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IntroductionDepression, anxiety and lack of impulse control are common neuropsychiatric symptoms in neurocognitive disorders and have been strongly associated with suicidality.ObjectivesThe aim of this study was to explore suicide rates in three major neuropsychiatric conditions including various degenerative neurocognitive disorders (DND), alcohol related neurocognitive disorders (ARND), and traumatic brain injuries (TBI).MethodsThe register cohort data of 231 817 patients with a diagnosis of degenerative dementias, ARND, or TBI, and their mortality data were collected from Finnish nationwide registers between 1998 and 2018. We calculated incidences of suicides, types of suicides, and suicide rates compared with the age- and sex matched general population (Standardized Mortality Ratio, SMR).ResultsIn fifteen years since diagnosis, 0.3% (95% CI: 0.2 to 0.5) of patients with DND, 1.1% (0.7 to 1.8) of patients with ARND, and 1.0% (0.7 to 1.3) of patients with TBI died from suicide (Figure). Men died from suicide more often than women [58.9 (51.3 to 67.4) vs. 9.8 (7.5 to 12.5) per 100 000 person-years]. Of all three groups of patients, the highest number of suicides per 100 000 was in ARND (98.8; 65.1 to 143.8), then in TBI (82.0; 62.4 to 105.8), and then in DND (21.2; 18.3 to 24.5). The most common cause of death per 100 000 person-years was self-inflicted injury by hanging, strangulation or suffocation and drowning (12.4, 10.3 to 14.8), the second highest incidence self-inflicted poisoning (5.7, 4.3 to 7.4), and then self-inflicted injury by firearms, explosives, smoke, fire, flames, steam, hot vapours or hot objects (4.7, 3.4 to 6.2). The SMRs (95% CI) in the DND group were 1.31 (1.13 to 1.51) for the whole group, 1.21 (0.90-1.62) for women, and 1.34 (1.14-1.58) for men. The SMRs in the ARND group were 3.69 (2.53-5.38), 5.05 (1.90 to 13.46), and 3.52 (2.34 to 5.30), and in the TBI group 2.99 (2.31 to 3.86), 5.68 (3.22 to 10.00), and 2.66 (2.00 to 3.55), respectively.Image:ConclusionsSuicide rates were higher in all three patient groups compared with the same-aged general population. Risk for death from suicide remained elevated for more than ten years after the initial diagnosis. Men committed more suicides than women, but there was no difference between sexes in comparison with the age-matched general population. The suicide methods were mostly violent.Disclosure of InterestT. Talaslahti Grant / Research support from: Helsinki University Hospital, grant no 212 9003, M. Ginters: None Declared, H. Kautiainen: None Declared, R. Vataja: None Declared, A. Palm: None Declared, H. Elonheimo: None Declared, J. Suvisaari: None Declared, H. Koponen: None Declared, N. Lindberg: None Declared

IntroductionOff-label use of antipsychotics has increased in many countries. In adult populations antipsychotics off-label prescriptions varied from 40 to 75% of all AP users.ObjectivesTo examine the off-label prescribing practices and experiences of antipsychotic medication in Finland.MethodsAn electronic questionnaire on physicians’ prescription practices of antipsychotics, especially for off-label use, was sent in 2019 for physicians (n=1195) in different health care facilities including primary health care, occupational health care, in- and outpatient mental health services and services for substance abuse. The sample was selected by systematic and convenience sampling covering five university hospital areas in Finland.ResultsIn total, 216 physicians (18% of the target sample) participated in the study, and 94% had prescribed antipsychotics for off-label use. The most common off-label indications were insomnia and anxiety. The most common antipsychotic used was quetiapine. Off-label antipsychotics was not prescribed as a first-choice medication: 99% of the physicians reported that the patients with off-label use have previously had other medications for the corresponding symptoms. In all, 88% of clinicians monitored the patients’ clinical condition, whereas metabolic values were followed more rarely. About 68% of physicians reported more benefit than harm from the antipsychotics off-labeluse.ConclusionsAntipsychotics are often prescribed for off-label use, most commonly for insomnia and anxiety. Most of the physicians see more benefits than harms for the patient in off-label use. There is a need to analyse the long-term benefits and harms of off-label use of antipsychotics and create more detailed treatment algorithms and clinical recommendations for such use.DisclosureNo significant relationships.

Background Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics. Objective The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people. Methods The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity). Results Overall, 11.4 % ( n  = 69) of the study participants were frail and 49.4 % ( n  = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people ( p  < 0.001). In multivariate analyses, frailty was positively associated with analgesic use (odds ratio 2.96; 95 % CI 1.38–6.36). However, frail analgesic users (46.7 %) were more likely to want their physicians to pay greater attention to pain management than robust (23.2 %) analgesic users. The most prevalent analgesic was acetaminophen (paracetamol) among frail (78.7 %) and pre-frail (63.2 %), and NSAIDs among robust (60.4 %) analgesic users. Frail (60.3 %) and pre-frail (58.1 %) participants were more likely to report musculoskeletal pain than robust (44.7 %) participants. Of robust, pre-frail and frail older people 33.0 %, 23.1 % and 4.9 % (respectively) did not use any analgesics to treat their pain. Conclusions Frailty was associated with a higher prevalence of analgesic use. As frail older people may be more susceptible to adverse events, careful selection of analgesics is warranted. Clinicians should pay more attention to pain management to ensure adequate pain relief.

An organic agricultural soil was exposed to freeze–thaw cycles (FTC) using either intact soil cores or cores packed with homogenized soil. The cores were first exposed to two mild FTCs (–1.5 °C/+4 °C) with soil water content being 56–85% of the water-filled pore space (WFPS). Both intact and packed soil cores showed high N2O emissions when the soil was thawing and had high WFPS. The second freeze–thaw cycle induced lower N2O emission than the first. After the mild FTCs, a deep frost (–15 °C) was applied. This greatly increased the N2O emissions when the soil was thawing. Freezing–thawing had a smaller effect on CO2 than on N2O release. The results show that both soil moisture and the severity of frost modify the N2O burst after thawing, and N2O release (denitrification) was favoured more by FTC than heterotrophic microbial activity (CO2 production) in general. The possible reason for this difference is discussed.

Background Depression is a sizeable problem in rheumatoid arthritis (RA) but data on the antidepressant use is sparse. Objectives To investigate antidepressant initiations and the prevalence of antidepressant use among persons with recent-onset RA. Methods Persons (age ≥50) with incident RA (n=10356) during the years 2000-2007 were identified and data on their antidepressant purchases and comorbid conditions were obtained from the National Registers of Social Insurance Institution of Finland. Participants were categorized as former (antidepressant purchase during the year preceding RA diagnosis), new (first purchase after RA diagnosis) or non-users (no purchases during the study period) of antidepressants. Results Ten percent of participants (n=1034) were former users of antidepressants, and 9.4% (n=975) initiated the use after RA diagnosis. Cumulative incidence of antidepressant initiations among men was 4.8% (95% CI: 4.1 to 5.6) at two years after RA diagnosis and 11.4% (95% CI: 10.0 to 12.9) at the end of follow-up (mean: 4.4 years). For women, corresponding incidences were 7.1% (95% CI: 6.5 to 7.8) and 16.2% (95% CI: 14.9 to 17.5). Rate of antidepressant initiations was higher in women [HR 1.39 (95% CI: 1.21 to 1.60)]. The number of comorbidities before RA was linearly associated with antidepressant initiations (p<0.001). The prevalence of antidepressant use among study participants was 11.3% (95% CI: 10.6 to 12.0) in the last follow-up year. Conclusions Antidepressant initiations were relatively frequent after RA diagnosis and significantly associated with comorbidity burden. This warrants the importance of psychological evaluation in early RA, especially among persons with several comorbidities. Disclosure of Interest None Declared

Background Co-existing diseases increase the burden caused by inflammatory rheumatic diseases (IRDs). Comorbidities may be associated with IRD-related factors or are independent. Objectives To examine the occurrence of comorbidities among incident patients with several IRDs. Methods Finland has a general sickness insurance covering the entire population. Patients with certain chronic diseases (e.g., chronic cardiac and pulmonary diseases, inflammatory bowel disease, IRDs, etc.) are entitled to special reimbursement of medications if their condition meets defined criteria. These patients are recorded in the national registry of the Social Insurance Institution. This registry was used to identify all incident cases of IRDs between 1 Jan 2000 and 31 Dec 2007. Data on their possible co-existing chronic diseases at the time of diagnosis were gathered from the same source. Results During the 8-year period, 25 994 incident patients over 16 years of age with IRDs were identified. Of them, 14 878 (57%) had rheumatoid arthritis (RA) (63% RF-positive, 68% female), 3686 (44% female) spondylarthropathy (ICD 10-codes M45 and M46, SpA), 2942 (48% female) psoriatic arthritis (PsA), 802 (55% female) chronic reactive arthritis (ReA), and 3610 (65% female) chronic undifferentiated arthritis (UA). Table shows occurrence per cent of principal groups of co-existing diseases at the time of diagnosis of these rheumatic conditions. Conclusions Occurrence of comorbidities differs markedly between various IRDs at the time of diagnosis. Disclosure of Interest None Declared

Citalopram is a serotonin reuptake inhibitor which has been demonstrated to be highly selective and with a superior tolerability profile to the classical tricyclic antidepressants. This study was designed to test whether there was any difference in efficacy in the management of panic disorder (PD) between citalopram and placebo. This was a double-blind, placebo and clomipramine controlled, parallel group eight-week study. A total of 475 patients with PD, with or without agoraphobia, were randomised to treatment with either placebo, clomipramine 60 or 90 mg/day, or citalopram 10 or 15 mg/day, or 20 or 30 mg/day, or 40 or 60 mg/day. Doses were increased over the first three weeks, stabilised during the fourth week and fixed between weeks five and eight. Treatment with citalopram at 20 or 30 mg, 40 or 60 mg and clomipramine were significantly superior to placebo, judged by the number of patients free of panic attacks in the week prior to the final assessment. All rating scales examined suggested that citalopram 20 or 30 mg was more effective than citalopram 40 or 60 mg. The most advantageous benefit/risk ratio for the treatment of PD was associated with citalopram 20 or 30 mg/day.

Objective To evaluate whether there is an association between maternal mental health, purchase of psychotropic drugs, socioeconomic status and major congenital anomalies in offspring. Methods A register-based cohort study of 6189 Finnish primiparous women who had a singleton delivery between 2009 and 2015. Data on pregnancy and delivery outcomes, psychiatric diagnosis, prescription drug purchases and offspring congenital anomalies were obtained from Finnish national registers. Results Severe depressive disorders were diagnosed in 2.0% of women and severe anxiety disorders in 1.1%. During pregnancy, 9.6% of women purchased psychotropic drugs. Of these women, 5.7% delivered an offspring with a major congenital anomaly. Women who purchased psychotropic drugs in pregnancy had an increased risk of delivering a child with major congenital anomalies compared with women who did not purchase psychotropic drugs. Multivariate regression analysis showed that purchase of benzodiazepines increased the risk of major congenital anomalies (odds ratio 2.11 [95% confidence interval 1.17 to 3.81]). Pregnant women purchasing psychotropic drugs more often lived alone and smoked, had higher body mass index, and had lower annual income and educational attainment than women not purchasing psychotropic drugs. Conclusions Benzodiazepine use, but not socioeconomic status, may be associated with major congenital abnormalities in offspring.

Residential wood combustion (RWC) emits large amounts of gaseous and particulate organic aerosol (OA). In the atmosphere, the emission is transformed via oxidative reactions, which are under daylight conditions driven mainly by hydroxyl radicals (OH). This continuing oxidative ageing produces secondary OA and may change the health- and climate-related properties of the emission. However, it is not well known how the composition of RWC-originated OA changes as the function of OH exposure. In this work, emissions from two modern residential logwood combustion appliances were photochemically aged in an oxidation flow reactor (OFR) with various OH exposure levels, reaching up to 6×1011 s cm−3 (equivalent to 1 week in the atmosphere). Gaseous organic compounds were analysed by proton transfer reaction time-of-flight mass spectrometry (PTR-ToF-MS), while particulate OA was analysed online by a high-resolution soot particle aerosol mass spectrometer (SP-HR-ToF-AMS) and offline by in situ derivatization thermal desorption–gas chromatography–time-of-flight mass spectrometry (IDTD-GC-ToF-MS). Photochemical reactions increased the mass of particulate organic carbon by a factor of 1.3–3.9. The increase in mass took place during the first atmospheric equivalent day of ageing, after which the enhancement was independent of the extent of photochemical exposure. However, ageing increased the oxidation state of the particulate OA linearly throughout the assessed range, with ΔH:C/ΔO:C slopes between −0.17 and −0.49 in van Krevelen space. Ageing led to an increase in acidic fragmentation products in both phases, as measured by the IDTD-GC-ToF-MS for the particulate and PTR-ToF-MS for the gaseous phase. For the gaseous organic compounds, the formation of small carbonylic compounds combined with the rapid degradation of primary volatile organic compounds such as aromatic compounds led to a continuous increase in both the O : C and H : C ratios. Overall, the share of polycyclic aromatic compounds (PACs) in particles degraded rapidly during ageing, although some oxygen-substituted PACs, most notably naphthaldehydic acid, increased, in particular during relatively short exposures. Similarly, the concentrations of particulate nitrophenols rose extensively during the first atmospheric equivalent day. During continuous photochemical ageing, the dominant transformation mechanisms shifted from the initial gas-phase functionalization/condensation to the transformation of the particulate OA by further oxidation reactions and fragmentation. The observed continuous transformation of OA composition throughout a broad range of OH exposures indicates that the entire atmospheric lifetime of the emission needs to be explored to fully assess the potential climate and health effects of RWC emissions.

Major depression is highly recurrent. Antidepressant maintenance treatment has proven efficacy against recurrent depression. Comparison of prophylactic efficacy of citalopram versus placebo in unipolar, recurrent depression. Patients 18-65 years of age with recurrent unipolar major depression (DSM-IV), a Montgomery-Asberg Depression Rating Scale score of > or =22 and two or more previous depressive episodes, one within the past 5 years, were treated openly with citalopram (20-60 mg) for 6-9 weeks and, if responding, continued for 16 weeks before being randomised to double-blind maintenance treatment with citalopram or placebo for 48-77 weeks. A total of 427 patients entered acute treatment and 269 were randomised to double-blind treatment. Time to recurrence was longer in patients taking citalopram than in patients taking placebo (P:<0.001). Prophylactic treatment was well tolerated. Citalopram (20, 40 and 60 mg) is effective in the prevention of depressive recurrences. Patients at risk should continue maintenance treatment at the dose necessary to resolve symptoms in the acute treatment phase.