Monday, February 24, 2020

Comments by Antero

Showing 3 of 3 comments.

  • Actually there is not much truth to what you write. Learned helplessness is a concept arising from animal studies conducted by psychologist Martin Seligman. It refers to a situation where one cannot escape from a frustrating situation, like caught between a rock and a hard place. Learned helplessness signifies the relationship between an organisms and its environment.

    Inflammation and increased stress hormone release are a result of acute or chronic stress, distressing life events, childhood traumas, low socio-economic status, overweight, insomnia among others. These are factors that precede any form of depression or its medication. Inflammation and stress hormone release are involved in many illnesses that have nothing to do with depression or its medication.

  • The first paragraph refers to the project in Turku, where the researchers focused on psychosocial methods and antipsychotics, but not on the fact that the doses of benzodiazepines were high and for a long time (which was evident to everybody working at the clinic in late 80´and early 90´s. It was marketed as a “medication free treatment”. That project resulted only in one paper (by Lehtinen et al. in European Psychiatry 2000). I think, however, the conclusion that it is not necessary to start antipsychotics routinely to all patients is sound. Traditionally the doses of antipsychotics used were in Finland low on a much lower level than in US or Europe.

    As to the project in Northern Finland, the sale of benzodiazepines is high and according to those who worked there and were disappointed, the case was similar to that in Turku. Also patients sent to state mental hospital from that region had high doses of benzodiazepines. What may be true to some average cases may not be true to other cases. The study reports are not actual papers on intervention outcomes but more reports of what is the theoretical background (prof. Alanen´s project, Tom Andreassen´s thinking, Bakhtin etc). The sample is too small to draw any conclusions. There are many other short-comings additionally. So, we do not know on the basis of the paper about much else than you state above and that is not enough. In comparison to the national statistics. Moreover, the treatment models used are rarely transferable elsewhere as there are local background factors and enthusiasm.

    The length of hospitalisations went down in all of Finland and the mean is currently 10 days in acute psychoses. Family interventions are also in use in most of Finland. What is positive in Keroputaa´s treatment is the fact that psychosocial interventions are carried out by same teams whether the patient is in hospital or outpatient care, and the are incorporated comprehensively, which is not the case somewhere else. But there have been development projects elsewhere in Finland and have been ion some respects a bit more innovative which have not been in the focus of attention internationally.

    I do not think that they would have manipulated the data regarding medication. It is more a question of poor reporting and lack of critical analysis. As to the suicides, it is an intentional concealment. Why this has happened, I do not know. We will hear about this later this year from a leading Nordic researcher on mortality in psychoses in the Nordic countries.

    In the end, all psychosocial/psychotherapeutic methods seem to lead to comparative results and the theoretical background does not exceed that of treatment allegiance and the so called general factors.

    Other projects using heavily psychosocial methods are e.g. the OPUS-project in Copenhagen and Early Psychosis teams in Australia.

  • Just a couple of words about the “Open dialogue” method. It was originally developed in Turku, Finland while I was a resident. Most of us were enthusiastic about the project. But later it became a lot of trouble. Most of the staff were relieved when the method was stopped. There were some suicides and serious suicide attempts. In general the patients were hospitalised for many months to years. It was never a method that used no medication. High doses of benzodiazepines were used (e.g. 20-25 mg of lorazepam) instead of antipsychotics. In general the patients were unable to kick of the benzodiazepines for years. At the time the model was called integrated treatment of psychosis indicating combination of individual therapy and family therapy. I was one of those who was enthusiastic but from my point of view it was heading for a disaster.

    In the Open Dialogue method benzodiazepines are also used in high doses. The study they made of the project was of weak quality but most of all the researhers concealed cases of suicides during the study period. Currently, the Keroputaa hospital area in Finland where the method is used has the highest suicide rate among schizophrenia patients in Finland.

    The method is by no means unique. It is like incorporating motivational interview routinely in the treatment, which is more than you get in most hospitals. In Australia they have done a better job also research-wise