Käsittämätöntä kartoittamassa : psykoottisenkaltaisten kokemusten ulottuvuudet ja niiden kliininen hyöty

Psychotic diseases are a great burden to both the affected individuals and society at large. Though psychoses are severe mental disorders, similar phenomena appear outside of the diagnosable disorders as psychotic or psychotic-like experiences (PLEs). The PLEs are on a continuum of liability and symptom expression in the population, from the healthy to the pathological, and the diagnosed disorders constitute the extreme of the distribution, rather than a clearly delineated class. Studying the psychosis continuum offers a way of understanding the underlying causes shared across the entire range. The frequent presence of PLEs before the first psychotic episode also helps in identifying a trajectory towards disease. However, the specific PLEs associated with increased psychosis risk or incipient disease require further elucidation. Though experiences similar to the positive symptoms of psychosis primarily hallucinations and delusions have been nominated as the most predictive of psychosis, these are broad categories that may contain subdivisions of varying levels of shared aetiology with psychotic disease, and varying predictive value. In this thesis, the latent dimensions of self-reported PLEs were explored in one sample of 6,611 adolescents and one sample of 31,822 adults from the general population (Studies I and II), as well as in one sample of 71 and one sample of 731 adolescents in psychiatric care (Studies III and IV). Three different PLE questionnaires were employed in the separate studies: the PROD-screen, the 92-item version of the Prodromal Questionnaire, and the positive items of the Community Assessment of Psychic Experiences. The clinical significance of the identified dimensions was studied via their associations with general mental health, cognitive performance, and their predictive value with respect to psychiatric hospitalization in general or for psychosis specifically. Overall, the results showed a general PLE structure of positive, negative, and disorganized dimensions similar to that of symptoms in non-affective psychotic disorders. The positive dimension further subdivided into dimensions of persecutory ideation, other delusions, and hallucinations and, in one study, depersonalization experiences. These dimensions were correlated with general psychiatric health, as assessed by lifetime depression and anxiety. In contrast, questionnaire items intended to address hypomanic, grandiose, or magical thinking appeared unrelated to psychiatric health. In a smaller sample of adolescents in psychiatric care, the positive, disorganized, and negative dimensions were not associated with cognitive performance, contrary to expectation. However, in a larger sample, especially functional disorganization, that is, impaired role functioning, was associated with later psychiatric hospitalization in general, while the depersonalization experiences dimension was the best predictor of hospitalization with a diagnosis of psychosis. The identified latent dimensions of psychotic-like experiences demonstrate the structural validity of the PLE questionnaires, while the concurrent clinical correlates and predictive value establish criterion validity. In particular, the finding of the empirically derived depersonalization dimension being specifically predictive of psychosis merits attempts at replication. Modern psychometric methods used in the present thesis improve the utility of PLE related rating scales. In future studies a more fine-grained approach to assessing PLEs is recommended, in order to improve the accuracy of psychosis prediction and our understanding of the psychosis continuum.Psykoottiset häiriöt ovat merkittävää ongelma niin yksilöille kuin yhteiskunnalle. Vaikka psykoosit ovat vakavia mielenterveysongelmia, vastaavia kokemuksia ja oireita ilmenee myös diagnosoitavien häiriöiden ulkopuolella psykoottisina tai psykoottisenkaltaisina kokemuksina. Nämä kokemukset muodostavat väestössä jatkumon, jossa diagnosoidut häiriöt ovat jakauman toinen ääripää pikemminkin kuin selvästi rajattavissa olevan ilmiöluokka. Psykoosijatkumoa tutkimalla voidaan selvittää koko jatkumolle yhteisiä selittäviä tekijöitä. Lisäksi psykoottisenkaltaiset kokemukset edeltävät usein ensimmäistä psykoottista sairastumista, joten niiden tutkiminen auttaa tunnistamaan sairauteen johtavia kehityskaaria. Vielä on kuitenkin epäselvää, mitkä tietyt psykoottisenkaltaiset kokemukset ovat yhteydessä kohonneeseen psykoosiriskiin tai alkavaan sairauteen. Aikaisempien tutkimusten perusteella psykoosien positiivisia oireita eli lähinnä harha-aistimuksia ja harhaluuloja muistuttavat kokemukset ennustavat parhaiten psykoosiin sairastumista. Positiivisten oireiden kaltaiset kokemukset on kuitenkin laaja ilmiöluokka, johon kuuluu useita alaluokkia. Niillä kaikilla ei välttämättä ole yhteyttä psykoottisiin häiriöihin eikä niistä ole hyötyä psykoosiin sairastumisen ennustamisessa. Tässä väitöskirjassa tutkittiin itsearviointikyselyillä psykoottisenkaltaisia kokemuksia ja niiden ulottuvuuksia 6611 nuoren ja 31822 aikuisen aineistoissa (osatutkimukset I ja II) sekä 71 ja 731 psykiatrisessa hoidossa olevan nuoren aineistoissa (osatutkimukset III ja IV). Osatutkimuksissa käytettiin kolmea eri kyselymenetelmää: PROD-screen, Prodromal Questionnaire (92 kysymyksen versio), sekä Community Assessment of Psychic Experiences (vain positiiviset oireet). Eri ulottuvuuksien kliinistä merkitystä arvioitiin selvittämällä niiden yhteyttä yleiseen psyykkiseen hyvinvointiin, kognitiiviseen suoriutumiseen sekä myöhempään psykiatriseen sairaalahoitoon psykoosin vuoksi tai yleensä. Kaiken kaikkiaan tulokset osoittivat, että psykoottisenkaltaiset kokemukset käsittävät samat kolme ulottuvuutta kuin ei-affektiivisten psykoosien oireet: positiivinen, negatiivinen ja hajanaisuusulottuvuus. Positiivinen ulottuvuus jakautui edelleen alaluokkiin vainoamis¬ajatukset, muut harhaluulot ja hallusinaatiot sekä yhdessä tutkimuksessa depersonalisaatiokokemukset. Nämä ulottuvuudet olivat yhteydessä masennukseen ja yleistyneeseen ahdistuneisuuteen. Sen sijaan kysymykset, joilla arvioitiin hypomaanista, grandioottista tai maagista ajattelua eivät olleet yhteydessä mielenterveyteen. Vastoin oletuksia psykiatrisessa hoidossa olevien nuorten suppeammassa aineistossa ulottuvuudet positiiviset, negatiiviset tai hajanaiset psykoottisenkaltaiset kokemukset eivät olleet yhteydessä kognitiiviseen suoriutumiseen. Sen sijaan laajemmassa aineistossa varsinkin toiminnallinen hajanaisuus ennusti myöhempää psykiatrista sairaalahoitoa yleensä, kun taas depersonalisaatio¬ulottuvuus oli paras ennustaja kun sairaalahoitoon liittyi psykoosidiagnoosi. Tutkimus tuo esiin, että psykoottisenkaltaisten kokemusten taustalla on useita eri ulottuvuuksia ja käytetyillä kyselylomakkeilla on sekä hyvä rakennevaliditeetti että hyvä kriteerivaliditeetti ennustettaessa myöhempää sairaalahoitoa. Erityisen kiinnostava ja toistotutkimuksen ansaitseva tulos oli uusi löydös, jonka mukaan depersonalisaatioulottuvuus ennustaa psykoosiin sairastumista. Tässä väitöskirjassa käytetyt modernit psykometriset menetelmät parantavat siis kyselylomakkeiden käyttöarvoa kun tutkitaan psykoottisenkaltaisia kokemuksia. Myös tulevissa tutkimuksissa psykoottisenkaltaisia kokemuksia tulisi tarkastella tällaisella hieno-jakoisemmalla lähestymistavalla, jotta saisimme tarkempaa tietoa psykoosijatkumon luonteesta ja psykoosiin sairastumisen ennustamis¬tarkkuus paranisi

Psychotic-like experiences of young adults in the general population predict mental disorders

Psychotic-like experiences (PLEs) have been identified as risk markers for psychotic disorders and may indicate an individual's susceptibility to mental disorders in general. We examined whether 23 PLEs (assessed with MCIDI questionnaire) reported in young adulthood (n = 1313) predict subsequent psychotic or any mental disorders in the general population. We also investigated whether these possible associations are explained by general psychological distress assessed with the General Health Questionnaire-12 (GHQ-12). The register follow-up period spanned 10-12 years. In Cox regression models, PLEs predicted subsequent psychotic disorders (n = 12) when the effects of age, sex, education, and marital status were adjusted for, but not when general psychological distress was added to the model. Having any mental disorders during follow-up (n = 91) was predicted by PLEs reported at a younger age, when controlling for age, sex, education, marital status, and general psychological distress. In line with earlier results in other age groups, PLEs can be seen as a sign of vulnerability to not just psychotic but all mental disorders during the following years also among young adults in the general population. PLEs were a predictive marker of general psychopathology independently from general psychological distress.Peer reviewe

Nuorten psykoottistyyppisten oireiden kliininen merkitys

English summaryPeer 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

Validation of the Finnish version of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and evaluation of the applicability of the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) and the Fatigue Scale for Motor and Cognitive Functions (FSMC)

Objectives Cognitive impairment is frequent in multiple sclerosis (MS) as approximately half of the patients manifest some degree of cognitive impairment. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been designed for brief cognitive evaluation. The purpose of the study was to validate the BICAMS along with the Finnish versions of one self-rating questionnaire each for cognition and fatigue.Methods A total of 65 MS patients and 45 healthy controls (HC) were assessed with the BICAMS, the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), and the Fatigue Scale for Motor and Cognitive Functions (FSMC) twice, approximately within nine days.Results MS patients scored markedly lower than the HCs on each of the three tests of the BICAMS. Of the patients, 60% scored at least 1.5 SD below the mean of the HCs on at least one test; 49% on the SDMT, 26% on the CVLT-II, and 28% on the BVMT-R. Correlation coefficients for the repeated measurement were between 0.75 and 0.89 for the three tests in the whole study sample. MS patients reported more cognitive symptoms and more fatigue than the HCs. Cronbach's alpha was 0.94 for the MSNQ and 0.98 for the FSMC. Correlation coefficient for the repeated measurement was 0.91 for the MSNQ and between 0.92 and 0.94 for the FSMC scores for the whole study sample.Conclusions The present study supports the validity of the Finnish version of the BICAMS. The SDMT was the most sensitive of the three BICAMS tests and showed cognitive impairment in half of the patients. The Finnish versions of the MSNQ and the FSMC proved useful tools in approaching concerns related to cognition and fatigue

Subjective mental well-being among higher education students in Finland during the first wave of COVID-19

Aims: Increased mental health problems during the COVID-19 pandemic have become a major concern among young adults. Our aim was to understand which COVID-19-related questions predicted mental well-being during the outbreak. Methods: Two cross-sectional datasets were used. The primary dataset was collected in May 2020 (n = 1001), during the initial COVID-19 outbreak, and the secondary in April 2019 (n = 10866), before the pandemic. Mental well-being was assessed with the Short Warwick-Edinburgh Mental Well-Being Scale. Relationships between mental well-being and COVID-19-related questions were investigated with lasso regression. As an exploratory analysis, two-way ANOVAs were used to compare mental well-being before and during the outbreak. Results: Higher levels of mental well-being were associated with lower levels of academic stress and COVID-19-related worry, along with a higher satisfaction with the procedures and information provided by the higher education institutions and the government. COVID-19-related symptoms and infections did not have an impact on students' mental well-being during the outbreak. Small to moderate effect sizes across the time points were detected, indicating an overall decrease in mental well-being across age and gender during the outbreak. Conclusions: COVID-19 had an impact on higher education students' mental well-being. Higher education institutes may play a crucial role in protecting their students' well-being during uncertain times.Peer reviewe

Theory of mind in a first-episode psychosis population using the Hinting Task

Deficiencies in theory of mind (ToM) are common in psychosis and may largely explain impaired social functioning. Currently, it is unclear whether impairments in ToM are explained by the more general cognitive deficits related to psychosis or whether ToM is impaired in psychosis independently of other cognitive deficits. This study examined ToM using the Hinting Task in young adults (n=66) with first-episode psychosis and matched controls (n=62). The participants were administered a broad neuropsychological assessment. Participants with psychosis performed worse than controls on the Hinting Task. However, 75 % of the variance between the groups was explained by general cognitive deficits, especially impaired processing speed and episodic memory. Hinting Task performance of the best functioning patient group did not differ from that of the control group. When the psychosis group was divided according to diagnosis, the Hinting Task difference between individuals with schizophrenia and controls remained significant even when general cognitive performance was controlled for, suggesting specific verbal ToM deficits in schizophrenia. In contrast, those with other psychotic disorders did not differ from controls. Our results suggest that ToM deficits can be seen in early phases of psychotic disorders, schizophrenia in particular, and are partly independent of other cognitive functions.Peer reviewe