Priset för psykiatrin

Vad kostar den psykiska ohälsan – i kronor, ören och lidande? Och vad kostar behandlingen av den? Vad ska den tillåtas kosta? Vilket är det pris samhället vill betala för psykiatrin – och den psykiatriska forskningen? Kring de frågorna kretsade diskussionen vid det seminarium som Göteborgs universitet och Psykiatri Sahlgrenska i sin serie Bilden av psykiatrin arrangerade på Jonsereds herrgård den 14 juni 2010

Sex Steroids and Gene Variants in Bipolar Disorder

Bipolar disorder is a chronic, cycling disorder affecting circa 2% of the population and whose pathophysiology is still largely unknown. It has been suggested that common treatments used for bipolar disorder have effects on the sex steroids yet sex steroids have also been shown to have widespread effects in the brain in systems of relevance to bipolar disorder. For example, DHEAS and progesterone have opposing effects on the glutamatergic and GABAergic systems essential for the regulation of other brain processes. The enzymes which are involved in the interconversions between these compounds are affected by a number of factors including polymorphisms in the genes coding for these enzymes. Papers 1-3 examine common polymorphisms in AKR1C4, HSD3B2 and SRD5A1, their relationships with 8-9 am serum hormone concentrations as well as to retrospectively but systematically collected data on symptoms which in animal and human studies have shown a possibility of connection to neurosteroid abnormalities. All investigations including history taking was done in euthymic phase of bipolar 1 or 2 disorders and included all available sources of information such as chart review and third party information. In paper 1, men but not women had lower serum progesterone concentrations during euthymic phase of bipolar disorder if they had exhibited manic irritability as opposed to euphoric mania. A gene variant of AKR1C4 was associated with lower progesterone concentrations and polymorphisms of this gene were also more frequent in the males with prior irritability during mood elevation. Paper 2 showed that these same polymorphisms that increased risk in men reduced the risk for paranoid ideation during mania in women. However in men, DHEAS and progesterone were both lower and this coupled at a trend level to a polymorphism in the HSD3B2 gene. In paper 3, depressive psychomotor agitation was coupled in both men and women to polymorphisms in SRD5A1. Yet only in men did one of the polymorphisms correspond to increased progesterone, a finding which was in line with the finding of higher progesterone if men had showed depressive psychomotor agitation. Testosterone has different effects to progesterone and DHEAS in the brain and has been implicated in psychosis, having effects on the dopamine system. In paper 4, parameters measuring testosterone effects at different points in development were investigated in women with bipolar disorder who had exhibited psychotic features and compared with those in women with bipolar disorder without such features as well as healthy control women. The A allele at rs6152 of the Androgen Receptor gene was associated with a greater risk of having had psychotic symptoms and was at a trend level associated with an earlier debut of psychotic symptoms. The D2:D4 finger ratio which is believed to be a measure of prenatal testosterone milieu correlated with age of onset of psychosis indicating that high testosterone in the foetus predisposed the individual to an earlier psychosis onset but not to getting psychotic per se. A possible gene by drug interaction was found whereby the G allele rs6152 was associated with much higher bioavailable testosterone in the presence of neuroleptics. Upon further investigation this was explained by lower SHBG (sex hormone binding globulin) even in the presence of low doses of atypical neuroleptics. Taken together these studies suggest the involvement of sex steroids in mediating risk to particular phenotypes of presentation of bipolar disorder, rather than bipolar disorder itself. The symptoms correspond to those regarded to be of the so called mixed states. Whilst the studies are of reasonable size in ascertaining hormonal differences the studies are small with respect to the genetic data and need to be replicated in larger samples

Mielisairaana yhteiskunnassa - mitä se minulle merkitsee ja merkitsi? : elämänkerta-analyysit kuudesta kirjasta, jossa asianomainen kertoi sairaudestaan

Työn aiheena oli mielenterveydellisistä ongelmista kärsineiden ihmisten kokemuksiin tutustuminen ja tarkastella sitä, miten mielisairaus oli vaikuttunut heidän asemaansa yhteisössään ja yhteiskunnassa. Opinnäytetyö sai alkunsa kiinnostuksesta mielenterveydellisten ongelmien kanssa painivien ihmisten kohtaloihin ja muun yhteiskunnan suhtautumisesta heihin. Tutkimusmateriaalina käytettiin elämänkerrallisia kirjoja. Opinnäytetyön aiheen määrittämät tutkimuskysymykset olivat seuraavat. Mitkä psyyken sairauden leimaavat ihmisen mielisairaaksi, eli mistä psyykkisistä sairauksista voi olla seurauksena leimautumista. Miten leimautuminen on vaikuttanut ihmisen elämään eri vuosikymmeninä, millaiseksi yksilön elämä on muuttunut leimautuminen vaikutuksesta eri aikoina. Mitä ihmiselle tapahtuu mielisairauden puhkeamisen jälkeen, valottaa sairastuneen elämää ajanjaksolta, jolloin sairaus on jo puhjennut. Aineistona tähän työhön käytettiin teoreettisia teoksia ja kuutta elämänkertaa. Teoria-osuuden aineisto valikoitui työn aihepiirin mukaisesti ja elämänkerrat seuloutuivat avainsanojen pohjalta. Tutkimusmenetelminä toimivat sisällönanalyysi ja elämänkerta-analyysi, joka on eräs sisältöanalyysin muodoista. Lähes kaikki mielisairaudet voivat tuoda mukanaan leiman, joka taasen on vaikuttanut ja vaikuttaa edelleen nykypäivänäkin negatiivisesti sairastuneen elämään. Pahimmillaan leimautuminen voi johtaa eristäytymiseen muusta yhteiskunnasta ja vaikeuttaa sairastuneen paranemista. Sairastuttuaan psyykkisesti ihmiset käyvät läpi erilaisia polkuja, toisten hiljalleen toipuessa ja joidenkin traagisesti menettäessä elämänilonsa hajonneen psyykensä johdosta.BEING MENTALLY ILL IN SOCIETY – WHAT THAT MATTERS AND MATTERED TO ME? - BIOGRAPHICAL-ANALYSIS OF SIX BOOKS, WHEREIN DESIGNATED TOLD ABOUT ONE`S ILLNESS Subject of this final paper was to obtain knowledge about experiences of people who have suffered of mental diseases. Purpose was also to examine how mental diseases had affected to patients posiotion in a community and a society. My final paper becun from interest for mental patients destinies and stand of a society towards them. Biographical books were used as a research material. Research guestions were formed from subject of my work. Which mental diseases imprint inviduals as a mentally ill, meaning, which of mental diseases result imprinting. How imprinting has affected lives of individuals on different decades, in other words, what sort of lives of individuals have become after imprinting in different times. What happens to person after gettin mentally ill, searching information about period of life, when the illnes has already becan in full scale. As a research material were used theoretical pieces and six biographical books. Material of theory-section was being selected by theme and biographies were selected with help of key words. Biographical-analysis and content analysis were used as a research methods. Almost all the mental diseases may bring stigma with one, which again has affected ja still affects negatively to patients life. In worst cases imprinting may result isolation and complicate the healing process. After falling psycgically ill people go through different kind of periods. Some get slowly better, when some others tragically lose their will of life because of their breaken psyche

Psychiatric Nurses' perceptions of patients' involvement

Introduction: Psychiatric nurses in the psychiatric care can meet complex situations if the basic knowledge is not enough. Therefore it demands research for secure, improve and develop care processes that will be benefit for both patients and nursing staff. Aim: The purpose of this study was to highlight psychiatric nurses’ experiences of patients' involvement in their own care. Method: Qualitative method was chosen for this study. Eight qualitative interviews in the form of semi- structured interview questions were conducted. The data was analyzed using content analysis (Graneheim, et. al, 2004). Results: The study showed three categories: participation, nursing and work environment. Discussion: Psychiatric nurses' approach and behavior to their profession is to see psychiatry as a whole. Conclusion: Psychiatric nurses’ work based on patient-centered care can favor psychiatric nursing and make the patient more active designer in their care and treatment. Person-centered care is a way to improve, assure, and optimize the individual's right to autonomy and participation.Introduktion: Psykiatrisjuksköterskor inom den psykiatriska vården möter påfrestningar i en komplex arbetssituation. Påfrestningar kan uppstå när den grundläggande kunskapen inte är tillräcklig. Därför krävs forskning för att säkerställa, förbättra och utveckla vårdprocesser som gynnar både patienter och vårdpersonalen. Syfte: Syftet med studien var att belysa psykiatrisjuksköterskors upplevelser av patienters delaktighet i sin egen vård. Metod: Kvalitativ metod valdes för denna studie. Åtta kvalitativa intervjuer i form av semistrukturerade intervjufrågor genomfördes. Datamaterialet analyserades med innehållsanalys utifrån Graneheim och Lundman (2004). Resultat: Ur dataanalysen framkom kategorierna; delaktighet, omvårdnad och arbetsmiljö. Diskussion: Psykiatrisjuksköterskornas förhållningssätt och agerande till sin profession är att se psykiatrin som en helhet. Slutsats: Psykiatrisjuksköterskors arbete utifrån patientcentrerad vård kan underlätta den psykiatriska omvårdnaden samt göra patienten till en aktiv designer i sin vård. Personcentrerad vård är ett sätt att förbättra, säkerställa och optimera individens rätt till autonomi och delaktighet

Kärsimyksen institutionaalinen tunnustaminen

Kirjoitus on osa "Elämän peruskysymykset – Anssi Peräkylän 60-vuotisjuhlakirja" –kirja