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

One-session cognitive behavior treatment for long-term frequent attenders in primary care: randomized controlled trial

Aim: The aim of the study was to find out, if a single cognitive behavior treatment (CBT) session for long-term frequent attenders in primary care affects the attendance frequency and mental well-being of the patients. Methods: Out of 193 long-term frequent attenders, 56 participated and were randomized to receive either a one-session CBT intervention or usual care. The groups were compared to each other regarding change in general practitioner visits and change in depressive symptoms, sense of coherence, somatoform symptoms and hypochondriacal anxiety at six months' follow-up. Results: The attendance frequency decreased in both groups, but there was no difference between the groups. Changes in mental functioning did not differ between the groups. When patients with no mental health disorder were analyzed separately, the decrease in GP visits was significantly higher in the intervention group than in the control group (p = .004). Conclusion: A single session of CBT is not useful in reducing GP visits or improving mental well-being of long-term frequent attenders. Frequent attenders without a psychiatric disorder may benefit from this kind of intervention.</div

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

Effect of administrative information on visit rate of frequent attenders in primary health care: ten-year follow-up study

Background: frequent attenders (FAs) use a disproportionately large share of the resources of general practitioners (GPs) working in primary healthcare centres. The aim of this study was to estimate the proportion of FAs among all patients in the primary health care centres of a medium-sized city in Finland, and to examine whether providing GPs with administrative information about their frequent attenders (names and numbers of visits per year) can reduce the number of FAs and the frequency of their visits.Methods: Statistic data on all GP visits (n = 1.8 million) to 11 public healthcare centres in one city were collected from the electronic patient records covering the period from 2001 to 2010. A FA-patient was defined as a person who made10 or more visits to GPs during one year. The baseline situation in 2001 was compared with the situation in 2006 after administrative information had been provided three times to all GPs working in the healthcare centres. Poisson's regression analysis was used, and FA numbers and consultation rates in the years 2002-2005 were compared with the year 2006; figures for 2006 were also compared with those for the follow-up period 2007-2010.Results: During the years 2001-2006, the proportion of visits of FA-patients fell overall from 9.1 to 8.5%, a decline of 0. 6% (p < 0.0001). This reduction was equivalent to an annual work load of two GPs in the study center. The proportion of visits of FA patients increased again in the follow-up period (2007-2010), when administrative information was no longer provided.Conclusion: When GPs are provided with information on the number and names of their FA-patients, the annual rate of FA visits to GPs drops significantly. The method is simple and repeatable. However, without a control group of GPs who have not received such information, it is impossible to assess if the intervention was the only circumstance affecting the reduction in FA consultation rates

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

How GPs can Recognize Persistent Frequent Attenders at Finnish Primary Health Care Using Electronic Patient Records

Introduction: The proportion of patients who are frequent attenders (FAs) varies from few percent to almost 30% of all patients. A small group of patients continued to visit GPs year after year. In previous studies, it has been reported that over 15% of all 1-year FAs were persistent frequent attenders (pFAs). Objectives: This study aimed to identify typical features of pFAs from the textual content in their medical entries, which could help GPs to recognize pFAs easily and facilitated treatment.Methods: A retrospective register study was done, using 10 years of electronic patient records. The data were collected from Finnish primary health care centers and used to analyze chronic symptoms and diagnoses of pFAs and to calculate the inverse document frequency weight (IDF) of words used in the patient records. IDF was used to determine which words, if any, are typical for pFAs. The study group consisted of the 5-year pFAs and control group of 1-year FAs. The main background variables were age, gender, occupation, smoking habits, use of alcohol, and BMI. Results: Out of 4392 frequent attenders, 6.6% were pFAs for 3 years and 1.1% were pFAs for 5 years. Of the pFAs, 65% were female and 35% were male. The study group had significantly more depressive episodes (P =.004), heart failure (P =.019), asthma (P =.032), COPD (P =.036), epilepsy (P =.035), and lumbago (P =.046) compared to the control group. GPs described their 5-year pFAs by words related to lung and breathing issues, but there was no statistical difference to the 1-year FAs’ descriptions. Conclusion: A typical pFA seems to be a woman, aged about 55 years with depressive episodes, asthma or COPD, and lower back pain. Physicians describe pFAs with ordinary words in patient records. It was not possible to differentiate pFAs from 1-year FAs in this way. © The Author(s) 2021.Author keywordsdescribing persistent frequent attenders; electronic patient entry; persistent frequent attender; practice management; primary care</p

Patient-Made Videos as a Tool of Self-Observation Enhancing Self-Reflection in Psychotherapy: Description of the Method and a Clinical Case

Photographs have been used in psychotherapy from the late 1970s, but patient-made videos have not been used directly as an integral part in individual psychotherapeutic treatment. We now propose a new approach, VideoTalk, using visual material as an aid in the psychotherapy process with a schema therapy framework as an example. VideoTalk builds on life-review method, providing information about the patient’s social relations, coping skills, affect/emotion regulation and schemas. This information is used as a platform for focused patient-made videos, i.e. self-talk at home in a typical problematic situation for the patient. The VideoTalk method enables documentation of the expression of mind states and dysfunctional schemas in a natural environment and related to an everyday emotional context. Subsequently, this video material is watched step by step together with the therapist. In this report, we describe the flow and functionality of the VideoTalk method through the case of a 24-year-old female patient suffering from depression and social phobia. The self-mirroring from the video facilitates self-observations of the patient’s own facial expressions, voice and body posture. We hypothesize that this new information gradually changes emotional processing, leads to better self-awareness and strengthens more functional schemas.</p

Depressio : Käypä hoito -suositus

Peer reviewe

Short-term functional outcome in psychotic patients: results of the Turku early psychosis study (TEPS)

Background Functional recovery of patients with clinical and subclinical psychosis is associated with clinical, neuropsychological and developmental factors. Less is known about how these factors predict functional outcomes in the same models. We investigated functional outcomes and their predictors in patients with first-episode psychosis (FEP) or a confirmed or nonconfirmed clinical high risk of psychosis (CHR-P vs. CHR-N). Methods Altogether, 130 patients with FEP, 60 patients with CHR-P and 47 patients with CHR-N were recruited and extensively examined at baseline (T0) and 9 (T1) and 18 (T2) months later. Global Assessment of Functioning (GAF) at T0, T1 and T2 and psychotic, depression, and anxiety symptoms at T1 and T2 were assessed. Functional outcomes were predicted using multivariate repeated ANOVA. Results During follow-up, the GAF score improved significantly in patients with FEP and CHR-P but not in patients with CHR-N. A single marital status, low basic education level, poor work situation, disorganization symptoms, perceptual deficits, and poor premorbid adjustment in patients with FEP, disorganization symptoms and poor premorbid adjustment in patients with CHR-P, and a low basic education level, poor work situation and general symptoms in patients with CHR-N predicted poor functional outcomes. Psychotic symptoms at T1 in patients with FEP and psychotic and depression symptoms at T1 and anxiety symptoms at T2 in patients with CHR-P were associated with poor functioning. Conclusions In patients with FEP and CHR-P, poor premorbid adjustment and disorganization symptomatology are common predictors of the functional outcome, while a low education level and poor work situation predict worse functional outcomes in patients with FEP and CHR-N. Interventions aimed at improving the ability to work and study are most important in improving the functioning of patients with clinical or subclinical psychosis.</p