Publications by authors named "Jorma Oksanen"

11 Publications

  • Page 1 of 1

Self-reported treatment adherence among psychiatric in- and outpatients.

Nord J Psychiatry 2018 Oct 16;72(7):526-533. Epub 2018 Nov 16.

d Department of Psychiatry , Institute of Clinical Medicine , Helsinki , Finland.

Background: Poor adherence to psychiatric treatment is a common clinical problem, leading to unfavourable treatment outcome and increased healthcare costs.

Aim: The aim of this study was to investigate the self-reported adherence and attitudes to outpatient visits and pharmacotherapy in specialized care psychiatric patients.

Methods: Within the Helsinki University Psychiatric Consortium (HUPC) pilot study, in- and outpatients with schizophrenia or schizoaffective disorder (SSA, n  =  113), bipolar disorder (BD, n  =  99), or depressive disorder (DD, n  =  188) were surveyed about their adherence and attitudes towards outpatient visits and pharmacotherapy. Correlates of self-reported adherence to outpatient and drug treatment were investigated using regression analysis.

Results: The majority (78.5%) of patients reported having attended outpatient visits regularly or only partly irregularly. Most patients (79.2%) also reported regular use of pharmacotherapy. Self-reported non-adherence to preceding outpatient visits was consistently and significantly more common among inpatients than outpatients across all diagnostic groups (p < .001). Across all groups, hospital setting was the strongest independent correlate of poor adherence to outpatient visits (SSA β = -2.418, BD β = -3.417, DD β = -2.766; p < .001 in all). Another independent correlate of non-adherence was substance use disorder (SSA β = -1.555, p = .001; BD β = -1.535, p = .006; DD β = -2.258, p < .000). No other socio-demographic or clinical factor was significantly associated with poor adherence in multivariate regression models.

Conclusions: Irrespective of diagnosis, self-reported adherence to outpatient care among patients with schizophrenia or schizoaffective disorder, bipolar disorder, and depression is associated strongly with two factors: hospital setting and substance use disorders. Thus, detection of adherence problems among former inpatients and recognition and treatment of substance misuse are important to ensure proper outpatient care.
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http://dx.doi.org/10.1080/08039488.2018.1538387DOI Listing
October 2018

Psychoactive substance use in specialized psychiatric care patients.

Int J Psychiatry Med 2017 Jul-Sep;52(4-6):399-415

1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.
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http://dx.doi.org/10.1177/0091217417738937DOI Listing
June 2018

Psychoactive substance use in specialized psychiatric care patients.

Int J Psychiatry Med 2017 Jul-Sep;52(4-6):399-415

1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.
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http://dx.doi.org/10.1177/0091217417738937DOI Listing
June 2018

Social Cognition and Interaction Training (SCIT) for Adults with Psychotic Disorders: A Feasibility Study in Finland.

Behav Cogn Psychother 2016 Nov 4;44(6):711-716. Epub 2016 May 4.

Helsinki University Hospital,and University of Helsinki,Finland.

Background: Social Cognition and Interaction Training (SCIT) is a psychosocial treatment designed to improve social functioning in schizophrenia by improving social cognition. Positive results have been reported from several studies, mainly from the USA, but more studies are needed to determine the feasibility of SCIT in different cultural contexts.

Aims: The objective of this study was to evaluate the feasibility and acceptability of the Finnish translation of SCIT in Finland.

Method: This was an uncontrolled, within-group study. Thirty-three patients with psychotic disorders participated in SCIT groups and also received the standard services provided at their respective care facilities. We measured participant attendance, attrition and responses on feedback surveys. Participants also completed measures of emotion perception, Theory of Mind (ToM), attributional bias and metacognitive overconfidence both before and after SCIT.

Results: The attendance rate was high, attrition was low, and the patients expressed satisfaction with SCIT. Preliminary efficacy analyses showed a statistically significant pre to posttest improvement in emotion perception and ToM, but not attributional bias or overconfidence.

Conclusions: SCIT is feasible and well accepted and may remediate social cognitive dysfunction in people with psychotic disorders in Finland.
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http://dx.doi.org/10.1017/S1352465816000151DOI Listing
November 2016

Social Cognition and Interaction Training (SCIT) for Adults with Psychotic Disorders: A Feasibility Study in Finland.

Behav Cogn Psychother 2016 Nov 4;44(6):711-716. Epub 2016 May 4.

Helsinki University Hospital,and University of Helsinki,Finland.

Background: Social Cognition and Interaction Training (SCIT) is a psychosocial treatment designed to improve social functioning in schizophrenia by improving social cognition. Positive results have been reported from several studies, mainly from the USA, but more studies are needed to determine the feasibility of SCIT in different cultural contexts.

Aims: The objective of this study was to evaluate the feasibility and acceptability of the Finnish translation of SCIT in Finland.

Method: This was an uncontrolled, within-group study. Thirty-three patients with psychotic disorders participated in SCIT groups and also received the standard services provided at their respective care facilities. We measured participant attendance, attrition and responses on feedback surveys. Participants also completed measures of emotion perception, Theory of Mind (ToM), attributional bias and metacognitive overconfidence both before and after SCIT.

Results: The attendance rate was high, attrition was low, and the patients expressed satisfaction with SCIT. Preliminary efficacy analyses showed a statistically significant pre to posttest improvement in emotion perception and ToM, but not attributional bias or overconfidence.

Conclusions: SCIT is feasible and well accepted and may remediate social cognitive dysfunction in people with psychotic disorders in Finland.
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http://dx.doi.org/10.1017/S1352465816000151DOI Listing
November 2016

[Supporting adherence to drug therapy in psychiatry].

Authors:
Jorma Oksanen

Duodecim 2015 ;131(16):1437-42

Maintenance therapy to reduce the risk of recurrence is an essential part of treatment of schizophrenia, bipolar disorder and major depressive disorder, but poor treatment adherence is common, impairing the treatment outcome. Improvement in the adherence to drug therapy requires a good therapeutic relationship. The patient and her/his family must be provided with information about the illness and its treatment. Drug therapy must be optimized on an individual basis. The use of long-acting antipsychotic injections should be encouraged. Regular contact with patients under long-term treatment must be maintained. The use of experts by experience is an effective supportive measure.
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November 2015

[Psychoeducation in the treatment and rehabilitation of psychoses].

Duodecim 2013 ;129(20):2133-9

HYKS Jorvi, psykoosiklinikka.

Psychoeducation is one of the most effective psychosocial forms of treatment for psychoses. It appears to prevent recurrence of psychosis and hospitalization periods and to increase treatment compliance. Psychoeducation should be included in the treatment and rehabilitation of psychoses as part of the overall rehabilitation, and is particularly important for persons with first-episode psychosis and their family. At least the vulnerability-stress model, basics of pyschosis as well as the recognition and management of warning signals and long-term symptoms should be discussed with the patient and her/his family.
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January 2014

[Update on current care guidelines: schizophrenia].

Duodecim 2013 ;129(8):846-7

Early recognition and treatment of persons at risk of psychosis is emphasized in the updated Current Care Schizophrenia guideline. Antipsychotic medication is effective in the treatment. To avoid side-effects, the lowest possible effective dosage is recommended. Psychosocial interventions, such as cognitive-behavioral therapy, psychoeducation and social skills training, as well as cognitive rehabilitation should be integrated with other treatments according to patient's individual needs. Supported employment is a feasible option to some patients. Care of people with schizophrenia is primarily offered in an outpatient setting.
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July 2013

[Psychosocial treatment of bipolar disorder].

Authors:
Jorma Oksanen

Duodecim 2010 ;126(4):371-7

Psychosocial treatment is an essential part of maintenance treatment of bipolar disorder. It aims to improve cooperation in treatment, to provide support to the family and to teach illness self-management skills. Group psychoeducation and cognitive-behavioural treatment have shown the best efficacy in controlled studies of specific treatment programs developed for this disorder. Central ingredients of these treatment programs can be included in usual outpatient treatment; they include teaching the patients to recognize early warning signs of mood episodes, monitoring mood changes, encouraging regularity of diurnal rhythms and relieving the emotional stress of family members. Group settings will provide peer support.
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June 2010

Topiramate add-on in treatment-resistant schizophrenia: a randomized, double-blind, placebo-controlled, crossover trial.

J Clin Psychiatry 2005 Aug;66(8):1012-5

Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, Kuopio, Finland.

Objective: We tested the hypothesis that topiramate is more effective than placebo in reducing symptoms in patients with treatment-resistant schizophrenia when combined with ongoing antipsychotic medication.

Method: Twenty-six hospitalized treatment-resistant patients with chronic DSM-IV-diagnosed schizophrenia participated in a randomized, double-blind, placebo-controlled trial in which 300 mg/day of topiramate was gradually added to their ongoing treatment (clozapine, olanzapine, risperidone, or quetiapine) over two 12-week crossover treatment periods. Data were collected from April 2003 to November 2003.

Results: In intention-to-treat analysis, topiramate was more effective than placebo in reducing Positive and Negative Syndrome Scale general psychopathologic symptoms (effect size = 0.7, p = .021), whereas no significant improvement was observed in positive or negative symptoms.

Conclusion: Glutamate antagonist topiramate may be an effective adjuvant treatment in reducing general psychopathologic symptoms in patients with schizophrenia resistant to treatment with second-generation antipsychotics.
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http://dx.doi.org/10.4088/jcp.v66n0808DOI Listing
August 2005
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