October has been an academically inspiring month! After the Nordic meeting on transgender health, which I mentioned in my last post, I soon attended a most interesting public discussion on the academic dissertation of licentiate of psychology Petra Waris.
Petra Waris had studied comorbidity between schizophrenia and pervasive developmental disorders in adolescence. My Department had participated in one of the studies included in the dissertation, the one where she studied neurocognition and social cognition between adolescents suffering from schizophrenia, schizophrenia with pervasive developmental disorder and pervasive developmental disorder alone. As the disputant pointed out, schizophrenia and pervasive developmental disorders have a long common history. For decades now, they have been considered separate entities, but they share in common certain features in symptom presentation as well as genetic and neuroimaging findings. Petra Waris and her coworkers found that 44% of adolescents with early onset schizophrenia also had a pervasive developmental disorder from childhood. Early onset schizophrenia alone is a very severe condition. Petra’s studies revealed that when comorbid with pervasive developmental disorder, it is more challenging still. Those presenting with both displayed more severe and earlier onset catatonic symptoms and more developmental delays than those with either disorder alone. My clinical observations in our adolescent forensic unit are in agreement with these findings. Particularly violent behaviours displayed by young people with comorbid schizophrenia and autism spectrum disorder are most difficult to understand, and with difficulties in understanding the young person, offering help that reduces violent behaviours is also difficult.
When we were opening our adolescent forensic unit in 2003, nobody talked about autism in adolescent psychiatry. We were perplexed when young people with autism and severe problems with violent behaviours started to come in. Since then we have in all our Department of Adolescent Psychiatry systematically developed our skills in diagnosing and treating adolescent psychiatric disorders in the context of autism spectrum disorders. Little epidemiological research is available of psychiatric comorbidities of autism spectrum disorders in adolescence, but in clinical practice, aggression problems, depression, social anxiety and psychotic episodes are common. Associations between autism spectrum and eating disorders have been noticed. We were the first in Finland to start a special service for adolescent neuropsychiatric problems – and also the first to stop it. Years have shown that there is no reason to think of adolescent neuropsychiatric problems a rarity that is best handled by placing the problem in a very special service in service. I nowadays consider autism spectrum disorders a one of the core topics in adolescent psychiatry that everybody working in adolescent psychiatry has to master. And ADHD, the other big topic in adolescent neuropsychiatry? ADHD is so common that without complex comorbidities it is not an issue of specialist level adolescent psychiatry at all.
But October had still more academic inspiration to offer! I also attended the 9th European congress on violence in clinical psychiatry in Copenhagen.
That was really a good meeting. I decided very late to participate in it, so I had no presentation myself. But I was most active in listening! The programme was so good that shopping and sight-seeing in Copenhagen did not cross my mind. (We visited Christiania and I also had a satisfying workout night in a wellness center, but that was all after the lectures!). I think that the most important message of the conference was respect. Helping an agitated and angry patient to de-escalate and avoid use of violence starts from showing respect. Another lesson to learn was the role of leadership. Brilliant ideas and great new approaches simply die down if they are not the matter of the heart for the leaders whose personal presence demonstrating their interest and commitment is the more required, the more difficult the challenge. And indeed, violent behaviours in the context of adolescent severe mental disorders are a difficult challenge. The congress really gave me new insights, and I definitely want to attend the next time in Dublin.
Finally I had the honor of giving a lecture in a symposium arranged to celebrate an important anniversary of a colleague and a friend of mine, professor Nina Lindberg (University of Helsinki). I discussed the problem whether repeated, intentional and malignant violent behaviour can occur in the context of healthy adolescent development (it can’t).
All this kept me so busy that I had not energy to think about removing autumn leaves from the garden. And why bother when there were still so many leaves in trees, one would need to do it again soon anyway! I really love autumn leaves! They are so pretty. Today I finally decided to remove them from our garden. How could there be so incredibly much of them? Certainly more than in earlier autumns! I don’t mind raking the leaves, even if I do enjoy more walking in them or taking photos of them, but where to put them? I really do not have expertise in gardening. I like working in the garden but I am bothered by a feeling that I am doing it all wrong and neighbours – who always do season’s garden work earlier than I – will see and think I am a disaster. After putting quite a load to composter and some under the bushes I had to cram them in waste bags and go consulting my more clever gardened friends in Facebook, whether there is a right solution…