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Psykedeelit eli serotonergiset hallusinogeenit ovat herättäneet uutta mielenkiintoa neurotieteissä ja psykiatriassa viime vuosina. Psykedeelejä tutkitaan nykyään pääsiassa psykedeeliavusteisen terapian muodossa. Tähänastiset tutkimukset antavat viitteitä mahdollisista hoidollisista ominaisuuksista muun muassa masennuksen, ahdistuksen, riippuvuuksien sekä kivun hoidossa. Nykyisten tutkimustulosten mukaan hoidolliset vaikutukset saattavat osalla potilaista jatkua pitkään hoitojakson jälkeen. Psykedeelit sitoutuvat keskushermostossa useisiin välittäjäainereseptoreihin, mutta niiden pääasiallinen molekulaarinen vaikutusmekanismi on serotonergisen 5-HT2A-reseptorin aktivaatio. Subjektiivisesti koetut vaikutukset välittyvät useita eri välittäjäaineita käyttävien hermoratojen toiminnallisten muutosten kautta, toistaiseksi melko huonosti tunnetuilla molekulaarisilla mekanismeilla. Aivotasolla psykedeelien on havaittu vähentävän tärkeiden yhteyskeskusten aktiivisuutta, lisäävän toiminnallisia yhteyksiä korkean tason aistikeskusten välillä sekä lisäävän hermosolujen muovautuvuutta. Psykedeelien voimakkaita psykologisia vaikutuksia ovat muutokset omassa kehonkuvassa ja ympäröivän maailman havainnoinnissa. Lisääntynyt hyvänolontunne, joka kuitenkin voi hetkessä muuttua voimakkaaksi ahdistukseksi on tyypillistä. Psykedeelien aikaansaama kokemus riippuu vahvasti käyttäjän omasta mielentilasta ja käytönaikaisesta ympäristöstä. Yliannostustilanteessa yleisiä haittoja ovat oksentelu, kuume, veren hyytymisen häiriöt, sympaattinen yliaktiivisuus ja lyhyet koomajaksot. Psykedeelejä pidetään fysiologisesti turvallisina aineina, mutta valvomattomissa olosuhteissa psykedeelien käyttäjä voi ajautua voimakkaiden psyykkisten vaikutusten alaisena vaarallisiin tilanteisiin ja onnettomuuksiin. Toleranssi psykedeeleihin kehittyy jo muutaman keskisuuren päivittäisen annoksen jälkeen. Lääketieteellinen psykedeelitutkimus on hyvin alkuvaiheessa. Tutkimukset ovat toistaiseksi olleet otannoiltaan pieniä ja asetelmiltaan usein avoimia ja kontrolloimattomia, minkä vuoksi ne ovat toistaiseksi riittämättömiä kuvastamaaan psykedeelien todellista vaikuttavuutta ja turvallisuutta.

Tutkielmassa kerättiin ja analysoitiin aineistoa psykoosilääkkeiden ja masennuslääkkeiden aiheuttamista myrkytyskuolemista vuosina 2016–2018 Suomessa. Tutkielmassa tarkastellut lääkeaineet valittiin siksi, että oikeuskemialliset tutkimukset ovat osoittaneet niiden lukeutuvan myrkytyskuolemien merkittävimpien aiheuttajien joukkoon. Eri psykoosi- ja masennuslääkkeiden aiheuttamia myrkytyskuolemia arvioitiin Fatal Toxicity Index (FTI) – käsitteen perusteella. FTI laskettiin jokaiselle tutkitulle lääkeaineelle jakamalla lääkeaineen aiheuttamien myrkytyskuolemien lukumäärä kyseisen lääkeaineen kulutuksella. Lääkeaineen kulutus ilmoitettiin WHO:n kansainvälisesti määrittelemän vuorokausiannoksen (DDD, Defined Daily Dose) avulla. Lääkeaineiden aiheuttamien myrkytyskuolemien suhde niiden kulutukseen antaa tärkeää tietoa lääkeaineisiin liittyvästä myrkytyskuoleman riskistä. Tutkimusaineiston myrkytyskuolemien lukumäärät sekä luokitellut kuolinsyyt vuositasolla saatiin oikeuslääketieteellisen kuolemansyyn selvittämisen yhteydessä Terveyden ja hyvinvoinnin laitoksen oikeustoksikologiayksikön tietokantaan tallennetuista tiedoista. Tiedot eri lääkeaineiden keskimääräisestä kulutuksesta vuositasolla saatiin Lääkealan turvallisuus- ja kehittämiskeskus Fimean sivuilta. Tiedot Suomen asukasluvusta eri vuosina ovat peräisin Tilastokeskukselta. Aineistossa oli tarkasteltavana 13 psykoosilääkettä ja 18 masennuslääkettä. Psykoosilääkkeiden aiheuttamia myrkytyskuolemia kirjattiin yhteensä 136 ja masennuslääkkeiden aiheuttamia myrkytyskuolemia 152 vuosina 2016–2018. Myrkytyskuolemat jakautuivat kolmeen eri kuolemanluokkaan: tapaturma, itsemurha ja epäselvä. Suurin osa myrkytyskuolemista oli itsemurhia. Tutkielmassa tarkastellulla aikavälillä 2016–2018 suurimmat FTI-arvot havaittiin seuraavilla lääkeaineilla: psykoosilääkkeissä levomepromatsiini, sulpiridi ja klooriprotikseeni, masennuslääkkeissä klomipramiini, doksepiini ja trimipramiini. Laskettujen FTI-arvojen pohjalta voidaan arvioida lääkeaineiden myrkyllisyyttä saman lääkeryhmän sisällä sekä eri lääkeryhmien välillä. Tutkielman tuloksilla on merkitystä arvioitaessa potilaalle sopivaa psykoosi- tai masennuslääkitystä sekä määritettäessä mahdollista seuraavaa saman lääkeaineryhmän lääkettä, kun potilaan lääkitystä vaihdetaan.

Psychotic symptoms are known to be associated with deficits in social functions. Previous research has shown that lower social functioning and less social support is associated with both psychotic disorders and subclinical psychotic symptoms. Social capital, however, has barely been studied in relation to psychotic symptoms. Also, few studies have investigated whether the associations of social factors differ between different psychotic symptoms and no study has examined social functioning, social support and social capital in the same study. The aim of the current study is to investigate whether social functioning, social support and social capital have differing associations to different psychotic symptoms and to the prevalence of a psychotic disorder. The data of this study was the Adult Psychiatric Morbidity Survey 2007, a representative community sample of over 16-year-olds living in private households in England (n = 7 403). Psychotic symptoms were assessed with the Psychosis Screening Questionnaire (PSQ) and consisted of hallucinations, paranoia, (hypo-)mania, thought interference and strange experience. Social functioning was assessed with the Social Functioning Questionnaire (SFQ). Assessment of social support consisted of two sections: social network size assessed with the Interview Measure of Social Relationships (IMRS) and perceived social support assessed with the Health and Lifestyle Survey. Social capital also consisted of two sections: social cohesion and trust, and social participation. The associations of the social variables to different psychotic symptoms and to a psychotic disorder were analyzed using logistic regression, entering social functioning, social support and social capital stepwise as predictors. Social functioning was independently associated with every psychotic symptom as well as with the prevalence of a psychotic disorder. For hallucinations, (hypo-)mania and thought interference lower social functioning was the only predictor. For social support only social network size was found to have associations: smaller social network was independently associated with psychotic disorder and paranoia. For social capital only social cohesion and trust was associated with two of the psychotic symptoms: lower levels on social cohesion and trust were independently associated with strange experience and paranoia. Paranoia was the only symptom to be independently associated with all the social variables. The results show that different psychotic symptoms and psychotic disorder differ in the social factors they are associated with. Further research should investigate how these differences develop, and what part do other factors, for example negative symptoms, social cognition and neurocognition, play in the association between social factors and psychotic symptoms.

Goals: The prevalence of subclinical psychotic symptoms in the normal population is 5–8%. Approximately 8% of the subclinical psychotic symptoms have been shown to predict the onset of later psychotic disorder. It can be assumed that if the number of subclinical psychotic symptoms is related to the locus of control and self-esteem, these connections would appear in the normal population at different stages of the psychosis continuum depending on the severity of the psychotic symptoms. A better understanding of these connections could in the future help distinguish those who report subclinical psychotic symptoms from those who later develop a clinically significant psychotic disorder. Methods: In this study, correlation of psychotic symptoms (UM-CIDI) with the locus of control (I.E. Scale in part) and self-esteem (RSES in part) were studied, as well as through variance analyzes of how the healthy (n = 5279) with little or more reported subclinical psychotic symptoms (n = 141 and n = 84), and persons with non-affective psychotic disorders (SCID) (n = 50) differed in relation to these factors (PSO groups). The study used the NCS-data collected from the normal population in 1990–1992. Results and Conclusions: According to previous research data, the number of psychotic symptoms was related to the external locus of control and the low self-esteem. The PSO groups differed more widely only in the case of external locus of control which based on other’s people power and control. The combined effect of psychotic symptoms and self-esteem explained the differences between groups only in relation to the above-mentioned locus of control. The results support previous findings of a more external locus of control, personalizing bias and low self-esteem related to psychotic disorders, as well as indications of their milder occurrence in the normal population already reported with psychotic symptoms. Exploratory study of causal relationships is still needed.

Objectives. The etiology of juvenile delinquency has been widely researched and several risk factors considering individual traits, parents or parenthood, and other environmental factors have been well established. There has been growing interest in the role of psychopathic traits on young offendings and recent evidence suggests that intensity of psychopathic traits enhances the risk of criminal behaviour in youth. However, the studies investigating the role of psychopathic traits as a predictor of criminal behaviour in youth are methodologically restricted and the effects of risk factors or moderating variables have not been considered comprehensively. The aims of this research were to examine the association between psychopathic traits and criminal behaviour in youth, and to study if risk factors strengthen this association. Methods. This sample consisted of 4855 Finnish students on the ninth grade of upper comprehensive school. Criminal behaviour was measured as the amount of forbidden actions conducted during the past year. Psychopathic traits were studied as a dimensional variable and it was measured with a validated self-report questionnaire for psychopathy (APSD-SR). Linear regressions were used to examine the association between psychopathic traits and juvenile delinquency. Nine different risk factors and cumulativity of risks were controlled for the analyses. Linear regression was also used to examine the moderating effects of risk factors and their cumulativity to the association between psychopathic traits and criminal behaviour. Results and conclusions. Most adolescents reported at least some psychopathic traits. The intensity of psychopathic traits, well established risk factors and the cumulativity of risk factors were all associated with greater amount of criminal behaviour. The association between psychopathic traits and criminal behaviour was enhanced by those risk factors that can be considered to provide antisocial models or opportunities for criminal behaviour. Antisocial peers were the most significant risk factor for criminal behaviour and it strongly enhanced the association between psychopathic traits and criminal behaviour. Overall, the results emphasize the importance of interventions for antisocial peer groups to prevent juvenile delinquency.

Psychopathy is a disorder characterized with unemotional and callous traits, grandiosity, tendency to lie and manipulate, adventurous and thrill seeking behavior, criminal versatility and unplanned, parasitic lifestyle. Psychopathic personality traits in adolescence are known to be associated with juvenile delinquency and early onset substance abuse. However, based on previous studies, it is difficult to reliably describe the relationship between unique features of psychopathy and the number of offences committed by an adolescent offender. This is mainly because few studies have controlled for the effects of other known factors contributing to antisocial behavior. The same goes for relationship between juvenile psychopathy and substance abuse. There are no published studies investigating the association between psychopathy and the assessment of one´s own overt antisocial behavior. The present study examined the association between psychopathy, number of committed offences and the degree of substance abuse among incarcerated juvenile offenders. The present study used data from the American Pathways to Desistance -research project where 14-18 years old adolescents (n = 1354) who had been found guilty for at least one serious offence were followed. The associations between psychopathic personality traits – as evaluated with PCL-YV method – and a) number of subject´s self-reported offences b) extent of subject´s self-reported substance abuse were examined with linear regression models that controlled for number of known correlates for antisocial behavior. The same analyses were carried out for discrepancy between subject´s and his/hers collateral reports regarding subject´s offending and substance abuse. Psychopathy was associated with the extent of illicit drug abuse but not alcohol consumption. Psychopathy did not explain the discrepancy between subject´s and his/hers collateral´s reports regarding subject´s substance abuse. Psychopathic traits were positively associated with the number of self-reported offences committed by the subject. In regard to number of offences committed, the discrepancy between subject´s and collateral´s reports were greater with those subjects who had higher levels of psychopathic traits. The results further support the validity of psychopathy as a construct that is uniquely associated with juvenile delinquency and illicit drug abuse. In addition, this study lends support to notion that psychopathic individuals seem to lie about their actions mainly when they perceive they can somehow benefit from it.

Objective: Untreated mental disorders result in notable costs to Finnish society, especially in the form of disability pensions. The delay of psychotherapy and psychiatric treatment has previously been associated with a higher risk of chronicity, poorer response to treatment and a higher number of recurrences. In Finland, a patient referred to psychotherapy is responsible for finding and choosing a psychotherapist that is suitable for them. Challenges in finding a psychotherapist can therefore lead to a delay of treatment. The aim of this study is to examine the following questions: 1) What is the association between guidance received by the patient when choosing a psychotherapist and the length of the delay associated with starting psychotherapy? 2) How are other factors related to the patient and the health care system associated with the delay of psychotherapy? The hypothesis for this study is that patients who receive more guidance when choosing a psychotherapist have shorter delays than patients who receive less or no guidance. Methods: The data used in this study are derived from the quality registry for psychotherapy, which is utilized by the Hospital District of Helsinki and Uusimaa (HUS) in order to monitor service voucher therapies from the first referral until the end of treatment. Guidance received by the patient was measured with one multiple choice question, in which patients picked the option that best corresponded with the method they used to choose their psychotherapist: 1) the psychotherapist was chosen independently with no guidance or with the help of a brochure, 2) the psychotherapist was chosen independently but with guidance from a health care professional regarding what kind of psychotherapist would suit the patient best (i.e. a specific approach or therapist specialization), 3) the psychotherapist was chosen together with a health care professional, 4) the psychotherapist was chosen for the patient by a health care professional. The subjects were divided into four groups based on the amount of guidance they received. Treatment delay was measured in days starting from the first referral to service voucher psychotherapy and ending at the starting date of treatment. Overall delay of psychotherapy was examined by fitting a Kaplan- Meier-curve to the entire data, as well as to each guidance group individually. The linear association between guidance and delay was examined by conducting a linear regression analysis. Associations between factors related to the patient or the health care system were assessed by conducting a stepwise multivariate regression analysis. Independent variables included in this analysis were guidance, patient age, sex, diagnosis, comorbidity, whether the patient was referred to psychotherapy from primary care or specialized care, and whether the patient was referred to short psychotherapy or long psychotherapy. Results and conclusions: Patients who received more guidance when choosing a psychotherapist had shorter delays than patients who received less or no guidance. The results of this study were in line with the hypothesis, with the exception that patients who chose their psychotherapist independently with no guidance, had shorter delays when compared to patients who chose their psychotherapist independently after receiving guidance from a health care professional. Higher age was found to be associated with shorter delays, as was belonging to the diagnosis group “bipolar disorder or schizophrenia”. Reported comorbidity and belonging to the diagnosis group “other” were associated with longer delays. Patients referred to short psychotherapy from specialized care had shorter delays than patients referred to long psychotherapy from specialized care or short psychotherapy from primary care. Overall, patients referred from specialized care had shorter delays than patients referred from primary care. The results show that by offering patients sufficient guidance when choosing a psychotherapist, delays associated with psychotherapy may be shortened and the unwanted consequences of treatment delay may be prevented. Further research is needed to identify factors associated with treatment delay and how patients referred to psychotherapy choose their psychotherapists.

Objective. Psychotherapy is widely recognized as an effective form of treatment for mental disorders. Therefore, it is important to ensure its availability. In Finland, the demand seems to exceed the supply for psychotherapy, and the burdensome process of searching for a psychotherapist may impede access to care. To ensure the availability of psychotherapy, more detailed information on waiting times and factors that affect them are needed. In this study, waiting times of outsourced short pscyhotherapies in Helsinki and Uusimaa Hospital District are modelled. Methods. The data was derived from the quality registry for psychotherapy, which is used to gather versatile information on the psychotherapy process. Our sample consists of 819 patients referred to psychotherapy between 12.09.2018-07.10.2019. Most of these patiens are women and come from Greater Helsinki. Since the final waiting time was not known for every patient, survival analysis methods were used. Results and conclusions. Using Kaplan-Meier analysis, the median waiting time was estimated to be three months. Based on a Cox regression model, the rate of starting a therapy has first accelerated and then slowed down during the study interval. It was also found that psychiatric comorbidity and referral from primary care were associated with longer waiting times, while the other variables were not. This study provides a point of reference for other psychotherapy services, and initial information for development of psychotherapy processes in Helsinki and Uusimaa. That being said, the study interval was quite short and information on waiting times should be updated regularly.

Goals: The Categorical definition of mental health disorders has been proven problematic. The Scientific endeavour to understand mental health disorders from categorical point of view and to develop better treatment accordingly has not reached its goals despite decades of study. Transdiagnostic psychopathology and especially dimensional models have been suggested to overcome these problems. The researchers who have suggested dimensional models define mental health disorders as manifestations of relatively few core underlying psychological constructs. However critique has been presented that these dimensional models are too simplifying to capture the fluctuating and multifaceted nature of mental health disorders. Consequently another novel conceptualization, namely the network theory of mental health, has been suggested to overcome the problems of dimensional models. From the network point of view psychopathology does not constitute of underlying constructs but instead from the direct causal network of relations between the symptoms. Network methods offer a powerful tool to study multidirectional causal connections between the different facets of mental disorders. But again, network theories have been criticized of not taking into account the thoroughly argued problems of categorical definitions of mental health as most network studies have focused on researching symptoms listed in different diagnostic manuals under categorically defined mental disorders (etc. DSM). The aim of this study is to combine the most functional parts of these two novel fields of study and to attempt to perform a network analysis on a transdiagnostic clinical assessment questionnaire. CORE-5 is used for this purpose, as it is arguably such a questionnaire since it includes items that measure both psychiatric symptoms (anxiety and depression symptoms) but also items of positive mental health (social functioning, psychological functioning and subjective well-being). Methods: The study used a longitudinal and frequently gathered sample that consisted of psychiatric patients. The sample was gathered by assessing the patients who were at a intensive psychiatric day ward clinic in Järvenpää. The sample consisted of 32 patients of whom 59 % (19) were female. The weighted directed networks were formed by using the coefficients created with lagged multilevel regression analysis. The sample was divided between the persisters and remitters by utilizing GAF -questionnaires results. The patients whose scores reflected moderate symptoms or more severe were selected to a group of persisters. Divided like this, the remitters group had 15 patients (47 %). Results and conclusions: The results indicated, that CORE-5 questionnaire's items that measured positive mental health, were in a temporal interaction with the assessed psychiatric symptoms - depression and anxiety. Especially the item of subjective well-being had a central role in a network of mental health. A difference in the role of psychological functioning in the network was noticed between persisters and remitters. These observations support the view that not just psychiatric symptoms but also positive mental health - especially subjective well-being - has a noticable role in psychopathology. This study suggests that in the study of psychological networks, a step towards transdiagnostic point of view should be taken and start taking into account also other variables than psychiatric symptoms. Also this study suggested, that in the definitions of psychopathology in general, the role of positive mental health should be considered as more integral part of mental health disorders.

Autoimmuuni polyendokrinopatia-kandidiaasi-ektodermaalinen dystrofia (APECED) on peittyvästi periytyvien AIRE-geenin muutosten aiheuttamana sairaus, jossa puolustusjärjestelmä hyökkää eri elimiä kohtaan. Sairauden yleisimmät manifestaatiot kuuluvat niin kutsuttuun klassiseen triadiin ja ovat krooninen limakalvojen hiivatulehdus, lisäkilpirauhasen vajaatoiminta ja lisämunuaiskuoren vajaatoiminta. Tutkimusaineisto koostui APECED-tautia sairastavien miesten sairaskertomuksista retrospektiivisesti kerätyistä tiedoista. Tutkimuksessa selvitettiin murrosiän kehitystä (n=37) sekä elinikäistä kivesten vajaatoiminnan ja siittiötuotannon häiriöiden ilmaantuvuutta (n=35). Murrosiän kehitys alkoi puolella pojista viiveisesti 13.6 ikävuoden jälkeen. Murrosiän käynnistyessä manifestaatioiden määrän mediaani oli neljä (vaihteluväli 1-9). Suurin osa murrosiän aikana ilmaantuneista uusista manifestaatioista kuului klassiseen triadiin. Potilaiden aikuispituuden mediaani (173 cm) jäi alle vanhempien pituuksista lasketun odotuspituuden ja suomalaismiesten keskivertopituuden. Murrosiän käynnistykseen tai joudutukseen käytettiin hormonaalista joudutushoitoa yhdeksällä pojalla. Murrosikä eteni hoidon jälkeen normaalisti kahdeksalla potilaalla. Pysyvä kivesten vajaatoiminnan diagnoosi asetettiin kuudelle miehelle, joista puolelle jo murrosiässä. Siittiöiden puuttumista (atsoospermia) todettiin neljällä miehellä, joista kahdella ei todettu hormonaalista kivesten vajaatoimintaa. Tutkimustulostemme perusteella APECED-tautia sairastavien poikien murrosiän fyysinen kehitys vaatii tarkkaa seurantaa, ja mahdollisen kivesten vajaatoiminnan ja siittiötuotannon häiriön kehittyminen voi olla vaikeasti ennustettavissa. Lisätutkimusta tarvitaan selvittämään kivesten vajaatoiminnan syntymekanismeja ja keinoja tukea hedelmällisyyden säilyttämistä. (174 sanaa)