Previous migrant population studies have shown that immigrants experience high level of psychological load and difficulties in accessing care. This is especially prevalent in those with refugee background. To tackle this issue, the PALOMA2 project (National support system for refugee mental health work and the knowhow dissemination) establishes a National PALOMA Centre of Expertise (PALOMA COE) for mental health work among refugees.

The PALOMA COE consists of all five University Hospital Areas and an NGO representative. The PALOMA COE work is becoming a permanent part of the Finnish health care structure. Each represented region has their own specific strengths and challenges, and the formation of Regional PALOMA COEs is planned accordingly. Together these Regional PALOMA COEs form the National PALOMA COE. Here we dive deeper into the Tampere University Hospital Region’s formation of PALOMA COE.

Psychiatric Clinic for Refugees (PCR) has been working for over 24 years in the Tampere City area. PCR has a long history of PALOMA COE work in forms of clinical work, consulting and training professionals working with refugee mental health. From the beginning of 2021, PCR is integrating with Tampere University Hospital.

As a part of the integration process, the PALOMA COE work has a possibility to expand to the entire University Hospital area and better fulfill the specific needs of the entire region.

The integration will improve the resources, quality and access to mental health care among people with refugee background.

There are lacking prospective studies in general population of adolescents about symptoms predicting the onset of first episode psychosis.

Members (N= 9,215) of the Northern Finland 1986 Birth Cohort, an unselected general population cohort, were invited to participate in a field survey during 2001, at ages of 15-16 years. The study included a 21-item PROD-screen questionnaire screening prodromal symptoms for psychosis for last six months (Heinimaa et al. 2003). PROD-screen included nine questions for positive and five questions for negative features. The Finnish Hospital Discharge Register was used to find out new cases of hospital treated mental disorders during 2002-2005.

Of the subjects 17 (0.3%) were treated due to first episode psychosis and 95 (1.5%) due to non-psychotic disorder during the follow-up period. Positive symptoms did not associate with the onset of psychosis, but negative symptoms did. 94% of subjects who got psychosis reported negative symptoms. Respective figure for those who were treated for non-psychotic disorder was 48%, and for those ‘healthy’ without psychiatric hospital treatment 46% (Fisher's exact test: psychosis vs. healthy p<0.001, psychosis vs. non-psychosis p<0.001, and non-psychosis vs. healthy p=0.61).

This study may be the only one exploring prospectively in general population features predicting onset of first episode psychosis. The findings emphasize the importance of negative symptoms in the development of neuropsychiatric disorder of first episode psychosis (Weinberger 1995).

The Academy of Finland, the Signe and Ane Gyllenberg Foundation, the Sigrid Juselius Foundation and the Thule Institute, Finland.

Subjects with family history of psychosis and with prodromal symptoms are at risk for schizophrenia. The aim was to study whether adolescents with familial risk have more commonly prodromal features.

Members (N= 9,215) of the Northern Finland 1986 Birth Cohort, an unselected general population cohort, were invited to participate in a field survey conducted during 2001-2002. At the ages of 15-16 years, the study included a 21-item PROD-screen questionnaire developed for screening prodromal psychotic symptoms with 12 specific questions for psychosis (Heinimaa et al. 2003). The scale measured symptoms for last six months. The Finnish Hospital Discharge Register was used to find out parental psychoses during 1972-2000.

Of the males 24% and 37% of the females were screen positives for prodromal features at the age of 15-16 years. Of the offspring, 1.8% had parents with psychosis. The prevalence of screen positives was 26% in males and 36% in females with familial risk for psychosis.

Prodromal features of psychosis are prevalent in adolescence. It may be difficult to screen adolescent subjects at risk for developing schizophrenia with a questionnaire in a general population, especially as these symptoms do not appear to be more common among subjects with familial risk.

The Academy of Finland, the National Institute of Mental Health, the Signe and Ane Gyllenberg Foundation and the Thule Institute, Finland.

Schizophrenia is considered to be a neurodevelopmental disorder arising as a result of interactions between genetic vulnerability and environmental risk factors. We studied the association between mothers" antenatal depressed mood and schizophrenia in their adult offspring with special consideration to Familial Risk for psychosis.

In the Northern Finland 1966 Birth Cohort mothers of 12,058 children were asked at mid-gestation at the antenatal clinic if they felt depressed. This general population birth cohort of the children was followed up for over 30 years, being record-linked with the Finnish Hospital Discharge Register (FHDR) for detecting psychosis in the subjects. The FHDR was also used for identifying psychosis in the parents. Familial Risk for psychosis was considered as a genetic risk factor and mothers’ depression as an environmental risk factor.

Offspring with both Familial Risk of psychosis and depressed mother had the highest cumulative incidence of schizophrenia, 7.4% (adjusted OR 10.3; 4.6-23.0). Of the offspring with only psychotic parent without antenatal depression, 2.3% got schizophrenia (OR 2.6; 1.2-5.4). In the offspring without Familial Risk of psychosis and with maternal depression the risk of developing schizophrenia was not elevated.

Mothers’ depressed mood during pregnancy per se is unlikely to increase the risk for schizophrenia in the offspring, but may effect in subjects at risk for psychosis. This finding is an example of a gene x environment interaction in the development of schizophrenia.

This work was supported by grants from the Signe and Ane Gyllenberg Foundation and the Academy of Finland.

There are limited amount of studies comparing time trends of incidence and risk factors of psychosis.

To compare time trends of incidence of psychosis in two population samples.

To study 1) onset age and cumulative incidence of psychoses in two Northern Finland Birth Cohorts (NFBC), 2) changes in type of diagnosis and risk factors.

The NFBC 1966 (N=12,058) and NFBC 1986 (N=9,432) are prospective cohorts of the two provinces of Finland with the live born children followed since pregnancy. The data for psychosis and risk factors were collected from variety of nationwide registers and earlier collected data of the NFBCs. The follow-up time was in both cohorts in average 26.5 years.

Proportion of all psychoses was higher in NFBC 1986 than in the NFBC 1966 (1.81% vs 1.0%). There were more affective psychoses in NFBC 1986 (0.5% vs 0.1%), but incidence of schizophrenia was the same (0.4%) in both cohorts. The age of onset was lower in NFBC 1986 than in NFBC 1966 and majority of this cases were females. Only parental psychosis was a significant risk factor predicting psychosis (Hazard Ratios >3.0) in both cohorts.

In conclusion, two birth cohorts within 20 years covering altogether about 40 years showed changes in terms of incidence, age of onset, and type of psychosis.

Job satisfaction has major impact on mental health and job performance. Expected work satisfaction may influence choice of specialization within medicine.

A postal survey was conducted in 2009 among the members (N=1398) of Finnish Psychiatric Association. Out of these respondents 1132 were still working-aged. All in all 64.8% (N=738) of the working-aged members returned the survey. Only psychiatrists and residents were included in the final cohort of the study (665). Factors associated to work satisfaction were studied and a principal component analysis was conducted on factors reported to disturb working. The correlations of factors scores with job satisfaction and job control were analyzed. Spearman correlation coefficients were calculated between factor scores and work satisfaction.

Most respondents (73.8%) were satisfied with their work. Job satisfaction showed a negative correlation with increase in pace of work (rho= -0.24, p< 0.001). Job control correlated positively with job satisfaction (rho = 0.46, p< 0.001). “Working conditions” factor explained 28.6%, “leadership” 8.8%, “failure without support” 7.8%, fear at work 6.5% and “patient records” factors 5.9% of the variation of perceived harmful factors at work. “Working conditions” and “leadership” factors showed the strongest and most significant negative correlations with job satisfaction (rho = -0.45, p< 0.001, rho= -0.32, p< 0.001, respectively. “Working conditions” associated strongly and significantly with and job control (rho=-0.57, p< 0.001).

Job satisfaction may be better than expected among psychiatrists. However, employers should put emphasis on good fit between person and job to promote well-being of their employees.

Our aim was to investigate how age of achieving early motor developmental milestones differ among subjects with and without a history of parental psychosis and whether parental psychosis may alter the effects of the age of achievement on the risk of schizophrenia.

The study sample comprised 10,307 individuals from the prospective Northern Finland Birth Cohort 1966. A total of 139 (1.3%) cohort members suffered from schizophrenia by the age of 46 years. Out of them 19 (13.7%) had a parent with a history of psychosis, while among the non-psychotic cohort members this figure was 524 (5.2%).

Out of eight different motor milestones investigated, parental psychosis associated (p>0.05) with later learning of holding head up, grabbing object, and walking without support. In the parental psychosis group, significant risk factors for schizophrenia included later learning of holding head up and touching thumb with index finger. In the non-parental psychosis group risk estimates were lower and statistical significant milestones were different i.e. turning over, sitting without support, standing up, standing and walking without support. Interactions between parental psychosis and touching thumb with index finger and walking without support was found.

Although parental psychosis associated with delays in motor milestones in the first year of life, it does not explain the association between late achievement of motor milestones and later risk for schizophrenia

Catatonia is a complication of bipolar disorder, which is a constellation of symptoms such as catalepsy, mutism, and stupor. Standard therapy for catatonia contains benzodiazepines and electroconvulsive therapy. An uncomplicated catatonia is usually a benign condition. On the other hand, malignant catatonia is a life-threatening condition that is complicated with fever, autonomic instability, delirium, and rigidity. The syndrome is typically fulminant and progresses rapidly within a few days without appropriate intervention. Several previous reports suggested that some catatonia are associated with the overstimulation of N-methyl-D-aspartate (NMDA) receptor, and that amantadine may have an effectiveness for catatonia, as a NMDA receptor antagonist. We report a case of successful treatment for malignant catatonia refractory to benzodiazepines, by using amantadine.

A 64-year-old Japanese woman with bipolar disorder was referred to our hospital because of 8-week prolonged fever. On admission, she was in febrile and stuporous states. Severe rigidity was observed in her extremities. Blood tests, lumbar puncture, and blood cultures were all negative. Brain MRI was normal. Consequently, we reached a diagnosis of malignant catatonia, and thus we gave additional benzodiazepines for her catatonic symptoms. However, there was no improvement, and we finally add a 50 mg/day amantadine for her malignant catatonic state.

Her fever resolved in a few days. Gradual dose-titration of amantadine led her clinical manifestation to completely disappeared.

Amantadine can be a potential option as one of the pharmacological therapies for refractory malignant catatonia.

The authors have not supplied their declaration of competing interest.

Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma.

ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure.

ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.

Low IQ is a risk factor for psychosis, but the effect of high IQ is more controversial. The aim was to explore the association of childhood school success with prodromal symptoms in adolescence and psychoses in adulthood.

In the general population-based Northern Finland Birth Cohort 1986 (n = 8 229), we studied the relationship between teacher-assessed learning deficits, special talents and general school success at age 8 years and both prodromal symptoms (PROD-screen) at age 15–16 years and the occurrence of psychoses by age 30 years.

More prodromal symptoms were experienced by those talented in oral presentation [boys: adjusted odds ratio (OR) 1.49; 95% confidence interval 1.14–1.96; girls: 1.23; 1.00–1.52] or drawing (boys: 1.44; 1.10–1.87). Conversely, being talented in athletics decreased the probability of psychotic-like symptoms (boys: OR 0.72; 0.58–0.90). School success below average predicted less prodromal symptoms with boys (OR 0.68; 0.48–0.97), whereas above-average success predicted more prodromal symptoms with girls (OR 1.22; 1.03–1.44). The occurrence of psychoses was not affected. Learning deficits did not associate with prodromal symptoms or psychoses.

Learning deficits in childhood did not increase the risk of prodromal symptoms in adolescence or later psychosis in this large birth cohort. Learning deficits are not always associated with increased risk of psychosis, which might be due to, e.g. special support given in schools. The higher prevalence of prodromal symptoms in talented children may reflect a different kind of relationship of school success with prodromal symptoms compared to full psychoses.

Few studies have compared time trends for the incidence of psychosis. To date, the results have been inconsistent, showing a decline, an increase or no significant change. As far as we know, no studies explored changes in prevalence of early risk factors. The aim of this study was to investigate differences in early risk factors and cumulative incidences of psychosis by type of psychosis in two comparable birth cohorts.

The Northern Finland Birth cohorts (NFBCs) 1966 (N = 12 058) and 1986 (N = 9432) are prospective general population-based cohorts with the children followed since mother's mid-pregnancy. The data for psychoses, i.e. schizophrenia (narrow, spectrum), bipolar disorder with psychotic features, major depressive episode with psychotic features, brief psychosis and other psychoses (ICD 8–10) were collected from nationwide registers including both inpatients and outpatients. The data on early risk factors including sex and place of birth of the offspring, parental age and psychosis, maternal education at birth were prospectively collected from the population registers. The follow-up reached until the age of 27 years.

An increase in the cumulative incidence of all psychoses was seen (1.01% in NFBC 1966 v. 1.90% in NFBC 1986; p < 0.001), which was due to an increase in diagnosed affective and other psychoses. Earlier onset of cases and relatively more psychoses in women were observed in the NFBC 1986. Changes in prevalence of potential early risk factors were identified, but only parental psychosis was a significant predictor in both cohorts (hazard ratios ≥3.0; 95% CI 1.86–4.88). The difference in psychosis incidence was not dependent on changes in prevalence of studied early risk factors.

Surprisingly, increase in the cumulative incidence of psychosis and also changes in the types of psychoses were found between two birth cohorts 20 years apart. The observed differences could be due to real changes in incidence or they can be attributable to changes in diagnostic practices, or to early psychosis detection and treatment.