Funding Information: This work was supported by the Sigrid Jusélius Foundation (J.S., E.R.), the Finnish Cultural Foundation (J.S. and T.M.), European Union Seventh Framework Programme ( FP7/2007–2013 ), grant agreement no 602478 (J.S.), the Jalmari and Rauha Ahokas Foundation (T.M.), the Doctoral Program Brain and Mind of the University of Helsinki (T.M.), the Yrjö Jahnsson Foundation (# 6781 to M.L.), the Päivikki and Sakari Sohlberg Foundation (M.L.), the Academy of Finland (# 278171 to J.S. and T.T.R.) and the Finnish Medical Foundation (T.T.R.) Funding Information: This work was supported by the Sigrid Jus?lius Foundation (J.S., E.R.), the Finnish Cultural Foundation (J.S. and T.M.), European Union Seventh Framework Programme (FP7/2007?2013), grant agreement no 602478 (J.S.), the Jalmari and Rauha Ahokas Foundation (T.M.), the Doctoral Program Brain and Mind of the University of Helsinki (T.M.), the Yrj? Jahnsson Foundation (#6781 to M.L.), the P?ivikki and Sakari Sohlberg Foundation (M.L.), the Academy of Finland (#278171 to J.S. and T.T.R.) and the Finnish Medical Foundation (T.T.R.) Publisher Copyright: © 2022 The Authors ; 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 first-episode psychosis patients. The subnetwork was mainly comprised of nodes of and links between the cingulo-opercular, 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. ; Peer reviewed

Comorbidity of substance use with affective symptoms and suicidality has been well documented in the general population. However, population-based migrant studies about this association are scarce. We examined the association of affective symptoms and suicidal ideation with binge drinking, daily smoking, and lifetime cannabis use among Russian, Somali, and Kurdish migrants in comparison with the Finnish general population. Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu, n = 1307) and comparison group data of the general Finnish population ( n = 860) from the Health 2011 Survey were used. Substance use included self-reported current binge drinking, daily smoking, and lifetime cannabis use. Affective symptoms and suicidal ideation were measured using the Hopkins Symptom Checklist-25 (HSCL-25). We performed multivariate logistic regression analyses, including age, gender, and additional socio-demographic and migration-related factors. Suicidal ideation (OR 2.4 95% CI 1.3–4.3) was associated with binge drinking among Kurds and lifetime cannabis use among Russians (OR 5.6, 95% CI 1.9–17.0) and Kurds (OR 5.5, 95% CI 1.9–15.6). Affective symptoms were associated with daily smoking (OR 1.6, 95% CI 1.02–2.6) and lifetime cannabis use (OR 6.1, 95% CI 2.6–14.5) among Kurdish migrants. Our results draw attention to the co-occurrence of suicidal ideation, affective symptoms, and substance use, especially among Kurdish migrants. These results highlight the variation of comorbidity of substance use and affective symptoms between the different populations. This implies that screening for substance use in mental healthcare cannot be neglected based on presumed habits of substance use.

Psykiatrisia avohoidon palveluita on digitalisoitu aktiivisesti jo ennen koronavirusepidemiaa, mutta varsinkin epidemian käynnistymisen jälkeen etäasioinnin merkitys on kasvanut. Tämän poikkileikkaustutkimuksen tavoitteena oli selvittää, kuinka koronaepidemia on vaikuttanut psykiatristen avohoitokäyntien toteutusmuotoon ja kuvailla psykiatristen erikoissairaanhoidon palveluiden johtajien kokemuksia etäasioimisesta. Tutkimuksen tuloksia voidaan hyödyntää psykiatristen avohoitopalveluiden arvioinnissa sekä kehittämisessä sekä jatkotutkimuksessa.
Kyselyaineisto kerättiin osana COVID-19 tilannekuvaseurantaa sähköisellä kyselylomakkeella koronaepidemian käynnistymisen jälkeen toukokuussa 2020. Kyselyssä oli sekä strukturoituja että avoimia kysymyksiä. Kyselyyn vastasi 39 aikuispsykiatrian, nuorisopsykiatrian ja lasten psykiatrian toimialojen esimiestä ja johtajaa 19 eri sairaanhoitopiiristä. Kvantitatiiviset kysymykset avohoitokäyntien toteutusmuotojen määrästä raportoitiin prosenttiosuuksina ja avointen kysymysten vastaukset analysointiin induktiivisella sisällönanalyysillä.
Tulosten perusteella etäasioinnin suhteellinen osuus kaikista asiointitavoista kasvoi voimakkaasti koronaepidemian käynnistymisen jälkeen. Psykiatrisista avohoitokäynneistä toteutettiin puhelimitse tai etäyhteydellä tammikuussa 9% ja toukokuussa 48% (39 prosenttiyksikön kasvu). Etäasiointia haastoivat välineiden riittämättömyys ja toimimattomat ohjelmat, asiakkaiden puuttuvat laitteet, yhteydet ja tilat, etäasioinnin soveltumattomuus kaikkeen toimintaan, ammattihenkilöiden ja asiakkaiden negatiivinen asennoituminen, riittämätön osaaminen etäasioinnin käyttöön ja organisatoriset ongelmat. Etäasiointia edistivät asiakkaiden ja ammattihenkilöiden myönteinen asenne ja ilmapiiri, koronaepidemian aiheuttama tarve etäasioinnille, etäasioinnin soveltuvuus ja tuttuus psykiatrisissa avohoitopalveluissa, asiakkaiden aikaisempi tuntemus, pitkät välimatkat, toimivat etäverkostot ja ajansäästö, toimiva tekniikka, ohjelmistot ja välineet sekä riittävä tuki.
Etäasiointi on mahdollistanut epidemiatilanteessa psykiatristen avohoitopalveluiden tarjoamisen niille asiakkaille, joille etäasiointi soveltuu ja jotka kykenevät etäasiointiin. Etäasioinnin merkitys koronaepidemian aikana on ollut tärkeä, mutta etäasioinnin lisäksi on tärkeää innovoida ratkaisuja, kuinka psykiatrisia avohoitopalveluita voitaisiin toteuttaa niille asiakkaille, joille etäasiointi ei syystä tai toisesta sovellu.

<b><i>Aim:</i></b> To examine the long-term predictors of persistence of risky drinking in a baseline group of risky drinkers in whom alcohol use disorder had not been diagnosed. <b><i>Methods:</i></b> The data was derived from a representative sample of the Finnish adult population aged 30 years or more, surveyed at 2 time points in the years 2000 (<i>n</i> = 5,726) and 2011 (<i>n</i> = 3,848, 67.2% of the baseline sample). Risky drinking was defined using BSQF-measurement (for men, 21 standard UK drinks or more per week; for women 14+ drinks) and not having alcohol abuse or alcohol dependence. The sample of risky drinkers in baseline comprised 642 persons, of whom 380 (59.2%) people provided follow-up data. Multivariable logistic regression models were estimated to identify determinants of persistence of risky drinking. <b><i>Results:</i></b> The rate for persistence of risky drinking was 48.7%. Persistence was predicted by daily smoking, low physical activity, and male gender, whereas higher age and later onset of drinking predicted cessation of risky drinking. Daily smoking remained an independent predictor after adjusting for other risk factors. <b><i>Conclusions:</i></b> Health behaviour predicts the persistence of risky drinking in a study population of adults aged 30 and over. These factors should be taken into account when assessing the long-term prognosis on risky drinking<i>.</i>

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field. ; Common sequence variants have recently joined rare structural polymorphisms as genetic factors with strong evidence for association with schizophrenia. Here we extend our previous genome-wide association study and meta-analysis (totalling 7 946 cases and 19 036 controls) by examining an expanded set of variants using an enlarged follow-up sample (up to 10 260 cases and 23 500 controls). In addition to previously reported alleles in the major histocompatibility complex region, near neurogranin (NRGN) and in an intron of transcription factor 4 (TCF4), we find two novel variants showing genome-wide significant association: rs2312147[C], upstream of vaccinia-related kinase 2 (VRK2) [odds ratio (OR) = 1.09, P = 1.9 × 10(-9)] and rs4309482[A], between coiled-coiled domain containing 68 (CCDC68) and TCF4, about 400 kb from the previously described risk allele, but not accounted for by its association (OR = 1.09, P = 7.8 × 10(-9)). ; European Union LSHM-CT-2006-037761 PIAP-GA-2008-218251 HEALTH-F2-2009-223423 National Genome Research Network of the German Federal Ministry of Education and Research (BMBF) 01GS08144 01GS08147 National Institute of Mental Health R01 MH078075 N01 MH900001 MH074027 Centre of Excellence for Complex Disease Genetics of the Academy of Finland 213506 129680 Biocentrum Helsinki Foundation Faculty of Medicine, University of Helsinki Stanley Medical Research Institute Danish Council for Strategic Research 2101-07-0059 H. Lundbeck A/S Research Council of Norway 163070/V50 South-East Norway Health Authority 2004-123 Medical Research Council Ministerio de Sanidad y Consumo, Spain PI081522 Xunta de Galicia 08CSA005208PR Swedish Research Council Wellcome Trust 083948/Z/07/Z Max Planck Society Eli Lilly and Company ; info:eu-repo/grantAgreement/EC/FP7/218251