Læknablaðið : fylgirit - 01.08.2003, Blaðsíða 39

ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS I
vance preparations, and the presence of depression which can be
treated medically.
Results: Someone aged 65 completes suicide every 90 minutes in the
United States and this rate will increase once today’s “baby- boom-
ers” reach that age. Although taking one’s life is a unique hunian
trait its ethics continue to be debated and physician assistance re-
mains illegal except in The State of Oregon and Tlie Netherlands.
Presently the University of Pennsylvania’s Center of Bioethics is
sponsoring research to find common grounds of understanding.
Conclusions: If the right to life can be advocated for the unborn
fetus why not recognize the human right to a “good death” once the
end of life’s spectrum is reached?
S-XIV/1 Friday 15/8, 11:00-12:30
What gives hope to schizoprenia sufferers and their
relatives?
Opcning rcmarks Professor Matti Isohanni
S-XIV/2 Friday 15/8,11:00-12:30
Outcome in schizophrenia
Raimo KR Salokangas. Professor of Psychiatry, University of Turku, Dept. of Psychiatry,
Kiinamyllynkatu 4-8,20520, Turku. Finland
raimo. k. r.salonkangas@tyks.fi
Results concerning the outcome of schizophrenia depend on several
methodological and patient-related factors such as definition of
schizophrenia, sampling procedure, instruments used in assessment,
Patient’s treatment compliance, and the natural course of the illness.
The outcome of patients with a broad definition of schizophrenia is
better than that of the patients with a narrow definition. During the
1900s, the outcome of schizophrenia improved, possibly because of
development of treatment methods and decreased stigma. Towards
the end of the Iast century, this favourable development seems to
have halted, possibly because of changes in classification of mental
disorders and changes in society. It has been suggested that the
outcome of schizophrenia is poorer in developed than in developing
countries, where emotional support from families is stronger and
opportunities to work, despite having disturbances in cognitive
Performance, is better than in developed countries. Acute onset and
affect-loaded symptoms are predictors of a good outcome, while
negative symptoms and disturbances in neurocognitive performance
Predict a poor outcome. Female and married patients usually have a
hetter outcome than male and unmarried patients. Single men
generally have an extensively poor outcome.
s~XIV/3 Friday 15/8,11:00-12:30
Outcome and its predictors in schizophrenia before 35
years of age within the northern Finland 1966 birth
°ohort
Taiiroiun, Medical Student (Bachelor of Medicine), Dept. of Psychiatry, University of
cji'u, pO BOX 5000, FIN-90014, Finland. J Koskinen, J Veijola, J Miettunen, PB Jones,
S Fenton, M Karhu, A Ala-Raisanen, M-R Jiirvelin, M Isohanni.
"aurone@paju.oulu.fi
Background: Although many follow-up studies of schizophrenia
have been reported, very few population-based studies have evalu-
ated the outcome of schizophrenia. Only follow-up of an epidemio-
logical population-based cohort can establish the natural history
and prognosis of schizophrenia.
Aims: We wished to investigate outcomes of schizophrenia before
age 35 years in a longitudinal, population based birth cohort, and to
test prognostic value of some historical variables including peri-
natal risk, gender, age of onset of illness, age of first hospital admis-
sion, educational performance, and genetic risk for mental disorder.
Method: We explored 59 DSM-III-R schizophrenia cases in the
Northern Finland 1966 Birth Cohort by using registers and inter-
views with several measures of outcome: social and occupational
functioning, positive and negative symptoms, occupational status,
psychiatric hospitalizations, and use of neuroleptic medication.
Three categories of outcome were used: good, moderate and poor.
Results: Nine (15%) patients had good outcome, 16 (27%) mode-
rate, and 34 (58%) had poor outcome. When compared to good
outcome, cases having poor outcome had e.g. earlier age of first
psychiatric hospitalization and more often genetic risk.
Conclusions: Too few patients have favourable outcome of schizo-
phrenia in this relatively early onset group. Some predictors for
good and poor outcome can be found.
S - XIV / 4 Friday 15/8, 11:00-12:30
Excess comorbidity, somatic morbidity and mortality in
psychoses - What can be done in clinical practice?
Koponcn HJ, Professor, Department of Psychiatry, University of Oulu, P.O. Box 5000,
FIN-90014 Oulun yliopisto, Finland. Saari K, Lindeman S, Savolainen MJ, Isohanni M.
hannu.koponen@reimari.net
For some schizophrenia patients the weight gain and disturbances in
blood lipid levels and glucose balance are significant disadvantages,
and pose health risks that may affect prognosis. Long-term weight
gain is the most important risk factor for adult onset diabetes. The
metabolic syndrome associated with obesity also involves other
significant risk factors for cardiovascular disease. Consequently,
weight gain can have a negative effect on the prognosis in a patient
on antipsychotic medication. The prognosis is often further adver-
sely affected by other factors prejudicial to health, such as smoking
and poor dietary habits. For instance, in patients with schizophrenia,
significant excess mortality from cardiovascular disease has been
observed. Metabolic changes can also increase risks of neurological
adverse effects, because diabetes has been found to be a risk factor
for abnormal movements and tardive dyskinesia.
A substantial body of evidence suggest that weight gain it is at
least partly related to the blocking effects of antipsychotic medication
on serotonin- and histamine-mediated neurotransmission. Tlie disad-
vantages associated with weight gain can be reduced by an appropri-
ate choice of antipsychotic and avoidance of polypharmacy, by regu-
lar monitoring of the patient's weight, glucose and lipid levels, and, if
necessary, by the patient’s participation in a dieting programme.
Reference
• Koponen H, Saari K, Savolainen M, Isohanni M. Weight gain and glucose and
lipid metabolism disturbances during antipsychotic medication. A review. Eur
Arch Psychiatry Clin Neurosci 2002; 252: 294-8.
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