Is Domestic Debt the Answer to Debt Crises?

Analysis of public debt in developing countries has traditionally focused on external debt. However, in recent years several countries have looked increasingly to domestic sources when expanding their net borrowing or adopted aggressive policies aimed at retiring public external debt and substituting it with domestically issued debt. Some countries are even building up domestic fiscal liabilities with the objective of sterilizing enlarged aid inflows. This chapter asks what possible challenges and opportunities might be arising from these new developments in sovereign debt management

Autoimmuunienkefaliitti psykoosin aiheuttajana

Hermosolujen pintarakenteisiin kohdistuvat vasta-aineet voivat aiheuttaa autoimmuunienkefaliitin. Se voi aiheuttaa tehohoitoa vaativan limbisen enkefaliitin tai psykoosiin rajautuvan oirekuvan, jonka erottaminen toiminnallisesta psykoosisairaudesta voi olla kliinisesti mahdotonta. Osa tapauksista on paraneoplastisia eli liittyy todettuun tai piilevään syöpäsairauteen, useimmin munasarjateratoomaan. Autoimmuunienkefaliitin ensilinjan hoitokäytäntönä on immunomodulatorisesti vaikuttava immunoglobuliinin ja metyyliprednisolonin yhdistelmälääkitys. Suosittelemme harkittavaksi tavallisimpien autoimmuunienkefaliittiin liittyvien NMDAR- ja VGKC-vasta-aineiden seulontaa uuteen psykoosiin sairastuneilta potilailta

The association of alcohol use and quality of life in depressed and non-depressed individuals : a cross-sectional general population study

To compare the associations of alcohol-related variables with Quality of Life (QoL) in depressed and non-depressed individuals of the general population. This cross-sectional study utilized data from the FINRISK 2007 general population survey. A subsample (n = 4020) was invited to participate in an interview concerning alcohol use. Of them, 2215 (1028 men, 1187 women; response rate 55.1%) were included in the analyses. Bivariate associations between mean weekly alcohol consumption, frequency of binge drinking, Alcohol Use Disorders Identification Test (AUDIT)-score and QoL were analysed according to categorization into depressed and non-depressed using the Beck Depression Inventory, Short Form. Linear regression models were calculated in order to determine the associations of the alcohol variables and QoL after adjusting for socio-demographic variables as well as somatic and mental illness. Depressed individuals had lower mean QoL and higher AUDIT-scores than non-depressed respondents. Bivariate correlations showed that mean weekly alcohol consumption, frequency of binge drinking and AUDIT-scores were statistically significantly associated with impaired QoL in depressed individuals. Abstinence was not associated with QoL. After adjustment for covariates, frequency of binge drinking and AUDIT-score were statistically significantly associated with QoL in depressed individuals and AUDIT-score in the non-depressed group. When analysing all respondents regardless of depression, both AUDIT-score and binge drinking were associated with QoL. Of the alcohol-related variables, binge drinking and alcohol problems indicated by AUDIT-score contributed to impaired QoL in depressed individuals and both should be assessed as part of the clinical management of depression.Peer reviewe

Temperamentti ja persoonallisuushäiriöt masennuksen muovaajina

Persoonallisuus on yksilön psyykkisistä ja fyysisistä tekijöistä rakentuva dynaaminen järjestelmä, joka selittää yksilön ainutlaatuisia tapoja sopeutua ympäristöönsä. Persoonallisuutta voidaan tarkastella sekä ulottuvuuksien että kehityksellisten teorioiden avulla. Temperamentilla tarkoitetaan ihmisen synnynnäistä, biologisesti ja geneettisesti määräytyvää psyyken perusrakennetta, josta kehittyy vuorovaikutuksen kautta yksilöllinen persoonallisuus. Temperamentin yhteys masennukseen ilmenee erityisesti korostuneen vaikeuksien välttämispiirteen muodossa. Persoonallisuushäiriöt johtavat poikkeaviin tapoihin tehdä havaintoja itsestä ja muista ihmisistä, säädellä tunteita ja tulla toimeen muiden ihmisten kanssa. Persoonallisuushäiriö huonontaa merkittävästi masennuksen ennustetta siten, että toipuminen masennuksesta on hitaampaa ja uudelleen sairastuminen on todennäköisempää kuin jos kyse olisi pelkästä masennuksesta. Aikuisiän temperamenttipiirteet, persoonallisuus ja persoonallisuushäiriöt ovat yhteydessä masennukseen

Sairaudentunnon ja hoitoon sitoutumisen merkitys skitsofrenian hoidossa

Skitsofrenian ja muiden psykoosisairauksien hoidossa huono pitkäaikaiseen hoitoon sitoutuminen on yleinen, monista eri syistä johtuva ongelma. Hoitoon sitoutumisella on ratkaiseva merkitys potilaan hoidon onnistumisen ja potilaan toipumisen kannalta. Skitsofreniaan liittyvä heikko sairaudentunto voi estää hoidollisen yhteistyön rakentumisen. Potilaan huonon hoitoon sitoutumisen riskin varhainen tunnistaminen ja kohdennettujen terapeuttisten interventioiden, kuten psykoedukaation käyttö saattavat auttaa potilasta ja omaisia hyväksymään paremmin hoidon tarpeen. Kunkin potilaan yksilöllisiä syitä huonoon hoitoon sitoutumiseen tulisi pyrkiä selvittämään ja ymmärtämään. Säännöllinen lääkehoidon vasteen seuraaminen sekä tarvittaessa pitkävaikutteisen ruiskelääkkeen aloitus ovat keskeisiä toimia oireiden hallinnan ja sen myötä paremman sairaudentunnon saavuttamiseksi.</p

Pessimism, diet, and the ability to improve dietary habits : a three-year follow-up study among middle-aged and older Finnish men and women

BackgroundDietary habits have a great influence on physiological health. Even though this fact is generally recognized, people do not eat as healthily as they know they should. The factors that support a healthy diet, on the other hand, are not well known. It is supposed that there is a link between personal traits and dietary habits. Personal traits may also partially explain why some people manage to make healthy dietary changes while some fail to do so or are not able to try to make changes even when they desire to do so. There is some information suggesting that dispositional optimism plays a role in succeeding in improving dietary habits. The aim of this study was to determine the role of optimism and pessimism in the process of dietary changes.MethodsDispositional optimism and pessimism were determined using the revised Life Orientation Test in 2815 individuals (aged 52-76years) participating in the GOAL study in the region of Lahti, Finland. The dietary habits of the study subjects were analysed. After 3years, the subjects' dietary habits and their possible improvements were registered. The associations between dispositional optimism and pessimism, dietary habits at baseline, and possible changes in dietary habits during the follow-up were studied with logistic regression. We also studied if the dietary habits or certain lifestyle factors (e.g. physical exercising and smoking) at baseline predicted success in improving the diet.ResultsPessimism seemed to correlate clearly negatively with the healthiness of the dietary habits at baseline - i.e. the higher the level of pessimism, the unhealthier the diet. Optimism also showed a correlation with dietary habits at baseline, although to a lesser extent. Those who managed to improve their dietary habits during follow-up or regarded their dietary habits as healthy enough even without a change were less pessimistic at baseline than those who failed in their attempts to improve their diet or did not even try, even when they recognized the need for a change.ConclusionsPessimistic people are more likely to eat an unhealthy diet than others. Pessimism reduces independently the possibilities to improve dietary patterns.Peer reviewe

Making implementation programmes better : mixed methods case study of an implementation process for two evidence-based brief psychotherapies

publishedVersionPeer reviewe

S-ketamine for the treatment of depression

Abstract Ketamine infusion has been reported to rapidly relieve depressive symptoms and suicidal ideation in patients with treatment-resistant depression (TRD). It has also been tested in electroconvulsive therapy (ECT) anaesthesia and has been suggested to enhance the response to ECT. S-ketamine is less studied than a racemic mixture or R-enantiomer in these patients. S-ketamine is more potent as an anaesthetic and might thus also have a better antidepressive effect. In this article we present recent data concerning the antidepressive and adverse effects of S-ketamine compared with racemic and R-ketamine in major depressive disorder (MDD), especially in TRD. Based on recent literature, it is obvious that S-ketamine also possesses antidepressive properties. In ECT anaesthesia, S-ketamine might enhance the antidepressive effect of this treatment. S-ketamine may also be preferable when compared with other anaesthetics regarding adverse cognitive effects. Its adverse psychotomimetic effects may be avoidable when used in anaesthetic doses. Although the data on S-ketamine at the moment is only based on case reports and expert opinions rather than adequate prospective randomized studies, it still may offer an important option when treating severe and resistant depression

CYP1A2 polymorphism −1545C > T (rs2470890) is associated with increased side effects to clozapine

Background Cytochrome P450 1A2 gene (CYP1A2) polymorphisms have been suggested to be associated with increased side effects to antipsychotics. However, studies on this are scarce and have been conducted with either various antipsychotics or only in small samples of patients receiving clozapine. The aim of the present study was to test for an association between the CYP1A2 −1545C > T (rs2470890) polymorphism and side effects in a larger sample of patients during long-term clozapine treatment. Methods A total of 237 patients receiving clozapine treatment completed the Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) assessing clozapine-induced side effects. Of these patients, 180 completed the questionnaire satisfactorily, agreed to provide a blood sample, and were successfully genotyped for the polymorphism. Results The TT genotype of CYP1A2 polymorphism −1545C > T (rs2470890) was associated with significantly more severe side effects during clozapine treatment (p = 0.011). In a subanalysis, all seven types of side effects (sympathicotonia–tension; depression–anxiety; sedation; orthostatic hypotension; dermal side effects; urinary side effects; and sexual side effects) appeared numerically (but insignificantly) more severely among TT carriers. In addition, use of mood stabilizers was more common among patients with the TT genotype (OR = 2.63, p = 0.004). Conclusions This study has identified an association between the CYP1A2 polymorphism −1545C > T (rs2470890) and the occurrence of more severe clozapine side effects. However, these results should be regarded as tentative and more studies of larger sample sizes will be required to confirm the result.BioMed Central opean acces