Uskonto kognition tuotteena : ja vähän kulttuurinkin

Kirjallisuusarvostelu

Benzodiazepines and Cognitive Functioning in Older Adults. With Emphasis on Long-Term Use and Withdrawal

Benzodiazepines (BZD) and benzodiazepine related drugs (RD) are the most commonly used psychotropics among the aged. The use of other psychotropics taken concomitantly with BZD/ RD or their cognitive effects with BZD/RD have not been studied frequently. The aim of this academic thesis was to describe and analyse relationships between the use of BZD/RD alone or concomitantly with antipsychotics, antidepressants, opioids, antiepileptics, opioids and anticholinergics in the aged and their health. Especially, the relationships between long-term use of BZD/RD and cognitive decline were studied. Additionally, the effect of melatonin on BZD/RD withdrawal and the cognitive effects of BZD/RD withdrawal were studied. This study used multiple data sets: the first study (I) was based on clinical data containing aged patients (≥65 years; N=164) admitted to Pori City Hospital due to acute disease. The second data set (Studies II and III) was based on population-based data from the Lieto Study, a clinico-epidemiological longitudinal study carried out among the aged (≥65 years) in the municipality of Lieto. Follow-up data was formed by combining the cohort data collected in 1990-1991 (N=1283) and in 1998-1999 (N=1596) from those who participated in both cohorts (N=617). The third data set (Studies IV and V) was based on the Satauni Study’s data. This study was performed in the City of Pori in 2009-2010. In the RCT part of the Satauni Study, ninety-two long-term users of BZD/RD were withdrawn from their drugs using melatonin against placebo. The change of their cognitive abilities was measured during and after BZD/ RD withdrawal. BZD/RD use was related to worse cognitive and functional abilities, and their use may predict worse cognitive outcomes compared with BZD/RD non-users. Hypnotic use of BZD/RD could be withdrawn with psychosocial support in motivated participants, but melatonin did not improve the withdrawal results compared to those with placebo. Cognitive abilities in psychomotor tests did not show, or showed only modest, improvements for up to six months after BZD/RD withdrawal. This suggests that the cognitive effects of BZD/RD may be longlasting or permanent.

Guilt, shame, emotion regulation, and social cognition: Understanding their associations with preadolescents' social behavior

In this thesis, two negatively valenced emotions are approached as reflecting children’s self-consciousness, namely guilt and shame. Despite the notable role of emotions in the psychological research, empirical research findings on the links between guilt, shame, and children’s social behavior – and particularly aggression – have been modest, inconsistent, and sometimes contradictory. This thesis contains four studies on the associations of guilt, shame, emotion regulation, and social cognitions with children’s social behavior. The longitudinal material of the thesis was collected as a survey among a relatively large amount of Finnish preadolescents. In Study I, the distinctiveness of guilt and shame in children’s social behavior were investigated. The more specific links of emotions and aggressive behavior were explored in Study II, in which emotion regulation and negative emotionality were treated as the moderators between guilt, shame, and children’s aggressive behavior. The role of emotion management was further evaluated in Study III, in which effortful control and anger were treated as the moderators between domain-specific aggressive cognitions and children’s aggressive behavior. In the light of the results from the Studies II and III, it seems that for children with poor emotion management the effects of emotions and social cognitions on aggressive behavior are straight-forward, whereas effective emotion management allows for reframing the situation. Finally, in Study IV, context effects on children’s anticipated emotions were evaluated, such that children were presented a series of hypothetical vignettes, in which the child was acting as the aggressor. Furthermore, the identity of the witnesses and victim’s reactions were systematically manipulated. Children anticipated the most shame in situations, in which all of the class was witnessing the aggressive act, whereas both guilt and shame were anticipated the most in the situations, in which the victim was reacting with sadness. Girls and low-aggressive children were more sensitive to contextual cues than boys and high-aggressive children. Overall, the results of this thesis suggest that the influences of guilt, shame, and social cognition on preadolescents’ aggressive behavior depend significantly on the nature of individual emotion regulation, as well as situational contexts. Both theoretical and practical implications of this study highlight a need to acknowledge effective emotion management as enabling the justification of one’s own immoral behavior.

Genetics of inherited small vessel diseases – in search of a novel small vessel disease and modifiers of the clinical course of CADASIL

The genetic and environmental risk factors of vascular cognitive impairment are still largely unknown. This thesis aimed to assess the genetic background of two clinically similar familial small vessel diseases (SVD), CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) and Swedish hMID (hereditary multi-infarct dementia of Swedish type). In the first study, selected genetic modifiers of CADASIL were studied in a homogenous Finnish CADASIL population of 134 patients, all carrying the p.Arg133Cys mutation in NOTCH3. Apolipoprotein E (APOE) genotypes, angiotensinogen (AGT) p.Met268Thr polymorphism and eight NOTCH3 polymorphisms were studied, but no associations between any particular genetic variant and first-ever stroke or migraine were seen. In the second study, smoking, statin medication and physical activity were suggested to be the most profound environmental differences among the monozygotic twins with CADASIL. Swedish hMID was for long misdiagnosed as CADASIL. In the third study, the CADASIL diagnosis in the Swedish hMID family was ruled out on the basis of genetic, radiological and pathological findings, and Swedish hMID was suggested to represent a novel SVD. In the fourth study, the gene defect of Swedish hMID was then sought using whole exome sequencing paired with a linkage analysis. The strongest candidate for the pathogenic mutation was a 3’UTR variant in the COL4A1 gene, but further studies are needed to confirm its functionality. This study provided new information about the genetic background of two inherited SVDs. Profound knowledge about the pathogenic mutations causing familial SVD is also important for correct diagnosis and treatment options.

The tree we heard fall : analyzing the societal processes following focusing events

Fokuserande händelser är plötsliga, ovanliga och för med sig negativa konsekvenser för ett stort antal människor. Det handlar om det vi i vardagligt tal kallar kriser och katastrofer. En intensiv medierapportering i kombination med oroade medborgare gör att kriser och katastrofer är viktiga samhällspåfrestningar som beslutsfattare måste hantera. Syftet med avhandlingen är att öka förståelsen för hur fokuserande händelser påverkar samhälleliga processer. Avhandlingens två övergripande forskningsfrågor tar fasta på jämförelsen av olika typer av fokuserande händelser. För det första, skillnader i hur naturkatastrofer och katastrofer som tillkommit genom mänskligt handlade påverkar samhället, och för det andra, hur händelser med olika stark fokuseringskraft påverkar samhället. Medborgarreaktioner studeras i en experimentell laboratoriestudie, den mediala rapporteringen analyseras genom kvantitativ innehållsanalys av texter och bilder, och på den parlamentariska arenan analyseras riksdagsdebatten genom kvantitativ innehållsanalys. De temaområden som identifieras i den teoretiska referensramen ligger till grund för analysen och tar fasta på de känslor som händelsen ger upphov till, hur händelsen kontextualiseras (framing), skuldbeläggning samt möjliga lösningar som förs fram. Resultatet från studierna visar att skillnader mellan olika typer av händelser syns tydligast hos medborgare, uttryckt genom starkare emotionella reaktioner för händelser med stark fokusering, och på den mediala arenan, genom mer utrymme för dessa händelser. Då kriser och katastrofer med olika stark fokuseringskraft når riksdagen får de däremot ett relativt likadant mottagande. I jämförelsen mellan naturkatastrofer och människoskapade händelser visar resultaten att naturkatastrofer ofta diskuteras som specifika händelser, medan människoskapade händelser placeras i en bredare samhällelig kontext och diskuteras under längre tid. Avhandlingen bidrar till diskussionen om hur våra känslor och vår kognition samspelar i krissituationer. De omedvetna signaler som vår kropp ger oss gällande hur vi ska reagera på en farlig situation kan påverka om vi är rädda, oroliga eller till och med positivt inställda. I ljuset av de tre studierna är det tydligt att de emotionella reaktionerna minskar ju högre upp i den politiska processen vi kommer. Trots att medborgare och medier reagerar starkt är de emotionella reaktionerna på den politiska arenan relativt milda och skuldbeläggningen näst intill icke-existerande.