Nuoren sosiaalisten tilanteiden pelon tunnistaminen, arviointi ja hoito

Sosiaalisten tilanteiden pelko (STP) kehittyy tavallisesti nuoruusiässä. Oireet haittaavat opiskelua ja ihmissuhteita: häiriö muokkaa tapaa olla vuorovaikutuksessa. Hoidollisessa arviossa tärkeää on arvioida oireiden tuottamaa toimintahaittaa, erityisesti välttämiskäyttäytymisen laajuutta. STP:hen liittyvä samanaikaissairastavuus tulee tunnistaa ja määrittää ensisijainen hoidettava häiriö. STP:n tutkituimmat psykoterapeuttiset hoidot ovat kognitiivisen käyttäytymisterapian sovelluksia. Lievää STP:tä voidaan hoitaa esimerkiksi nettiterapialla tai ahdistukseen yleisemmin kohdistetulla terapialla, keskivaikean STP:n ensisijainen hoito on siihen fokusoitu lyhytterapia. Vaikean tai komplisoituneen STP:n hoito koostuu ydinoireisiin kohdistetusta, riittävän pitkäkestoisesta psykoterapiasta, jota tuetaan tarvittaessa lääkityksellä. Perheen osallistaminen etenkin varhaisnuorten hoitoon on tärkeää. Hoidon seurannassa on tärkeää arvioida toimintakyvyn muutosta. Lääkitystä voidaan käyttää häiriön vaikeiden muotojen hoidossa psykoterapiaan liitettynä tai jos psykoterapialla ei ole saavutettu vastetta.publishedVersionPeer reviewe

Nuoren sosiaalisten tilanteiden pelon tunnistaminen, arviointi ja hoito

Vertaisarvioitu.Sosiaalisten tilanteiden pelko (STP) kehittyy tavallisesti nuoruusiässä. Oireet haittaavat opiskelua ja ihmissuhteita: häiriö muokkaa tapaa olla vuorovaikutuksessa. Hoidollisessa arviossa tärkeää on arvioida oireiden tuottamaa toimintahaittaa, erityisesti välttämiskäyttäytymisen laajuutta. STP:hen liittyvä samanaikaissairastavuus tulee tunnistaa ja määrittää ensisijainen hoidettava häiriö. STP:n tutkituimmat psykoterapeuttiset hoidot ovat kognitiivisen käyttäytymisterapian sovelluksia. Lievää STP:tä voidaan hoitaa esimerkiksi nettiterapialla tai ahdistukseen yleisemmin kohdistetulla terapialla, keskivaikean STP:n ensisijainen hoito on siihen fokusoitu lyhytterapia. Vaikean tai komplisoituneen STP:n hoito koostuu ydinoireisiin kohdistetusta, riittävän pitkäkestoisesta psykoterapiasta, jota tuetaan tarvittaessa lääkityksellä. Perheen osallistaminen etenkin varhaisnuorten hoitoon on tärkeää. Hoidon seurannassa on tärkeää arvioida toimintakyvyn muutosta. Lääkitystä voidaan käyttää häiriön vaikeiden muotojen hoidossa psykoterapiaan liitettynä tai jos psykoterapialla ei ole saavutettu vastetta.Peer reviewe

Treating adolescent depression in multi-professional school health and welfare services with IPC-A : implementation results from a national pilot trial

English abstract.Peer reviewe

Brief, developmentally oriented cognitive therapy for adolescents with social anxiety disorder : a case series from a pilot evaluation

English abstract.Peer reviewe

Discrepant views of social competence and links with social phobia

Adolescents’ biased perceptions about their social competence (SC), whether negatively or positively, serve to influence their socioemotional adjustment such as early feelings of social phobia (nowadays referred to as Social Anxiety Disorder-SAD). Despite the importance of biased self-perceptions in adolescents’ psychosocial adjustment, the extent to which discrepancies between self- and others’ evaluations of one’s SC are linked to social phobic symptoms remains unclear in the literature. This study examined the perceptual discrepancy profiles between self- and peers’ as well as between self- and teachers’ evaluations of adolescents’ SC and the interrelations of these profiles with self-reported social phobic symptoms. The participants were 390 3rd graders (15 years old) of Finnish lower secondary school (50.8% boys, 49.2% girls). In contrast with variable-centered approaches that have mainly been used by previous studies when focusing on this subject, this study used latent profile analysis (LPA), a person-centered approach which can provide information regarding risk profiles by capturing the heterogeneity within a population and classifying individuals into groups. LPA revealed the following five classes of discrepancy profiles: i) extremely negatively biased perceptions of SC, ii) negatively biased perceptions of SC, iii) quite realistic perceptions of SC, iv) positively biased perceptions of SC, and v) extremely positively biased perceptions of SC. Adolescents with extremely negatively biased perceptions and negatively biased perceptions of their own SC reported the highest number of social phobic symptoms. Adolescents with quite realistic, positively biased and extremely positively biased perceptions reported the lowest number of socio-phobic symptoms. The results point out the negatively and the extremely negatively biased perceptions as possible contributors to social phobic symptoms. Moreover, the association of quite realistic perceptions with low number of social phobic symptoms indicates its potential protective power against social phobia. Finally, positively and extremely positively biased perceptions of SC are negatively associated with social phobic symptoms in this study. However, the profile of extremely positively biased perceptions might be linked as well with the existence of externalizing problems such as antisocial behavior (e.g. disruptive impulsivity). The current findings highlight the importance of considering discrepancies between self- and others’ perceptions of one’s SC in clinical and research efforts. Interventions designed to prevent or moderate social phobic symptoms need to take into account individual needs rather than aiming for uniform treatment. Implications and future directions are discussed.Peer reviewe

Predictors of outcome after a time-limited psychosocial intervention for adolescent depression

Research on the predictors of outcome for early, community-based, and time-limited interventions targeted for clinical depression in adolescents is still scarce. We examined the role of demographic, psychosocial, and clinical variables as predictors of outcome in a trial conducted in Finnish school health and welfare services to identify factors associating to symptom reduction and remission after a brief depression treatment. A total of 55 12-16-year-olds with mild to moderate depression received six sessions of either interpersonal counseling for adolescents (IPC-A) or brief psychosocial support (BPS). Both interventions resulted in clinical improvement at end of treatment and 3- and 6-month follow-ups. Main outcome measures were self-rated BDI-21 and clinician-rated Adolescent Depression Rating Scale (ADRSc). Latent change score (LCS) models were used to identify predictors of change in depressive symptom scores and clinical remission at end of treatment and 3- and 6-month follow-ups over the combined brief intervention group. Symptom improvement was predicted by younger age and having a close relationship with parents. Both symptom improvement and clinical remission were predicted by male gender, not having comorbid anxiety disorder, and not having sleep difficulties. Our results add to knowledge on factors associating with good treatment outcome after a brief community intervention for adolescent depression. Brief depression interventions may be useful and feasible especially for treatment of mild and moderate depression among younger adolescents and boys, on the other hand clinicians may need to cautiously examine sleep problems and anxiety comorbidity as markers of the need for longer treatment.Peer reviewe

Social Phobia and Educational and Interpersonal Impairments in Adolescence : A Prospective Study

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Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents

Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heiro R, Marttunen M. Psychometric properties of the GAD-7 in a large and representative adolescent sample. Psychiatry Res 2018 Dec 3;272:30-35. doi: 10.1016/j.psychres.2018.12.004.Symptoms of generalized anxiety disorder (GAD) are common among adolescents and can lead to severe psychosocial impairment, yet there is a lack of a good quality scale to measure symptoms of generalized anxiety in young people. The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a self-report scale used to measure GAD symptoms and has been validated in adult populations, but the measures psychometric properties regarding adolescents are unknown. The aim of this study was to investigate the reliability, factorial validity, and construct validity of the GAD-7 in adolescents in a nationally representative sample from a general population. Our study was based on Finnish survey data on 111,171 adolescents aged 14-18 years. Our results show that the GAD-7 demonstrates good psychometric properties in adolescents. The internal consistency of the GAD-7 was good (Cronbach's alpha = 0.91) and the instrument's unidimensional factor structure was supported. The associations of GAD-7 sum scores with self-report measures of depression and social anxiety supported construct validity. The psychometric properties of the GAD-7 in this sample of adolescents were similar to those reported among adults. However, studies in which diagnostic interviews are performed are needed to demonstrate the diagnostic efficacy of the measure in this age group.Peer reviewe

Community-oriented family-based intervention superior to standard treatment in improving depression, hopelessness and functioning among adolescents with any psychosis-risk symptoms

The aim of the present study was to compare change in functioning, affective symptoms and level of psychosis-risk symptoms in symptomatic adolescents who were treated either in an early intervention programme based on a need-adapted Family- and Community-orientated integrative Treatment Model (FCTM) or in standard adolescent psychiatric treatment (Treatment As Usual, TAU). 28 pairs were matched by length of follow-up, gender, age, and baseline functioning. At one year after the start of treatment, the matched groups were.compared on change in functioning (GAF-M), five psychosis-risk dimensions of the Structured Interview for Psychosis-Risk Syndromes (SIPS), and self-reported anxiety, depression, and hopelessness symptoms (BAI, BDI-II, BHS). FCTM was more effective in improving functioning (20% vs. 6% improvement on GAF-M), as well as self-reported depression (53% vs. 14% improvement on BDI-II) and hopelessness (41% vs. 3% improvement on BHS). However, for psychosis-risk symptoms and anxiety symptoms, effectiveness differences between treatment models did not reach statistical significance. To conclude, in the present study, we found greater improvement in functioning and self-reported depression and hopelessness among adolescents who received a need-adapted Family and Community-orientated integrative Treatment than among those who were treated in standard adolescent psychiatry. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Peer reviewe

Nuorten mielenterveys koulumaailmassa

Koulumenestys, osallisuus koulukiusaamiseen ja poissaolot koulusta ovat paitsi kognitiivisten ja sosiaalisten taitojen myös mielenterveyden indikaattoreita. Mielenterveyden häiriöt puolestaan voivat haitata oppilaan oppimista ja koulussa olemista monella tavalla. Mielenterveyden häiriöt liittyvät keskittymisvaikeuksiin, hahmottamisongelmiin ja motivaatioon ja epäonnistuminen koulutyössä saattaa altistaa tunne-elämän ja käyttäytymisen ongelmille. Oppimisvaikeuksien varhainen tunnistaminen ja oikein ajoitetut tukitoimet voivat ehkäistä mielenterveyshäiriöiden kehittymistä. Koulukiusaamiseen osallisilla nuorilla, niin kiusaajilla kuin uhreilla, on keskimääräistä enemmän niin internalisoivia kuin eksternalisoivia mielenterveyden häiriöitä samoin kuin oppilailla, jotka ovat usein poissa koulusta. Toveripiirin hyljeksimäksi joutuminen on nuoruusiässä erityisen huolestuttava merkki. Nämä ilmiöt voidaan huomata koulussa ja niihin on mahdollista puuttua oppilashuollon keinoin. Kouluyhteisön pitäisi olla jokaiselle turvallinen, ja myös yksilölliset mielenterveyttä tukevien interventioiden tarpeet tulee huomata. English summary: Adolescent mental health promotion in school context School performance, involvement in bullying and frequent absences from school are indicators of not only cognitive and social skills but also mental health. Mental disorders may interfere with learning and adjustment in many ways. Mental disorders may bring about problems in attention and motivation, and failure in schoolwork often makes an adolescent vulnerable to mental disorders. Early recognition of and prompt intervention in specific learning difficulties may prevent mental disorders. Adolescents involved in bullying present with increased risk of both internalising and externalising mental disorders, as do adolescents who are frequently absent from school, whether due to illness or due to truancy. Peer rejection is an important warning sign during adolescent development. These features can fairly easily be recognised at school, and school's psychosocial support systems should have plans for intervention. Mental health promotion in school should comprise approaches that make school safe and involving for all, and individual interventions for those at risk