Browsing by Subject "psykiatria"

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  • Janno, Sven (Helsingin yliopisto, 2006)
    The prevalence and assessment of neuroleptic-induced movement disorders (NIMDs) in a naturalistic schizophrenia population that uses conventional neuroleptics were studied. We recruited 99 chronic schizophrenic institutionalized adult patients from a state nursing home in central Estonia. The total prevalence of NIMDs according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) was 61.6%, and 22.2% had more than one NIMD. We explored the reliability and validity of different instruments for measuring these disorders. First, we compared DSM-IV with the established observer rating scales of Barnes Akathisia Rating Scale (BARS), Simpson-Angus Scale (SAS) (for neuroleptic-induced parkinsonism, NIP) and Abnormal Involuntary Movement Scale (AIMS) (for tardive dyskinesia), all three of which have been used for diagnosing NIMD. We found a good overlap of cases for neuroleptic-induced akathisia (NIA) and tardive dyskinesia (TD) but somewhat poorer overlap for NIP, for which we suggest raising the commonly used threshold value of 0.3 to 0.65. Second, we compared the established observer rating scales with an objective motor measurement, namely controlled rest lower limb activity measured by actometry. Actometry supported the validity of BARS and SAS, but it could not be used alone in this naturalistic population with several co-existing NIMDs. It could not differentiate the disorders from each other. Quantitative actometry may be useful in measuring changes in NIA and NIP severity, in situations where the diagnosis has been made using another method. Third, after the relative failure of quantitative actometry to show diagnostic power in a naturalistic population, we explored descriptive ways of analysing actometric data, and demonstrated diagnostic power pooled NIA and pseudoakathisia (PsA) in our population. A subjective question concerning movement problems was able to discriminate NIA patients from all other subjects. Answers to this question were not selective for other NIMDs. Chronic schizophrenia populations are common worldwide, NIMD affected two-thirds of our study population. Prevention, diagnosis and treatment of NIMDs warrant more attention, especially in countries where typical antipsychotics are frequently used. Our study supported the validity and reliability of DSM-IV diagnostic criteria for NIMD in comparison with established rating scales and actometry. SAS can be used with minor modifications for screening purposes. Controlled rest lower limb actometry was not diagnostically specific in our naturalistic population with several co-morbid NIMDs, but it may be sensitive in measuring changes in NIMDs.
  • Laisi, Salla (Helsingin yliopisto, 2021)
    Asunnottomuus ja mielenterveysongelmat näkyvät arjessa ja vaikuttavat toimimiseen. Asunnottomuus ja mielenterveysongelmat kietoutuvat myös monin tavoin yhteen. Asumispalveluiden ja psykiatrian sosiaalityön toimintaympäristö on moniammatillinen ja monitoimijainen. Asumisen turvaaminen, mielenterveyden tukeminen ja asiakkaan tilanteen tarkasteleminen kokonaisvaltaisesti ovat sosiaalityön lakisääteisiä ja ammattieettisten ohjeiden velvoittamia tehtäviä. Asiakkaan tuen tarpeita ei silti pirstaleisessa järjestelmässä aina tunnisteta, jos tuen tarpeita on monia yhtä aikaa. Tässä tutkielmassa tarkastellaan psykiatrian ja asumispalveluiden sosiaalityöntekijöiden puheessa muovaamia asunnottoman ja mielenterveyskuntoutujan institutionaalisia kategorioita, jotka toimivat asiakkuuden ehtojen määrittäjinä. Lisäksi tarkastellaan asumispalveluiden ja psykiatrian sosiaalityötä asiantuntija-ammattina. Tutkielmassa on kriittisen sosiaalityön näkökulma. Tutkielman aineisto koostuu yhteensä seitsemästä asumispalveluiden ja psykiatrian sosiaalityöntekijän teemahaastattelusta. Aineiston analyysimenetelmänä on teoriaohjaava sisällönanalyysi, jota ohjaavat institutionaalisen kategorian ja poiskäännytyksen käsitteet ja ammattien järjestelmän teoria. Institutionaaliset kategoriat asettavat asunnottomalle ja mielenterveyskuntoutujalle asiakkuuden ehdot, jolloin kategorisoinnit mahdollistavat poiskäännytyksen. Ammattien järjestelmä on institutionaalisten kategorioiden muovaamisen toimintaympäristö asumispalveluiden ja psykiatrian sosiaalityössä. Ammattien järjestelmässä ammatit kiistelevät toimialasta ja sosiaalityö psykiatriassa ja asumispalveluissa osana järjestelmää osallistuu toimialakiistoihin. Analyysin tuloksena aineistosta hahmottuu vaihteleva asumispalveluiden ja psykiatrian sosiaalityön kategorisoinnin käytäntö. Asunnottomalle ja mielenterveyskuntoutujalle on molemmille havaittavissa kaksi samankaltaista institutionaalisen kategorisoinnin tapaa: holistinen kategorisointi ja neoliberaali kategorisointi. Holistinen kategorisointi perustuu sosiaalityön kokonaisvaltaiseen tarkastelutapaan. Holistisiin kategorioihin liittyy laajan moniammatillisen yhteistyön tekeminen ja palveluiden räätälöinti asiakkaalle sopivaksi. Neoliberaaleihin kategorioihin liittyy resurssien puutteeseen keskittyvä argumentointi ja yksilön vastuun korostaminen. Yhteistyön tekeminen muiden tahojen kanssa ei näyttäydy neoliberaaleissa kategorioissa yhtä merkityksellisenä kuin holistisissa kategorioissa. Mielenterveyskuntoutujan neoliberaali kategoria nojaa lääketieteelliseen mielenterveyden tarkastelutapaan, jolloin sosiaalityön näkökulma mielenterveyteen jää pienempään rooliin. Asunnottoman neoliberaalissa kategoriassa asiakkaan tilannetta tarkastellaan palvelulähtöisesti. Neoliberaalit kategoriat määrittävät asunnottomalle ja mielenterveyskuntoutujalle asiakkuuteen ottamisen ja poiskäännyttämisen perusteet. Holistiset kategoriat voivat toimia täydentävinä kategorioina ensisijaisen neoliberaalin kategorisoinnin jälkeen. Holistisissa kategorioissa on mahdollista huomioida yhtäaikaisia palvelutarpeita; neoliberaaleissa kategorioissa yhtäaikaisia palvelutarpeita huomioidaan satunnaisesti. Eri kategorisointien perusteella asiakkaan toimijuuden mahdollisuudet muotoutuvat eri tavoin: holistiset kategorisoinnit antavat enemmän tilaa toimijuudelle kuin neoliberaalit kategorisoinnit. Asumispalveluiden ja psykiatrian sosiaalityö näyttäytyy aineistossa osittain lääketieteelle ja neoliberaalille agendalle alisteisena asiantuntija-ammattina. Sosiaalityön toimialakiista lääketieteen ja neoliberaalin agendan kanssa osoittaa, että sosiaalityöllä ei ole täyttä määrittelyvaltaa toimialaansa. Nykyisessä kroonisessa resurssipulassa sosiaalityö ei voi toimia täysin periaatteidensa mukaisesti niin kauan kuin sosiaalityö ei voi täysin määrittää asiakkuuden ehtoja ja resurssien jakoa.
  • Ahlgrén-Rimpiläinen, Aulikki (Helsingin yliopisto, 2014)
    Aims and background: The purpose of this study was to investigate movement disturbances in schizophrenia and Restless Legs Syndrome (RLS) with the help of Transcranial magnetic stimulation (TMS) and Computerized force platform posturography (CFPP). Motor and postural controls are supported by central regulation of dopamine transmission. Dysregulation of dopamine is considered to be one of the background factors in schizophrenia and RLS. Methods: TMS and intramuscular recording electrodes were applied to study the function of descending motor pathways and the inhibitionary motor control. After stimulation of motor cortex motor evoked potentials, motor conduction time and central silent periods (CSP) were measured in the Abductor digiti minimi (ADM) and Tibialis anterior (TA) muscles. CFPP was used to investigate postural control. Center point of pressure forces (CPPF) and the center point of force velocity (CPFV) were measured during the subject`s stance eyes open and eyes closed on a stable computerized platform. Volunteers with schizophrenia having a long-term antipsychotic medication and volunteers with RLS were compared to healthy controls with these two methods. The CFPP in RLS study was repeated after a single day intervention with a dopaminergic agent. Findings: The function of the corticospinal motor pathways was normal in all subjects. Central inhibition was found to be disrupted into multiple separate CSPs. The number of CSPs was significantly higher in the dominant ADM in subjects with schizophrenia and in subjects with RLS compared to the controls. In subjects with schizophrenia the closing of the eyes had less impact on the CPFV than in controls. Subjects with RLS demonstrated lower sway velocity eyes open compared to controls. Pramipexole intervention balanced the CPFV differences. Conclusions: Motor inhibitory control was different in subjects with RLS and with schizophrenia compared to controls, appearing as repeated suppressions of muscle activity preferably in the dominant ADM. The ability of controlling the upright stance was not impaired per se in schizophrenia or in RLS. It was discovered a defect of visual compensation in schizophrenia, and in turn, a hyper compensatory effect of vision on postural control in RLS. The findings may refer to different feedback mechanisms in the CNS and to a shared subcortical CNS origin involved in the changed inhibitionary motor control and related dopamine dysregulation.
  • Terevnikov, Viacheslav (Helsingin yliopisto, 2013)
    Although a number of add-on treatment strategies have been studied to improve the outcome of antipsychotic-treated chronic schizophrenia, none of them have thus far proved to be conclusively effective. Mirtazapine, an antidepressant with a unique receptor profile, improves the clinical effect of first generation antipsychotics (FGAs), in terms of negative and extrapyramidal symptoms (EPS) in some published studies, when used in conjunction with FGAs. The present study aimed to explore the efficacy of adjunctive mirtazapine on the symptoms of schizophrenia in patients with an insufficient response to different FGA monotherapies at adequate stable dosages. Thirtynine patients who met the DSM-IV-TR criteria for schizophrenia or schizoaffective disorder depressive type, and who were at least moderately ill (as measured by the Clinical Global Impression Scale) despite their FGA treatment, received add-on mirtazapine 30 mg/day (n=20) or placebo (n=19) in a 6-week double-blind randomized controlled trial (RCT). Thirtyseven completers of the double-blind phase were treated in an open-label design with mirtazapine 30 mg/day during an additional 6 weeks. Dosages of current antipsychotics remained unchanged. The Positive and Negative Syndrome Scale (PANSS) total score (primary outcome), as well as secondary outcomes, which included PANSS subscales, Simpson-Angus Scale for Extrapyramidal Side-effects (SAS) and Calgary Depression Scale for Schizophrenia (CDSS) were measured prospectively. Patients underwent a physical examination (weight, vital signs) and a range of laboratory measures that included fasting glucose and total cholesterol. Within group and between group differences were compared on the Modified Intent-to-Treat basis with Last Observations Carried Forward. Correlation analyses and regression analyses were used to measure relationships between clinical and metabolic parameters. In the within group analyses, mirtazapine add-on treatment led to a statistically significant improvement of all measured clinical parameters during the double-blind phase. Improvement in PANSS total scores was as large as 12.5% (p less than 0.001), whereas the improvement in PANSS positive symptoms was 17.2% (p less than 0.001) while the improvement in PANSS negative symptoms was 12.0% (p less than 0.001). SAS scores improved by 9.8% (p=0.017) and CDSS scores improved by 52% (p=0.003). The latter change exhibited a direct correlation with several subscales of PANSS. In the mirtazapine group, the effect size was 1.00 (95%CI 0.34-1.67) on the primary outcome parameter. The between-group difference favoured mirtazapine on PANSS total scores (p=0.004), PANSS positive subscale (p=0.001) and PANSS negative subscale (p=0.001). No significant differences were found in other parameters. Mirtazapine treatment led to an increase in body weight and cholesterol levels, and the latter change was associated with a clinical improvement on all PANSS subscales, where an increase in total cholesterol by 1 mmol/L predicted a reduction on the PANSS total score by 7 points [r=0.85, p=0.001]. 8 During the open-label phase, patients who switched to mirtazapine demonstrated an improvement in PANSS (effect size 0.94 on PANSS total scores), CDSS and SAS scores in a manner similar to their mirtazapine-treated counterparts in the double-blind phase. The incidence of adverse events did not differ between mirtazapine and placebo. These findings indicate that add-on mirtazapine to current FGA treatment is significantly more efficacious in the reduction of positive, negative and depressive symptoms than a placebo add-on. This is the first RCT report of a statistically significant additive antipsychotic effect from an adjunctive antidepressant. Mirtazapine induced changes in body weight and lipid metabolism were similar to those seem with the most effective antipsychotics, and this metabolic effect may even contribute to its clinical efficacy. The main limitation of the study was its small sample size. Thus, larger and longer follow up trials are undoubtedly needed to confirm these results. Further research should also consider combinations of mirtazapine with second generation antipsychotics, and especially comparisons with clozapine.
  • Jylhä, Pekka (Kansanterveyslaitos, 2008)
    This study is part of the Mood Disorders Project conducted by the Department of Mental Health and Alcohol Research, National Public Health Institute, and consists of a general population survey sample and a major depressive disorder (MDD) patient cohort from Vantaa Depression Study (VDS). The general population survey study was conducted in 2003 in the cities of Espoo and Vantaa. The VDS is a collaborative depression research project between the Department of Mental Health and Alcohol Research of the National Public Health Institute and the Department of Psychiatry of the Peijas Medical Care District (PMCD) beginning in 1997. It is a prospective, naturalistic cohort study of 269 secondary-level care psychiatric out- and inpatients with a new episode of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) MDD. In the general population survey study, a total of 900 participants (300 from Espoo, 600 from Vantaa) aged 20 70 years were randomly drawn from the Population Register Centre in Finland. A self-report booklet, including the Eysenck Personality Inventory (EPI), the Temperament and Character Inventory Revised (TCI-R), the Beck Depression Inventory and the Beck Anxiety Inventory was mailed to all subjects. Altogether 441 participants responded (94 returned only the shortened version without TCI-R) and gave their informed consent. VDS involved screening all patients aged 20-60 years (n=806) in the PMCD for a possible new episode of DSM-IV MDD. 542 consenting patients were interviewed with a semi-structured interview (the WHO Schedules for Clinical Assessment in Neuropsychiatry, version 2.0). 269 patients with a current DSM-IV MDD were included in the study and further interviewed with semi-structured interviews to assess all other axis I and II psychiatric diagnoses. Exclusion criteria were DSM-IV bipolar I and II, schizoaffective disorder, schizophrenia or another psychosis, organic and substance-induced mood disorders. In the present study are included those 193 (139 females, 54 males) individuals who could be followed up at both 6 and 18 months, and their depression had remained unipolar. Personality was investigated with the EPI. Personality dimensions associated not only to the symptoms of depression, but also to the symptoms of anxiety among general population and in depressive patients, as well as to comorbid disorders in MDD patients, supporting the dimensional view of depression and anxiety. Among the general population High Harm Avoidance and low Self-Directedness associated moderately, whereas low extraversion and high neuroticism strongly with the depressive and anxiety symptoms. The personality dimensions, especially high Harm Avoidance, low Self-Directedness and high neuroticism were also somewhat predictive of self-reported use of health care services for psychiatric reasons, and lifetime mental disorder. Moreover, high Harm Avoidance associated with a family history of mental disorder. In depressive patients, neuroticism scores were found to decline markedly and extraversion scores to increase somewhat with recovery. The predictive value of the changes in symptoms of depression and anxiety in explaining follow-up neuroticism was about 1/3 of that of baseline neuroticism. In contrast to neuroticism, the scores of extraversion showed no dependence on the symptoms of anxiety, and the change in the symptoms of depression explained only 1/20 of the follow-up extraversion compared with baseline extraversion. No evidence was found of the scar effect during a one-year follow-up period. Finally, even after controlling for symptoms of both depression and anxiety, depressive patients had a somewhat higher level of neuroticism (odds ratio 1.11, p=0.001) and a slightly lower level of extraversion (odds ratio 0.92, p=0.003) than subjects in the general population. Among MDD patients, a positive dose-exposure relationship appeared to exist between neuroticism and prevalence and number of comorbid axis I and II disorders. A negative relationship existed between level of extraversion and prevalence of comorbid social phobia and cluster C personality disorders. Personality dimensions are associated with the symptoms of depression and anxiety. Futhermore these findings support the hypothesis that high neuroticism and somewhat low extraversion might be vulnerability factors for MDD, and that high neuroticism and low extraversion predispose to comorbid axis I and II disorders among patients with MDD.
  • Schoultz, Viveca (2006)
    Undersökningen strävar efter att kartlägga det sociala arbetet vid ett psykiatriskt sjukhus. Forskningspopulationen är 31 döva patienter som för första gången vårdas pa en öppen, akutpsykiatrisk avdelning och som har teckenspråk som sitt första språk. Undersökningens huvudsakliga material är SOS-bladen i patientjournalen, på vilka socialarbetaren dokumenterar sitt arbete. Mötet mellan de döva patienterna och socialarbetaren analyseras med hjälp av sjukvårdsdistriktets statistikprogram för socialarbetare. Metoden som används för att analysera texterna pa SOS-bladen är tematisk kodning. Med hjälp av denna metod skapades en kodapparat som möjliggjorde analys av socialarbetarens texter. I praktiken undersökte forskaren sina egna texter. Eftersom döva patienter inom psykiatrin aldrig tidigare har kartlagts i Finland hade undersökningen också en deskriptiv sida. Undersökningen var aktuell också för att hälsovården idag star på tröskeln till att ta i bruk den elektroniska patientjournalen, vilken möjliggör att hälsovårdspersonal på ett annat sätt kan läsa olika texter som skrivits om patienten. Materialet som används i undersökningen hade skapats som en arbetsprodukt vid aktivt patientarbete vid ett psykiatriskt sjukhus under åren 1996 - 2000 då Dövas Servicestiftelse genom ett projekt strävade efter att utveckla psykiatrisk avdelningsvård för döva vid Lappvikens sjukhus. Socialkonstruktivismen har därför använts som teoretisk bakgrund. Både de döva patienterna och dokumentationen utgjorde fokus för denna undersökning. Frågeställningar var: Vad består det sociala arbetet som gjorts med döva patienter på ett psykiatriskt sjukhus av samt hur socialarbetaren har dokumenterat detta arbete i de döva patienternas journaler? Undersökningen strävade efter att ge svar på den mer specifika frågan: Vilken sorts kunskap skapades om det sociala arbete och om patienterna? Resultaten av undersökningen gav ny information om döva psykiatriska patienterna som inte tidigare existerat i Finland. Socialarbetarens dokumentation på SOS-bladet visade sig vara kort formulerade men var i de fiesta fall mycket djupgående och behandlade komplexa sociala situationer. Overraskande var att socialarbetaren ofta tagit ställning till olika saker och gjort en bedömning. Brister i dokumentationen framkom också, bl.a. var patientens egen syn på olika ärenden inte alltid dokumenterad. Socialarbetaren hade heller inte alltid dokumenterat sitt arbete på SOS-bladet.
  • Sammi, Sonia (Helsingin yliopisto, 2022)
    Suomalaisen väestön päihteiden käyttö on lisääntynyt 1990-luvulta lähtien. Psykoosipotilaiden päihteiden käyttö on yleistä. Päihteiden käyttö on voinut olla psykoosia aiheuttava tekijä ja lisäksi sillä on merkitystä psykoosin hoidon ja ennusteen kannalta. Erityisesti jatkuva käyttö voi johtaa positiivisten oireiden vaikeutumiseen, yhteisvaikutuksiin hoidon kanssa, psykoosin uusiutumiseen, huonompaan hoitomyöntyvyyteen ja huonompaan ennusteeseen. Tässä tutkielmassa tavoitteena on ollut tutkia ensipsykoosiin liittynyttä päihteiden käyttöä. Aineisto ja menetelmät: Aineistona toimi potilasasiakirjoista vuosilta 2016 - 2019 kerätty ensipsykoosipotilaista koostuva potilasaineisto. Aineistosta tutkittiin ensipsykoosiin liittynyttä päihteiden käyttöä, sen selvittämistä, psykoosiin liittynyttä keskimääräistä psykiatrista oireilua ja ensipsykoosin tutkimusprotokollaan kuuluvien tutkimuksien toteutumista potilasjoukossa. Tutkimukset käsittivät erilaisia psykiatrisia oireita ja päihteiden käyttöä mittaavia kyselyitä ja virtsan huumausaineiden tutkimuksia. Lisäksi tutkittiin miten päihdediagnoosi vaikutti potilaan tutkimuksien toteutumiseen ja niiden tuloksiin verrattuna potilaisiin, joilla oli pelkkä psykoosidiagnoosi ilman päihdediagnoosia. Analyyseihin käytettiin SPSS-ohjelmistoa. Tulokset: Tulokset käsittivät aineiston demografisten tekijöiden esittelyn, päihteiden käytön selvittelyn tulokset, ensipsykoosin tutkimuksien toteutumisen ja tulokset koko potilasjoukossa ja sitten päihdediagnoosin saaneilla ja heillä, joilla ei ollut päihdediagnoosia. Kyselyitä ja virtsan huumausaineiden tutkimuksia oli teetetty 23,4 – 58,6 %:lle aineiston potilaista. Yleisimmät päihdelöydökset olivat olleet bentsodiatpsepiinit, kannabis ja amfetamiini. Bentsodiatsepiinilöydökset ovat voineet osin selittyä potilaiden lääkityksellä. Alkoholin riskikulutuksen rajat olivat keskimääräisesti ylittyneet koko potilasjoukolla ja reilusti päihdediagnoosin saaneilla, kuten myös huumeiden ongelmakäytön seulontaraja. Brief psychiatric rating scale:lla mitattu psykiatrinen oireilu oli keskimääräisesti ollut vähäisempää päihdediagnoosin saaneilla kuin pelkän psykoosidiagnoosin saaneilla. Huumeseuloja teetettiin enemmän päihdediagnoosin saaneille potilaille, muiden tutkimuksien toteutuminen ei ollut erityisesti yhteydessä päihdediagnoosin olemassaoloon.
  • Perälä, Jonna (Helsingin yliopisto, 2013)
    Abstract: Schizophrenia and other psychoses are among the most severe mental disorders. There are few general population surveys of psychotic disorders. Most epidemiological studies have focused on schizophrenia and bipolar I disorder, while data of many other specific psychotic disorders are scarce. This study investigated the lifetime prevalence and epidemiological features of different psychotic disorders in the adult Finnish general population. The data were derived from the Health 2000 Study, a comprehensive general population survey of Finnish adults aged 30 years and over (N=8028). In the Psychoses in Finland study, the Health 2000 Study sample was screened for psychotic disorders. Those selected by the screens were invited for a mental health interview. Final best-estimate DSM-IV diagnoses were based on systematic evaluation of the interview and the case note data. The lifetime prevalence 3.5% of psychotic disorders was higher than has been estimated in most recent general population studies. The most common disorder was schizophrenia with lifetime prevalence 1%. Substance-induced psychotic disorders were common among working aged men and psychotic disorder due to general medical condition among women aged 65 years or over. Psychotic disorders were generally associated with socioeconomic disadvantage like being unmarried, pensioned or unemployed; having low income or education level. The highest lifetime prevalence of psychotic disorders was found in northern and eastern parts of Finland. The region of birth was a more important determinant of the risk of psychotic disorders than the region of residence, and most marked in schizophrenia. Alcohol-induced psychotic disorders were common in middle-aged men and associated with high morbidity and mortality. Clinical features of delusional disorder were different from schizophrenia. Disorganized schizophrenia was a schizophrenia subtype associated with poor outcome. With a high lifetime prevalence exceeding 3%, psychotic disorders are a major public health concern. The high and unevenly distributed prevalence should be taken into account when resources are allocated to health care.
  • Björklund, Michaela Ann-Charlotte (2008)
    Föreliggande undersökning kan inrymmas i den forskningstradition, vars syften i forskningshänseende fokuseras till konkretisering och synliggörande av det sociala arbetet. Syftet med min pro gradu-avhandling har varit att lyfta fram det specifika kunnande och den expertis som socialarbetarna inom psykiatriska specialsjukvården innehar och hur denna expertis utkristalliseras sig i ett mångprofessionellt team. Frågeställningen granskas utgående från teman som kunskapskärna och mångprofessionellt samarbete Undersökningen genomfördes som kvalitativa temaintervjuer av fem (5) socialarbetare vid ett (1) sjukhus. Den teoretiska referensramen för avhandlingen har utgjorts av teorier om sakkunskap, profession, multiprofessionellt samarbete samt en kontextuell del, som beskriver den samhälleliga kontexten för socialt arbete. I analysen användes kvalitativ innehållsanalys, där intervjuguidens teman delvis strukturerade analysen. Förutom tematisering kodades materialet utgående från informanternas tal i tre olika huvudkategorier: samhällskontext, kunskapskärna och mångprofessionellt samarbete. Två av dessa huvudkategorier fick tillhörande underkategorier. Huvudkategorin kunskapskärnan fick underkategorin kunskapsutveckling medan mångprofessionellt samarbete fick underkategorierna: gränsdragningar mellan socialarbetarens och de övriga professionernas expertis, spänningar mellan den medicinska och sociala expertisen samt spänningar mellan anstalts och öppen vården. Denna indelning av materialet utgjorde stommen för den empiriska delen av avhandlingen. På basen av undersökningens resultat ser det ut som om förhållanden i samhället påverkar det sociala arbetet som sker inom hälsovården. Förändringar, som t.ex. kraven på ökad effektivitet, har gjort att socialarbetare som arbetar inom psykiatriska specialsjukvården allt mer diskuterar sitt eget arbete, dess innehåll, ställning och betydelse. Det har blivit allt viktigare att också för utomstående och den egna ledningen visa vad detta sociala arbete består av. Synliggörandet av socialarbetet är knutet till stärkandet av socialarbetets position som profession För detta behövs det ett nära förbund mellan systematisk utvärdering, kritisk reflektion, praktiskt arbete och forskning. Det är också viktigt att uppmuntra socialarbetarna till ett undersökande och utvecklande grepp om arbetet samt till kompetenshöjande utbildning och påbyggnadsstudier. På det praktiska socialarbetet ställs allt större krav på en omfattande allmänsakkunskap och å andra sidan på kärn- och specialsakkunskap. Av socialarbetaren krävs mångsidig sakkunskap och behärskande av helheter och sociala kontexter. Arbetet med psykiatrisk specialsjukvård som miljö och medlemskap i ett mångprofessionellt team förutsätter att kärn- och specialsakkunskapen i socialarbete förenar till psykiatriska sjukdomars sociala karaktär ur ett samhälls- och patientperspektivet. Realiserandet av samarbetet i de mångprofessionella teamena varierar beroende på ett flertal olika faktorer, samarbete och gränsöverskridande främjas av ett samarbete med samma aktörer över en längre tidsperiod så samarbetsformerna blir stabil. Det är också i det mångprofessionella samarbetet som socialarbetarens expertis framträder klarast. Socialarbetaren är den enda representanten på avdelningen för sin sektor bland tiotals vårdare och läkare. Upprätthållandet av en stark yrkesidentitet vid sidan av andra starka yrken förutsätter kontinuerligt fortbildning och handledning. Även ömsesidigt stöd av socialarbetar kolleger och yrkesmässig diskussion är synnerligen viktig. De centrala utmaningarna finns i samarbetet med öppen vården, närsektorerna och de anhöriga, framförallt genom att vårdtiderna förkortas, servicestrukturen förändras och patienternas många problem ställer krav på ett fungerande nätverkssamarbete.
  • Viertiö, Satu (Helsingin yliopisto, 2011)
    There is substantial evidence of the decreased functional capacity, especially everyday functioning, of people with psychotic disorder in clinical settings, but little research about it in the general population. The aim of the present study was to provide information on the magnitude of functional capacity problems in persons with psychotic disorder compared with the general population. It estimated the prevalence and severity of limitations in vision, mobility, everyday functioning and quality of life of persons with psychotic disorder in the Finnish population and determined the factors affecting them. This study is based on the Health 2000 Survey, which is a nationally representative survey of 8028 Finns aged 30 and older. The psychotic diagnoses of the participants were assessed in the Psychoses of Finland survey, a substudy of Health 2000. The everyday functioning of people with schizophrenia is studied widely, but one important factor, mobility has been neglected. Persons with schizophrenia and other non-affective psychotic disorders, but not affective psychoses had a significantly increased risk of having both self-reported and test-based mobility limitations as well as weak handgrip strength. Schizophrenia was associated independently with mobility limitations even after controlling for lifestyle-related factors and chronic medical conditions. Another significant factor associated with problems in everyday functioning in participants with schizophrenia was reduced visual acuity. Their vision was examined significantly less often during the five years before the visual acuity measurement than the general population. In general, persons with schizophrenia and other non-affective psychotic disorder had significantly more limitations in everyday functioning, deficits in verbal fluency and in memory than the general population. More severe negative symptoms, depression, older age, verbal memory deficits, worse expressive speech and reduced distance vision were associated with limitations in everyday functioning. Of all the psychotic disorders, schizoaffective disorder was associated with the largest losses of quality of life, and bipolar I disorder with equal or smaller losses than schizophrenia. However, the subjective loss of qualify of life associated with psychotic disorders may be smaller than objective disability, which warrants attention. Depressive symptoms were the most important determinant of poor quality of life in all psychotic disorders. In conclusion, subjects with psychotic disorders need regular somatic health monitoring. Also, health care workers should evaluate the overall quality of life and depression of subjects with psychotic disorders in order to provide them with the basic necessities of life.
  • Järvinen, Suvi (Helsingin yliopisto, 2022)
    Työ koostuu kirjallisuuskatsauksesta ja havainnoivasta tutkimuksesta. Kirjallisuuskatsauksen ensimmäinen osa käsittelee yleisesti depressiota, ja toinen osa ketamiini-infuusiota tämän hoidossa. Havainnoiva tutkimus pohjautuu HUS Psykiatriassa vuosina 2021–2022 kerättyyn potilasaineistoon. Hoitoresistentistä depressiosta kärsivälle 27 tutkittavalle annettiin kolmesti viikon välein ketamiini-infuusio, ja depressio-oireiden kehitystä seurattiin 21 päivän ajan BDI-21 -oirepistemittarin avulla. Tämän perusteella tarkastelin depressio-oireiden, hoitovasteen ja remission osuuksia sekä ajallista kehitystä aineistossa. Lisäksi analysoin ennustavien tekijöiden (sukupuoli, ikä ja diagnoosi) merkitystä suhteessa hoidon tehoon. Osa tutkittavista ei vastannut kaikkina päivinä oirepistekyselyihin, joten jouduin supistamaan analysoitavien päivien osuutta lopullisessa työssä 11 vuorokauteen. BDI-21-pisteiden keskiarvot laskivat toistettujen infuusioiden seurauksena, ja oirelievitys oli voimakkaimmillaan välittömästi hoitojen jälkeen. Ennen 1. infuusiota keskiarvo oli 42,2 (keskihajonta 7,4), ennen 2. infuusiota 39,1 (keskihajonta 8,3) ja ennen 3. infuusiota 36,1 (keskihajonta 9,2). Seuranta-aikana hoitovasteen saavutti kaikkiaan 67 %:a (N = 18) ja remission 11 %:a (N = 3) potilaista. Hoitovasteen ja remission osuudet noudattivat vastaavaa ajallista kehitystä depressio-oireiden kanssa. 1. ja 2. infuusion jälkeen (3. infuusion jälkeen ei tilastollista merkittävyyttä) oirepisteiden muutos säilyi merkittävänä neljän vuorokauden ajan (p = 0.035, p = 0.006). Hoitovasteella ja ajalla oli merkittävä yhteys vain 1. ja 3. infuusion jälkeen (p = 0.014, p = 0.003). Remissiolla tai ennustavilla tekijöillä en todennut tilastollista merkittävyyttä. Kliininen kokonaiskuva vaikuttaisi mielestäni siltä, että ketamiini-infuusion saaneet potilaat hyötyivät hoidosta ainakin lyhytaikaisesti depressio-oireiden lievityksessä. Hoito vaikuttaisi käyttökelpoiselta erityisesti nopeaa oirelievitystä tavoiteltaessa. Tämän tutkimuksen haasteiksi muodostuivat tutkittavien paikoitellen matala vastausosuus ja pieni aineistokoko. Jatkossa uudella menetelmiltään tätä työtä kattavammalla tutkimuksella saatettaisiin vielä saada merkittävää lisätietoa ketamiini-infuusion käytöstä depression hoidossa sekä ennustavien tekijöiden merkityksestä tässä prosessissa.
  • Riihimäki, Kirsi (Helsingin yliopisto, 2014)
    This study is the first naturalistic prospective long-term follow-up with a life-chart among primary care patients with depressive disorders. Patients with lifetime MDD spent 34% of follow-up time in MDEs, 24% in partial and only 42% in full remission. Nine in ten achieved at least partial and two-thirds full remission. Baseline severity of depression and substance use comorbidity predicted time spent in MDEs: a rise in Hamilton Rating Scale for Depression (HAMD) score of ten at baseline predicted 14 months and comorbid substance use disorder 25 months more time in MDEs. One-half of those who achieved partial remission and one-third of those who reached full remission were having at least one recurrence. The recurrences were predicted by personality disorders. The time from remission to recurrence was predicted by generalized anxiety disorder and somatoform disorder. One-tenth of patients attempted suicide one to three times. The incidence rate varied robustly depending on the level of depression, being 0 per 1000 patient-years during full remission, 5.8 during partial remission and 107 during MDEs. Functional and work ability were strongly associated with duration and severity of depression. Patients who belonged to the labour force spent one-third of the follow-up off work due to depression; two-thirds were granted sick leave, and one-tenth a disability pension due to depression. Longer duration of depression, comorbid disorders and having received social assistance predicted dropping out from work. A quarter of patients suffered from concurrent borderline personality disorder (BPD). Comorbid anxiety and substance use disorders were common among them. Concurrent BPD increased the severity and duration of depression, suicidal behaviour, unemployment and economic difficulties. This study revealed often slow and incomplete recovery and a common recurrent course, which needs to be taken into account when developing services. The use of measurement scales is warranted when planning and monitoring treatment. Comorbidity, concurrent substance use disorder, anxiety disorders, somatoform disorder and BPD all need to be taken into account in clinical practice guidelines. Duration of depression appears most decisive for suicide attempts among primary care patients with depression. Efforts should focus on the continuity of care.
  • Holma, Mikael (Helsingin yliopisto, 2010)
    Much of what we know regarding the long-term course and outcome of major depressive disorder (MDD) is based on studies of mostly inpatient tertiary level cohorts and samples predating the era of the current antidepressants and the use of maintenance therapies. In addition, there is a lack of studies investigating the comprehensive significance of comorbid axis I and II disorders on the outcome of MDD. The present study forms a part of the Vantaa Depression Study (VDS), a regionally representative prospective and naturalistic cohort study of 269 secondary-level care psychiatric out- and inpatients (aged 20-59) with a new episode of DSM-IV MDD, and followed-up up to five years (n=182) with a life-chart and semistructured interviews. The aim was to investigate the long-term outcome of MDD and risk factors for poor recovery, recurrences, suicidal attempts and diagnostic switch to bipolar disorder, and the association of a family history of different psychiatric disorders on the outcome. The effects of comorbid disorders together with various other predictors from different domains on the outcome were comprehensively investigated. According to this study, the long-term outcome of MDD appears to be more variable when its outcome is investigated among modern, community-treated, secondary-care outpatients compared to previous mostly inpatient studies. MDD was also highly recurrent in these settings, but the recurrent episodes seemed shorter, and the outcome was unlikely to be uniformly chronic. Higher severity of MDD predicted significantly the number of recurrences and longer time spent ill. In addition, longer episode duration, comorbid dysthymic disorder, cluster C personality disorders and social phobia predicted a worse outcome. The incidence rate of suicide attempts varied robustly de¬pending on the level of depression, being 21-fold during major depressive episodes (MDEs), and 4-fold during partial remission compared to periods of full remission. Although a history of previous attempts and poor social support also indicated risk, time spent depressed was the central factor determining overall long-term risk. Switch to bipolar disorder occurred mainly to type II, earlier to type I, and more gradually over time to type II. Higher severity of MDD, comorbid social phobia, obsessive compulsive disorder, and cluster B personality disorder features predicted the diagnostic switch. The majority of patients were also likely to have positive family histories not exclusively of mood, but also of other mental disorders. Having a positive family history of severe mental disorders was likely to be clinically associated with a significantly more adverse outcome.
  • Levy, Päivi (2007)
    Tutkimukseni tarkoituksena oli selvittää seurantatutkimuksen avulla nuorten tilanteen etenemistä aikaisemman vuoden 2001 lastensuojelunuorten psykiatrisen tuen kartoituksen jälkeen. Tavoitteenani oli tutkia nuorten selviytymistä arjessa suhteessa heidän elämänhallintaansa ja itsenäistymiseensä. Kiinnostuksen kohteenani oli nuorten tämän hetkinen elämäntilanne liittyen asumiseen, koulutukseen, työssäkäyntiin ja ihmissuhteisiin. Lisäksi halusin tietää nuorten tarvitsemasta psykiat-risesta tuesta, vapaa-ajan vietosta, päihteidenkäytöstä ja rikoksista. Tarkoituksena oli saada yleinen kuva siitä, minkälaista elämää nuoret ovat eläneet viiden vuoden aikana. Tutkimusaineistossani on viisi nuorta naista, jotka ovat iältään 19-24-vuotiaita. Aikaisemmassa vuoden 2001 kartoituksessa nuoria oli yhteensä 10, mutta vain viisi heistä suostui tähän tutkimukseen haastateltaviksi. Tutkimusmenetelmänä olen käyttänyt teemahaastattelua etukäteen mietittyjen teemojen mukaisesti. Aineiston analyysiä tein teemoittelun avulla poimimalla aineistosta teemoja, jotka myötäilivät haastattelurungon teema-alueita. Keskeisimpien teemojen mukaan muodostui viitekehykseksi nuoruusikä, syrjäytymisen riskit, elämänhallinta ja selviytyminen. Huolimatta vaikeista kasvuolosuhteista ja elämäntilanteista lapsuudessa ja varhaisnuoruudessa tutkimuksen nuoret olivat selviytyneet hyvin elämässään tähän asti. Viisi vuotta aiemmin kaikilla nuorilla oli riskitekijöitä, jotka ilmenivät jaksamattomuutena, tulevaisuuden suhteen näköalattomuutena ja syrjäytymisen uhkana. Kaikilla nuorilla oli koulunkäyntiin liittyviä vaikeuksia sekä masennusta. Nuorten perhetaustat olivat rikkonaiset ja useimpien nuorten vanhemmilla oli ollut psyykkistä oireilua. Tutkimuksen tulokset vahvistavat käsitystä suojaavien tekijöiden tärkeydestä riskialttiissa kasvuympäristössä elävillä lapsilla ja nuorilla. Haastatteluhetkellä yhtä lukuun ottamatta kaikki nuoret olivat saaneet peruskoulun suoritetuksi ja olivat aloittaneet ammattiopinnot. Vaikeista elämäntilanteista huolimatta nuoret suhtautuivat itseensä ja tulevaisuuden mahdollisuuksiinsa myönteisesti. Vaikka nuorten taustalla oli ollut eri ikävaiheissa tärkeiden ihmisten hylkäämisiä ja menetyksiä, niin lähes kaikilta löytyi tutkimushetkellä läheisiä ihmisiä, joilta he kokivat saaneensa tukea. Myös yksilölliset kyvyt ja ominaisuudet olivat vaikuttaneet suojaavasti. Yhtenä suojaavana tekijänä on ollut myös psykiatrisen tuen saaminen. Terapia ja lyhytaikaisetkin hoitokontaktit ovat tukeneet nuorten selviytymistä ja arjenhallintaa, vaikka nuorempana tuen hyötyä oli ollut vaikea nähdä. Koulunkäynnin tukeminen erityisjärjestelyin, lastensuojelun tukitoimet ja nuorisopsykiatrian hoitokontaktit ovat olleet interventioita, jotka ovat auttaneet nuoria eteenpäin elämässä. Tutkimuksen myötä on vahvistunut näkökulma siitä, että eri viranomaisten yhteistyöllä on oleellinen merkitys nuorten asioiden hoidossa. Ennalta ehkäisevän työn merkitys korostuu lastensuojelussa ja nuorisopsykiatriassa tehtävässä työssä.
  • Markkula, Niina (Helsingin yliopisto, 2016)
    Depressive disorders are a major public health concern worldwide due to their pervasiveness, often chronic or recurrent course and serious adverse outcomes. These include psychosocial disability, reduced quality of life, physical health problems and increased mortality. This study examined prevalence, predictors and different adverse outcomes of depressive disorders (major depressive disorder and dysthymia) in a general population setting. Specifically, the study aimed to establish the prevalence of depressive disorders in Finland in 2011 and assess possible changes over the past decade; to examine risk factors for new-onset depressive disorders; to investigate the long-term prognosis of depressive disorders and its determinants; and to assess excess mortality associated with depressive, anxiety and alcohol use disorders. A large longitudinal study of the Finnish population, consisting of the Health 2000 and Health 2011 Surveys, was used to investigate these questions. The survey data was complemented with data from the Care Register for Health Care and the Finnish Causes of Death Statistics. The results show that one in 10 adults in Finland suffered from a depressive disorder in 2011, and the prevalence increased from 2000 to 2011, particularly among women. Methods to account for non-participation also showed that the non-participation of people with depressive disorders in population studies significantly biases prevalence estimates. People who were younger, had a history of multiple childhood adversities, lower trust axis of social capital, or an anxiety disorder or subclinical depressive symptoms at baseline, had a higher risk of developing depressive disorders. In addition, having three or more physical diseases was a risk factor for dysthymia. Among people with depressive disorders at baseline, 34-43% still had some depressive, anxiety or alcohol use disorder after 11 years, and 48-61% had clinically significant depressive symptoms. Unmarried people and those with more severe initial symptoms had a higher risk of persistent course. People with depressive disorders had a twofold mortality risk, whereas the risk was 1.7-fold in alcohol use disorders and was not increased in anxiety disorders, when adjusted for other risk factors. This study confirms that depression is an increasing public health concern in Finland, and that depressive disorders have serious long-term consequences. To reduce the burden of depressive disorders, it is of key importance to develop primary prevention efforts and measures to reduce the negative health and social consequences of depression.
  • Kettunen, Sakari (Helsingin yliopisto, 2022)
    Tämän tutkimuksen tavoitteena oli selvittää pre- ja postoperatiivista psykiatrista sairastavuutta ortognaattis-kirurgista hoitoa vaativilla potilailla. Tuloksien perusteella pyrimme tarkentamaan ortognaattista kirurgiaa saavien potilaiden psykiatrisen tuen tarvetta osana hoitoprosessia. Tähän retrospektiiviseen yksikeskustutkimukseen (Suu- ja leukasairauksien osasto, Helsingin yliopistollinen sairaala, Suomi) otettiin mukaan yli 18-vuotiaat potilaat, jotka saivat kirurgisena hoitona bilateral sagittal split osteotomian, LeFort I- taikka edellä mainittujen yhdistelmäosteotomian vähintään kuuden kuukauden seuranta-ajalla vuosina 2017–2019. Tulosmuuttujana oli uusi psykiatrinen sairastavuus tai aiemman psykiatrisen sairauden pahenemisvaihe postoperatiivisen hoidon aikana vuoden seuranta-ajalla. Ensisijainen ennustemuuttuja oli psykiatrinen sairastavuus ennen leikkausta. Lopulliseen tilastoanalyysiin suodattui 182 potilasta. Potilaista 44:llä (24 %) todettiin olleen leikkausta edeltävä psykiatrinen sairaus. Leikkausta edeltävä psykiatrinen sairaus ennakoi postoperatiivisesti sairauden pahenemista tai uutta psykiatrista sairautta. Uusia sairauksia tai niiden pahenemisia esiintyi 12 (7 %) potilaalla. Saadut tulokset puolsivat myös varovaisuutta deksametasonin annostelussa hoidon perioperatiivisessa vaiheessa. Suurella deksametasoniannoksella oli tilastollisesti merkitsevä yhteys postoperatiiviseen psykiatriseen sairastavuuteen. Johtopäätöksenä voimme todeta, että potilaan mielenterveyteen tulee kiinnittää erityistä huomiota sekä pre- että postoperatiivisessa ortognaattis-kirurgisen hoidon vaiheissa. Mielenterveydenhäiriöt ovat kirjoltaan laaja joukko sairauksia, joiden perusteet tulee ortognaattis-kirurgiseen hoitoon osallistuvien ammattilaisten tietää. Hoidon tulisi painottaa mielenterveyden osalta profylaktisiin toimenpiteisiin, tavoitteenaan estää postoperatiivisen psykiatrisen terveyden paheneminen. Tulokset puoltavat tarvetta strukturoidulle mielenterveydentilan arvioinnille sekä psykiatrisille konsultaatioille hoidon yhteyteen.
  • Ketola, Sirpa (Helsingin yliopisto, 2014)
    Vertigo and dizziness are among the most frequent complaints in primary care. The symptoms are usually self-limited, and the clinical course is benign, with full recovery. In many cases, however, vertigo and dizzy spells recur, leading to impairment and chronic outcome. A number of studies have documented a high prevalence of psychiatric comorbidity in vertiginous patients. Vertigo and dizzy symptoms themselves can provoke psychological distress, because recurrent unpredictable attacks can induce fear of losing control, concern of serious illness, and worry about severe attacks compromising one s ability to adapt. Recurrent spells can also provoke earlier mental problems. Yet the degree of subjective handicap and emotional distress has shown no close relationship to measures of vertigo symptom severity. Psychiatric disorders do not cause vertigo or dizziness, but can, together with vertigo and dizzy symptoms, lead to persistent complaints. Anxiety and depression are the most common disorders associated with vertigo and dizziness. Vertigo and dizziness in children is not rare. One population-based study found a prevalence of vertigo of 14% (Russell and Abu-Arafeh 1999). The etiology varies, but usually involves organic causes. Psychiatric etiology is investigated only after the exclusion of organic etiology. Psychosomatic symptoms are common in children and adolescents, often reflecting problems in psychosocial background. The first study aimed to evaluate the adapting ability of patients with Ménière s disease based on the sense of coherence scale. Data were collected with two different postal questionnaires involving 547 recipients (Study I). Studies II and III evaluated the prevalence of psychiatric symptoms in vertiginous patients. This study group comprised 100 vertiginous subjects from a randomly selected community sample participating in a vertigo prevalence study in the Helsinki University Hospital district. The investigative program entailed a neuro-otological examination and psychiatric evaluation in questionnaire form. Study IV assessed the prevalence of psychiatric disorders in a group of 119 children and adolescents between the ages of 7 months to 17 years who had visited the ear, nose and throat clinic with a primary complaint of vertigo. An otologist and a psychiatrist reviewed and evaluated each patient s detailed medical history. The results indicate a high sense of coherence (SOC) to represent deeper contentment in life and less psychological distress despite the chronic disease. Although SOC scores did not relate to the severity of illness, subjects with low SOC scores exhibited more symptoms of both vertigo and psychological distress (Study I) than did subjects with high SOC scores. In Studies II and III, the prevalence of depressiveness was 19%, and the prevalence of symptoms of anxiety, 12%. A total of 68% of subjects reported psychiatric symptoms, the most common of which was personality disorder. Comorbidity between depressive, anxiety and personality symptoms were ample and related significantly to reduced functional capacity. In Study IV, the prevalence of psychogenic vertigo was 8%. Major depression was the most common disorder, and 2.5% of patients suffered from somatization disorder. The psychiatric distress commonly reflected psychosocial problems and affected seriously on daily life functioning. In conclusion, this study found that psychiatric symptoms are common in vertiginous patients. Comorbidity may lead to a more debilitating course of vertigo independently of an organic cause or the severity of vertigo symptoms. Feelings of disability correlated with psychological distress. In children and adolescents, vertigo symptoms with compromised daily functioning, together with psychosocial stress factors, should invoke at least the possibility of psychiatric distress. Keywords: vertigo, depression, anxiety, personality disorder, comorbidity, disability, coping, chronic 
  • Ojalammi, Marjo (Helsingin yliopisto, 2020)
    Tutkimuksessa tarkastellaan Vivamon Rikotusta eheä terapeuttisen sielunhoidon koulutuksessa ilmenevää ihmiskäsitystä vuosina 2010-2012. Tutkimusmateriaali sisältää koulutuksen opetussuunnitelman luentomateriaaleineen samoilta vuosilta. Lisäksi tutkimuksen lähdemateriaaliin sisältyy RE -sielunhoitoterapiamallin kehittäjän Seppo Jokisen kirja, Rikotusta eheä, vuodelta 2011 jossa hän esittelee sielunhoitoterapiamallinsa. Jokisen formaatti on Vivamon opetuksen perustana, jonka ympärille on kehitetty lisäkoulutusta. Tutkimuksessa selvitetään koulutuksen oppimateriaalissa ilmenevää ihmiskäsitystä ja sitä minkälaiseen teologiseen ja psykologiseen oppipohjaan koulutusmateriaali perustuu. Keskiössä on teologisen ja psykologisen ihmiskuvan suhde. Tarkastelen lähdemateriaalia sekä systemaattisen teologian dogmatiikan että käytännöllisen teologian sielunhoidon perinteiden valossa. Lähdemateriaalini monimuotoisuuden vuoksi olen käyttänyt systemaattisen analyysin ja sisällönanalyysin yhdistelmää. Tutkimukseni rakenne etenee koulutusteemojen mukaisesti. Ihmiskäsityksen sekä teologisen ja psykologisen ajattelun selvittämiseksi tarkastellaan kutakin koulutusteemaa erikseen. Koska aihealueesta ei ole aikaisempaa akateemista tutkimusta, pyrkimykseni on ollut selvittää tutkimuskysymysteni ja tutkimusnäkökulmani lisäksi myös laajemmin sitä, mistä RE -sielunhoitoterapiassa on kysymys. Tutkimuksen tuloksena on, että lähdemateriaalissa esiintyy monia psykologisia ihmiskuvia. Koulutusmateriaalista ilmeni useita psykologian ja psykoterapian teorioita ja metodeja. Teologinen ja kristillinen ihmiskuva vaihteli Jokisen luomisteologisesti painottuneesta ihmiskuvasta lunastusteologiseen ja kristologiseen ihmiskuvaan lunastusteologinen ihmiskuvan ollen keskiössä. Jokisen terapeuttissielunhoidollinen päämäärä on ihmisen palauttaminen luomiskertomuksen tilaan, jossa ihminen on Jumalan kuva. Täydellisimmin ihminen on Jumalan kuva miehen ja naisen rakkaudellisessa ja kommunikatiivisessa yhteydessä. Jumala on rakkaus, siksi imago Dei tulee miehen ja naisen rakkaudellisessa parisuhteessa parhaiten esiin. Koska mies ja nainen on luotu erilaisiksi ja toisiaan täydentäviksi, pelkkä mies tai nainen ei voi olla kokonainen Jumalan kuva, kuten eivät samaa sukupuolta olevat pariskunnat. Eksplisiittisesti ilmaistaan koulutuksen psykologisen ihmiskuvan olevan teologiselle ihmiskuvalle alisteinen. Implisiittisesti materiaalista nousi useita psykologisia ihmiskuvia, joiden voi ajatella olevan poleemisia Raamatun ihmiskuvien kanssa.
  • Mantere, Outi (Helsingin yliopisto, 2007)
    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.
  • Baryshnikov, Ilya (Helsingin yliopisto, 2017)
    Mood disorders and both Borderline (BPD) and Schizotypal (SPD) Personality Disorder often co-occur. BPD shares some similar symptoms with both bipolar disorder (BD) and SPD, resulting in difficulties in distinguishing them. The first aim of the study was to define similarities and differences in self-reported features of BD and BPD. The second aim was to determine the overlapping and non-overlapping clusters of self-reported symptoms of BPD and SPD in patients with mood disorders. Concurrent self-reported psychotic-like experiences (PEs) may also complicate the diagnosis of mood disorders; hence the third aim was to investigate the prevalence of self-reported PEs in patients with mood disorders and to examine the factors that predict them. Features of BPD are common in these patients and have a negative impact on the course of the disorders, hence it is important to focus on treatment. However, the relationships between self-reported features of BPD and neuroticism, attachment styles and traumatic experiences in childhood (TEs) are not fully understood. The fourth aim of the study, therefore, was to examine these relationships in patients with mood disorders. The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 282 patients in psychiatric care on the grounds of ICD-10-DCR unipolar depression and BD. The patients were requested to rate themselves on scales for BPD (the McLean Screening Instrument (MSI)), hypomania or mania (the Mood disorder Questionnaire (MDQ)), SPD (the Schizotypal Personality disorder Questionnaire-Brief (SPQ-B)), PEs (the Community Assessment of Psychic Experiences (CAPE-42)), adulthood attachment style (Experiences in Close Relationships-Revised (ECR-R)), TEs (the Trauma and Distress Scale (TADS)) as well as depression (the Beck Depressive Inventory (BDI)), anxiety (the Overall Anxiety Severity and Impairment Scale (OASIS)) and neuroticism (Short 5 (S5)). The total scores of the MDQ and the MSI correlated moderately (r=0.431, P<0.001), and there were significant correlations between the MSI items "impulsivity" and "mood instability" and all the MDQ items (P<0.01). Moreover, the MSI items "impulsivity" and "mood instability" had significant cross-loadings (0.348 and 0.298, respectively) with the MDQ factor in the exploratory factor analysis. The MDQ items "irritability", "flight of thoughts" and "distractibility" (0.280, 0.210 and 0.386, respectively) cross-loaded on the MSI factor. There was a strong correlation between the MSI and the SPQ-B scores. MSI items reflecting disrupted relatedness and affective dysregulation correlated moderately (rφ varied between 0.2 and 0.4, P < 0.005) with the SPQ items. MSI items reflecting behavioural dysregulation correlated only weakly with the SPQ items. Depressive symptoms, gender and MSI were significant predictors of the SPQ-B score, whereas symptoms of anxiety, age and SPQ-B were significant predictors of the MSI score. The “frequency of positive symptoms” score of the CAPE-42 correlated strongly with the total score of the SPQ-B (rho=0.63; p<0.001), and moderately with the total scores of the BDI, the MDQ, OASIS and the MSI (rho varied from 0.37 to 0.56; p<0.001). Symptoms of anxiety, mania or hypomania, and BPD were significant predictors of the “frequency of positive symptoms” score of CAPE-42. A young age, S5 Neuroticism and TADS predicted the MSI scores (p<0.001). ECR-R Attachment Anxiety mediated 33 per cent (CI = 17-53%) of the relationships between TADS and MSI. Self-reported features of BPD and SPD are prevalent in patients with mood disorders. Self-reported features of BD and BPD such as “affective instability”, “impulsivity”, “irritability”, “flight of thoughts” and “distractibility” appear to overlap in terms of content whereas other features are more specific, which may make it easier to distinguish them. Items reflecting cognitive-perceptual distortions and affective symptoms in BPD overlap with disorganized and cognitive-perceptual symptoms of SPD. Symptoms of depression may aggravate self-reported features of SPD, and symptoms of anxiety features of BPD. BPD symptoms of behavioural dysregulation and the interpersonal deficits of SPD appear to be non-overlapping. Several state- and trait-related factors may underlie self-reported PEs among patients with mood disorders. These include cognitive-perceptual distortions in SPD; distrustfulness, identity disturbance, dissociative and affective symptoms of BPD; and cognitive bias related to depressive or manic symptoms. TEs as well as high neuroticism independently predict the features of BPD in patients with mood disorders, and insecure attachment may partially mediate the relationship between childhood TEs and BPD features.