Predictors of future stroke in adults 60-64 years living in the community

AIM: To investigate predictors of incident stroke in a large epidemiological sample of cognitively healthy individuals in their early 60’s. METHODS: Cardiovascular (systolic and diastolic blood pressure, hypertension status and medication, body mass index, lung forced vital capacity), lifestyle (alcohol intake, smoking, physical activity), mental health (anxiety and depression status, medication and symptomatology), cognition (executive function, processing speed, working memory, sensorimotor skills), and personality measures (behavioural inhibition and activation, positive and negative affect, neuroticism, psychoticism, extraversion) were investigated as predictors of incident stroke in 1774 participants from the Personality and Total Health Through Life Project over an 8-year follow-up. Logistic regression analyses controlled for age, gender, and education were conducted in the whole cohort as well as in case-control sub-analyses including precisely matched controls to identify factors associated with stroke incidence. RESULTS: The cohort selected had a mean age of 62.5 years (SD = 1.5) and was 48.6% female with an average of 14.1 years of education (SD = 2.6). When 28 individuals with incident stroke were compared to 1746 cognitively healthy individuals in multivariate logistic regression analyses the only significant predictors of stroke across the five domains considered (cardiovascular, lifestyle, mental health, cognition, personality) and after controlling for gender, age, and education were systolic blood pressure (per unit above 140 mmHg: OR = 1.04, 95%CI: 1.01-1.07, P = 0.002), smoking (trend OR = 2.28, 95%CI: 0.99-5.24, P = 0.052), and sensorimotor skills (purdue pegboard: OR = 0.80, 95%CI: 0.62-0.96, P = 0.037). Similarly, in matched-control analyses significant group differences were found for systolic blood pressure (P = 0.001), smoking (P = 0.036), and sensorimotor skills (P = 0.028). CONCLUSION: Identified predictors of incident stroke in community-living individuals included high systolic blood pressure and smoking - but also, sensorimotor performance, a measure which has not yet been reported in the literature.     

Depression and other mental health diagnoses increase mortality risk after ischemic stroke

OBJECTIVE: Poststroke depression has been linked to higher mortality after stroke. However, the effect of other mental health conditions on poststroke mortality has not been examined. The objective of this study was to evaluate the effect of poststroke depression and other mental health diagnoses on mortality after ischemic stroke. METHOD: The authors examined a national cohort of veterans hospitalized after an ischemic stroke at any U.S. Department of Veterans Affairs (VA) medical center from 1990 to 1998. Demographic, admission, and all-cause mortality data were abstracted from VA administrative databases. Chronic conditions present at discharge and new poststroke depression and other mental health diagnoses within 3 years after the stroke were identified with ICD-9 codes. Mortality hazard ratios were modeled by using Cox regression models. RESULTS: A total of 51,119 patients hospitalized after an ischemic stroke who survived beyond 30 days afterward were identified; 2,405 (5%) received a diagnosis of depression, and 2,257 (4%) received another mental health diagnosis within 3 years of their stroke. Patients with poststroke depression were younger, more often white, and less likely to be alive at the end of the 3-year follow-up period. Both poststroke depression (hazard ratio=1.13, 95% CI=1.06-1.21) and other mental health diagnoses (hazard ratio=1.13, 95% CI=1.07-1.22) independently increased the hazard for death even after other chronic conditions were controlled. CONCLUSIONS: Despite being younger and having fewer chronic conditions, a higher 3-year mortality risk was seen in patients with poststroke depression and other mental health diagnoses after hospitalization for an ischemic stroke. The biological and psychosocial mechanisms driving this greater risk should be further explored, and the effect of depression treatment on mortality after stroke should be tested.     

Quality of medical care and excess mortality in older patients with mental disorders

BACKGROUND: This study investigated whether differences in quality of medical care might explain a portion of the excess mortality associated with mental disorders in the year after myocardial infarction. METHODS: This study examined a national cohort of 88 241 Medicare patients 65 years and older who were hospitalized for clinically confirmed acute myocardial infarction. Proportional hazard models compared the association between mental disorders and mortality before and after adjusting 5 established quality indicators: reperfusion, aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and smoking cessation counseling. All models adjusted for eligibility for each procedure, demographic characteristics, cardiac risk factors and history, admission characteristics, left ventricular function, hospital characteristics, and regional factors. RESULTS: After adjusting for the potential confounding factors, presence of any mental disorder was associated with a 19% increase in 1-year risk of mortality (hazard ratios [HR], 1.19; 95% confidence interval [CI], 1.04-1.36). After adding the 5 quality measures to the model, the association was no longer significant (HR, 1.10; 95% CI, 0.96-1.26). Similarly, while schizophrenia (HR, 1.34; 95% CI, 1.01-1.67) and major affective disorders (HR, 1.11; 95% CI, 1.02-1.20) were each initially associated with increased mortality, after adding the quality variables, neither schizophrenia (HR, 1.23; 95% CI, 0.86-1.60) nor major affective disorder (HR, 1.05; 95% CI, 0.87-1.23) remained a significant predictor. CONCLUSIONS: Deficits in quality of medical care seemed to explain a substantial portion of the excess mortality experienced by patients with mental disorders after myocardial infarction. The study suggests the potential importance of improving these patients' medical care as a step toward reducing their excess mortality.     

Dysthymia in male adolescents is associated with increased risk of later hospitalization for psychotic disorders: a historical-prospective cohort study

Aim: Retrospective studies indicate that patients with psychotic disorders and schizophrenia often suffer from depressive symptoms before the onset of psychosis. In a historical‐prospective design, we studied the association between dysthymia in adolescence and later hospitalization for psychotic disorders and schizophrenia. Methods: The Israeli Draft Board screens the entire, unselected population of 16–17 years old male adolescents for psychiatric disorders. These adolescents were followed for hospitalization for psychotic disorders and schizophrenia using the Israeli National Psychiatric Hospitalization Case Registry. Of 275 705 male adolescents screened, 1267 (0.5%) were hospitalized for psychotic disorders (International Classification of Diseases [ICD]‐10 20.0–29.9), and 757 (0.3%) were hospitalized for schizophrenia (ICD‐10 20.0–20.9) over the next 1–10 years. Results: Of 275 705 male adolescents screened, 513 (0.2%) were diagnosed as suffering from dysthymia by the Draft Board. Of these adolescents, 10/513 (2.0%) were later hospitalized for psychotic disorders (including schizophrenia, HR = 3.967, 95%CI (confidence intervals): 2.129–7.390), and 4/513 (0.8%) were later hospitalized for schizophrenia (HR = 2.664, 95%CI: 0.997–7.116). Conclusions: In this population‐based cohort of male adolescents, dysthymia was associated with increased risk for future psychotic disorders. Dysthymia in some adolescents might be a prodromal symptom, while in others it might be a risk factor for later psychosis. Clinicians assessing dysthymic adolescents should be aware that these symptoms might be part of the prodrome.     

深圳市社区严重精神障碍不服药患者发生暴力行为的影响因素分析

目的分析深圳市社区严重精神障碍不服药患者暴力行为发生的相关因素。方法利用深圳市精神卫生防治工作信息管理系统收集严重精神障碍患者个案资料和随访资料,描述分析不服药患者暴力行为的发生现状,应用Logistic回归模型分析其影响因素。结果3163例社区严重精神障碍不服药患者中9.1%(288/3163)的患者发生暴力行为。多元Logisitic回归分析显示,急性起病(OR=1.589,95%CI 1.181~2.139)为暴力行为发生的危险因素;有共同居住者(OR=0.596,95%CI 0.410~0.867)、精神发育迟滞伴发精神障碍(OR=0.432,95%CI 0.199~0.938)、申请监护补助(OR=0.440,95%CI 0.319~0.606)、签约家庭医师服务(OR=0.642,95%CI 0.492~0.838)和社区面访(OR1-2次=0.633,95%CI 0.466~0.861;OR3-4次=0.546,95%CI 0.368~0.811)为暴力行为发生的保护因素。结论急性起病的严重精神障碍不服药患者暴力行为发生率较高。提升社区精神卫生综合服务水平,制定有针对性的干预措施,有助于降低社区严重精神障碍不服药患者暴力行为的发生。     

Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study

BackgroundStroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown.MethodsWe used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45–64 years old at baseline (1987–1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31^st, 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95% CI) were estimated with Cox proportional hazards regression models.ResultsMedian (25%-75%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53% were women and 35% Black. Individuals with LS7 score ≥10 had 65% lower risk (HR: 0.35; 95% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2% (n=502) had composite CVD and 68.3% (n=832) died during a median (25%-75%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke.ConclusionsGood and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention.     

Genetic factors underlying the bidirectional relationship between autoimmune and mental disorders – Findings from a Danish population-based study

BackgroundPrevious studies have indicated the bidirectionality between autoimmune and mental disorders. However, genetic studies underpinning the co-occurrence of the two disorders have been lacking. In this study, we examined the potential genetic contribution to the association between autoimmune and mental disorders and investigated the genetic basis of overall autoimmune disease.MethodsWe used diagnostic information from patients with seven autoimmune diseases and six mental disorders from the Danish population-based case-cohort sample (iPSYCH2012). We explored the epidemiological association using survival analysis and modelled the effect of polygenic risk scores (PRSs) on autoimmune and mental diseases. Genetic factors were investigated using GWAS and imputed HLA alleles in the iPSYCH cohort.ResultsOf 64,039 individuals, a total of 43,902 (68.6%) were diagnosed with mental disorders and 1383 (2.2%) with autoimmune diseases. There was a significant comorbidity between the two disease classes (P = 2.67 × 10⁻⁷, OR = 1.38, 95%CI = 1.22–1.56), with an overall bidirectional association, wherein individuals with autoimmune diseases had an increased risk of subsequent mental disorders (HR = 1.13, 95%CI: 1.07–1.21, P = 7.95 × 10⁻⁵) and vice versa (HR = 1.27, 95%CI = 1.16–1.39, P = 8.77 × 10⁻¹⁵). Adding PRSs to these adjustment models did not have an impact on the associations. PRSs for autoimmune diseases were only slightly associated with increased risk of mental disorders (HR = 1.01, 95%CI: 1.00–1.02, p = 0.038), whereas PRSs for mental disorders were not associated with autoimmune diseases overall. Our GWAS highlighted 12 loci on chromosome 6 (minimum P = 2.74 × 10⁻³⁶, OR = 1.80, 95% CI: 1.64–1.96), which were implicated in gene regulation through bioinformatic functional analyses, thereby identifying new candidate genes for overall autoimmune disease. Moreover, we observed 20 human leukocyte antigen (HLA) alleles strongly associated, either positively or negatively, with overall autoimmune disease, but we did not find significant evidence of their associations with overall mental disorders. A GWAS of a comorbid diagnosis of an autoimmune disease and a mental disorder identified a genome-wide significant locus on chromosome 7 as well (P = 1.43 × 10⁻⁸, OR = 10.65, 95%CI = 3.21–35.36).ConclusionsOur findings confirm the overall comorbidity and bidirectionality between autoimmune diseases and mental disorders and identify HLA genes which are significantly associated with overall autoimmune disease. Additionally, we identified several new candidate genes for overall autoimmune disease and ranked them based on their association with the investigated diseases.     

Childhood growth and future development of psychotic disorder among Helsinki high-risk children

BACKGROUND: The Helsinki High-Risk (HR) Study is a follow-up study of offspring (born between 1960 and 1964) of all females treated for schizophrenia spectrum disorders in mental hospitals in Helsinki before 1975, and controls. AIM: To compare childhood growth among HR and control children, and to determine if any patterns in childhood growth predict later development of psychotic disorders within the HR group. METHODS: We accessed growth information from childhood health cards, which we obtained for 114 HR and 53 control offspring. The growth of HR children was compared with that of control children. Within the HR group, we investigated whether any association existed between childhood growth patterns and morbidity from psychotic disorders using logistic regression models. RESULTS: The HR girls were shorter than controls at birth (p=0.030), but this disparity vanished by age 7. In contrast, HR boys were only slightly shorter at birth than controls, but the height difference increased with age, being statistically significant at 10 years (p=0.020). Among HR children, the combination of being in the lowest tertile for ponderal index at birth but in the highest tertile for BMI at 7 years predicted later development of schizophrenia (OR 22.8, 95% CI 2.0, >100, p=0.040). CONCLUSIONS: Catch-up growth increases the risk of schizophrenia among offspring of mothers with psychotic disorder. Whether this is an independent risk factor or merely a reflection of some other risk factors needs further research.     

Risk of Mortality in Elderly Coronavirus Disease 2019 Patients With Mental Health Disorders: A Nationwide Retrospective Study in South Korea

ObjectiveThis study aimed to investigate the different clinical characteristics among elderly coronavirus disease 2019 (COVID-19) patients with and without mental disorders in South Korea and determine if these characteristics have an association with underlying mental disorders causing mortality.MethodA population-based comparative cohort study was conducted using the national claims database. Individuals aged ≥65 years with confirmed COVID-19 between January 1, 2020 and April 10, 2020 were assessed. The endpoints for evaluating mortality for all participants were death, 21 days after diagnosis, or April 10, 2020. The risk of mortality associated with mental disorders was estimated using Cox hazards regression.ResultsWe identified 814 elderly COVID-19 patients (255 [31.3%] with mental disorder and 559 [68.7%] with nonmental disorder). Individuals with mental disorders were found more likely to be older, taking antithrombotic agents, and had diabetes, hypertension, chronic obstructive lung disease, and urinary tract infections than those without mental disorders. After propensity score stratification, our study included 781 patients in each group (236 [30.2%] with mental disorder and 545 [69.8%] with nonmental disorder). The mental disorder group showed higher mortality rates than the nonmental disorder group (12.7% [30/236] versus 6.8% [37/545]). However, compared to patients without mental disorders, the hazard ratio (HR) for mortality in elderly COVID-19 patients with mental disorders was not statistically significant (HR: 1.57, 95%CI: 0.95–2.56).ConclusionAlthough the association between mental disorders in elderly individuals and mortality in COVID-19 is unclear, this study suggests that elderly patients with comorbid conditions and those taking psychiatric medications might be at a higher risk of COVID-19.     

限制性立方样条评估抗高血压治疗与卒中的J型曲线

目的评估抗高血压治疗中血压值与卒中的发生是否存在J型曲线。方法回顾性分析2009年1月-2013年10月于门诊或住院接受治疗的2059例高血压患者,采用限制性立方样条(restricted cubic spline,RCS)拟合Cox回归模型来评估不同的血压截点与卒中的关系,用Kaplan-Meier法评估随访期间卒中的发生率,Cox比例风险模型分析影响卒中的独立危险因素。结果总体患者1、3、5年累积卒中发生率分别为2.5%、8.8%和16.6%。经RCS拟合Cox模型评估,发现血压值与是否发生卒中呈非线性关系,对于收缩压(systolic blood pressure,SBP)110 mmHg或150 mmHg的患者,以及舒张压(diastolic blood pressure,DBP)60 mmHg或90 mmHg的患者,卒中的发生风险增加。经Cox风险比例模型多因素分析,吸烟史(HR 2.32,95%CI 1.36~3.13,P=0.009)、糖尿病(HR 2.07,95%CI 1.18~3.05,P=0.011)、心房颤动(HR 1.89,95%CI 1.16~2.98,P=0.014)、SBP110 mm Hg(HR 1.62,95%CI 1.11~2.24,P=0.032)或150 mmHg(HR 1.79,95%CI 1.21~2.72,P=0.013)和颈动脉狭窄(HR 2.47,95%CI 1.37~4.18,P=0.008)是卒中的独立危险因素。结论抗高血压治疗中,存在血压值与卒中的J型曲线现象;SBP110 mmHg或150 mmHg的患者,卒中的发生风险增加。     

Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns

Expanding clinical strategies to identify high risk groups for psychotic and bipolar disorders is a research priority. Considering that individuals diagnosed with psychotic and bipolar disorder are at high risk of self-harm, we hypothesised the reverse order relationship would also be true (ie, self-harm would predict psychotic/bipolar disorder). Specifically, we hypothesised that hospital presentation for self-harm would be a marker of high risk for subsequent development of psychotic/bipolar disorder and sought to test this hypothesis in a large population sample. This prospective register-based study included everyone born in Finland in 1987, followed until age 28 years (N = 59 476). We identified all hospital records of self-harm presentations, as well as all ICD-10 healthcare registrations of first diagnoses of psychotic and bipolar disorders. Cox proportional hazards models were used to assess the relationship between self-harm and psychotic/bipolar disorders. Of all individuals who presented to hospital with self-harm (n = 481), 12.8% went on to receive a diagnosis of psychosis (hazard ratio [HR] = 6.03, 95% confidence interval [CI] 4.56–7.98) and 9.4% a diagnosis of bipolar disorder (HR = 7.85, 95% CI 5.73–10.76) by age 28 years. Younger age of first self-harm presentation was associated with higher risk—for individuals who presented before age 18 years, 29.1% developed a psychotic or bipolar disorder by age 28 years. Young people who present to hospital with self-harm are at high risk of future psychotic and bipolar disorders. They represent an important cohort for the prevention of serious mental illness.     

Successful mental health aging: results from a longitudinal study of older Australian men.

OBJECTIVE: The authors investigated the associations of medical and lifestyle factors with the mental health of men in their 80s. METHODS: This was a prospective study of a community-representative cohort of older men. Successful mental health aging was defined as reaching age 80 years with Mini-Mental State Examination score (MMSE) of 24 or more and Geriatric Depression Scale-15 items (GDS-15) score of 5 or less. RESULTS: Of 601 men followed for 4.8 years, 76.0% enjoyed successful mental health aging. Successful mental health aging was inversely associated with age (hazard ratio [HR] = 0.87; 95% confidence interval [CI]: 0.81-0.94), non-English-speaking background (HR = 0.42; 95% CI: 0.21-0.85), and the consumption of full-cream milk (HR = 0.63; 95% CI: 0.45-0.89), and directly associated with high school or university education (HR = 1.92; 95% CI: 1.34-2.75) and vigorous (HR = 1.89; 95% CI: 1.17-3.05) and nonvigorous physical activity (HR = 1.50; 95% CI: 1.05-2.14). Marital status, smoking and alcohol use, weekly consumption of meat or fish, and a medical history of hypercholesterolemia, hypertension, diabetes, myocardial infarction, and stroke were not associated with mental health outcomes in men aged 80 years or over. CONCLUSION: Three in four men who reach age 80 years undergo successful mental health aging. Factors associated with successful mental health aging include education and lifestyle behaviors such as physical activity. Lifestyle modification by means of increasing physical activity and reducing saturated fat intake may prove to be a safe, inexpensive, and readily available strategy to help maximize the successful mental health aging of the population.     

颅内动脉粥样硬化负荷对缺血性卒中预后的影响

目的 了解颅内动脉粥样硬化负荷（intracranial atherosclerosis burden,ICASB）对缺血性卒中1年复发 的影响。 方法 入组中国22家医院共计2864例发病7 d内的缺血性卒中患者。所有入组患者均进行MRA检查, 并根据颅内血管狭窄程度和数量计算ICASB,根据不同的ICASB将患者分为<4分组、4～5分组和>5分 组。比较不同ICASB组间基线数据的差异,并分析1年卒中复发的危险因素。 结果 ICASB<4分组、4～5分组和>5分组分别有2491例、214例和159例。不同ICASB组责任血管 狭窄程度的分布不同,差异有统计学意义（P <0.0001）。多变量分析显示,ICASB 4～5分（HR 2.28, 95%CI 1.41～3.71,P =0.0008）、卒中家族史（HR 2.06,95%CI 1.27～3.33,P =0.0033）、缺血性卒中 病史（HR 2.12,95%CI 1.29～3.50,P =0.0030）、以前和现在吸烟史（HR 0.54,95%CI 0.35～0.85, P =0.0075）及入院时NIHSS评分（HR 1.05,95%CI 1.00～1.09,P =0.028）是1年卒中复发的独立危险因 素。Kapl an-Meier生存曲线分析显示,ICASB 4～5分组1年卒中复发率（10.28%）较<4分组（3.89%）和 >5分组（6.91%）增高（均P <0.0001）。 结论 ICASB 4～5分是缺血性卒中患者1年卒中复发的独立危险因素。     

An Asian Perspective on Gender Differences in In-Hospital and Long-Term Outcome of Cardiac Mortality and Ischemic Stroke after Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

ObjectivesGender differences historically exist in cardiovascular disease, with women experiencing higher rates of major adverse cardiovascular events. We investigated these trends in a contemporary Asian cohort, examining the impact of gender differences on cardiac mortality and ischemic stroke after primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI).Materials and MethodsWe analysed 3971 consecutive patients who underwent primary PCI for STEMI retrospectively. The primary outcome was cardiac mortality and ischemic stroke in-hospital, at one year and on longer-term follow up (median follow up 3.62 years, interquartile range 1.03–6.03 years).ResultsThere were 580 (14.6%) female patients and 3391 (85.4%) male patients. Female patients were older and had higher prevalence of hypertension, diabetes, previous strokes, and chronic kidney disease. Cardiac mortality was higher in female patients during in-hospital (15.5% vs. 6.2%), 1-year (17.4% vs. 7.0%) and longer term follow up (19.9% vs. 8.1%, log-rank test: p < 0.001). Similarly, females had higher incidence of ischemic stroke at in-hospital (2.6% vs. 1.0%), 1-year (3.6% vs. 1.4%) and in the longer-term (6.7% vs. 3.1%) as well (log-rank test: p < 0.001). Female gender remained an independent predictor of in-hospital cardiac mortality (HR 1.395, 95%CI 1.061-1.833, p=0.017) and on longer-term follow-up (HR 1.932 95%CI 1.212-3.080, p=0.006) even after adjusting for confounders.ConclusionsFemales were at higher risk of in-hospital and long-term cardiac mortality and ischemic stroke after PPCI for STEMI. Future studies are warranted to investigate the role of aggressive management of cardiovascular risk factors and follow-up to improve outcomes in the females with STEMI.     

Psychiatric disorders in a representative sample of incarcerated boys in the Netherlands

OBJECTIVE: To determine the prevalence of psychiatric disorders among incarcerated male adolescents and to investigate the influence of psychopathology on allocation to either plain detention or detention with compulsory treatment. METHOD: A cross-sectional study of a representative sample (N = 204) of incarcerated boys aged 12 to 18, using the Diagnostic Interview Schedule for Children (DISC). Data were collected from December 1998 to December 1999. RESULTS: Of the eligible subjects, 79% agreed to participate. Ninety percent reported at least one psychiatric disorder: disruptive behavior disorder 75% (95% confidence interval [CI]: 68-81%), substance use disorder 55% (95% CI: 48-63%), psychotic symptoms 34% (95% CI: 27-41%), ADHD 8% (95% CI: 5-13%), anxiety disorder 9% (95% CI: 6-15%), and affective disorder 6% (95% CI: 3-10%). After controlling for a broad range of sociodemographic characteristics and former treatment parameters, the presence of a psychiatric disorder was not associated with allocation to compulsory treatment. CONCLUSIONS: Compared with North American studies, relatively low rates of anxiety and affective disorders were found, probably due to the better availability of mental health services to disadvantaged youths with internalizing problems in the Netherlands. It should be examined whether standardized psychiatric assessments can improve the efficiency of allocation to detention programs with or without psychiatric treatment options.     

Case Fatality Decline from 2009 to 2013 among Medicare Beneficiaries with Ischemic Stroke

ObjectivesThis study aimed to examine the temporal trend of 30-day and 1-year mortality among U.S. Medicare beneficiaries who were hospitalized for ischemic stroke, with special focus on the mortality among subgroup of patients in relation to acute reperfusion therapies including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT).MethodsWe evaluated Medicare fee-for-service beneficiaries age 65 years or older who were hospitalized for ischemic stroke between 2009 and 2013. Multivariable Cox proportional hazards models were generated to analyze the trend of adjusted mortality.ResultsA total of 1,070,574 patients were included in the study. The 30-day mortality did not change among patients who were not treated with IVT or EVT. It decreased by 13% among patients treated with IVT but not EVT (HR = .87, 95% CI .82-.92), 25% among patients treated with EVT but not IVT (HR = .75, 95% CI .59-.95), and 37% among patients treated with both IVT and EVT (HR = .63, 95% CI .52-.77). One-year mortality decreased by 19% among patients who were not treated with IVT nor EVT (HR = .81, 95% CI .80-.83), 22% among those treated with IVT but not EVT (HR = .78, 95% CI .75-.81), 33% among those treated with EVT but not IVT (HR = .67, 95% CI .55-.81), and 38% among those treated with both IVT and EVT (HR = .62, 95% CI .53-.73).ConclusionsFrom 2009 to 2013, the 30-day stroke case fatality decreased only among the patients received reperfusion therapy. The 1-year mortality declined among all the stroke patients, with the greatest decline among those treated with both IVT and EVT.     

Police-registered offenses and psychiatric disorders among young males

OBJECTIVE: To study associations between crime and psychiatric disorders among adolescent males in a representative population-based cohort study. METHOD: The sample includes 2,712 Finnish boys born in 1981. Information on criminality consists of offenses registered in the Finnish National Police Register 1998-2001. Crime was classified according to frequency and type (drug, violent, property, traffic, and drunk driving offenses). Information on psychiatric diagnoses between 1999 and 2004 was collected from the Finnish National Military Register. RESULTS: Of the 2,712 boys, 22% had a crime registration during the 4-year period, and 10% had at least one psychiatric disorder according to the Military Register. Those with psychiatric disorders accounted for 49% of all crimes. Of those with more than five crimes (n = 98), 59% had psychiatric diagnoses. After adjusting for other crime types and childhood socio-economic status, property crime was independently associated with several diagnoses: antisocial personality (APD), substance use (SUD), psychotic, anxiety, and adjustment disorders. Drug offending was independently associated with APD, SUD, and psychotic disorder, and traffic offenses with APD. CONCLUSIONS: Youth crime is predominantly associated with antisocial personality and substance use disorders. Crime prevention efforts should focus on boys showing a risk for antisocial and substance use problems. In particular, property, drug, and repeat offenders need mental health and substance use assessment. There is a need to develop integrated mental health and substance use treatment services for young offenders within or alongside the criminal justice system.     

Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old.

BACKGROUND: Psychotic symptoms are reported to be uncommon in the elderly, and may be underrated in traditional epidemiological studies. METHODS: Psychotic symptoms, physical disorders, disability in daily life, and sensory impairments were assessed using results of psychiatric and physical examinations, key-informant interviews, and medical record reviews in a representative sample of nondemented individuals aged 85 years living in the community or in institutions in G?teborg, Sweden (n = 347). The sample was observed for 3 years regarding psychotic symptoms, mortality, and incident dementia. RESULTS: The prevalence of any psychotic symptom was 10.1% (95% confidence interval [CI], 7.1%-13.7%); hallucinations, 6.9% (95% CI, 4.5%-10.1%); and delusions, 5.5% (95% CI, 3.3%-8.4%). The prevalence of paranoid ideation was 6.9% (95% CI, 4.5%-10.1%). Stepwise logistic regression analyses showed that hallucinations were associated with major depressive syndrome (odds ratio [OR], 3.9; 95% CI, 1.3-11.9), disability in daily life (OR, 5.2; 95% CI, 1.8-14.9), and visual deficits (OR, 3.4; 95% CI, 1.0-11.1). Delusions were associated with disability in daily life (OR, 4.9; 95% CI, 1.8-13.3). Paranoid ideation was associated with visual deficits (OR, 3.6; 95% CI, 1.2-10.5) and myocardial infarction (OR, 4.6; 95% CI, 1.7-12.6). Hallucinations (OR, 3.1; 95% CI, 1.4-6.8), delusions (OR, 2.9; 95% CI, 1.2-6.9), and paranoid ideation (OR, 2.7; 95% CI, 1.2-6.2) were each related to increased incidence of dementia from 85 to 88 years of age. Hallucinations and paranoid ideation were associated with increased 3-year mortality in women but not in men. CONCLUSIONS: We found a higher prevalence of psychotic symptoms and paranoid ideation in the elderly than previously reported, and these symptoms were associated with a poor prognosis.     

Risk assessment of mechanic thrombectomy on post-stroke seizures: a systematical review and meta-analysis

PurposeWe conducted a systematic review and meta-analysis to evaluate the risk of early and late onset seizures following stroke mechanic thrombectomy (MT) compared with other systematic thrombolytic strategies.MethodsA literature search was conducted to identify articles covering databases (PubMed, Embase, and Cochrane Library) published from 2000 to 2022. The primary outcome was the incidence of post-stroke epilepsy or seizures following MT or in combination with intravenous thrombolytics therapy. Risk of bias was assessed by recording study characteristics. The study was conducted according to the PRISMA guidelines.ResultsThere were 1346 papers in the search results, and 13 papers were included in the final review.We identified 29,793 patients with stroke, of which 695 had seizures. Pooled incidence of post-stroke seizures had no significant difference between mechanic thrombolytic group and other thrombolytic strategy group (OR=0.95 (95%CI= 0.75-1.21); Z=0.43; p=0.67). In subgroup analysis, mechanic group have a lower risk of post-stroke early onset of seizures (OR=0.59 (95%CI=0.36-0.95); Z=2.18; p<0.05) but showed no significant difference in post-stroke late onset of seizures (OR=0.95 (95%CI= 0.68-1.32); Z=0.32; p=0.75).ConclusionsMT may be associated with a lower risk of post-stroke early onset of seizures, despite MT does not affect the pooled incidence of post-stroke seizures compared with other systematic thrombolytic strategies.     

Geographic variation and sociodemographic characteristics of psychotic disorders in Finland

BACKGROUND: Geographical variation and sociodemographic characteristics may differ in affective and nonaffective psychotic disorders. We examined the geographical variation in the lifetime prevalence of psychotic disorders in a comprehensive general population study. METHOD: A nationally representative sample of 8028 Finns aged 30 or over was screened for psychotic and bipolar I disorders and interviewed with the Structured Clinical Interview for DSM-IV. Best-estimate DSM-IV diagnoses were formed by combining interview and case note data. Nationwide health care register data were used for the nonrespondents. Associations with sociodemographic features, place of birth and residence in urban or rural areas and in five regions, and migration between the regions were examined. RESULTS: Schizophrenia and other nonaffective psychoses, but not affective psychoses, showed prominent regional variation, with highest odds found for schizophrenia among those born in the North (OR 7.72 95%CI 2.48-24.04) and the East (OR 3.99 95%CI 1.22-13.11). The risk of any psychotic disorder was lower for those born in urban areas (OR 0.73 95%CI 0.54-0.98), but no associations were found for separate diagnostic groups. Region of birth was the strongest determinant of geographical variation when both place of birth and residence were accounted for. Selective migration was not found. Education and income were higher and being employed more common in subjects with affective psychosis than in subjects with other psychotic disorders. CONCLUSIONS: Large area variation is more important than urban-rural disparity in psychotic disorders in Finland. Affective psychoses were different from nonaffective psychoses in terms of both regional variation and sociodemographic features.