Recognition, comorbidity, and outcome of DSM-IV bipolar I and II disorders in psychiatric care

This study is part of an ongoing collaborative bipolar research project, the Jorvi Bipolar Study (JoBS). The JoBS is run by the Department of Mental Health and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital (HUCH), Espoo, Finland. It is a prospective, naturalistic cohort study of secondary level care psychiatric in- and outpatients with a new episode of bipolar disorder (BD). The second report also included 269 major depressive disorder (MDD) patients from the Vantaa Depression Study (VDS). The VDS was carried out in collaboration with the Department of Psychiatry of the Peijas Medical Care District. Using the Mood Disorder Questionnaire (MDQ), all in- and outpatients at the Department of Psychiatry at Jorvi Hospital who currently had a possible new phase of DSM-IV BD were sought. Altogether, 1630 psychiatric patients were screened, and 490 were interviewed using a semistructured interview (SCID-I/P). The patients included in the cohort (n=191) had at intake a current phase of BD. The patients were evaluated at intake and at 6- and 18-month interviews. Based on this study, BD is poorly recognized even in psychiatric settings. Of the BD patients with acute worsening of illness, 39% had never been correctly diagnosed. The classic presentations of BD with hospitalizations, manic episodes, and psychotic symptoms lead clinicians to correct diagnosis of BD I in psychiatric care. Time of follow-up elapsed in psychiatric care, but none of the clinical features, seemed to explain correct diagnosis of BD II, suggesting reliance on cross- sectional presentation of illness. Even though BD II was clearly less often correctly diagnosed than BD I, few other differences between the two types of BD were detected. BD I and II patients appeared to differ little in terms of clinical picture or comorbidity, and the prevalence of psychiatric comorbidity was strongly related to the current illness phase in both types. At the same time, the difference in outcome was clear. BD II patients spent about 40% more time depressed than BD I patients. Patterns of psychiatric comorbidity of BD and MDD differed somewhat qualitatively. Overall, MDD patients were likely to have more anxiety disorders and cluster A personality disorders, and bipolar patients to have more cluster B personality disorders. The adverse consequences of missing or delayed diagnosis are potentially serious. Thus, these findings strongly support the value of screening for BD in psychiatric settings, especially among the major depressive patients. Nevertheless, the diagnosis must be based on a clinical interview and follow-up of mood. Comorbidity, present in 59% of bipolar patients in a current phase, needs concomitant evaluation, follow-up, and treatment. To improve outcome in BD, treatment of bipolar depression is a major challenge for clinicians.

Metrology of gaseous air pollutants

The need for mutual recognition of accurate measurement results made by competent laboratories has been very widely accepted at the international level e.g., at the World Trade Organization. A partial solution to the problem was made by the International Committee for Weights and Measures (CIPM) in setting up the Mutual Recognition Arrangement (CIPM MRA), which was signed by National Metrology Institutes (NMI) around the world. The core idea of the CIPM MRA is to have global arrangements for the mutual acceptance of the calibration certificates of National Metrology Institutes. The CIPM MRA covers all the fields of science and technology for which NMIs have their national standards. The infrastructure for the metrology of the gaseous compounds carbon monoxide (CO), nitrogen monoxide (NO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) has been constructed at the national level at the Finnish Meteorological Institute (FMI). The calibration laboratory at the FMI was constructed for providing calibration services for air quality measurements and to fulfil the requirements of a metrology laboratory. The laboratory successfully participated, with good results, in the first comparison project, which was aimed at defining the state of the art in the preparation and analysis of the gas standards used by European metrology institutes and calibration laboratories in the field of air quality. To confirm the competence of the laboratory, the international external surveillance study was conducted at the laboratory. Based on the evidence, the Centre for Metrology and Accreditation (MIKES) designated the calibration laboratory at the Finnish Meteorological Institute (FMI) as a National Standard Laboratory in the field of air quality. With this designation, the MIKES-FMI Standards Laboratory became a member of CIPM MRA, and Finland was brought into the internationally-accepted forum in the field of gas metrology. The concept of ‘once measured - everywhere accepted’ is the leading theme of the CIPM MRA. The calibration service of the MIKES-FMI Standards Laboratory realizes the SI traceability system for the gas components, and is constructed to enable it to meet the requirements of the European air quality directives. In addition, all the relevant uncertainty sources that influence the measurement results have been evaluated, and the uncertainty budgets for the measurement results have been created.