Näkökulma laajenee, mielenterveysstigma vähenee

Psykososiaalisia selitysmalleja psykoosi-ilmiön ymmärtämisen ja integratiivisen hoidon tueksi

Psykoosi-ilmiön epäyhtenäisyys on vaikeuttanut tarkoin määriteltyjen hoitomenetelmien kehitystä. Psykososiaalisen näkökulman avulla voidaan hahmottaa psykoosi-ilmiön ja sen määritelmien suhteellinen luonne. Tästä näkökulmasta psykoosiksi tulkittavia ilmiöitä ei voida tyhjentävästi kategorisoida, samaistaa biologisiin mekanismeihin tai hoitaa kontekstista eli henkilön elinpiiristä irrotettuna psykopatologiana. Näkökulman laajentaminen auttaa kehittämään tutkimus- ja hoitokäytäntöjä integratiivista lähestymistapaa käyttäen. peerReviewed

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…

Psykoosilääkehoidon ohjaus voi tehostaa skitsofrenian hoitoa

Psykoosilääkkeet lievittävät skitsofrenian psykoosioireita ja vähentävät relapsiriskiä. Psykoosilääkityksen pitkäaikaiskäytön hyöty-haittasuhde skitsofrenian hoidossa on osin tuntematon. Etenkin suurten psykoosilääkeannosten pitkäaikaiskäyttö voi altistaa metabolisille, neurologisille, kognitiivisille ja psykologisille haitoille. Psykoosilääkehoidon haittoja voidaan minimoida systemaattisella lääkehoidon ohjauksella, jossa lääkehoito suunnitellaan ja toteutetaan moniammatillisessa yhteistyössä potilaan ja hänen läheistensä kanssa. Lääkehoidon ohjaus voi auttaa käyttämään pienintä vaikuttavaa hoitoannosta sekä parantaa hoitoon sitoutumista ja hoidon tuloksellisuutta. Skitsofrenian psykoosilä…

Protocol for a participatory survey to investigate the long-term effectiveness of adult psychiatric services (PSILEAPS) : a prospective exploratory cohort study

Mental health research and practice is currently moving beyond a focus on group-level symptom reduction models. Hence, research and treatment increasingly emphasize the real-life individual needs of service users and their social networks. One example is the Open Dialogue approach (OD), which has demonstrated promising outcomes in the Finnish Western Lapland (WL) catchment area. Nevertheless, it is unclear how OD-based services have so far been maintained in WL. It is also unclear how the experiences of multi-disciplinary care teams, service users and their social network members differ, with regard to differing approaches to mental health treatment. More generally, there is a global need f…

Rakenteelliset tekijät mutkistavat väestösuhteutettujen mielenterveysindikaattorien tulkintaa

Kansallisten rekisteriaineistojen käyttö väestön mielenterveyden ja mielenterveyspalvelujen laadun kuvaamiseen on lisääntynyt julkisten indikaattoripankkien myötä. nonPeerReviewed

Mielenterveyspalveluita käyttävien asiakkaiden ja heidän työntekijöidensä näkemyksiä siitä mikä asiakkaan vointia kohentaa

Tämän kyselytutkimuksen tavoitteena oli selvittää aikuispsykiatrian poliklinikan asiakkaiden ja heidän hoitavien työntekijöidensä näkemyksiä asioista, jotka ovat kohentaneet tai jotka saattaisivat kohentaa asiakkaan vointia. nonPeerReviewed

Need adapted use of medication in the open dialogue approach for psychosis : a descriptive longitudinal cohort study

Background The open dialogue (OD) approach includes the need-adapted use of psychiatric medication in treating first-episode psychosis (FEP), but there is limited information on how psychiatric medications are actually used in OD-based services. This study aims to analyse long-term medication dispensing patterns among FEP cohort treated according to the OD. Methods The OD cohort consisted of people who received treatment for FEP in the Finnish Western Lapland catchment area at a time of OD implementation (n=61). The comparison group included people whose FEP treatment commenced outside the catchment area during the mid-1990s (n=1378). Data were gathered from national registers from onset to…

Mitä mielenterveysongelmat ovat ja mikä mielenterveyshoidossa auttaa? : kokemuksia Länsi-Pohjan psykiatrian kyselytutkimuksen pilotoinnista

Psykiatriassa on alettu korostaa sellaisten osallistavien tutkimus- ja hoitostrategioiden merkitystä, joilla pyritään huomioimaan mielenterveyspalveluita käyttävien ja heidän läheistensä yksilöllinen avuntarve. Eräs esimerkki on Länsi-Pohjan sairaanhoitopiirin (LPSHP) alueella kehitetty avoimen dialogin hoitomalli, jolla on saavutettu lupaavia hoitotuloksia. On kuitenkin epäselvää, miten malli on juurtunut LPSHP:n psykiatrian palvelujärjestelmään kehityshankkeiden jälkeen. Lisätietoa tarvitaan myös siitä, miten sekä työntekijät että asiakkaat itse näkevät erilaiset hoitokäytännöt ja sen, mistä psykiatrisen hoidon tarve lähtökohtaisesti johtuu. Näihin kysymyksiin pyrimme vastamaan LPSHP:n ps…

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,…

From treatment of mental disorders to the treatment of difficult life situations: A hypothesis and rationale

The group-level symptom-reduction model of mental health care emphasizes predetermined treatment guidelines for those mental and social difficulties that are diagnosable as mental health disorders on the basis of predetermined diagnostic criteria. The model have produced generalizable information to support medical decision-making for symptom reduction. However, it may have also increased the reification of diagnostic labels, and in so doing medicalized and stigmatized complex human-life experiences, with a lack of attention to a range of social determinants and existential factors associated with mental health. Since symptom-reduction model can easily lose sight of essential non-technical …

Open Dialogue as a Human Rights Aligned Approach

Throughout the last 20 years, the human rights perspective has increasingly developed into a paradigm against which to appraise and evaluate mental health care. This article investigates to what extent the Finnish open dialogue (OD) approach both aligns with human rights and may be qualified to strengthen compliance with human rights perspectives in global mental health care. Being a conceptual paper, the structural and therapeutic principles of OD are theoretically discussed against the background of human rights, as framed by the Universal Declaration of Human Rights, the UN Convention on the Rights of People with Disabilities, and the two recent annual reports of the Human Rights Council…