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Sosiaalisten tilanteiden pelko (STP) kehittyy tavallisesti nuoruusiässä. Oireet haittaavat opiskelua ja ihmissuhteita: häiriö muokkaa tapaa olla vuorovaikutuksessa. Hoidollisessa arviossa tärkeää on arvioida oireiden tuottamaa toimintahaittaa, erityisesti välttämiskäyttäytymisen laajuutta. STP:hen liittyvä samanaikaissairastavuus tulee tunnistaa ja määrittää ensisijainen hoidettava häiriö. STP:n tutkituimmat psykoterapeuttiset hoidot ovat kognitiivisen käyttäytymisterapian sovelluksia. Lievää STP:tä voidaan hoitaa esimerkiksi nettiterapialla tai ahdistukseen yleisemmin kohdistetulla terapialla, keskivaikean STP:n ensisijainen hoito on siihen fokusoitu lyhytterapia. Vaikean tai komplisoituneen STP:n hoito koostuu ydinoireisiin kohdistetusta, riittävän pitkäkestoisesta psykoterapiasta, jota tuetaan tarvittaessa lääkityksellä. Perheen osallistaminen etenkin varhaisnuorten hoitoon on tärkeää. Hoidon seurannassa on tärkeää arvioida toimintakyvyn muutosta. Lääkitystä voidaan käyttää häiriön vaikeiden muotojen hoidossa psykoterapiaan liitettynä tai jos psykoterapialla ei ole saavutettu vastetta.
Koulumenestys, osallisuus koulukiusaamiseen ja poissaolot koulusta ovat paitsi kognitiivisten ja sosiaalisten taitojen myös mielenterveyden indikaattoreita. Mielenterveyden häiriöt puolestaan voivat haitata oppilaan oppimista ja koulussa olemista monella tavalla. Mielenterveyden häiriöt liittyvät keskittymisvaikeuksiin, hahmottamisongelmiin ja motivaatioon ja epäonnistuminen koulutyössä saattaa altistaa tunne-elämän ja käyttäytymisen ongelmille. Oppimisvaikeuksien varhainen tunnistaminen ja oikein ajoitetut tukitoimet voivat ehkäistä mielenterveyshäiriöiden kehittymistä. Koulukiusaamiseen osallisilla nuorilla, niin kiusaajilla kuin uhreilla, on keskimääräistä enemmän niin internalisoivia kuin eksternalisoivia mielenterveyden häiriöitä samoin kuin oppilailla, jotka ovat usein poissa koulusta. Toveripiirin hyljeksimäksi joutuminen on nuoruusiässä erityisen huolestuttava merkki. Nämä ilmiöt voidaan huomata koulussa ja niihin on mahdollista puuttua oppilashuollon keinoin. Kouluyhteisön pitäisi olla jokaiselle turvallinen, ja myös yksilölliset mielenterveyttä tukevien interventioiden tarpeet tulee huomata. English summary: Adolescent mental health promotion in school context School performance, involvement in bullying and frequent absences from school are indicators of not only cognitive and social skills but also mental health. Mental disorders may interfere with learning and adjustment in many ways. Mental disorders may bring about problems in attention and motivation, and failure in schoolwork often makes an adolescent vulnerable to mental disorders. Early recognition of and prompt intervention in specific learning difficulties may prevent mental disorders. Adolescents involved in bullying present with increased risk of both internalising and externalising mental disorders, as do adolescents who are frequently absent from school, whether due to illness or due to truancy. Peer rejection is an important warning sign during adolescent development. These features can fairly easily be recognised at school, and school's psychosocial support systems should have plans for intervention. Mental health promotion in school should comprise approaches that make school safe and involving for all, and individual interventions for those at risk.
• Kehitystason mukaiset lyhytpsykoterapiat ovat nuorten ahdistuneisuushäiriöiden ja depression hoidossa keskeisiä perustasolle sovellettavissa olevia interventioita. • Perustasolla lievien ahdistuneisuushäiriöiden hoitoon soveltuvat noin 10 käyntikerran kognitiivisen käyttäytymisterapiaan (KKT) pohjautuvat ohjelmat, esimerkiksi Cool Kids. • Lievän depression hoidoksi perustasolle käyttökelpoisia ovat esimerkiksi 6–12 kerran KKT, interpersoonallinen terapia IPT-N ja sen lyhytversiot IPC-N tai BIPT-A. • Interventiot sisältävät psykoedukaatiota, taitoharjoittelua ja oireita ylläpitävän välttämis- tai eristäytymiskäyttäytymisen purkua. • Suomessa on aloitettu IPC-N:n ja Cool Kidsin levittäminen perustasolle.
Background: Implementation of research-based interventions for adolescent depression to primary level services is important, given the need for treatment among depressive youth. Knowledge of factors facilitating or hindering implementation in multiprofessional school health and welfare services (SHWS) is needed. Method : A national pilot project implemented IPC-A to SHWS in upper secondary schools of Espoo in 2016-2017. Fifty-five professionals (psychologists, social workers, nurses), 28 delivering IPC-A and 27 comparison intervention, were trained in the first year. Process and individual level implementation variables, and trainees’ clinical IPC-A skills were examined with basic statistical methods and qualitative analyses. Results : Over half of adolescents were identified by nurse referral, 24% self-referred and 22% had been advised to seek support by teacher/friend. No additional cross-profession referrals were observed. Adolescents reported equal rates of interpersonal/family-related (49%) and emotional (51%) problems when specifying the reason for needing help. SHWS professionals reported multiple roadblocks in introducing the new intervention to the school context, including identifying adolescents with severity of symptoms targeted by the intervention, assessing depression and time constrains. Those providing comparison intervention without a specified model, supervision or support perceived it as difficult. As implementation facilitators, SHWS professionals relied on health checks, screenings and informing teachers and other professionals. Professionals trained in IPC-A delivered on average one IPC-A intervention per year, those delivering comparison interventions even less. IPC-A counsellors self-reported mastery of most IPC-A delivery skills in their first interventions. They experienced IPC-A as widely beneficial for adolescents and themselves as professionals. Supervisors’ assessments of counsellors’ competence indicated that delivery skills related to basic principles of IPC-A were relatively well mastered, but skills related to specific IPC-A techniques were inconsistent and poorly mastered. Conclusion : Implementation efforts should take into account issues related to identification and assessment of mental health disorders. Inconsistent mastery of IPC-A intervention skills by trainee counsellors suggests that a systematic approach to clinical training and supervision, and protected time for professionals to learn skills are of key importance.
Purpose: Social anxiety disorder (SAD) is prevalent in adolescents. Increase in levels of general anxiety since 2010’s has been observed in young people. Little is known of time trends in symptoms of social anxiety during 2010’s, of pre- to during-COVID-19 era changes, or of associations between social anxiety symptoms and pandemic severity, distance education, and COVID-19-related experiences in young people. Methods: We examined social anxiety symptoms, their temporal changes, and their associations with COVID-19 related factors in a sample of 450 000 13-to-20-year-old Finns in 2013–2021. Data from nationwide School Health Promotion study was used. Social anxiety symptoms were assessed with the Mini-SPIN using cut-off score ≥ 6 as indicator of high social anxiety. Multivariate logistic regression analyses were used, controlling for gender, age, family SES, and symptoms of general anxiety and depression. Results: High-level social anxiety symptoms increased markedly from 2013/2015 to 2021 among both sexes. A steeper increase was found among females. In 2021, 47% of females self-reported high social anxiety, a two-fold increase relative to 2013/2015. No association between regional COVID-19 incidence and change in social anxiety symptoms was found. No clear associations between time spent in distance education and social anxiety symptoms were found. Fears of getting infected or transmitting coronavirus, and reports of not getting needed support for schoolwork during distance education were all associated with high social anxiety. Conclusion: Prevalence of high social anxiety in young people aged 13–20 has increased considerably from 2013 to 2021, especially among girls. During COVID-19 pandemic, socially anxious young people report a need for educational support and suffer from infection-related fears.
Research on the predictors of outcome for early, community-based, and time-limited interventions targeted for clinical depression in adolescents is still scarce. We examined the role of demographic, psychosocial, and clinical variables as predictors of outcome in a trial conducted in Finnish school health and welfare services to identify factors associating to symptom reduction and remission after a brief depression treatment. A total of 55 12–16-year-olds with mild to moderate depression received six sessions of either interpersonal counseling for adolescents (IPC-A) or brief psychosocial support (BPS). Both interventions resulted in clinical improvement at end of treatment and 3- and 6-month follow-ups. Main outcome measures were self-rated BDI21 and clinician-rated Adolescent Depression Rating Scale (ADRSc). Latent change score (LCS) models were used to identify predictors of change in depressive symptom scores and clinical remission at end of treatment and 3- and 6-month follow-ups over the combined brief intervention group. Symptom improvement was predicted by younger age and having a close relationship with parents. Both symptom improvement and clinical remission were predicted by male gender, not having comorbid anxiety disorder, and not having sleep difficulties. Our results add to knowledge on factors associating with good treatment outcome after a brief community intervention for adolescent depression. Brief depression interventions may be useful and feasible especially for treatment of mild and moderate depression among younger adolescents and boys, on the other hand clinicians may need to cautiously examine sleep problems and anxiety comorbidity as markers of the need for longer treatment.
Background : Social anxiety disorder (SAD) is one of the key mental health disorders of adolescence. Due to the mental health challenge across the globe in this age group, a growing acknowledgement of the need to effectively identify and treat incipient SAD at an early stage has been presented in many countries. Aim : The aim of this study was to examine the accuracy of detection of SAD in schools, using a detection toolkit and a professional operating model in which school psychologists acted in a consultant/coordinator role. The second aim was to gain initial data on usefulness and feasibility of brief, developmentally oriented cognitive therapy (DOCT-SAD) for adolescents with SAD. Methods : Ten adolescents, identified from upper secondary schools with a mean age of 13.8 years, participated in DOCT-SAD. Accuracy rate of detection in the school was calculated as the proportion of adolescents who had interview-confirmed SAD and completed the treatment out of those altogether referred from schools. Usefulness of DOCT-SAD was assessed with pre- post-treatment changes in symptoms of SAD (SPIN), mood (PHQ-9) and in adolescents’ wellbeing (YP-CORE), and by evaluating change in DSM-5 diagnostic status. Feasibility was evaluated by semi-structured interviews of adolescents and their parents. Results : Use of the SAD detection toolkit and the professional operating model yielded a 71% accuracy rate for schoolbased identification of adolescents who had SAD, and who eventually completed treatment. DOCT-SAD showed promise as treatment of SAD: adolescents’ symptoms of SAD and depression decreased markedly pre-post effect sizes being 1.6 and 1.4 respectively, adolescents’ wellbeing improved, and a 60% rate of diagnostic remission, comparable to established treatments, was found. Feasibility of DOCT-SAD appeared good or excellent for adolescents and parents. Discussion : As incidence of SAD is high in adolescence, methods for detection and treatment are needed. The 10-session DOCT-SAD shows promise for further development as a treatment for adolescent SAD. Conclusion : This case series found support for using a structured detection model, and for treatment of SAD using a brief cognitive therapy program among adolescents identified in the school.
Lähtökohdat : Nuorisopsykiatrian konsultaatiotyöryhmä HYKS Varhain toimii perusterveydenhuollon ja erikoissairaanhoidon yhdyspinnalla tukien perustasolla tapahtuvaa nuorten mielenterveystyötä. Toiminta on suunnattu 13–17 -vuotiaille nuorille, jotka eivät ole nuorisopsykiatrisen erikoissairaanhoidon asiakkaita ja joiden alkavan psyykkisen oireilun arvioimisessa ja hoidossa perusterveydenhuolto tarvitsee tukea. HUS Varhain -työtä toteuttaa pääkaupunkiseudun alueella kahdeksanhenkinen moniammatillinen tiimi. Menetelmät : Toimintaa tarkasteltiin seuraamalla vuoden 2017 aikana Varhain-toimenpidekoodeilla raportoituja nuorten (n = 351) käyntitietoja. Tulokset : Tarkasteluajankohtana toteutui yhteensä 1 370 toimenpidettä, ja nuoren asioissa oltiin yhteydessä konsultaatiotyöryhmään keskimäärin 3,9 kertaa. Seuranta-aikana konsultoiduista nuorista 108 (30,8 %) ohjattiin nuorisopsykiatriseen erikoissairaanhoitoon, ja 243 nuorta (69,2 %) jäi perusterveydenhuoltoon Varhain -työskentelyn jälkeen (p < 0,001). Päätelmät: Tulosten valossa Varhain-työ toteutuu enimmäkseen konsultatiivisena verkostotyönä. Suurempi osa nuorista näyttäisi jäävän perustason hoitoon Varhain-intervention jälkeen kuin ohjautuvan erikoissairaanhoitoon.
Oral class presentations are regularly assigned to adolescents, but often provoke social anxiety, due to the importance of peer approval and need to appraise oneself as normal. Also, little is known about gender differences in girls’ and boys’ interpersonal cognition and appraisals of anxiety and self in anxiety-provoking speech situations. We examined gender differences in interpersonal cognition and appraisals of anxiety in an imagined class presentation scenario in a normative sample of 687 adolescents, 14-16-years-old, from Southwest Finland. Measures included the Classroom Questionnaire of Social Anxiety and Interpersonal Cognition and the Social Anxiety Scale for Adolescents. T-tests examined gender differences in interpersonal cognition, and chi-square tests examined adolescents’ appraisals of the likelihood of their own presentation anxiety and self as anxious. Girls more frequently reported positive, and less frequently reported negative, responses toward the depicted, anxious peer than boys. Also, a higher percentage of girls predicted that becoming anxious in the situation was likely, and non-acceptance of self as anxious was more frequent among girls. Boys predicted negative overt classmate reactions (e.g., laughing) towards the depicted, anxious peer, and towards themselves more frequently than did girls. Results are discussed in the context of gender-specific development and procedures for reducing adolescent social anxiety.
Depression is one of the most common psychiatric disorders among adolescents and young adults. Interpersonal counselling, adolescent version (IPC-A) is a short method to treat depression of adolescents in 3 to 8 sessions in primary healthcare. IPC-A has been selected in a participatory project for national implementation in Finland, starting 2020. By the end of 2022, the estimated need to treat 7000 depressed adolescents per year in primary care will be targeted by training about 1600 professionals in providing IPC-A. In preparation for implementation of this strategy, the Finnish Ministry of Social Affairs and Health funded a project in 2016-2017. The first step was selection of evidence-based interventions that would be suitable for national implementation in primary care. The government then funded a pilot study using IPC-A intervention in one city. The pilot had the goal of constructing a national implementation model for further testing within adolescent mental health services. As the results were encouraging, IPC-A was then chosen as the first intervention to test for nationwide implementation of short interventions in primary care. Five university clinics coordinated subsequent national training and local implementation. The Finnish Institute for Health and Welfare (THL) and Itla Children’s Foundation provided implementation support for local project teams. While the training is still ongoing, the successes and limitations of the implementation process will be explored from the perspective of national coordination and support of implementation.
Parvovirus B19 (B19V) DNA persists lifelong in human tissues, but the cell type harbouring it remains unclear. We here explore B19V DNA distribution in B, Tand monocyte cell lineages of recently excised tonsillar tissues from 77 individuals with an age range of 2–69 years. We show that B19V DNA is most frequent and abundant among B cells, and within them we find a B19V genotype that vanished from circulation 440 years ago. Since re-infection or re-activation are unlikely with this virus type, this finding supports the maintenance of pathogen-specific humoral immune responses as a consequence of B-cell long-term survival rather than continuous replenishment of the memory pool. Moreover, we demonstrate the mechanism of B19V internalization to be antibody dependent in two B-cell lines as well as in ex vivo isolated tonsillar B cells. This study provides direct evidence for a cell type accountable for B19V DNA tissue persistence.
Human bocavirus 1 (HBoV1), a nonenveloped single-stranded DNA parvovirus, causes mild to life-threatening respiratory tract infections, acute otitis media, and encephalitis in young children. HBoV1 often persists in nasopharyngeal secretions for months, hampering diagnosis. It has also been shown to persist in pediatric palatine and adenoid tonsils, which suggests that lymphoid organs are reservoirs for virus spread; however, the tissue site and host cells remain unknown. Our aim was to determine, in healthy nonviremic children with preexisting HBoV1 immunity, the adenotonsillar persistence site(s), host cell types, and virus activity. We discovered that HBoV1 DNA persists in lymphoid germinal centers (GCs), but not in the corresponding tonsillar epithelium, and that the cell types harboring the virus are mainly naive, activated, and memory B cells and monocytes. Both viral DNA strands and both sides of the genome were detected, as well as infrequent mRNA. Moreover, we showed, in B-cell and monocyte cultures and ex vivo tonsillar B cells, that the cellular uptake of HBoV1 occurs via the Fc receptor (FcγRII) through antibody-dependent enhancement (ADE). This resulted in viral mRNA transcription, known to occur exclusively from double-stranded DNA in the nucleus, however, with no detectable productive replication. Confocal imaging with fluorescent virus-like particles moreover disclosed endocytosis. To which extent the active HBoV1 GC persistence has a role in chronic inflammation or B-cell maturation disturbances, and whether the virus can be reactivated, will be interesting topics for forthcoming studies.