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      Forensic psychiatry in Finland: an overview of past, present and future

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          Abstract

          Despite a recent contrary trend, Finland has been for decades one of the most violent countries in Western Europe. Also, Finland has had one of the highest number of psychiatric beds per capita in Europe, although this, too, has seen a sharp decline. Against this background, among other national idiosyncrasies, Finland has developed its forensic psychiatric services. Here, we describe the legal, organizational and clinical structure of these services, and outline the historical and current issues that have shaped them. Finally, we consider future challenges facing the Finnish forensic service system, as part of wider European and global trends.

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          Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia

          Jari Tiihonen, Heidi Taipale, Juha Mehtälä … (2019)
          Key Points Question Are there specific antipsychotic combinations that are superior to monotherapies in the maintenance treatment of schizophrenia? Findings This cohort study on 62 250 individuals with schizophrenia with up to 20-year follow-up used within-individual analysis to minimize selection bias and showed that antipsychotic polypharmacy in general was associated with slightly lower risk of psychiatric rehospitalization than monotherapy. Clozapine plus aripiprazole combination was associated with the best outcome, having 14% to 23% lower risk of rehospitalization than clozapine alone, which was the monotherapy associated with the best outcomes. Meaning The findings of this study suggest that certain types of polypharmacy may be associated with fewer rehospitalizations than monotherapies.
          Article 0 comments Cited 90 times – based on 0 reviews     Review now
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            Antipsychotics and mortality in a nationwide cohort of 29,823 patients with schizophrenia

            Erik Jedenius, Juha Mehtälä, Fabian Hoti … (2018)
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              A POPULATION-SPECIFIC HTR2B STOP CODON PREDISPOSES TO SEVERE IMPULSIVITY

              Laura Bevilacqua, Stéphane Doly, Jaakko Kaprio … (2011)
              SUMMARY Impulsivity, describing action without foresight, is an important feature of several psychiatric diseases, suicidality and violent behavior. The complex origins of impulsivity hinder identification of the genes influencing both it and diseases with which it is associated. We performed exon-centric sequencing of impulsive individuals in a founder population, targeting fourteen genes belonging to the serotonin and dopamine domain. A stop codon in HTR2B that is common (MAF >1%) but exclusive to Finns was identified. Expression of the gene in the human brain was assessed, as well as the molecular functionality of the stop codon that was associated with psychiatric diseases marked by impulsivity in both population and family-based analyses. Knockout of Htr2b increased impulsive behaviors in mice, indicative of predictive validity. Our study shows the potential for identifying and tracing effects of rare alleles in complex behavioral phenotypes using founder populations, and suggests a role for HTR2B in impulsivity.
              Article 0 comments Cited 64 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Allan Seppänen: allan.o.seppanen@hus.fi
                Journal
                Journal ID (nlm-ta): Int J Ment Health Syst
                Journal ID (iso-abbrev): Int J Ment Health Syst
                Title: International Journal of Mental Health Systems
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1752-4458
                Publication date (Electronic): 16 April 2020
                Publication date PMC-release: 16 April 2020
                Publication date Collection: 2020
                Volume: 14
                Electronic Location Identifier: 29
                Affiliations
                [1 ]GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Psychoses and Forensic Psychiatry, , Helsinki University Hospital, ; Helsinki, Finland
                [2 ]GRID grid.417253.6, ISNI 0000 0004 0628 2766, Vanha Vaasa Hospital, ; Vaasa, Finland
                [3 ]GRID grid.14758.3f, ISNI 0000 0001 1013 0499, National Institute for Health and Welfare, Forensic Psychiatry, ; Helsinki, Finland
                [4 ]GRID grid.9668.1, ISNI 0000 0001 0726 2490, University of Eastern Finland, ; Kuopio, Finland
                Article
                Publisher ID: 362
                DOI: 10.1186/s13033-020-00362-x
                PMC ID: 7164302
                PubMed ID: 32322299
                SO-VID: 28b2878f-efd1-4ba6-b204-90da8d27e783
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 9 October 2019
                Date accepted : 11 April 2020
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Neurology
                Keywords: forensic psychiatry,finland,forensic assessments
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: forensic psychiatry, finland, forensic assessments

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