Purpose of the study: Specialized doctor requests a statement regarding the renewal of the psychological study, ak recommended the study of cognition, e.g. to support the evaluation of rehabilitation possibilities for a subject with undifferentiated schizophrenia (tva).
Previous studies:
A psychological examination has been carried out for Tva twice in connection with hospitalizations, in the statements of which Tva's development history was also described. In 2009, a psychological examination (ps Kaura-Väinölä) revealed slowness, mild perseveration and difficulty taking the demands of the situation into account, indicating a psychiatric diagnosis. At that time, the decline in cognition was assessed as mild or at most moderate. Weakness in performance was estimated to predict an expected, more noticeable drop in level. There was a scarcity of emotional nuances and internal fragmentation in the projective output. tva itself was not clear about the shakiness of its reality testing. The world of experience, filled with psychotic threat images, was perfectly kept together by relying on massive denial.
In the 2010 re-examination (ps Nyrhine) regarding cognition, a decrease in working memory was seen, but the cognitive reasoning capacity as a whole at that time reached the average level of its age group. Mental functioning was characterized by a strong experience of being an outsider and partial impulsiveness of behavior. The structure of the personality appeared partly unstructured and there was a clear discontinuity in the experience of identity. In his personality, especially primary-type isolating traits were reflected. The world of experience was also characterized by a strong need for protection. With regard to reality testing, the studies did not reveal any features suggestive of schizophrenia to a considerable extent in terms of perceptual functions, but on the other hand, partially qualitatively weak logic of thinking and autistic features as well as maladaptive features of behavior were found to be suitable psychotic symptoms for incipient schizophrenia.
Interview:
Tva describes current everyday life as smooth, but largely focused on home, "simple pastime". According to her, household chores and taking care of yourself are successful. Visits the store regularly. Has sleep apnea. Sleeps 4-8 hours at night, sometimes lies in bed during the day. Time passes e.g. playing strategy games on the phone and computer, sitting on the balcony and listening to audio books in English (fantasy for young adults, biographies). He says that English is currently her second language along with Finnish. Says that she currently listens to about a book a month, constantly decreasing, while he had previously been aiming for a book a week pace. As a network of friends, bestis, with whom I recently broke up for a few months, online dating and some people who, e.g. tva's social media publications are commented on.
School performance is specified on the basis of certificates. Primary school graduation average 8.4, mother tongue 9, mathematics 8, English 9. High school graduation grades average about 8, mother tongue 7 short mathematics 7, English 8. Yo essays have not been passed many times because of the rejected mother tongue. Reaali A, English M. Says that he spent a year on exchange in England during high school. Completed a basic degree in media at a vocational school, grades 2-3. In the background, two years of Kela psychotherapy. Not interested in social rehabilitation”
from stick horse workshops". Was at Näsinkulma's Klubitalo sometime before. Says that he has been in vocational rehabilitation promoting employment on a work trial in the post-processing of digital printing, says that it has been a few years. Remembers that the work was partly repetitive and required concentration. During the last two years, have done individual work days in the cloak room of festivals. The work days were 8-11 hours long, which found to be tough. In 2016, sold channel packages over the phone at a contract salary for three months. She does not feel that he can get a job in line with his education because of the shift work format. Tva says that he has been asked to do telephone assistance work abroad. Reflects on her own employment opportunities in the future and cognition.
TVa says that his mood is stable, which, in more detail, is described as a certain degree of flattening of emotions rather than a neutral good mood. No anxiety is experienced. I would like to exercise, which seems to be easily possible, because there is an exercise bike at home and a gym in the apartment building. However, it brings up the problem of initiative. According to tva, there are no positive symptoms of psychosis now, he says that his symptoms have always been negative. The ability to concentrate is said to stay up for about an hour continuously in an everyday context. Regarding drug use, he says that he drank a couple of beers in 2024. The last time, before the breakup, there was a little more social use than this with best friend, I estimate about one beer a week. Does not use drugs. Says she has stopped smoking.
Testing and evaluation results Observation of the research situation
The research is carried out in cooperation. During the interview, tva is somewhat reserved, but answers the questions. Calm nature, with difficult test tasks, a slight expression of irritation, e.g. with facial expressions. Task work is overall smooth and tva works visibly without tension. He just feels that he can handle the research visits lasting about an hour. Afterwards, he estimates that the tasks went "probably pretty badly", which he himself explains by the fact that he doesn't really use the Finnish language in his everyday life and during the morning research time.
Research results:
The profile of Tva's reasoning performance becomes fluctuating. In the area of linguistic reasoning abilities, the definition of concepts is at an average level in their age group, the control of higher concepts is at a good average level, but the scope of knowledge related to culture and society is clearly below the average level. Visual reasoning performances run smoother but weaker than expected: visuoconstructive reasoning is clearly below the average level, visual reasoning and the task requiring the ability to visualize the interrelationships of level stimuli run at a very low level. Regarding the speed of information processing, differences emerge between sub-tasks: the task requiring visual search goes both slower than expected and more error-prone, answering a little below the average level, the visuomotor coding task goes a little above the average level. As far as working memory functions are concerned, auditory working memory corresponds to a weak average level, qualitatively it can be seen that working on material based on working memory is difficult for TV; arithmetic reasoning based on working memory is slightly below the average level. The overall index of reasoning performance is clearly below average in its age group. The primary ability is at least average based on previous studies, the strongest partial results obtained now, and school history.
In the learning functions, a partial weakening of the primary is noted. tva's acquisition of broad linguistic heard entities is clearly below average in his age group. He is able to store in his memory mainly the central things while the details are mostly forgotten. The immediate recall of visual entities is also below the expected level, i.e. slightly below the average level of their age group. tva, on the other hand, absorbs loose vocabulary material with repetitions in a way that corresponds to an average level. The intervening material makes it somewhat difficult to remember the original list. What was learned during the delay stays in the mind as expected throughout, so the challenge is the assimilation phase.
In a simpler task that requires operational control, speed and maintenance of attentiveness, tva performs according to expectations, as well as in a more demanding set of tasks that requires operational control planning, flexibility and changing strategy.
Plan
Summary of psychological research
Conclusions and recommendations
In the study, it is found that the level of cognition is widespread and to a moderate-significant degree in the area of visual reasoning abilities, and at least to a slight degree in the areas of working memory and information processing speed. Slowdown and inefficiency of working memory have already been seen in previous studies, but in the latter one in 2010, the cognitive reasoning capacity as a whole still reached the average level, while now it is clearly below the average level. There is also a partial impairment in learning functions. The problem of action guidance does not come up in the research, and linguistic conceptual thinking is responsible for age levels. The challenges regarding the ability to work and study are therefore the decline in cognition brought about by psychotic illness, the difficulty of absorbing large entities, maintaining the ability to concentrate for a longer period of time, and taking initiative. At this stage, I recommend the Pääpointti group of neurocognitive rehabilitation at the Polyclinic for Psychotic Diseases, which is discussed at the feedback visit and in which the patient is willing to participate
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