Psykososiaalisia selitysmalleja psykoosi-ilmiön ymmärtämisen ja integratiivisen hoidon tueksi

Abstract

Psykoosi-ilmiön epäyhtenäisyys on vaikeuttanut tarkoin määriteltyjen hoitomenetelmien kehitystä. Psykososiaalisen näkökulman avulla voidaan hahmottaa psykoosi-ilmiön ja sen määritelmien suhteellinen luonne. Tästä näkökulmasta psykoosiksi tulkittavia ilmiöitä ei voida tyhjentävästi kategorisoida, samaistaa biologisiin mekanismeihin tai hoitaa kontekstista eli henkilön elinpiiristä irrotettuna psykopatologiana. Näkökulman laajentaminen auttaa kehittämään tutkimus- ja hoitokäytäntöjä integratiivista lähestymistapaa käyttäen.

The term psychosis refers to a complex phenomenon, characterized by a variety of phenotypic expressions, courses and clinical outcomes. This heterogeneous nature challenges the development of optimal treatment strategies. In response to this challenge, integrative approaches have been preferred, in which the disorder is explained as the result of an interaction between biological vulnerability and psychosocial stress. However, in some cases this could underrate the complex and interrelated nature of psychotic experiences by emphasizing the causal role of the underlying and diagnosable disease entities. This can be balanced with psychosocial and dimensional approaches, and by emphasizing real-world experiences. Based on this, experiences interpreted as a psychosis can be understood as a variation of normal biological, mental and social processes, and often as a consistent reaction to trauma or other life adversities. Respectively, for some, such experiences are extremely painful, whereas for others some aspects of psychosis can be both meaningful and valuable. Due to this complexity and multifaceted nature of phenomena categorized under the psychosis, it cannot be comprehensively treated as a symptom of a singular disease entity apart from its context, including the patient’s social and other “real-life” environments. In treatment, the shift from a traditional one-way interaction to more collaborative dialogues enables the creation of shared understanding between staff, patients, and their close networks concerning each situation. This makes it possible to provide treatment in a more need-adapted manner, and it may itself reduce psychotic symptoms by offering a shared language and meanings for difficult experiences within the patient’s natural environments. In sum, expanding the scope of psychosis has the potential to increase both the validity of research and the effectiveness of treatment practices, though more research is still needed.