These studies were carried out at the Department of Psychiatry in Tampere University Hospital and the Centre for Laboratory Medicine, Department of Clinical Chemistry, Tampere University Hospital, Finland.
I owe my profoundest gratitude and respect to my supervisor, Professor Esa Leinonen, who has been the best teacher I have ever had during my years of studying. He has created an inspiring atmosphere to learn. To him I owe my capability to think logically about psychiatric illnesses and my understanding of the biology behind them. He has encouraged and supported me with this work in every way and has also been ready to help and guide me whenever I have needed it. He believed steadfastly in my capabilities to finish this dissertation even when I doubted it myself.
My warmest thanks are due to Docent Sami Anttila as a co-supervisor of this work. He has great enthusiasm for scientific work, which I admire. He shared a part of his huge knowledge with me and motivated and even compelled me to do my best.
Professor Terho Lehtimäki gave me the invaluable opportunity to work with his expert team and also introduced me to the field of genetics, for which I warmly thank him.
Docent Kirsi Suominen and Docent Jesper Ekelund reviewed the manuscript of this dissertation and I thank them for the careful and constructive comments and criticism. This dissertation benefited greatly from their valuable help.
Special thanks go to Docent Olli Kampman as a member of the follow-up team and also as a co-author. He shared his knowledge about genetics and statistics and scientific research as a whole with me. He was always willing to help me in every way I needed. Outi Poutanen MD, PhD was likewise a valuable part of this work as a member of the follow-up team. She is also a warm and kind colleague from whom I have learned a lot during my studies in psychiatry.
I have been privileged to have had an opportunity to work together with such a skillful group of co-authors: Professor Jarmo Hietala, Professor Mikko Hurme, Docent Ari Illi, Docent Kari M Mattila, Nina Mononen PhD and Docent Riikka Rontu. I thank all of them for sharing their professional skills with me and for their valuable contribution to this work.
Special thanks to Heini Huhtala MSc for introducing me to the amazing world of statistics. She was always kind to me and ready to help me when my understanding was limited. Warmest thanks to Mrs Virginia Mattila for being such a wonderful person. I thank her for all the efforts she has made in checking the language of the manuscript of this dissertation.
My warm gratitude goes to Maire Santala for being such a kind and wise teacher and superior. I learned a lot from her about clinical work. She had never-ending patience to answer all my questions and she always had time for me. I also thank Hanna-Mari Alanen for her active and generous support and understanding. She has helped me in so many practical things and also with the manuscript of this dissertation. She moreover had the capability to bring me back to realities from my brief panics. She is a truly excellent superior. Klaus Lehtinen and Maija-Liisa Lehtonen gave me the opportunity to do this scientific work alongside my daily work and I am so thankful for that.
I warmly thank Kristiina Niiranen for all the help she has provided me in this work. I could not have survived without her. She found so many articles for me and shared her knowledge about computer work. Raija Virtanen also helped me find the right articles and I thank her too.
My dear co-workers in the ECT team, Minna Björkqvist and Kati Tuohimaa have created a safe and warm atmosphere to work in. It is so easy to work with them.
They also gently reminded me about my basic tasks so I never forgot anything even when my capability to keep track of everything may have been limited. I also thank Anne Leinonen for creating the ECT team and for her pioneering work with ECT and bringing it to its present level. Without her these studies would have not been possible. I also thank the skillful and fine anesthesiologists Gerhard Baer, Wojciech Chrapek, Osmo Romppanen, Michael Rorarius, Mikko Scharlin, Pentti Suominen and Arvi Yli-Hankala, with whom it has been my good fortune to work.
My esteemed co-workers Ulla Kujanpää, Pia Loisa, Anneli Närhi, Leena Sirkeoja and Tarja Tammentie have been beside me for so many years. I really enjoy working with them. I also gratefully acknowledge their patience and support even when this dissertation took so much time from my clinical work. I also want to express warm thanks to all my colleagues in the Department of Psychogeriatrics:
Pirkko Eskola, Anja Heino, Sanna Ruuhonen and Anna-Mari Sorri for being such wonderful people to work with. I also thank all my colleagues in the Department of Adult Psychiatry.
I owe my deepest gratitude to my beloved parents who brought me up with lots of love and time together. They have always supported me in every area of my life and in all my worries and joys I can always rely on them. My dear sister Kirsi, a part of me indeed, is always there for me whenever I need her. We have shared so much joy and life. Her husband, Kimmo, has offered me debates and conversations that I
93 have enjoyed. I also thank their fine sons, Oskari and Eemeli, the real turtles of my life, just for being there. I am also thankful that my dear brothers Petri and Risto and Petri’s wife, Ronja, are part of my life.
However, my dearest and most special thanks go to members of my immediate family. They all have supported and understood me when I have had too much work to do. I am so full of pride and joy at my wonderful children Elias, Karoliina and Katariina. They are what is really best in my life. They constantly remind me about what really matters and nothing is more valuable to me. I also thank Katri, Tanja and Anna-Lotta with their families for giving me joy and love during our years together. Finally, I want to express my warmest gratitude to my husband, Martti, for sharing both professional and personal life with me. I never could have finished this work without his help. I thank him for giving me what is best in my life.
I also want to thank all the patients for participating in this study and thereby enabling me to research this most distressing illness and its treatment.
This work was financially supported by the Medical Research Fund of Tampere University Hospital and the Department of Psychiatry, Tampere University Hospital.
Tampere, October 2009
Kaija Huuhka