Yrjö O. Alanen

Need‐adapted treatment of new schizophrenic patients: experiences and results of the Turku Project

This article describes a psychotherapeutically oriented approach to schizophrenia developed especially to meet the needs of the community psychiatric field. Because of the heterogeneous nature of the schizophrenic psychoses, the authors emphasize that these patients should always be treated based on case‐specific premises. The main principles of the need‐adapted approach are: I. The therapeutic activities are planned and carried out flexibly and individually in each case so that they meet the real and changing needs of the patients as well as of their family members. 2. Examination and treatment are dominated by a psychotherapeutic attitude. 3. The different therapeutic activities should support and not impair each other. 4. The process quality of therapy is clearly perceived. A family‐centred initiation of the treatment is especially emphasized for both diagnostic and therapeutic reasons. The positive experiences of this led the Finnish national programme for the treatment and rehabilitation of schizophrenic patients to recommend the establishment of family‐ and environment‐oriented acute psychosis teams (APT) in the mental health districts. In later phases of treatment, the significance of individual psychotherapy is increased. The preliminary results of the approach are presented and compared with an earlier sample of patients.

The content of 5-hydroxyindoleacetic acid and homovanillic acid in the cerebrospinal fluid of patients with acute schizophrenia☆

Abstract The level of 5-hydroxyindoleacetic acid and homovanillic acid in the cerebrospinal fluid were determied in a group of acute untreated schizophrenic patients and an age-matched group of other acute phychiatric patients as controls. No significant differences could be shown between the patients and the controls. When all paranoid patients are compared to all non-paranoid patients of the series, those patients with dominant paranoid thought content and/or paranoid hallucinations had a significantly higher level of HVA ( p

A critical review of genetic studies of schizophrenia. II. Molecular genetic studies

Recent molecular genetic studies of schizophrenia have, until now, been unable to demonstrate any specific major gene for schizophrenia. On the contrary, linkage and association studies have yielded almost exclusively negative or contradictory results. Such studies have involved certain candidate genes, such as the genes, for dopamine receptors and other brain neurotransmitters. Some of these candidate genes have now actually been excluded as specific aetiological factors in schizophrenia. Similarly, studies searching for a major gene for susceptibility to schizophrenia involving the whole human genome or large parts of chromosomes have not yielded unambiguously positive results. However, the most recent empirical evidence suggests that many polygenes, acting together, could constitute a risk factor for schizophrenia. It is thus most probable that genetic susceptibility to schizophrenic psychoses is polygenic, and that their effects are dependent on interaction with physical and psychosocial environmental factors.

A critical review of genetic studies of schizophrenia. I. Epidemiological and brain studies

Family, twin and adoption studies suggest that susceptibility to schizophrenia is based at least to some extent on genes. The results of these studies vary and depend greatly on the diagnostic criteria used. When a broad definition of schizophrenia is employed, even high degrees of heritability are observed. However, when more narrow criteria are employed, the degrees of heritability decrease. According to a large Finnish adoption study, the patient‐family interaction has an even more important role in the origin of schizophrenia than purely genetic factors. Interaction between the genetic factors on the one hand and physical, psychological and psychosocial factors on the other hand is emphasized.

The Finnish National Schizophrenia Project 1981–1987: 10-year evaluation of its results

This study reports the 10‐year evaluation of the Finnish National Schizophrenia Project. The aims of the national project were achieved. The number of long‐stay schizophrenic patients in psychiatric hospitals decreased by 63% between 1982 and 1992. Both the treatment of schizophrenic patients and the structure of mental health services have changed greatly in Finland. Psychosocial treatment methods in particular have developed. The major innovations of the Project are the acute psychosis teams now serving over 50% of the country, and social skills training programmes. The 10‐year evaluation of the Finnish National Schizophrenia Project shows that it is possible to conduct successfully nation‐wide projects to develop the treatment of schizophrenic patients and psychiatric practices across an entire country.

Towards a more humanistic psychiatry: Development of need‐adapted treatment of schizophrenia group psychoses

The group of schizophrenic psychoses is clinically and prognostically very heterogeneous. Contradictory views about etiology have had a major negative effect of the development of treatment, especially psychotherapeutic methods. There is an obvious need for more integrated approaches. We should study the development and precipitating factors of every person’s psychosis individually and plan his/her treatment on this knowledge. This has been done in the need‐adapted treatment of schizophrenia group psychoses, developed gradually by the author and his co‐workers in Finland over 40 years ago. Our aim is a comprehensive and psychotherapeutically oriented treatment approach for public psychiatric health care. A crucial step forward was the initiation of treatment with therapy meetings, including the treatment team, the patient, and his/her family members (or sometimes other persons close to him). During the last few decades, several projects applying the need‐adapted model have been developed. The author describes the experiences and results of some projects and also deals with the use of neuroleptic drugs in connection with the need‐adaptive orientation.

Maintenance of grip on life and goals of life: a valuable criterion for evaluating outcome in schizophrenia

This article describes the evaluation of schizophrenia patients’ maintenance of grip as a comprehensive assessment of the total psychosocial status of these patients. This evaluation was tested with new schizophrenic patients (DSM‐III) who took part in a standardized interview at entry and after a 2‐year follow‐up. The interviews and examinations were conducted by the psychiatric teams responsible for the treatment of the patients. There was a clear positive correlation between the evaluation of maintenance of grip and interpersonal interaction, heterosexual development, hobbies, level of activity and productivity (working) of the patients, and a negative correlation with negative symptoms. The psychody‐namically interpreted evaluation of the degree of regression correlated positively with maintenance of grip, but only after the 2‐year follow‐up. At entry the other variables describing the psychosocial status of ihe patient explained 22% of the variation in maintenance of grip, but 41% at the follow‐up stage. The evaluation of maintenance of grip presented at baseline also predicted the coping of the patients during the follow‐up stage. The authors recommend that the evaluation of maintenance of grip be used as an auxiliary tool in the assessment and treatment of schizophrenia patients.

NEED-ADAPTED TREATMENT OF SCHIZOPHRENIC PROCESSES: THE ESSENTIAL ROLE OF FAMILY- CENTERED THERAPY MEETINGS

Need-adapted treatment is a psychotherapeutically oriented approach to psychoses that has been planned and is implemented individually in each case, combining different activities so that they meet the needs of each patient as well as the people making up her or his personal interactional network (usually the family). A systemic initial intervention, carried out as a conjoint session of the patient, the family members, and a team of 3–4 staff members is an essential part of this approach. The name “therapy meeting” was given to these sessions because of their notable therapeutic significance. Therapy meetings are often continued during the later phases of treatment to follow up the course of treatment and to reassess the therapeutic plans.

Psychotherapeutically Oriented Treatment of Schizophrenia: Results of 5‐year‐follow‐up

The authors have developed a psychotherapeutic approach to schizophrenia within the community psychiatric health care system. The orientation is psychodynamic but global in the meaning that the therapeutic plans are made on the basis of case‐specific need of the patients and of their families and include both individual psychotherapy, family therapy and therapeutic communities.

Psychotherapy of Schizophrenia in Community Psychiatry

In 1976 we began a project in Turku, Finland, for developing treatment of schizophrenic patients within the framework of the community psychiatric health services of our country (Alanen et al. 1979, 1980, 1982). The project was based on a broad psycho-therapeutic treatment approach previously developed in the psychiatric teaching hospital of the University of Turku over several years. It was facilitated by the fact that this teaching hospital is also part of the community psychiatric treatment system of the Mental Health District of the City of Turku (population 165,000), and works in close cooperation with the other treatment units of the district. Ideologically we had two chief goals: that the efforts of our four-member team, although based on an integrated illness model of schizophrenia, should be directed so as to strengthen and to especially develop psychotherapeutic and family-centered treatment activities; and that they should be directed in a way suitable to the community psychiatric framework.