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Method: The Open Dialogue Method was developed in Finland in order to deal with severe psychotic crises using dialogue and social network inclusion. By means of a review of the literature on the Open Dialogue Method, this article sought to identify the principles and contributions for deinstitutionalization.The PubMed (365), PsycInfo (134), Lilacs (no articles found) databases and 2 books were consulted. Thirty-four publications that fulfilled the requirements of this review were selected. The search was conducted in October 2015. The key words used were: open dialogue, crisis, first psychotic episode, schizophrenia, family therapy, need-adapted approach., Results: There were 3 reviews, 5 theoretical studies, 21 qualitative studies and 5 quantitative studies. Two of them were written in Italian, one in French and thirty-one in English. The authors were from Norway, the United States, Finland, Australia, the United Kingdom, Belgium, Canada and Poland. The publications were grouped for purposes of analysis into the following categories: Open Dialogue concepts and principles; Open Dialogue contributions; Challenges for Open Dialogue implementation in other countries, realities and contexts.

Open Dialogue (OD) is a family-oriented early intervention approach which has demonstrated good outcomes in the treatment of first-episode psychosis (FEP). Nevertheless, more evidence is needed. In this register-based cohort study the long-term outcomes of OD were evaluated through a comparison with a control group over a period of approximately 19 years. We examined the mortality, the need for psychiatric treatment, and the granting of disability allowances. Data were obtained from Finnish national registers regarding all OD patients whose treatment for FEP commenced within the time of the original interventions (total N = 108). The control group consisted of all Finnish FEP patients who had a follow-up of 19-20 years and who were guided to other Finnish specialized mental healthcare facilities (N = 1763). No difference between the samples was found regarding the annual incidence of FEP, the diagnosis, and suicide rates. Over the entire follow-up, the figures for durations of hospital treatment, disability allowances, and the need for neuroleptics remained significantly lower with OD group. Findings indicated that many positive outcomes of OD are sustained over a long time period. Due to the observational nature of the study, randomized trials are still needed to provide more information on effectiveness of approach., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This study tested predictors of 2-year antipsychotic-free response from the Soteria study (older, better social functioning, fewer cardinal symptoms) using data from the Finnish Acute Psychosis Integrated treatment study. The quasi-experimental study compared need-adapted family-oriented psychosocial intervention within a 3-week antipsychotic-free trial to psychosocial intervention plus antipsychotic medications. Forty-six percent of experimental completers (37% of intent-to-treat subjects) were successfully treated without antipsychotic medications for the entire 2-year study. The DSM-III-R diagnoses of schizophrenia and schizophreniform disorder and Soteria-suggested predictors were not related to antipsychotic-free response. Different variables within the same domains of good prognosis and fewer schizophrenia symptoms predicted antipsychotic-free response or nonresponse with 74% accuracy. The 6-month duration of symptom criterion distinguishing schizophrenia from schizophreniform disorder does not separate medication-free treatment responders from those requiring medications. Prognosis appears related to antipsychotic-free response and may be helpful in distinguishing schizophrenia from schizophreniform disorder in early episodes.

Videoconferencing is used in psychiatry for various purposes. There is a need for research on videoconferencing in family therapy, as there are hardly any reports on the topic: in a literature search, we found only four references to family therapy and videoconferencing. In the Department of Psychiatry at Oulu University Hospital, the use of videoconferencing has steadily increased over the last few years, and in 2002 the equipment was used for 600 hours, of which 84 hours (14%) involved consultation and 12 hours (2%) family therapy. We postulate that the use of videoconferencing for family therapy will incur various restrictions, but may also open up new opportunities. Videoconferencing may allow people in remote regions to benefit from family therapy services. Using modern equipment, it is possible to attain television broadcast quality in a videoconference, but we do not know the effect of videoconferenced delivery on the outcome of therapy. It will therefore be important to collect systematic data on family therapy delivered via videoconference.

Network therapy flourished in the U.S. during the 1970s, but has since dwindled there and begun to find new applications in Europe, especially in the Nordic countries. State social and healthcare systems, in developing deep vertical expertise, seems to build up a need for complementary horizontal expertise. The latest theories of sociology are used to analyze the need for networking, with the focus on language and dialogue as specific form. Two approaches developed in crisis service for psychotic patients (Open Dialogue) and in consultation for stuck cases in social care (Anticipation Dialogues), are dealt with. What becomes essential seems no longer to be the therapeutic method itself but the ability to see the polyphonic nature of clients' reality. In this respect, language--and dialogue as a specific form of being in language--as the focus of treatment, makes the practical forms of different approaches secondary.

The purpose of this study was to describe video home training as a method of early support in problems of family life control. Answers were sought to the following questions: how does a family counsellor use video home training to support families' own resources and family life control, and what are the uses and benefits of video home training from parents' perspective? The data consisted of the videotaped counselling sessions and family service plans for five families, and were analysed using the general method of analysing photographs and video material developed by anthropologist-photographers. Video home training as a method in supporting family life control consisted of goal-orientated reflection by parents on videotaped episodes of their everyday family life under the guidance of a family counsellor. The process of videotaping family life, in-depth analysis of the videotapes, recognition of instances of successful interaction, and search for new alternatives gave participants a feeling that it would be possible for them to make their everyday life fluent and functional. The findings show that video home training helped the families to gain better control over their family life.

In Open Dialogue the first treatment meeting occurs within 24 hr after contact and includes the social network of the patient. The aim is to generate dialogue to construct words for the experiences embodied in the patient's psychotic symptoms. All issues are analyzed and planned with everyone present. A dialogical sequence analysis was conducted comparing good and poor outcomes of first-episode psychotic patients. In good outcomes, the clients had both interactional and semantic dominance, and the dialogue took place in a symbolic language and in a dialogical form. Already at the first meeting, in the good outcome cases, the team responded to the client's words in a dialogical way, but in the case with the poor outcome, the patient's reflections on his own acts were not heard.

This article describes a new integrated child psychiatric family ward treatment model at the Tampere University Hospital. Theoretically, the treatment is based on an integration of systems and psychoanalytical theories as well as behavioral approach. A centerpiece of the model is a 3-week treatment period for the whole family at the family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are also used as tools, including a reflective working model and sharing concrete interaction with the family. So far, the family ward has offered 165 family treatment periods for 113 different families. Altogether in 63% of the total treatment periods one or both parents have had mental illness and in 15% of the total treatment periods there have been serious custody disputes with accusations of sexual abuse of the child. Helping these multi-problem families is a special challenge for our treatment model and at the moment we are developing new methods for assessment and support of parenthood.

This article describes a psychotherapeutically oriented approach to schizophrenia developed especially to meet the needs of the community psychiatric field. Because of the heterogeneous nature of the schizophrenic psychoses, the authors emphasize that these patients should always be treated based on case-specific premises. The main principles of the need-adapted approach are: 1. The therapeutic activities are planned and carried out flexibly and individually in each case so that they meet the real and changing needs of the patients as well as of their family members. 2. Examination and treatment are dominated by a psychotherapeutic attitude. 3. The different therapeutic activities should support and not impair each other. 4. The process quality of therapy is clearly perceived. A family-centred initiation of the treatment is especially emphasized for both diagnostic and therapeutic reasons. The positive experiences of this led the Finnish national programme for the treatment and rehabilitation of schizophrenic patients to recommend the establishment of family- and environment-oriented acute psychosis teams (APT) in the mental health districts. In later phases of treatment, the significance of individual psychotherapy is increased. The preliminary results of the approach are presented and compared with an earlier sample of patients.