Masentuneen potilaan hoito videoavusteisella lyhytpsykoterapialla

VideoTalk-menetelmässä psykoterapiaa tehostetaan potilaan kotona itsestään ottamilla videoilla. Terapiatunnilla potilas tekee havaintoja itsestään videolta. Hän voi oivaltaa, miten kielteinen puhe itsestä aiheuttaa välittömästi huonovointisuuteen liittyviä kehollisia muutoksia, kuten ryhdin lysähtämisen ja kasvojen ilmeettömyyden. Masennuksesta kärsivän potilaamme toipumisessa merkittävää oli se, että video auttoi häntä tarkastelemaan itseään etäämpää, mikä aktivoi aiemmin piilossa olleita tunteita.</p

Lääkeparkinsonismi

Vertaisarvioitu.Lääkeparkinsonismi on Parkinsonin taudin jälkeen parkinsonismin yleisin syy. Se aiheutuu tyypillisesti psykoosilääkkeistä, ja vaikka ensimmäisen polven psykoosilääkkeitä käytettäessä riski on suurin, myös uudemmat psykoosilääkkeet voivat aiheuttaa lääkeparkinsonismia. Lääkeparkinsonismi voi liittyä myös muiden lääkkeiden käyttöön, esimerkiksi yleisesti käytettyyn pahoinvointilääkkeeseen metoklopramidiin. Kyseessä on alitunnistettu ja -diagnosoitu ilmiö, ja sen kliininen erottaminen parkinsonismin muista syistä on vaikeaa. Keskeisin hoitomuoto on parkinsonismia aiheuttavan lääkkeen annoksen vähentäminen tai lääkkeen lopettaminen.Peer reviewe

Dopaminergic and serotonergic mechanisms in the modulation of pain : In vivo studies in human brain

Here we review the literature assessing the roles of the brain dopaminergic and serotonergic systems in the modulation of pain as revealed by in vivo human studies using positron emission tomography. In healthy subjects, dopamine D-2/D-3 receptor availability particularly in the striatum and serotonin 5-HT1A and 5-HT2A receptor availabilities in the cortex predict the subject's response to tonic experimental pain. High availability of dopamine D-2/D-3 or serotonin 5-HT2A receptors is associated with high pain intensity, whereas high availability of 5-HT1A receptors associates with low pain intensity. Chronic neuropathic pain is associated with high striatal dopamine D-2/D-3 receptor availability, for which low endogenous dopamine tone is a plausible explanation, although a compensatory increase in striatal dopamine D-2/D-3 receptor density may also contribute. In contrast, chronic musculoskeletal pain is associated with low baseline availability of striatal dopamine D-2/D-3 receptors. In healthy subjects, brain serotonin 5-HT1A as well as dopamine D-2/D-3 receptor availabilities associate with the subject's response criterion rather than the capacity to discriminate painful thermal stimuli suggesting that these neurotransmitter systems act mainly on non-sensory rather than sensory factors of thermally induced pain experience. Additionally, 5-HT1A receptor availability predicts the subject's discriminative ability but not response criterion for non-painful tactile test stimuli, while no such correlation is observed with dopamine D-2/D-3 receptors. These findings suggest that dopamine acting on striatal dopamine D-2/D-3 receptors and serotonin acting on cortical 5-HT1A and 5-HT2A receptors contribute to top-down pain regulation in humans.Peer reviewe

Determinants of costs of care for patients attending primary care

Aims: We aimed to evaluate determinants of costs of somatic and psychiatric care forpatients attending primary care (PrC).Methods: 495 PrC patients filled in a questionnaire including questions on background,health behaviour, social contacts, perceived health and depressive symptoms. Costs ofsomatic and psychiatric care were obtained from the local healthcare register.Results: During 5 years’ follow-up, total inflation-adjusted costs of care were 8145 Eurosper capita in 2010 prices: 87.2% was due to somatic and 12.8% to psychiatric care. Ageassociated positively, but being single and working associated negatively with costsof somatic care. Costs of psychiatric care were high in young adults, single,divorced, unemployed, smokers, and those with few social contacts. In zero-inflatedmultivariate modelling, poor perceived health and being retired increased probabilityof seeking somatic care. Depressive symptoms and being unemployed increased, and oldage decreased probability of seeking psychiatric care.Concerning both services together, poor perceived health and being retired associatedwith increased, but depressive symptoms with decreased likelihood of being a serviceuser. Among service users, age group 25-44 and having poor perceived health associatedwith higher costs of care. Female gender, being single, employed, having low educationlevel, regular user of alcohol and regular physical exercise associated with lowercosts of care.Conclusions: In patients attending PrC, more than a tenth of total costs of care weredue to psychiatric care. Patients’ perceived health associated with costs of somatic,and depressive symptoms with costs of psychiatric care. Sociodemographic backgroundalso associated with costs of care.</p

A study on the association of psychiatric diagnoses and childhood adversities with suicide risk

Background: In addition to psychiatric disorders, childhood adversities may increase the risk of suicidal behavior. In previous studies, the effects of clinical co-morbidity and overlap of childhood adversities has rarely been taken into account. Aim: The study aims to search associations of psychiatric diagnoses and childhood adversities and trauma (CAT) with suicide risk. Methods: Altogether 415 adult patients attending primary and psychiatric outpatient care filled in the Trauma and Distress Scale, including assessment of five core CAT domains (emotional, physical and sexual abuse, and emotional and physical neglect). The study patients' current psychiatric disorders and suicide risk were assessed by the Mini International Neuropsychiatric Interview. Results: Age, poor perceived health, poor social support, current psychiatric treatment, all psychiatric disorders, except hypomania, emotional and physical abuse, and emotional neglect did associate significantly with suicide risk. Number of psychiatric disorders and CAT domains had dose-dependent effects on suicide risk. In multivariate analysis, current psychiatric treatment, current and life-time major depression, social phobia, alcohol, and drug dependency, as well as emotional abuse had direct associations with suicide risk. In females, manic disorders and drug dependence, and in males, dysthymia, social phobia, and emotional abuse associated with suicide risk. Conclusions: Psychiatric disorders and most CAT domains associate with suicide risk. However, when the effect of co-morbidity and overlap of CAT domains is controlled, major depression, social phobia, alcohol, and drug dependency and emotional abuse seem to increase the risk of suicide. The risk profile varies between the genders.</div

Segmentation of Striatal Brain Structures from High Resolution PET Images

We propose and evaluate an automatic segmentation method for extracting striatal brain structures (caudate, putamen, and ventral striatum) from parametric 11C-raclopride positron emission tomography (PET) brain images. We focus on the images acquired using a novel brain dedicated high-resolution (HRRT) PET scanner. The segmentation method first extracts the striatum using a deformable surface model and then divides the striatum into its substructures based on a graph partitioning algorithm. The weighted kernel k-means algorithm is used to partition the graph describing the voxel affinities within the striatum into the desired number of clusters. The method was experimentally validated with synthetic and real image data. The experiments showed that our method was able to automatically extract caudate, ventral striatum, and putamen from the images. Moreover, the putamen could be subdivided into anterior and posterior parts. An automatic method for the extraction of striatal structures from high-resolution PET images allows for inexpensive and reproducible extraction of the quantitative information from these images necessary in brain research and drug development

Increased Risk of Parkinson's Disease in Patients With Schizophrenia Spectrum Disorders

Background PD comorbid with schizophrenia has been considered rare because these diseases associate with opposite alterations in the brain dopamine system. The objective of this study was to investigate the risk of PD after a diagnosis of a schizophrenia spectrum disorder. Methods Regionally, this was a retrospective record-based case-control study. The cohort included 3045 PD patients treated 2004-2019 in southwestern Finland. Nationally this was a nested case-control study using registers to examine Finnish patients who received a clinically confirmed PD diagnosis 1996-2015 (n = 22,189). PD patients with previously diagnosed schizophrenia spectrum disorder (separate analysis for schizophrenia) were included. Comparable non-PD control groups were derived from both data sets. All PD diagnoses were based on individual clinical examinations by certified neurologists. Results In PD patients, the prevalence of earlier schizophrenia spectrum disorder was 0.76% in regional data and 1.50% in nationwide data. In age-matched controls, the prevalence in the regional and national data was 0.16% and 1.31%, respectively. The odds ratio for PD after schizophrenia spectrum disorder diagnosis was 4.63 (95% CI, 1.76-12.19; P <0.01) in the regional data and 1.17 (95% CI, 1.04-1.31; P <0.01) in the national data. Conclusions Schizophrenia spectrum disorder increases the risk of PD later in life. This association was observed in both individual patient data and nationwide register data. Therefore, despite the opposite dopaminergic disease mechanisms, schizophrenia spectrum disorder increases rather than decreases the risk of PD. The increased PD risk could be related to risk-altering effects of dopamine receptor antagonists or to the increased vulnerability of the dopamine system induced by illness phase-dependent dopamine dysregulation in schizophrenia/schizophrenia spectrum disorder. (c) 2021 International Parkinson and Movement Disorder SocietyPeer reviewe

Facilitating psychotherapy with patient-made videos: A qualitative study of patient experiences

We have developed a method utilizing video material to facilitate the psychotherapeutic process we call VideoTalk. In this method, which uses schema therapy as a theoretical framework, patients make videos at home in various emotional situations following the therapist’s detailed instructions. They then watch the videos together with the therapist making observations about the patient and how they speak about themselves and other people. The aim of this article is to describe five patients’ personal experiences of psychotherapy consisting of 15 video-assisted sessions. We used mixed methods methodology consisting of material-based content analysis of patient interviews done after the therapy and changes in symptoms measured by psychological symptom scales. Based on the symptom scales, this outcome study found that all participants benefited from the VideoTalk therapy. ‘Gaining bodily self-awareness and insight’, ‘Thinking more clearly and with self-compassion’, and ‘Challenges associated with the technology and practicalities of video work’ were found to be the main categories in the content analysis. After some minor technical difficulties, the patients found the video method workable. The results showed a wide range of self-observations, which began to be positively integrated into the patients’ lives and to increase their overall wellbeing. In the course of VideoTalk therapy, patients face painful emotions and may begin to create a new kind of connection between their own insulated internal world and the surrounding world.</p

Magical thinking in individuals with high polygenic risk for schizophrenia but no non-affective psychoses-a general population study

A strong genetic background for psychoses is well-established. Most individuals with a high genetic risk for schizophrenia, however, do not develop the disorder. We investigated whether individuals, who have a high genetic risk for schizophrenia but no non-affective psychotic disorders, are predisposed to develop milder forms of deviant thinking in terms of magical thinking. Participants came from the population-based Young Finns Study (n = 1292). The polygenic risk score for schizophrenia (PRS) was calculated on the basis of the most recent genome-wide association study (GWAS). Psychiatric diagnoses over the lifespan were collected up to 2017 from the registry of hospital care. Magical thinking was evaluated with the Spiritual Acceptance Scale (e.g., beliefs in telepathy, miracles, mystical events, or sixth sense) of the Temperament and Character Inventory in 1997, 2001, and 2012 (participants were 20-50-year-olds). We found that, among those who did not develop non-affective psychotic disorders, high PRS predicted higher magical thinking in adulthood (p = 0.001). Further, PRS predicted different developmental courses: a low PRS predicted a steady decrease in magical thinking from age 20 to 50 years, while in individuals with high PRS the decrease in magical thinking ceased in middle age so that their level of magical thinking remained higher than expected for that age. These findings remained when controlling for sex, childhood family environment, and adulthood socioeconomic factors. In conclusion, if high PRS does not lead to a non-affective psychotic disorder, it predicts milder forms of deviant thinking such as elevated magical thinking in adulthood, especially in middle age. The finding enhances our understanding of different outcomes of high genetic psychosis risk.Peer reviewe

Extrapyramidal symptoms predict cognitive performance after first-episode psychosis

Publisher Copyright: © 2022, The Author(s).Extrapyramidal (EP) symptoms such as tremor, rigidity, and bradykinesia are common side effects of most antipsychotics, and may associate with impaired performance in neurocognitive testing. We studied EP symptoms in first-episode psychosis (FEP; n = 113). Cognitive testing and EP symptoms (three items of the Simpson-Angus Scale) were assessed at baseline and follow-up (mean follow-up time 12 months). Mild EP symptoms were present at treatment onset in 40% of the participants. EP symptoms were related with lower performance in neurocognitive testing at baseline and at follow-up, especially among those with nonaffective psychotic disorder, and especially in tasks requiring speed of processing. No associations between EP symptoms and social cognition were detected. In linear regression models, when positive and negative symptom levels and chlorpromazine equivalents were accounted for, baseline EP symptoms were associated with worse baseline global neurocognition and visuomotor performance. Baseline EP symptoms also longitudinally predicted global, verbal, and visuomotor cognition. However, there were no cross-sectional associations between EP symptoms and cognitive performance at follow-up. In sum, we found both cross-sectional and longitudinal associations between EP symptoms and neurocognitive task performance in the early course of psychosis. Those without EP symptoms at the start of treatment had higher baseline and follow-up neurocognitive performance. Even mild EP symptoms may represent early markers of long-term neurocognitive impairment.Peer reviewe