Open Dialogue

The Open Dialogue approach is both a philosophical/theoretical approach to people experiencing a mental health crisis and their families/networks, and a system of care, developed in Western Lapland in Finland over the last 30 years or so. In the 1980s psychiatric services in Western Lapland were in a poor state, in fact they had one of the worst incidences of ‘schizophrenia’ in Europe. Now they have the best documented outcomes in the Western World. For example, around 75% of those experiencing psychosis have returned to work or study within 2 years and only around 20% are still taking antipsychotic medication at 2 year follow-up.

Remarkably, Open Dialogue is not an alternative to standard psychiatric services, it is the psychiatric service in Western Lapland. This has afforded a unique opportunity to develop a comprehensive approach with well-integrated inpatient and outpatient services. Working with families and social networks, as much as possible in their own homes, Open Dialogue teams help those involved in a crisis situation to be together and to engage in dialogue. It has been their experience that if the family/team can bear the extreme emotion in a crisis situation, and tolerate the uncertainty, in time shared meaning usually emerges and healing is possible. Open Dialogue has drawn on a number of theoretical models, including systemic family therapy, dialogical theory and social constructionism.

Videography

• OPEN DIALOGUE: an alternative Finnish approach to healing psychosis
• Ανοιχτός Διάλογος: Μια εναλλακτική Φινλανδική προσέγγιση στη Θεραπεία της Ψύχωσης

Bibliography

Websites

• the international website for the Open Dialogue approach

Articles

Open Dialogue

• Open dialogues in the present and the future – new developments

Jaakko Seikkula August 20, 2016 [1]

• Ο Ανοιχτός Διάλογος στο παρόν και το μέλλον – νέες εξελίξεις

Jaakko Seikkula, 20 Αυγούστου 2016 [2]

• Dialoghi aperti nel presente e nel futuro: nuovi sviluppi

Jaakko Seikkula November 21, 2016 [3]

• Otevřené dialogy v současnosti a do budoucna – aktuální vývoj

Jaakko Seikkula August 20, 2016 [4]

Hallucinations

Hallucinations: A Systematic Review of Points of Similarity and Difference Across Diagnostic Classes

Neuroleptics vs Social Approach

• Whitaker, R., (2004). The case against antipsychotic drugs: a 50-year record of doing more harm than good
• The Treatment of Acute Schizophrenia Without Drugs: An Investigation of Some Current Assumptions WILLIAM T. CARPENTER, JR., M.D., THOMAS H. MCGLASHAN. M.1)., AND JOHN S. STRAUSS, M.D. 14 Am J Psychiatry /34:1, January 1977
• Bola, John R. (2006). Medication-Free Research in Early Episode Schizophrenia: Evidence of Long-Term Harm? Schizophrenia Bulletin vol. 32 no. 2 pp. 288–296, 2006 doi:10.1093/schbul/sbj019
• Harrow, M., Jobe, T. H. Factors Involved in Outcome and Recovery in Schizophrenia Patients Not on Antipsychotic Medications: A 15-Year Multifollow-Up Study
• Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multi-follow-up study M. Harrow*, T.H. Jobe and R. N. Faull
• The limitations of antipsychotic medication on schizophrenia relapse and adjustment and the contributions of psychosocial treatment Gerard E[ Hogarty\ Richard F[ Ulrich
• Two-year outcome in first-episode psychosis treated according to an integrated model. Is immediate neuroleptisation always needed? V. Lehtinen 1* , J. Aaltonen 2 , T. Koffert 1 , V. Räkköläinen 3 , E. Syvälahti
• A Non-Neuroleptic Treatment for Schizophrenia: Analysis of the Two-Year Postdischarge Risk of Relapse
• GUY CHOtJINARD, M.D., M.SC. (PHARMACOL), BARRY D. JONES, M.D., AND LAWRENCE ANNABLE, DIP. STAT. Neuroleptic-Induced Supersensitivity Psychosis
• Wunderink, Lex MD, PhD; Roeline M. Nieboer, MA; DurkWiersma, PhD; SjoerdSytema, PhD; FokkoJ.Nienhuis, MA Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy Long-term Follow-up of a 2-Year Randomized Clinical Trial

Withdrawal

• Clinical Risk Following Abrupt and Gradual Withdrawal of Maintenance Neuroleptic Treatment
• Guided discontinuation versus maintenance treatment in remitted First Episode Psychosis: relapse Rates and Functional Outcome
• Neuroleptic Withdrawal in Schizophrenic Patients

Study in favor of neuroleptics

• Schizophrenia A Follow-up Study of Results of Treatment Philip R. A. May, MD; A. Hussain Tuma, PhD; Coralee Yale, MS; Penelope Potepan; Wilfrid J. Dixon, PhD
• 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study
• Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study