Browsing by department "Faculty of Medicine"

This review will address how individual symptomology may be used to model a person’s psychological disorder. The discussed disorders are depression, generalised anxiety disorder and social anxiety disorder, which will be discussed separately and as simultaneous compositions of symptoms. Traditionally mental health disorders have been elucidated by dividing them into separate categories. In 2010s network analysis has risen as an alternative method, where the relationship between symptoms is examined in time and visualised as a network. The network analysis viewpoint suggests that psychological symptoms cause each other and that activation spreads through the network via the interactions between those symptoms. Two disorders that occur simultaneously are thought to constitute separate clusters of symptoms, which are united by bridge symptoms that mediate activation from one cluster to another. This review will focus particularly on idiographic, personalised networks. These personalised models aspire to take into consideration all the variation in a person’s symptomology. These models are formulated from occurring symptoms in several points in time, so it is possible to speculate, although not prove, the direction of an interaction between symptoms. The symptoms that affect several other symptoms strongly spread activation all around them when activated, whereas those symptoms that receive several effects from other symptoms particularly often associate with other symptoms. The application of network models to clinical practice is based on this idea. To demonstrate idiographic modelling, two different cases will be considered. In both examples the person is afflicted with both depression and an anxiety disorder, and for each person an idiographic network model is formed. The observation can be made from these cases that the symptoms described as most central in categorical models are not equal to the symptoms in these networks that most maintain its activation. The idiographic networks of the example cases also do not indicate bridge symptoms, but rather the symptoms form a single cluster and maintain each other across disorder category boundaries. The conclusions made from personalised network analyses cannot be generalised to the population or even the same person in other points in time. In addition, conclusions cannot be made about the validity of DSM categories or the concept of comorbidity. Nevertheless, they open windows to the individual variation and complexity of symptomology, which categorical diagnostic classifications cannot consider. From these observations different study questions and designs can be formulated and novel clinical interventions developed.

Kielellinen erityisvaikeus on merkittävä riskitekijä lukivaikeuksille. Jopa 50 %:lla kielihäiriöisistä lapsista todetaankin dysleksia ja vielä suuremmalla määrällä on lievempiä kirjoitetun kielen prosessoinnin ongelmia. Dysleksia on pohjimmiltaan fonologisen prosessoinnin häiriö ja myös kielihäiriöön liittyy usein samankaltaisia fonologisia ongelmia, mikä tekee häiriöiden toisistaan erottamisesta usein vaikeaa. Aiemmat tutkimukset ovat kuitenkin osoittaneet sen olevan mahdollista fonologista prosessointia tarkemmin analysoimalla. Sekä SLI että dysleksia heikentävät usein merkittävästi koulumenestystä ja häiriöiden esiintyessä yhdessä on negatiivinen vaikutus koulumenestykseen vielä suurempi. Olisikin tärkeää pystyä mahdollisimman varhaisessa vaiheessa erottamaan kielihäiriöisistä lapsista ne, jotka ovat dysleksiariskissä, jotta heidän lukivalmiuksiensa kuntoutus päästäisiin aloittamaan jo ennen koulun alkamista. Tämän tutkielman tarkoituksena on koota tutkimustietoa kielihäiriöisten lasten dysleksiariskistä ja erityisesti siitä, mitkä piirteet alle kouluikäisten kielihäiriöisten lasten fonologisessa prosessoinnissa ennakoivat dysleksiaa. Tämä kuvailevan kirjallisuuskatsauksen muodossa toteutettu tutkielma pohjautuu neljään tutkimusartikkeliin, jossa yhteensä 133:n kielihäiriöisen lapsen fonologista prosessointia arvioitiin 4-6-vuotiaana ja tuloksia verrattiin heidän teknisen lukemisensa sekä lukemisen sujuvuuden taitoihin ensimmäisinä kouluvuosina. Tutkimusten tuloksista kävi ilmi, että lyhytkestoisella kielellisellä muistilla ei ollut yhteyttä SLI-lasten dysleksiariskiin. Merkittäväksi dysleksiaa ennustavaksi tekijäksi osoittautui sen sijaan pulmat nopeassa sarjallisessa nimeämisessä, varsinkin mikäli lapsella oli ongelmia myös fonologisessa tietoisuudessa. Aiempaa tutkimusta aiheesta on tehty vasta vähän, mutta nyt saatujen tulosten perusteella näyttää kuitenkin siltä, että kielihäiriöisten lasten dysleksiariskiä ei voida ennustaa samoin kuin tyypillisesti kehittyneiden lasten dysleksiariskiä.

Body dysmorphic disorder (BDD) is a disorder that consists of a distressing and impairing preoccupation with a nonexistent or slight defect in appearance. Patients often seek surgical, dermatologic and other nonpsychiatric medical treatment for their perceived appearance flaws. Psychological and pharmacological interventions are suggested format for the treatment. The aim of this study is to determine the effectiveness of the treatments of body dysmorphic disorder. The main interest is in the effectiveness of psychotherapy and which therapeutic techniques or strategies are effective in the treatment of body dysmorphic disorder. Although research on treatment is still limited, findings support the effectiveness of psychotherapy suggesting that cognitive-behavioral therapy is effective in treating patients with body dysmorphic disorder. Effective therapy may consist of both cognitive and/or behavioral elements, but use of exposure and response prevention is reported in many studies. Findings also suggest that serotonin reuptake inhibitors may be useful in treating patients with body dysmorphic disorder but nonpsychiatric medical treatment usually does not improve BDD symptoms. Although treatments improved the appearance of the treated body part, it led not to improvement in BDD symptoms.

Objective. Transdiagnostic models of psychopathology assume that the commonalities across disorders may outweigh their differences. While these models acknowledge that disorder-specific symptoms and features undoubtedly exist, the same underlying factors are perceived to cause and maintain various disorders. In recent years, this approach has received growing attention and several new forms of therapy have been developed based on it. These may be well-suited for the treatment of mixed-diagnosis groups or individuals with comorbid disorders, and as such, they hold the promise of being very cost-effective. One of the most established transdiagnostic treatments is the Unified Protocol (UP), designed to help patients suffering from depression and the full range of anxiety disorders. The purpose of the present study is to review the evidence regarding the efficacy and effectiveness of the UP for the transdiagnostic treatment of adult anxiety and depression. Methods. For this review, systematic literature searches were performed using the PsychInfo and PubMed online databases in October 2018. The search term used was “Unified Protocol”. The search yielded 114 results in PsychInfo and 138 in PubMed. Ten of these matched the following study selection criteria and were included in the current review: a) the study measured either the efficacy or effectiveness of the cognitive-behavioral UP therapy developed by Barlow (2011), b) treatment was delivered face-to-face in either individual or group setting, c) treatment followed the UP therapist guide without major modifications, d) participants suffered from an anxiety disorder or depression, e) participants were over 18 years of age, d) the study was published in 2015 or later, and f) the study was published in English in a peer-reviewed journal. Results and conclusions. The UP appeared both efficacious and efficient in reducing the severity of adult anxiety and depression as well as the number of comorbid diagnoses; however, there were some conflicting findings regarding recovery rates and effect sizes. The results achieved were comparable to those achieved using diagnosis-specific cognitive-behavioral therapy. The UP treatment had a positive impact on the patients’ functioning and quality of life and the amount of positive and negative affect they experienced. Treatment retention was generally high, particularly when treatment was delivered individually, and the UP received high ratings from those who participated in the studies. All in all, the current empiric evidence regarding the UP appears fairly promising. However, these results must be interpreted with caution, as the research concerning the UP is still in its infancy and a large part of it has been conducted by researchers affiliated with the treatment.

Empathy is an ability to recognize, understand and share the emotional states and understand subjective experience of others. Empathy is assumed to consist of two components: affective and cognitive empathy. Deficit in empathy are reported in autism spectrum disorder (asd) and with callous-unemotional (cu) traits. Studies have suggested that these deficits and their cause might be different between asd-traits and cu-traits. The main aim of the current review is to describe the association between asd-traits, cu-traits and lack of empathy. In addition, the review discusses the possibility that structures of empathy processes behind those traits are separate. The review also presents used methods of measuring empathy. A literature search was done by using Pubmed in March 2019. Following search terms were used: autism spectrum disorder, callous-unemotional traits, psychopathy and empathy. Every original articles that considered both asd-traits and cu-traits and that had been published between 2006 and 2019, were selected to the review. After selection, seven studies were included to the review and they were published in years 2006-2016. Based on the current knowledge from original studies untypical empathy processes and lack of empathy are connected to asd-traits and cu-traits. Mechanisms that cause lack of empathy seems to be different behind those traits. In asd-traits cognitive empathy seems to be impaired and on the contrary in cu-traits affective empathy seems to be impaired. Difference in traits level can occur also in disorder level. Therefore these findings should be taken into consideration in case of structuring subjective assistance for person with asd or cu-traits.

First impressions are quickly formed observations of a new acquaintance. The basis of these observations is to find out what are the intentions of the other person. Therefore, the question behind is to find out whether they are a friend or an enemy. This happens automatically and as studies have found within mere fraction of seconds. It has been found that longer observations of others lead to more precise conclusions and after five seconds people are able to judge each other’s extroversion above chance level. Furthermore, studies point out that first impressions are vulnerable to error as for example positive features like physical attractiveness and success are linked together. In addition, studies show that features signaling threat are seen faster than positive features. According to evolutionary psychology this behavior is valuable for staying alive. Studies also show that to some extent people can impact on their first impression and in photographs people have been successfully able to act extraversion and openness. The purpose of this overview is to consider first impressions and the questions of how they are formed and if they are truthful. In addition, this overview analyzes whether people are aware of the first impressions made of them and whether they can have an impact on them.

Studies have shown that childhood physical abuse is associated with later adverse psychological development and mental health. Additionally, people who have experienced physical abuse have a higher risk for later violence. However, most people who have experienced childhood abuse do not become violent offenders which implies that the two factors are not directly linked. Mediating factors might account for the relationship. Alcohol related problems and antisocial personality disorder are psychiatric disorders which have been associated with childhood physical abuse and intimate partner violence. These disorders are examined here as possible mediators in the relationship between childhood physical abuse and later intimate partner violence. There are mixed results concerning the mediating role of alcohol related problems. These results indicate that alcohol related problems do not mediate the relationship between childhood abuse and violence. Alcohol related problems might work as a mediator for individuals with other risk factors. Studies have found that antisocial personality disorder has a mediating role in the relationship between childhood physical abuse and intimate partner violence. Abuse in childhood combined with a genetic risk for antisocial personality may lead to the development of the disorder which increases the risk for violence. In order to develop effective interventions, it is important to understand the adverse effects of childhood abuse. Moreover, mediating factors should be considered when designing interventions targeting intimate partner violence.

Introduction: The purpose of this review is to point out the results of genetic studies on borderline personality disorder and to discuss the possible genetic influence in the development of the disorder in relation to other influencing etiological factors. This review evaluates if research results support the heritability of borderline personality disorder. At the early stages of the disorders’ etiological studies only psychosocial factors were examined, thus the genetic point of view in the development of borderline symptoms was ignored. The genetic perspective has received more attention lately, however the amount of genetic studies on the subject is still rather limited. Methods: A literature search was conducted using OvidMedline database using search terms borderline personality disorder, BPD, impulsivity, heritability, genetics, development, family studies, adoption studies and twin studies. Results and Conclusions: The results of genetic studies on borderline personality disorder support its heritability. Family studies suggest a noticeable familial aggregation effect, and the risk for borderline personality disorder was greater for immediate relatives of individuals who have been diagnosed with borderline personality. Based on findings from twin studies, the heritability varied between 42-69 percent. Genetic research has not yet identified genetic variants specific to borderline personality disorder, but there was some evidence of a common genetic liability across multiple mental health disorders. Borderline personality disorder is one of the most challenging mental health disorders, and regardless its low prevalence it often leads to hospitalization or outpatient care. With an early identification and focused treatment, it could be possible to lessen individual’s suffering, increase ability to function and reduce the financial burden it causes to society. Since research results support borderline personality disorder’s heritability, raised awareness about the genetic liability amongst health care professionals is a promising start in identifying high-risk groups and planning the treatment.

The recognition of faces is a widely researched process. Typically, this process is thought of as separate from other object recognition: a specific mechanism. Today’s neural models of face processing also presume the previous assumption. A competing hypothesis for this specificity hypothesis is the expertise hypothesis, which claims that the recognition of faces is unique due to the vast amount of experience we have with faces. The conversation regarding the expertise hypothesis has surrounded largely the function of the FFA. In this review, evidence for the FFA’s role as a general, not face specific, object recognition module is presented. As an explanation for the current evidence for the role of the FFA a holisticity hypothesis is proposed: FFA is a module of holistic visual processing. Finally, critical notations for following research are discussed.

Tavoitteet. Tämän kandidaatintutkielman tarkoituksena on selvittää, miten toimivia halkiovauvojen syömisen tukemiseen käytettävissä olevat keinot ovat sinä aikana, kun halkioita ei vielä ole suljettu ja kun vauva ei vielä syö kiinteää ravintoa. Huuli- ja suulakihalkiovauvojen hoidosta ei ole Käypä hoito suositusta. Aikaisempien tutkimusten ja opinnäytetöiden mukaan halkiovauvojen syömisen tukemiseen on olemassa erilaisia keinoja ja välineitä, mutta syömistä ei juurikaan tueta synnytyssairaalassa eikä neuvolassa. Etenkin vaikeimmissa tilanteissa vauva voi kuitenkin saada apua syömisvaikeuksiin perehtyneeltä puheterapeutilta. Menetelmät. Tutkielman menetelmänä käytettiin kuvailevaa kirjallisuuskatsausta. Aineisto kerättiin seuraavista viitetietokannoista: ProQuest, MEDLINE (ProQuest), EBSCO ja Scopus. Hakulausekkeeseen sisältyivät englanninkieliset vastineet termeille halkio, syöminen, imeminen ja ravitsemus. Valintakriteerien mukaan artikkelien tuli olla vertaisarvioituja ja englanninkielisiä, käsitellä halkiovauvojen syömisvaikeuksia ennen korjausleikkauksia ja artikkelin tuli olla saatavilla maksutta. Haku tuotti 424 artikkelia, joista valintakriteerien avulla kirjallisuuskatsauksen aineistoksi valikoitui seitsemän vuosina 1997–2016 julkaistua tutkimusartikkelia. Tulokset ja johtopäätökset. Halkiovauvojen syömisen tukena ennen korjausleikkauksia on käytettävissä monenlaisia riittävän hyvin toimivia keinoja. Tässä aineistossa esiin nousivat pehmeä tuttipullo, Pigeon-pullotutti, pitkänokkainen syöttökuppi, lusikka, lääkeruisku ja rintaruokinta. Halkion tyyppi ja koko sekä vauvan syömistaidot vaikuttavat syömisen sujumiseen. Huulihalkiovauvoilla syömisen ongelmat tyypillisesti ovat lievempiä kuin muilla halkiovauvoilla. Pelkästään halkiotyypin perusteella voidaan kuitenkin tehdä vain karkeita päätelmiä kullekin vauvalle parhaiten soveltuvasta keinosta syömisen tukemiseksi, ja syömisratkaisut arvioidaan yksilöllisesti.