Recognition, comorbidity, and outcome of DSM-IV bipolar I and II disorders in psychiatric care

This study is part of an ongoing collaborative bipolar research project, the Jorvi Bipolar Study (JoBS). The JoBS is run by the Department of Mental Health and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital (HUCH), Espoo, Finland. It is a prospective, naturalistic cohort study of secondary level care psychiatric in- and outpatients with a new episode of bipolar disorder (BD). The second report also included 269 major depressive disorder (MDD) patients from the Vantaa Depression Study (VDS). The VDS was carried out in collaboration with the Department of Psychiatry of the Peijas Medical Care District. Using the Mood Disorder Questionnaire (MDQ), all in- and outpatients at the Department of Psychiatry at Jorvi Hospital who currently had a possible new phase of DSM-IV BD were sought. Altogether, 1630 psychiatric patients were screened, and 490 were interviewed using a semistructured interview (SCID-I/P). The patients included in the cohort (n=191) had at intake a current phase of BD. The patients were evaluated at intake and at 6- and 18-month interviews. Based on this study, BD is poorly recognized even in psychiatric settings. Of the BD patients with acute worsening of illness, 39% had never been correctly diagnosed. The classic presentations of BD with hospitalizations, manic episodes, and psychotic symptoms lead clinicians to correct diagnosis of BD I in psychiatric care. Time of follow-up elapsed in psychiatric care, but none of the clinical features, seemed to explain correct diagnosis of BD II, suggesting reliance on cross- sectional presentation of illness. Even though BD II was clearly less often correctly diagnosed than BD I, few other differences between the two types of BD were detected. BD I and II patients appeared to differ little in terms of clinical picture or comorbidity, and the prevalence of psychiatric comorbidity was strongly related to the current illness phase in both types. At the same time, the difference in outcome was clear. BD II patients spent about 40% more time depressed than BD I patients. Patterns of psychiatric comorbidity of BD and MDD differed somewhat qualitatively. Overall, MDD patients were likely to have more anxiety disorders and cluster A personality disorders, and bipolar patients to have more cluster B personality disorders. The adverse consequences of missing or delayed diagnosis are potentially serious. Thus, these findings strongly support the value of screening for BD in psychiatric settings, especially among the major depressive patients. Nevertheless, the diagnosis must be based on a clinical interview and follow-up of mood. Comorbidity, present in 59% of bipolar patients in a current phase, needs concomitant evaluation, follow-up, and treatment. To improve outcome in BD, treatment of bipolar depression is a major challenge for clinicians.

Basement membrane and provisional matrix components (collagen type IV, laminins and von Willebrand factor) in rheumatoid arthritis and Sjögren s syndrome

The aim of this study was twofold- Firstly, to determine the composition of the type IV collagen which are the major components of the basement membrane (BM), in the synovial lining of the rheumatoid arthritis (RA) patient and in the BM in the labial salivary gland of the Sjögrens syndrome (SS) patient. Secondly, this thesis aimed to investigate the role of the BM component laminin α4 and laminin α5 in the migration of neutrophils from the blood vessels thorough the synovial lining layer into synovial fluid and the presence of vWF in the microvasculature of labial salivary gland in SS. Our studies showed that certain α chains type IV collagen are low in RA compared to control synovial linings, while laminin α5 exhibited a pattern of low expression regions at the synovial lining interface towards the joint cavity and fluid. Also, high numbers of macrophage-like lining cells containing MMP-9 were found in the lining. MMP-9 was also found in the synovial fluid. Collagen α1/2 (IV) mRNA was found to be present in high amount compared to the other α(IV) chains and also showed intense labelling in immunohistochemical staining in normal and SS patients. In healthy glands α5(IV) and α6(IV) chains were found to be continuous around ducts but discontinuous around acini. The α5(IV) and α6(IV) mRNAs were present in LSG explants and HSG cell line, while in SS these chains seemed to be absent or appear only in patches around the ductal BM and tended to be absent around acini in immunohistochemical staining, indicating that their synthesis and/or degradation seemed to be locally regulated around acinar cells. The provisional matrix component vWF serves as a marker of vascular damage. Microvasculature in SS showed signs of focal damage which in turn might impair arteriolar feeding, capillary transudation and venular drainage of blood. However, capillary density was not decreased but rather increased, perhaps as a result of angiogenesis compensatory to microvascular damage. Microvascular involvement of LSG may contribute to the pathogenesis of this syndrome. This twofold approach allows us to understand the intricate relation between the ECM components and the immunopathological changes that occur during the pathogenesis of these inflammatory rheumatic disease processes. Also notably this study highlights the importance of maintaining a healthy ECM to prevent the progression or possibly allow reversal of the disease to a considerable level. Furthermore, it can be speculated that a healthy BM could quarantine the inflamed region or in case of cancer cells barricade the movement of malignant cells thereby preventing further spread to the surrounding areas. This understanding can be further applied to design appropriate drugs which act specifically to maintain a proper BM/BM like intercellular matrix composition.

Tests of a Roman Pot Prototype for the TOTEM Experiment

The TOTEM collaboration has developed and tested the first prototype of its Roman Pots to be operated in the LHC. TOTEM Roman Pots contain stacks of 10 silicon detectors with strips oriented in two orthogonal directions. To measure proton scattering angles of a few microradians, the detectors will approach the beam centre to a distance of 10 sigma + 0.5 mm (= 1.3 mm). Dead space near the detector edge is minimised by using two novel "edgeless" detector technologies. The silicon detectors are used both for precise track reconstruction and for triggering. The first full-sized prototypes of both detector technologies as well as their read-out electronics have been developed, built and operated. The tests took place first in a fixed-target muon beam at CERN's SPS, and then in the proton beam-line of the SPS accelerator ring. We present the test beam results demonstrating the successful functionality of the system despite slight technical shortcomings to be improved in the near future.

Roman Ingarden’s Objectivity vs. Subjectivity as a problem of Translatability

Ingarden (1962, 1964) postulates that artworks exist in an “Objective purely intentional” way. According to this view, objectivity and subjectivity are opposed forms of existence, parallel to the opposition between realism and idealism. Using arguments of cognitive science, experimental psychology, and semiotics, this lecture proposes that, particularly in the aesthetic phenomena, realism and idealism are not pure oppositions; rather they are aspects of a single process of cognition in different strata. Furthermore, the concept of realism can be conceived as an empirical extreme of idealism, and the concept of idealism can be conceived as a pre-operative extreme of realism. Both kind of systems of knowledge are mutually associated by a synecdoche, performing major tasks of mental order and categorisation. This contribution suggests that the supposed opposition between objectivity and subjectivity, raises, first of all, a problem of translatability, more than a problem of existential categories. Synecdoche seems to be a very basic transaction of the mind, establishing ontologies (in the more Ingardean way of the term). Wegrzecki (1994, 220) defines ontology as “the central domain of philosophy to which other its parts directly or indirectly refer”. Thus, ontology operates within philosophy as the synecdoche does within language, pointing the sense of the general into the particular and/or viceversa. The many affinities and similarities between different sign systems, like those found across the interrelationships of the arts, are embedded into a transversal, synecdochic intersemiosis. An important question, from this view, is whether Ingardean’s pure objectivities lie basically on the impossibility of translation, therefore being absolute self-referential constructions. In such a case, it would be impossible to translate pure intentionality into something else, like acts or products.

Governmental rationalities and the local dimension of European politics. A study of the Interreg IV programme "Alpenrhein-Bodensee-Hochrhein"

The thesis aims at investigating the local dimension of the EU cohesion policy through the utilization of an alternative approach, which aims at the analysis of discourse and structures of power. The concrete case under analysis is the Interreg IV programme “Alpenrhein-Bodensee-Hochrhein”, which is conducted in the border region between Germany, Switzerland, Austria and the principality of Liechtenstein. The main research question is stated as such: What governmental rationalities can be found at work in the field of EU cross-border cooperation programmes? How is directive action and cooperation envisioned? How coherent are the different rationalities, which are found at work? The theoretical framework is based on a Foucaultian understanding of power and discourse and utilizes the notion of governmentalities as a way to de-stabilize the understanding of directive action and in order to highlight the dispersed and heterogeneous nature of governmental activity. The approach is situated within the general field of research on the European Union connected to basic conceptualisations such as the nature of power, the role of discourse and modes of subjectification. An approach termed “analytics of government”, based on the work of researchers like Mitchell Dean is introduced as the basic framework for the analysis. Four dimensions (visiblities, subjectivities, techniques/practices, problematisations) are presented as a set of tools with which governmental regimes of practices can be analysed. The empirical part of the thesis starts out with a discussion of the general framework of the European Union's cohesion policy and places the Interreg IV Alpenrhein-Bodensee-Hochrhein programme in this general context. The main analysis is based on eleven interviews which were conducted with different individuals, participating in the programme on different levels. The selection of interview partners aimed at maximising heterogeneity through including individuals from all parts of the programme region, obtaining different functions within the programme. The analysis reveals interesting aspects pertaining to the implementation and routine aspects of work within initiatives conducted under the heading of the EU cohesion policy. The central aspects of an Interreg IV Alpenrhein-Bodensee-Hochrhein – governmentality are sketched out. This includes a positive perception of the work atmosphere, administrative/professional characterisation of the selves and a de-politicization of the programme. Characteristic is the experience of tensions by interview partners and the use of discoursive strategies to resolve them. Negative perceptions play an important role for the specific governmental rationality. The thesis contributes to a better understanding of the local dimension of the European Union cohesion policy and questions established ways of thinking about governmental activity. It provides an insight into the working of power mechanisms in the constitution of fields of discourse and points out matters of practical importance as well as subsequent research questions.

Zorros märke : Manligt identitetsbygge i Per Pettersons roman "Jeg forbanner tidens elv"

Avhandlingens syfte är att belysa hur porträtten av jagberättaren Arvid och hans mor växer fram i Per Pettersons roman Jeg forbanner tidens elv. Det paradigm jag utgår ifrån är det psykoanalytiska. Förutom texter av Sigmund Freud och Jacques Lacan stöder jag mig på texter av Peter Brooks och Terry Eagleton. För en tolkning av Arvids sätt att berätta sin historia använder jag mig av James Phelans tankar kring den opålitliga berättaren . Analysen bygger på en närläsning av romanen och några av de intertexter som förekommer i den. Av dessa är särskilt myten om kung Oidipus samt berättelsen om Zorro centrala för förståelsen av Arvids personlighet och hur den manliga identiteten byggs. Andra centrala intertexter som granskas närmare är Erich Maria Remarques roman Triumfbågen och Somerset Maughams roman Den vassa eggen. Porträttet av mor belyses indirekt via den funktion hon har i Arvids berättelse. Arvids porträtt analyseras ur två olika perspektiv. I uppsatsens första del, Romanbygget , undersöker jag hur romanen är uppbyggd och hur bilden av Arvid formas genom vad han berättar om sin mor, sitt liv, sin bakgrund och sina uppväxtår. Det perspektiv som Konung Oidipus i Freuds tolkning av det antika dramat ger, lyfter, som en nyckel in i romanen, fram dynamiken mellan Arvid, mor och den övriga familjen. I romanen dödas far i psykisk bemärkelse, han blir medvetet föraktad och förbisedd som manlig förebild och identifikationsobjekt. Arvids fixering vid mor gör att han ser sig själv med hennes ögon. Också bröderna får sin gestalt som rivaler i kampen om mor. I ljuset av den oidipala problematiken framhåller jag Arvids olösta relation till familjemedlemmarna som den avgörande orsaken till Arvids misslyckanden i livet och hans oförmåga att forma en fungerande och stabil vuxenidentitet. Men jag föreslår också en tidig, omedveten fadersidentifikation, symboliserad av Zorro och Zorros magiska märke, som i sublimeringen eventuellt finner sin lösning i en dröm om att bli författare. I uppsatsens andra del Berättarrösten undersöker jag Arvids sätt att berätta utgående ifrån Phelans tankar kring den opålitliga berättaren . Jag analyserar några centrala avsnitt i romanen med avseende på hur berättarröstens och den implicita författarens framställningar överensstämmer eller skiljer sig ifrån varandra. I min läsning är Arvid en komplext pålitlig och opålitlig berättare. Arvid framhåller i sin berättelse och i sina återblickar ett tillrättalagt och i någon mån förskönat porträtt av sig själv, en livslögn vars upplösning enligt min mening antyds i de avslutande kapitlen. För min förståelse av psykoanalysens teori och hur den kan tillämpas i litteraturforskningen är Ludwig Wittgensteins tankar om bildens användning centrala. I avsnittet om Zorro tar jag kortfattat upp frågan hur psykoanalytisk litteraturtolkning kan leda vilse i form av övertolkning, det vill säga att analysen övergår i fantasi. En annan möjlig felkälla som jag lyfter fram i analysen är att romanen tolkas av en svenskspråkig läsare som eventuellt läser in andra nyanser i den norska texten, än vad författaren avsett. Jag tar också upp frågan om Arvid i Pettersons tidigare produktion och huruvida det är frågan om en fortgående berättelse om Arvid Jansen under olika livsbetingelser. Mitt intryck är att det inte är fråga om ett enhetligt personporträtt utan olika frågeställningar som modelleras ur samma material.

Arvoja näkyvissä : Kaunokirjallisuuden etiikka Ludwig Wittgensteinin filosofian valossa

The goal of this dissertation was to study whether it is possible and meaningful to apply Ludwig Wittgenstein s distinction between saying (Sagen) and showing (Zeigen) to ethically oriented literary criticism. The following questions were used as the primary guidelines: 1. Is it possible, in the context of literary criticism, to put in practice Wittgenstein s ethical conceptions, which are quite theoretical and metaphysical by nature? 2. If so, what practical literary devices do authors use if they want to demonstrate their ethical values within the frame of a fictional work? 3. Does philosophy offer useful ethical consepts that open us new and interesting readings in fiction? The philosophical background of Wittgenstein s distinction is clarified in chapter I. This clarification is based on his main works, Tractatus logico-philosophicus and Philosophishe Untersuchungen, the published correspondence between Wittgenstein and Paul Engelmann, and selected Wittgenstein research and papers. Analyzing ethics and it s expression in Georg Trakl s poetry further elucidates Wittgenstein s concept of showing. The concept that a literary work is an act of an author was used as a starting point. The presumption was that analyzing this act of an author will reveal how ethical values can be demonstrated in literature. Categorizing an author s act at different levels of literary expression provides the structure of this study. In chapters IV - XIII literary devices useful for demonstrating ethics are examined and explained using examples from the works of Joseph Conrad, Charles Dickens, Nikolay Leskov, Ludwig Uhland, Eino Leino, Pentti Haanpää and Maria Jotuni. The concepts and views of researchers and writers such as Mihail Bahtin, Peter Juhl, E. D. Hirsch, Peter Lamarque and Stein Haugom Olsen are used. The concepts outlined in previous chapters are then applied in three case studies: Aeschylus s Oresteia trilogy, J-L. Runeberg s poem Sven Dufva and Sofi Oksanen s novel Puhdistus (Purge). On the whole, Wittgenstein s idea that ethical values can be demonstrated (shown) by means of literature is revealed as a fruitful point of departure for a more exact ethical reading, offering a new perspective on literary works.