Moderne forståelse av psykisk lidelse= Dimensjonell forståelse av psykiske lidelser - Kristiansand Professor Jan Olav Johannessen, Stavanger Universitetssjukehus Norway

“An air of desolation more calculated to fix than to remove”

 Psyk osis, jfr osteopor osis  På norsk: alvorlig forvirringstilstand  Følelser overbelaster psykologisk mestringsapparat (forsvar):fortrengning, rasjonalisering, dissosiering etc  Ikke hokus-pokus….. Hva er psykose?

 Høre stemmer= hører sine tanker som stemmer  Stemmer og andre symptomer har mening Psykisk lidelse er følelser ute av kontroll…

 PF ca 80%  Psykose %  Anorexi høyt  Dose-respons  Kronisitet høyere load? Uheldige livshendeleser vs Traumebegrepet

The Trauma of Late Intervention Early intervention group Late intervention group

Viking-Start 3-2

Lars Thorgaard (LTH 3-R) Schizofreni er:  A separation/attachment disorder  Distrust/loss of trust disorder  A relation disorder  An identity disorder  A paroxysmal and relapse disorder  A control and loss of control disorder  A selfcare-failing disorder

Mental illness and substance use disorders account for 60% of the non-fatal burden of disease amongst young people aged (Public Health Group 2005) 75% of mental health problems occur before the age of 25 (Kessler et al 2005) 14% of young people aged 12-17, and 27% of young people aged experience a mental health problem in any 12 month period (Sawyer et al 2000, Andrews et al 1999, ABS 2008)

11 Young persons with disabledness pension i Norway ?

12 Harry Stack Sullivan

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Cowntinuity of care…

Progression through the prodromal period psychosis mania depression psychosis depressionmania Psychosis depressionmania Stage 1a Stage 2+ Stage 1b schizophrenia

Psychosis Risk Syndrome Bipolar Risk Syndrome Tenacious Depression Syndrome THE GRAND DSM V RAILROAD

19 …schizophrenic psychosis is one stage in a process of psychological and biological breakdown that has a specific structure and a characteristic unfolding. This structure consists of the sequential appearance of hierarchically ordered, distinguishable, and recognisable psychological states Docherty Am J Psych 1978 Stages of onset of schizophrenia

20 Stages of decompensation: 0Equilibrium IOverextension IIRestricted consciousness IIIDisinhibition IVPsychotic disorganisation 1. destructuring of the external world 2. destructuring of the self 3. total fragmentation VPsychotic resolution Dockerty, Am J Psych 1978 Stages of onset of schizophrenia

21 sleeping problems anxiety problems with concentration isolation suspiciousness hearing voices delusions bizarre delusions the ”Domino-effect”