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E Leinonen

Publications and source records attributed to E Leinonen.

At least 19 recordsLinked to original sources
PubMed2006

RGS4 genotype is not associated with antipsychotic medication response in schizophrenia.

The aims of the present study were to compare the allele frequencies of a common single nucleotide polymorphism located upstream of the regulator of G-protein signaling 4 (RGS4) gene (T > G, Rs 951436) in 219 Finnish patients with schizophrenia and in 389 control subjects, to analyze corresponding frequencies between two different subtypes of 93 schizophrenia patients according to their medication response, and to study the effect of this SNP on age at onset in schizophrenia. The RGS4 (T > G, Rs 951436) genotype was not associated with incidence or age at onset in schizophrenia. Neither was the RGS4 genotype associated with medication response with two different subpopulations with schizophrenia.

Adult↗
PubMed2005

Increased augmentation of central blood pressure is associated with increases in carotid intima-media thickness in type 2 diabetic patients.

AIMS/HYPOTHESIS: Type 2 diabetes is associated with a two- to seven-fold increase in cardiovascular morbidity and mortality. The aim of this study was to determine the relationships between intima-media thickness (IMT), an established marker of atherosclerosis, large artery function and other determinants of cardiovascular risk in type 2 diabetic patients. METHODS: We studied 228 type 2 diabetic patients (75 women, aged 62+/-2 years [mean+/-SEM]). Carotid IMT was bilaterally measured using ultrasound technology. Applanation tonometry and pulse wave analysis were used to measure aortic systolic and diastolic blood pressures, central pressure augmentation (AG) and the augmentation index (AIx), a measure of systemic arterial stiffness. Conventional cardiovascular risk factors (lipids, HbA(1)c, smoking and diabetes duration) were also assessed. RESULTS: Women had higher AG and AIx (p<0.0001), despite comparable systolic BP and heart rate in women and men. In women, AG (r=0.39, p<0.001), age (r=0.32, p<0.01), brachial systolic BP (r=0.34, p<0.01) and aortic systolic BP (r=0.34, p<0.01) correlated with IMT. In men, age (r=0.41, p<0.001), diabetes duration (r=0.25, p<0.01), AG (r=0.22, p<0.01), aortic systolic BP (r=0.21, p<0.01), brachial systolic BP (r=0.21, p<0.01) and body weight (r=0.16, p<0.05) correlated with IMT. In multiple linear regression analyses, AG and aortic systolic BP, but not brachial systolic BP, were age-independent determinants of IMT in men and women. In all patients, increased AG (adjusted for sex, age and heart rate) correlated with longer duration of diabetes, urinary albumin excretion and IMT. CONCLUSIONS/INTERPRETATION: Measures of central systolic pressure correlate with carotid IMT, independently of age and other risk markers.

Aged↗
PubMed2004

Lack of association between two polymorphisms of brain-derived neurotrophic factor and response to typical neuroleptics.

Several studies have connected brain-derived neurotrophic factor (BDNF) with treatment response to neuroleptics. In recent studies, the BDNF expression was reduced by typical neuroleptics. We conducted a retrospective study on 94 patients with schizophrenia and 98 controls. The BDNF G196A and C270T polymorphisms are not associated with treatment response to typical neuroleptics or with age at first hospitalization. Moreover, these polymorphisms of the BDNF gene are not associated with the risk of schizophrenia.

Age of Onset↗
PubMed2003

Four-year outcome in non-compliant schizophrenia patients treated with or without home-based ambulatory outpatient care.

Non-compliance in neuroleptic maintenance treatment is a major concern in schizophrenia. Home-based outpatient care has been shown both to improve medication compliance and reduce relapse frequency. We analysed the need for hospitalisation, levels of functioning and mortality rate during the de-institutionalisation process in 41 schizophrenia patients with repeated hospitalisations and prolonged history of non-compliance. Eighteen of the patients received ambulatory outpatient care (AOC) after discharge. This treatment procedure focuses on enduring neuroleptic maintenance treatment. One of the hospital nurses takes care of home visits every 2-4 weeks. In the 4-year follow-up, half of the patients in the AOC group did not need hospitalisation at all and the number of days of hospitalisation in the whole group diminished by almost four-fifths compared with the previous 4 years. In the non-AOC group, there was a more limited decrease in the number of days of hospitalisation during the corresponding follow-up period. The mortality rates showed a slight tendency towards a better outcome in the AOC group. There was no change in the levels of functioning in the AOC group. This treatment can be carried out with limited resources. It clearly reduces the need for hospitalisation in a subgroup of schizophrenia patients having problems with compliance and recurrent relapse. The effectiveness of AOC on the mortality rates of schizophrenia patients needs further examination.

Adult↗
PubMed2001

The comparison of burden between caregiving spouses of depressive and demented patients.

BACKGROUND: The opportunities for a depressive or demented elderly patient to live at home are dependent on the availability of support. If the spouse is alive, her or his resources to care for the patient are an essential option. In this study we compared the burden of the spouses of depressive and demented elderly patients admitted to the University Psychogeriatric Clinic. METHODS: The Zarit Burden Interview was used when comparing the burden between the groups. Psychological distress was screened by the 12-item General Health Questionnaire. The care and support given by the spouse was assessed by Involvement Evaluation Questionnaire. The spouse's stress related to the health state of the patient was evaluated by the Pearlin Caregiving Stress Inventory. Twenty-two spouses living with a depressive patient and 43 with a demented patient were included in the study. RESULTS: The spouses of demented patients as a group were psychologically more stressed than the spouses of depressive patients. However, when demented patients were divided into two groups, in those admitted mainly for noncognitive symptoms related to dementia and in those admitted for memory assessment and diagnostic purposes, the burden of the spouses in the former group was higher than that of the group of depressive patients' spouses. No difference was found between the latter group of demented patient spouses and depressive patients' spouses. Both the patients and the spouses in the demented group were older than those in the depressive group. However, no correlation was found between stress of the spouse and her or his own age or the age of the patient either within the depressive or within the demented group. As expected, the function level of demented patients was lower than that of depressive patients. A correlation was found within both groups between low functional capacity of the patient and the stress of the spouse. In both groups the spouses who felt their own mental health to be poor were more likely to have high levels of burden. CONCLUSIONS: Among the general psychogeriatric patient groups, the caregiving spouses of demented patients with noncognitive psychiatric symptoms are the most burdened group. However, spouses of depressive patients are as much burdened as those of demented patients with mild to moderate memory impairment. More support is needed for every spouse group caring for psychogeriatric patients.

Aged↗
PubMed2001

Leptin concentrations are elevated in newborn infants of diabetic mothers.

BACKGROUND: Infants of diabetic mothers have been characterized by macrosomia due to hyperinsulinism. A relation has been observed between circulating levels of leptin and the intrauterine growth pattern. METHODS: We studied the leptin and insulin concentrations in the cord blood of 29 newborn infants of mothers with type 1 diabetes (iT1DM), 70 newborn infants of mothers with gestational diabetes and 105 newborn infants of nondiabetic mothers. RESULTS: There were significant differences (p < 0.001) between the 3 groups with the highest leptin levels 24.9 microg/l (range 1.7-94.1) in infants of mothers with iT1DM and the second-highest levels 14.0 microg/l (range 2.6-74.9) in infants of mothers with gestational diabetes (iGDM), whereas the control infants had the lowest leptin levels 10.0 microg/l (range 0.10-45.9). Girls had higher leptin concentrations than boys among the iT1DM and control infants. The insulin concentrations were 18.1 mU/l (range 1.9-123.3), 6.1 mU/l (range 1.1-51.4) and 3.6 mU/l (range 0.5-21.5) in the 3 groups (p < 0.001), respectively. A significant correlation was observed between leptin and insulin concentrations in iGDM and control infants (r = 0.51; p < 0.001 and r = 0.25; p < 0.05). Both absolute and relative birth weights correlated with leptin levels in all 3 groups (r = 0.60, p = 0.01 and r = 0.51, p = 0.05 in iT1DM; r = 0.51 and 0.56, p < 0.001 in iGDM and r = 0.42 and 0.59, p < 0.001 in control infants). CONCLUSION: Our results confirm the relation between leptin concentrations and birth weight. They also suggest that leptin may be involved in the increased accumulation of adipose tissue characteristic of infants of diabetic mothers.

Diabetes Mellitus, Type 1↗
PubMed2000

Attitudes towards neuroleptic treatment: reliability and validity of the attitudes towards neuroleptic treatment (ANT) questionnaire.

Non-compliance problems may rise to 50% among patients undergoing neuroleptic treatment. There are no direct measures available to predict compliance, if previous non-compliance is not taken into account. Attitudes towards neuroleptic treatment and insight into psychotic symptoms may vary during the course of the treatment process. It would be relevant to evaluate these items before taking any clinical action and later reassess the degree of change. The instrument thus far available has been the Drug Attitude Inventory. It has limitations for use with first-episode-patients and their follow-up. Its statements are dichotomous, which makes it difficult to determine the variation of attitudes e.g. during maintenance treatment, and most of the items concentrate on the subjective state of the patient, leaving attitudes as a minority in the scale. In this study, we report the new Attitudes towards Neuroleptic Treatment (ANT) questionnaire for the quantitative assessment of attitudes. We developed 10 statements for attitudes and two items for insight in the Visual Analogue Scale form (0-100 points). These were compared with the Drug Attitude Inventory 10 Questionnaire (DAI-10) (Hogan, T. P., Awad, A.G., Eastwood, R., 1983. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol. Med. 13, 177-183.) among 106 subjects receiving neuroleptic medication. The 12 Visual Analogue Scales showed a high inter-item consistency and fair test-retest validity. The results were in accordance with the DAI-10. The scales comprised three factors: general attitudes, subjective feeling and expectations and insight. Attitudes towards neuroleptic treatment and insight into psychotic symptoms are different dimensions and can be measured quantitatively. The Attitudes towards Neuroleptic Treatment scale is useful in assessing the state of attitudes before starting medication and for follow-up among patients receiving neuroleptic medication.

Adolescent↗
PubMed2000

Neuroleptic malignant syndrome during olanzapine and levomepromazine treatment.

OBJECTIVE: To date only five reports of neuroleptic malignant syndrome (NMS) related to olanzapine exist. The first case report was published in November 1998. METHOD: We report the case of a 78-year-old woman suffering from chronic schizophrenia who developed a NMS while being treated with olanzapine and levomepromazine. Before this her medication had been unchanged for more than 2 years. RESULTS: When treated with olanzapine and levomepromazine, the patient had a fulminant NMS which was complicated with pneumonia. When the neuroleptic drug treatment was discontinued, the patient recovered. However, when this combination was restarted later due to severe agitation and hallucinations, the symptoms of NMS reappeared. CONCLUSION: This case report shows that the neuroleptic malignant syndrome can occur during olanzapine treatment as well as during treatment with conventional neuroleptics. This syndrome may develop even after a long and stable neuroleptic treatment.

Aged↗
PubMed2000

Citalopram controls phobic symptoms in patients with panic disorder: randomized controlled trial.

OBJECTIVE: To examine the effects of long-term treatment with citalopram or clomipramine on subjective phobic symptoms in patients with panic disorder. DESIGN: Double-blind, parallel-group, five-arm study. PATIENTS: Patients aged 18 to 65 years with panic disorder (DMS-III-R diagnosis) and with no major depressive symptoms. INTERVENTIONS: Four hundred and seventy-five patients were randomized to 8 weeks of treatment with either citalopram (10 to 15 mg per day; 20 to 30 mg per day; or 40 to 60 mg per day), clomipramine (60 to 90 mg per day) or placebo. Two hundred and seventy-nine patients continued treatment after the 8-week acute phase. OUTCOME MEASURES: Phobic symptoms were assessed using the Phobia Scale and the Symptom Checklist's (SCL-90) phobia-related factors. RESULTS: At all dosages, citalopram was more efficacious than placebo, with 20 to 30 mg generally being the most effective dosage. Citalopram (20 to 30 mg) generally decreased phobic symptoms significantly more than placebo after Month 3. Interpersonal sensitivity decreased when measured on the respective SCL-90 sub-scale. Alleviation of phobic symptoms generally continued to increase towards the end of the treatment. The effect of clomipramine was not as consistent. CONCLUSIONS: All active treatment groups, especially the group receiving 20 to 30 mg per day of citalopram, effectively controlled phobic symptoms in patients with panic disorder. Long-term treatment with citalopram further decreased phobic symptoms.

Adolescent↗
PubMed1999

Efficacy and tolerability of mirtazapine versus citalopram: a double-blind, randomized study in patients with major depressive disorder. Nordic Antidepressant Study Group.

We aimed to compare the antidepressant and anxiolytic effects, tolerability and effects on quality of life of mirtazapine and citalopram in a randomized, double-blind, multicentre, 8-week study. Patients with a Major Depressive Episode (DSM-IV) and a baseline score of > or = 22 on the Montgomery-Asberg Depression Rating Scale (MADRS) were randomized to 8 weeks treatment with either mirtazapine (n = 137, 15-60 mg/day) or citalopram (n = 133, 20-60 mg/day). Efficacy was evaluated by the MADRS, Hamilton Anxiety Scale (HAM-A), Clinical Global Impression scales (CGI), the Leeds Sleep Evaluation Questionnaire (LSEQ) and Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ). The efficacy analyses were performed on the Intent-To-Treat Group using the Last Observation Carried Forward method. Vital signs and laboratory variables are measured and adverse events recorded at each weekly visit. The magnitude of reduction from baseline in group mean MADRS scores was large in both groups, reaching after 8 weeks of treatment mean scores of 9.1 in the mirtazapine group and 8.9 in the citalopram group. Both treatments also resulted in a substantial improvement in anxiety symptoms, sleep disturbances and quality of life, and high percentage of responders. However, at day 14, statistically significantly larger magnitudes of change favouring mirtazapine were present in the group mean MADRS, HAM-A and CGI-Severity of illness and Quality of life scores. A difference of 2.3 points on MADRS favouring mirtazapine is considered indicative for a clinically relevant superiority between two proven antidepressants. Mirtazapine treatment was also related to faster improvement of sleep, quality of sleep and improved alertness following awakening, as shown by statistically significant differences on the self-rating LSEQ at various time points. There were no differences between two treatment groups on self-rating QLSEQ. Both drugs were well tolerated, with a low number of patients in either group prematurely terminating the study due to adverse events (mirtazapine: 3.6%, citalopram, 3.0%). Sweating and nausea were statistically significantly more frequent in the citalopram group and increased appetite and complaints of weight increase in the mirtazapine group. There were no clinically relevant changes in laboratory parameters and vital sign variables with either treatment, except for clinically relevant increase in body weight, occurring more frequently in mirtazapine patients. In this study, mirtazapine and citalopram were equally effective in reducing symptoms of depression and anxiety, and well tolerated. However, mirtazapine was significantly more effective than citalopram after 2 weeks of treatment on the MADRS, HAM-A and CGI Severity of illness and Quality of life scales. This finding, consistently present at all major efficacy variables, suggests potentially faster onset of efficacy of mirtazapine over citalopram.

Adult↗
PubMed1997

Delusional parasitosis in the elderly: a review and report of six cases from northern Finland.

A patient with delusional parasitosis has a strong conviction of being infested with parasites: for example, lice or worms. Such a patient is not satisfied with assurances or test results that no parasites are present, but is so convinced that he or she will go as far as to bring the parasites in "matchboxes" to a physician. Subjectively worried, the patient may try to pick the parasites out of the skin, causing cutaneous lesions and even ulcerations. The condition is classified as a delusional/paranoid disorder, somatic type according to DSM-III-R. Not much is known epidemiologically of this rare disorder, which usually affects older women who often are isolated socially. Therapy is regarded as difficult, and a wide variety of treatment methods have been attempted. In this article six female cases are presented, showing that a typical patient is an elderly woman who has suffered losses or is socially isolated. These patients lack deeper psychiatric insight into their problem, so they are mostly in the care of nonpsychiatric physicians. Treatment with a low dose of high-potency neuroleptics combined sometimes with antidepressants appears to be effective. Reducing social isolation is also important.

Aged↗
PubMed1997

Why pragmatic impairment? A case study in the comprehension of inferential meaning.

This paper discusses a case study of Sarah (aged 9;8-10;3) who is reported to have pragmatic difficulties. The focus is on her comprehension of questions, which are asked on the basis of pictures and heard stories. Particular focus is on the pragmatic (or inferential) demands of the input questions and their relationship to the (in)appropriacy of the answer. Data from 16 normally functioning 6- and 8-year-old children are also presented for comparative purposes. The study shows that Sarah has difficulty with questions which require her to go beyond visually presented or verbally stated information. On one set of tasks she was to answer questions on the basis of composite pictures: for some of the questions, the answer was obvious from the picture (descriptive questions) and for others information needed to be inferred beyond the picture (for example, by imagining what had happened before and what is likely to happen next). Sarah's performance was poorer on the inferential questions than the descriptive questions and poorer than the performance of 6- and 8-year-old normally functioning control children. Although the control children also found the inferential questions more difficult than the descriptive questions, this difficulty was not as pronounced as Sarah's. This trend was also apparent in a set of tasks which required the children to answer questions on the basis of verbally told stories. This study suggests that pragmatically impaired children may have difficulty going beyond explicitly presented information and this would manifest as pragmatic production and comprehension problems. In cognitive terms, this may indicate difficulty with the process of inferencing.

Case-Control Studies↗
PubMed1997

Referential communication tasks: performance by normal and pragmatically impaired children.

Two groups of children, a pragmatically impaired (PI) group and a group of language-normal (LN) age-matched peers, were compared by use of a referential communication task. Experimenter and child both played the roles of listener and instructor during the task and, in addition, the experimenter sometimes failed to give adequate information when in the role of instructor. Lexical content and structural complexity were controlled, and it was hypothesised that difficulties for the PI group would arise when in the role of instructor, as a result of failing to specify necessary information in order for the experimenter to respond appropriately. In fact, the main difference between the two groups arose when the experimenter failed to give adequate information to the child; the LN children were quick to realise this and to request clarification, whereas the PI children requested clarification to a lesser extent and appeared less aware of the need to do so. Possible explanations for this pattern of results are explored.

Child↗
PubMed1997

Citalopram in the treatment of obsessive-compulsive disorder: an open pilot study.

Obsessive-compulsive disorder (OCD) is a common anxiety disorder, which often causes significant impairment of the affected individual's social, occupational or interpersonal functioning. Previous reports suggest that the disorder may be treated with the tricyclic antidepressant clomipramine, and also with the more recently introduced selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, fluvoxamine, sertraline and paroxetine. The present 24-week open pilot study was designed to examine the efficacy, appropriate dose range, side-effects and clinical usefulness of citalopram in OCD. A total of 29 OCD patients were included in the study, of whom 76% showed alleviation of symptoms as evaluated by various self- and observer-rated scales, such as the Yale-Brown Obsessive Compulsive Scale. In most cases the citalopram doses used were in most cases 40 or 60 mg daily, and the treatment was well tolerated. The most commonly experienced adverse events during the study were nausea, vomiting, increased dreaming and decreased sleep. Diminished sexual desire and orgasmic dysfunction were also reported. Despite having the limitations of an open study, our results suggest that citalopram may be effective in the treatment of obsessive-compulsive disorder.

Adult↗
PubMed1997

Long-term efficacy and safety of milnacipran compared to clomipramine in patients with major depression.

Milnacipran is a new antidepressive drug, a combined noradrenaline/serotonin (NA/5-HT) reuptake inhibitor, which has been suggested to be as effective as and better tolerated than tricyclic antidepressants. Since long-term studies are lacking, we compared the efficacy, safety and tolerability of milnacipran and clomipramine in a double-blind, randomized, parallel-group study setting during 26 weeks of treatment in patients with major depression. A total of 107 patients were treated with either milnacipran (n=52) or clomipramine (n=55). Due to active treatment of duration less than 12 days in four patients and protocol deviation in one patient, in total 47 milnacipran-treated patients were eligible for efficacy analysis. Nine patients in the clomipramine group continued on active treatment for less than 12 days. Thus 46 clomipramine-treated patients were finally included in the efficacy analysis. After 1 week of dose escalation, there was a fixed dosage regimen of either milnacipran (200 mg daily) or clomipramine (150 mg daily) during weeks 2 to 10, followed by flexible dosing of milnacipran (100, 150 or 200 mg daily) or clomipramine (75, 100 or 150 mg daily) during weeks 11 to 26. A total of 53 patients (49%) completed the 26-week study period; 21% (11/52) of the patients in the milnacipran group and 38% (21/55) of the patients in the clomipramine group discontinued their medication prematurely due to adverse events, whereas 19% (10/52) of those on milnacipran and 7% (4/55) of those on clomipramine treatment withdrew due to either lack of efficacy or clinical deterioration. The mean change (+/-SD) in the Hamilton Depression Rating Scale (HAMD) score between the baseline and the last rating ranged from 23.7+/-3.1 to 12.0+/-9.5 in the milnacipran-treated patients and from 23.1+/-3.5 to 8.0+/-8.5 in the clomipramine-treated patients, revealing a significant difference in favour of clomipramine. In total 58% of the milnacipran-treated patients vs. 72% of the clomipramine-treated patients showed a > or = 50% reduction in their baseline HAMD scores and 45% vs. 63% had an HAMD score of < or = 7 at the last rating, respectively. Moreover, the time to the onset of the antidepressant action (defined as > or = 50% reduction of the baseline HAMD score) showed a significant difference in favour of clomipramine. In addition, clomipramine was significantly more efficacious in patients with a baseline HAMD score of > or = 24 as evidenced by the analysis of the HAMD score at week 6 and at the last rating. The Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) scale did not show significant differences between the treatment groups. The safety analysis did not reveal any differences of clinical significance in cardiovascular variables between the study drugs. Dry mouth was significantly less frequently reported by the milnacipran-treated patients during the early and later phases (weeks 6 to 26) of the study, while insomnia was more common in the milnacipran group during weeks 1 to 6. In conclusion, milnacipran appeared to be less effective than clomipramine in the long-term treatment of depression. The side-effects of the drugs differed to a certain extent, and milnacipran tended to be somewhat better tolerated than clomipramine.

Adolescent↗