Transcript Yleinen (pitkä).pot

Western Lapland
Birgitta Alakare
Psychiatrist, family therapist, family
therapy trainer
B Alakare 2016
Tornio
Jyväskylä
B Alakare 2016
Psychiatric medication
The patient, family and other professionals:
- Hope of the miracle
- Fears
The treatment can become only the following of
medication
B Alakare 2016
API-project 1992 - 1993
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In our district we tried
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to avoid hospitalization
to avoid neuroleptic medication in the first
beginning(during first 2 weeks)
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J.Seikkula & al (2006, Psychotherapy Research, 16(2)214-228)
5 years follow-up of Open Dialogue
in the first episode psychosis
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1992 –1997 in Western Lapland, 72 000 inhabitants
Naturalistic study – not a randomized trial
Aim 1: To increase treatment outside the hospital in home
settings
Aim 2: To increase knowledge of the place of medication
– not to start neuroleptic medication in the beginning of
treatment but to focus on an active psychosocial treatment
N = 90 at the outset; n=80 at 2 year; n= 76 at 5 years
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IN WESTERN LAPLAND
1. 3/92 – 12/93 (API project)
2. 1/94 – 3/97
(ODAP project)
3. 2/02 – 2/06
( Multicentre project)
Diagnoses
Short psychotic
episode
Reactive psychotic
Schziophreniform
psychosis
Schizophrenia
Total
API
ODAP
MC
Total
5
7
9
11
10
6
11
5
6
27
22
21
13
19
5
37
34
46
27
107
Antipsychotic medication used at
2 years follow-up
Not used
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Started
Ongoing
API
25
ODAP
34
MC Total
9
68
9 (26%)
5 (15%)
12 (26%) 9 (50%)
5 (11%) 5 (28%)
Table 3. Psychotic symptoms at 5 year follow-up
compared to neuroleptic medication during the
first 2 years / %
Neuroleptics
Not used
Used or cont.
Total
Rating of symptoms
0
1
2
------------------------------------85
9
3
58
17
8
------------------------------------80
10
4
Chi-square 5.93; df=3; p=.145 (NS)
Rating of symptoms according Strauss-Carpenter
3
4
Total
3
17
0
0
100
100
6
0
100
” RELAPSES”
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How do we understand it?
Is it a new crises?
Is it a sign of the disease
In our studies Total number of relapse cases
In 2 years 18 %
2 – 5 years 27 %
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OPEN DIALOGUE IN ACUTE PSYCHOSIS
Table 5. Employment status at 2 and 5 years follow-up/ %
2 years
5 years
(N=79)
(N=73)
-------------------------------------------Studying
28
19
Employed
42
55
Unemployed and
14
7
job-seeking
Disability allowance
16
19
or passive
-------------------------------------------Total
100
100
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MAIN ELEMENTS OF
OPEN DIALOGUE APPROACH
Principles of Open dialogue
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IMMEDIATE HELP
NETWORK
FLEXIBILITY AND MOBILITY
RESPONSIBILITY
PSYCHOLOGICAL CONTINUITY
TOLERANCE OF UNCERTANTY
DIALOG
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THE MAIN ELEMENT OF OPEN
DIALOGUE APPROACH
The basic element of the treatment is
”Treatment meeting”, where patient, family and
network and also the case specific team together
in dialogue are finding new understanding about the
whole situation and the needed treatment.
Also the medication is discussed.
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Prescribing the psychiatric medication
In the treatment meeting together the patient,
network and case specific team:
Not the patient and psychiatrist together
 Not too early – anxiolytics if needed
 Discussions many times; to give
time to spontaneous recover and time to dialogue
 Everyone understand why medication is used
 Low doses and not too long time
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Get off the medication
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Psychiatric medications – effects to many reseptors in
the brains
The brains are wise and flexible –adapting consequence: increasing receptors
Much more receptors than before the medication –
antipsychotics stopped – brainstorm- hallucinations –
as consequence of the stopping the medication – not
the relapse
Stopping the medication slowly so the brains can
adapt: It can take two years to four years
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