0000000000179973
AUTHOR
Birgitta Alakare
The long-term use of psychiatric services within the Open Dialogue treatment system after first-episode psychosis
AbstractOpen Dialogue is a family-oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. In the present study, the aim was to describe how psychiatric services were used in Western Lapland after decades of first-episode psychosis services, and to analyze how baseline characteristics were related to re-admission rates and the total duration of psychiatric treatment in geographical area where Open Dialogue approaches were developed and efforts made to systematically apply them to all psychiatric treatments. The data were obtained from the medical histories of patients who had first-episode psychosis in 1992–2005 and who lived…
Retrospective Experiences of First-Episode Psychosis Treatment Under Open Dialogue-Based Services: A Qualitative Study.
AbstractOpen Dialogue (OD) is an integrated approach to mental health care, which has demonstrated promising outcomes in the treatment of first-episode psychosis (FEP) in Finnish Western Lapland region. However, little is known how treatment under OD is retrospectively experienced by the service users themselves. To address this, twenty participants from the original Western Lapland research cohort diagnosed with psychosis (F20–F29) were asked about their treatment of FEP, initiated under OD 10–23 years previously. Thematic analysis was used to explore how the treatment was experienced. Most participants viewed network treatment meetings as an important part of their treatment, as they enab…
The comprehensive Open-Dialogue approach in Western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care
An open dialogue need-adapted approach was applied in Finnish Western Lapland by organizing three-year family therapy training for the entire staff, and by following the outcomes. Three inclusion periods of first-episode psychotic patients were compared. In a two-year follow-up of two consecutive periods during the 1990s (1992–3 and 1994–7) it was found that 81% of patients did not have any residual psychotic symptoms, and that 84% had returned to full-time employment or studies. Only 33% had used neuroleptic medication. A third inclusion period, covering 2003–2005, was organized to determine whether the outcomes were consistent 10 years after the preliminary period. Fewer schizophrenia psy…
The family-oriented Open Dialogue approach in the treatment of first-episode psychosis : nineteen–year outcomes
Open Dialogue (OD) is a family-oriented early intervention approach which has demonstrated good outcomes in the treatment of first-episode psychosis (FEP). Nevertheless, more evidence is needed. In this register-based cohort study the long-term outcomes of OD were evaluated through a comparison with a control group over a period of approximately 19 years. We examined the mortality, the need for psychiatric treatment, and the granting of disability allowances. Data were obtained from Finnish national registers regarding all OD patients whose treatment for FEP commenced within the time of the original interventions (total N = 108). The control group consisted of all Finnish FEP patients who h…
How do people talk decades later about their crisis that we call psychosis? : A qualitative study of the personal meaning-making process
Psychosis refers to a severe mental state that often significantly affects the individual’s life course. However, it remains unclear how people with the lived experiences themselves view these phenomena, as part of their life story. In order to evaluate this personal meaning-making process, we conducted in-depth life-story interviews with 20 people who had been diagnosed with non-affective psychosis 10 to 23 years previously in one catchment area. 35% of them were still receiving mental health treatment, and 55% of them were diagnosed with schizophrenia. Only a minority named their experiences as psychosis. On the basis of narrative analysis, two types of stories appeared to encompass how m…
Five-year cumulative exposure to antipsychotic medication after first-episode psychosis and its association with 19-year outcomes
Abstract Background: The long-term effectiveness of antipsychotic maintenance treatment after first-episode psychosis (FEP) is contested. In this real-world observational study, we examined how cumulative exposure to antipsychotics within the first 5 years from FEP was associated with the 19-year outcome. Methods: Finnish national registers were used to detect all patients who were hospitalized due to non-affective psychosis in the mid-1990s, and who were treatment naïve prior to the inclusion period (N = 1318). Generalized linear models with logit link function were used to estimate how cumulative exposure to antipsychotics within the first 5 years from onset was associated with mortality,…
The 10‐year treatment outcome of open dialogue‐based psychiatric services for adolescents: A nationwide longitudinal register‐based study
Aim: To evaluate the 10-year treatment outcomes and cost-effectiveness of adolescents' mental health treatment initiated under the social network-oriented open dialogue (OD) approach. -- Methods: This longitudinal register-based study included all persons who, for the first time, received psychiatric treatment in Finland during the period 1 January 2003–31 December 2008, and who were aged 13–20 at onset (n = 44 868). The OD group included all persons whose treatment commenced in the Western Lapland catchment area (n = 780), this being the only region in Finland where OD covered the entire mental healthcare service at the time of inclusion. The comparison group (CG) included the rest of Finl…