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Gohar SM, Hegelstad WTV, Auestad B, Haahr UH, Joa I, Johannessen JO, Larsen TK, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Friis S, Melle I. Association between early suicidal trajectories in first-episode psychosis and 10-year follow-up: TIPS registry-linked study. Lancet Psychiatry 2023; 10:528-536. [PMID: 37353264 DOI: 10.1016/s2215-0366(23)00156-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Although the risk of suicidality is high in first-episode psychosis, patterns and individual variability in suicidal thoughts and behaviours over time are under-researched. We aimed to identify early trajectories of suicidality over a 2-year follow-up, assess their baseline predictors, and explore associations between those trajectories and later suicidality. METHODS This longitudinal follow-up study was a part of the Early Treatment and Intervention in Psychosis (TIPS)study. Participants, linked to Norwegian and Danish death registries, were recruited from four catchment areas (665 000 inhabitants) in Norway and Denmark (both inpatient and outpatient). We included participants aged 15-65 years, with an intelligence quotient of more than 70, willing to give informed consent, and with a first episode of active psychotic symptoms. Individuals with comorbid neurological or endocrinal disorders, or those with contraindications to antipsychotics, were excluded. Growth mixture modelling was used to identify trajectories of suicidal thoughts and behaviours over the first 2 years. Multinomial logistic regression was applied to examine the baseline predictors of those trajectories and their associations with suicidality at 10-year follow-up. FINDINGS A total of 301 participants were recruited from Jan 1, 1997, to Dec 31, 2000. Of the 299 with completed suicidality data at baseline, 271 participated in 1-year follow-up, 250 in 2-year follow-up, 201 in 5-year follow-up, and 186 at 10-year follow-up. At baseline, 176 (58%) were male, 125 (42%) were female. The mean age was 27·80 years (SD 9·64; range 15-63). 280 (93%) participants were of Scandinavian origin. Four trajectories over 2 years were identified: stable non-suicidal (217 [72%]), stable suicidal ideation (45 [15%]), decreasing suicidal thoughts and behaviours (21 [7%]), and worsening suicidal thoughts and behaviours (18 [6%]). A longer duration of untreated psychosis (odds ratio [OR] 1·24, 95% CI 1·02-1·50, p=0·033), poorer premorbid childhood social adjustment (1·33, 1·01-1·73, p=0·039), more severe depression (1·10, 1·02-1·20, p=0·016), and substance use (2·33, 1·21-4·46, p=0·011) at baseline predicted a stable suicidal ideation trajectory. Individuals in the stable suicidal ideation trajectory tended to have suicidal thoughts and behaviours at 10-year follow-up (3·12, 1·33-7·25, p=0·008). Individuals with a worsening suicidal trajectory were at a higher risk of death by suicide between 2 and 10 years (7·58, 1·53-37·62, p=0·013). INTERPRETATION Distinct suicidal trajectories in first-episode psychosis were associated with specific predictors at baseline and distinct patterns of suicidality over time. Our findings call for early and targeted interventions for at-risk individuals with persistent suicidal ideation or deteriorating patterns of suicidal thoughts and behaviours, or both. FUNDING Health West, Norway; the Norwegian National Research Council; the Norwegian Department of Health and Social Affairs; the National Council for Mental Health and Health and Rehabilitation; the Theodore and Vada Stanley Foundation; the Regional Health Research Foundation for Eastern Region, Denmark; Roskilde County, Helsefonden, Lundbeck Pharma; Eli Lilly; Janssen-Cilag Pharmaceuticals, Denmark; a National Alliance for Research on Schizophrenia and Depression Distinguished Investigator Award and The National Institute of Mental Health grant; a National Alliance for Research on Schizophrenia & Depression Young Investigator Award from The Brain & Behavior Research Foundation; Health South East; Health West; and the Regional Centre for Clinical Research in Psychosis.
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Affiliation(s)
- Sherif M Gohar
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Public Health, Faculty of Health Sciences, Network for Medical Sciences, University of Stavanger, Stavanger, Norway; Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Wenche Ten Velden Hegelstad
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Bjørn Auestad
- Research Department, Stavanger University Hospital, Stavanger, Norway; Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Ulrik Helt Haahr
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Inge Joa
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Public Health, Faculty of Health Sciences, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Public Health, Faculty of Health Sciences, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway; Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svein Friis
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; NORMENT Centre, Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Ottesen A, T. V. Hegelstad W, Joa I, Opjordsmoen SE, Rund BR, Røssberg JI, Simonsen E, Johannessen JO, Larsen TK, Haahr UH, McGlashan TH, Friis S, Melle I. Childhood trauma, antipsychotic medication, and symptom remission in first-episode psychosis. Psychol Med 2023; 53:2399-2408. [PMID: 37144963 PMCID: PMC10123824 DOI: 10.1017/s003329172100427x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND To what extent psychotic symptoms in first-episode psychosis (FEP) with a history of childhood interpersonal trauma (CIT) are less responsive to antipsychotic medication is not known. In this longitudinal study, we compare symptom trajectories and remission over the first 2 years of treatment in FEP with and without CIT and examine if differences are linked to the use of antipsychotics. METHODS FEP (N = 191) were recruited from in- and outpatient services 1997-2000, and assessed at baseline, 3 months, 1 and 2 years. Inclusion criteria were 15-65 years, actively psychotic with a DSM-IV diagnosis of psychotic disorder and no previous adequate treatment for psychosis. Antipsychotic medication is reported as defined daily dosage (DDD). CIT (<18) was assessed with the Brief Betrayal Trauma Survey, and symptomatic remission based on scores from the Positive and Negative Syndrome Scale. RESULTS CIT (n = 63, 33%) was not associated with symptomatic remission at 2 years follow-up (71% in remission, 14% in relapse), or time to first remission (CIT 12/ no-CIT 9 weeks, p = 0.51). Those with CIT had significantly more severe positive, depressive, and excited symptoms. FEP with physical (N = 39, 20%) or emotional abuse (N = 22, 14, 7%) had higher DDD at 1 year (p < 0.05). Mean DDD did not excerpt a significant between-group effect on symptom trajectories of positive symptoms. CONCLUSION Results indicate that antipsychotic medication is equally beneficial in the achievement of symptomatic remission in FEP after 2 years independent of CIT. Still, FEP patients with CIT had more severe positive, depressive, and excited symptoms throughout.
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Affiliation(s)
- Akiah Ottesen
- NORMENT Centre, Division of Mental Health and Addiction Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - W. T. V. Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Stein E. Opjordsmoen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway
- Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Olav Johannessen
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Tor K. Larsen
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ulrik Helt Haahr
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | | | - Svein Friis
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT Centre, Division of Mental Health and Addiction Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Johannessen JO, McGorry PD. Johan Christoffer Cullberg (6th January 1934-14th June 2022) 1. Early Interv Psychiatry 2023; 17:3-4. [PMID: 36468290 DOI: 10.1111/eip.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | - Patrick D McGorry
- University of Melbourne, Melbourne, Victoria, Australia.,Orygen, Melbourne, Victoria, Australia
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Hustoft K, Larsen TK, Brønnick K, Joa I, Johannessen JO, Ruud T. Psychiatric patients' attitudes towards being hospitalized: a national multicentre study in Norway. BMC Psychiatry 2022; 22:726. [PMID: 36414961 PMCID: PMC9682722 DOI: 10.1186/s12888-022-04362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of the study was to explore patients' attitudes towards voluntary and involuntary hospitalization in Norway, and predictors for involuntary patients who wanted admission. METHODS A multi-centre study of consecutively admitted patients to emergency psychiatric wards over a 3 months period in 2005-06. Data included demographics, admission status (voluntary / involuntary), symptom levels, and whether the patients expressed a wish to be admitted regardless of judicial status. To analyse predictors of wanting admission (binary variable), a generalized linear mixed modelling was conducted, using random intercepts for the site, and fixed effects for all variables, with logit link-function. RESULTS The sample comprised of 3.051 patients of witch 1.232 (40.4%) were being involuntary hospitalised. As expected 96.5% of the voluntary admitted patients wanted admission, while as many as 29.7% of the involuntary patients stated that they wanted the same. The involuntary patients wanting admission were less likely to be transported by police, had less aggression, hallucinations and delusions, more depressed mood, less use of drugs, less suicidality before admission, better social functioning and were less often referred by general practitioners compared with involuntary patients who did not want admission. In a multivariate analysis, predictors for involuntary hospitalization and wanting admission were, not being transported by police, less aggression and less use of drugs. CONCLUSIONS Almost a third of the involuntary admitted patients stated that they actually wanted to be hospitalized. It thus seems to be important to thoroughly address patients' preferences, both before and after admission, regarding whether they wish to be hospitalized or not.
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Affiliation(s)
- Kjetil Hustoft
- Center of Clinical Research in Psychosis, Department of Adult Psychiatry, Stavanger University Hospital, 8100, Jan Johnsen gate 12, N-4068, Stavanger, Norway.
| | - Tor Ketil Larsen
- grid.412835.90000 0004 0627 2891Center of Clinical Research in Psychosis, Department of Adult Psychiatry, Stavanger University Hospital, 8100, Jan Johnsen gate 12, N-4068 Stavanger, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kolbjørn Brønnick
- grid.18883.3a0000 0001 2299 9255Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway ,grid.412835.90000 0004 0627 2891Centre of Age-related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- grid.412835.90000 0004 0627 2891Center of Clinical Research in Psychosis, Department of Adult Psychiatry, Stavanger University Hospital, 8100, Jan Johnsen gate 12, N-4068 Stavanger, Norway ,grid.18883.3a0000 0001 2299 9255Network for Medical Sciences, Faculty of Health, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- grid.412835.90000 0004 0627 2891Center of Clinical Research in Psychosis, Department of Adult Psychiatry, Stavanger University Hospital, 8100, Jan Johnsen gate 12, N-4068 Stavanger, Norway ,grid.18883.3a0000 0001 2299 9255Network for Medical Sciences, Faculty of Health, University of Stavanger, 4036 Stavanger, Norway
| | - Torleif Ruud
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Johannessen JO, McGorry P. Johan Christoffer Cullberg. Psychosis 2022. [DOI: 10.1080/17522439.2022.2132416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bjornestad J, Tjora T, Langeveld JH, Stain HJ, Joa I, Johannessen JO, Friedman-Yakoobian M, Ten Velden Hegelstad W. Exploring specific predictors of psychosis onset over a 2-year period: A decision-tree model. Early Interv Psychiatry 2022; 16:363-370. [PMID: 33991405 DOI: 10.1111/eip.13175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
AIM The fluctuating symptoms of clinical high risk for psychosis hamper conversion prediction models. Exploring specific symptoms using machine-learning has proven fruitful in accommodating this challenge. The aim of this study is to explore specific predictors and generate atheoretical hypotheses of onset using a close-monitoring, machine-learning approach. METHODS Study participants, N = 96, mean age 16.55 years, male to female ratio 46:54%, were recruited from the Prevention of Psychosis Study in Rogaland, Norway. Participants were assessed using the Structured Interview for Psychosis Risk Syndromes (SIPS) at 13 separate assessment time points across 2 years, yielding 247 specific scores. A machine-learning decision-tree analysis (i) examined potential SIPS predictors of psychosis conversion and (ii) hierarchically ranked predictors of psychosis conversion. RESULTS Four out of 247 specific SIPS symptom scores were significant: (i) reduced expression of emotion at baseline, (ii) experience of emotions and self at 5 months, (iii) perceptual abnormalities/hallucinations at 3 months and (iv) ideational richness at 6 months. No SIPS symptom scores obtained after 6 months of follow-up predicted psychosis. CONCLUSIONS Study findings suggest that early negative symptoms, particularly those observable by peers and arguably a risk factor for social exclusion, were predictive of psychosis. Self-expression and social behaviour might prove relevant entry points for early intervention in psychosis and psychosis risk. Testing study results in larger samples and at other sites is warranted.
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Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,TIPS - Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Tore Tjora
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Johannes H Langeveld
- TIPS - Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Helen J Stain
- TIPS - Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,School of Arts and Humanities, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Inge Joa
- TIPS - Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS - Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Michelle Friedman-Yakoobian
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA.,Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Wenche Ten Velden Hegelstad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,TIPS - Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
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Bjornestad J, Tjora T, Langeveld JH, Joa I, Johannessen JO, Friedman-Yakoobian M, Hegelstad WTV. Reduced Expression of Emotion: A Red Flag Signalling Conversion to Psychosis in Clinical High Risk for Psychosis (CHR-P) Populations. Psychiatry 2022; 85:282-292. [PMID: 35138998 DOI: 10.1080/00332747.2021.2014383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: In this hypothesis-testing study, which is based on findings from a previous atheoretical machine-learning study, we test the predictive power of baseline "reduced expression of emotion" for psychosis.Method: Study participants (N = 96, mean age 16.55 years) were recruited from the Prevention of Psychosis Study in Rogaland, Norway. The Structured Interview for Prodromal Syndromes (SIPS) was conducted 13 times over two years. Reduced expression of emotion was added to positive symptoms at baseline (P1-P5) as a predictor of psychosis onset over a two-year period using logistic regression.Results: Participants with a score above zero on expression of emotion had over eight times the odds of conversion (OR = 8.69, p < .001). Data indicated a significant dose-response association. A model including reduced expression of emotion at baseline together with the positive symptoms of the SIPS rendered the latter statistically insignificant.Conclusions: The study findings confirm findings from the previous machine-learning study, indicating that observing reduced expression of emotion may serve two purposes: first, it may add predictive value to psychosis conversion, and second, it is readily observable. This may facilitate detection of those most at risk within the clinical high risk of psychosis population, as well as those at clinical high risk. A next step could be including this symptom within current high-risk criteria. Future research should consolidate these findings.
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Aase I, Langeveld JH, Johannessen JO, Joa I, Dalen I, Ten Velden Hegelstad W. Cognitive predictors of longitudinal positive symptom course in clinical high risk for psychosis. Schizophr Res Cogn 2021; 26:100210. [PMID: 34381698 PMCID: PMC8340303 DOI: 10.1016/j.scog.2021.100210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023]
Abstract
Background Clinical High Risk (CHS) for psychosis is a state in which positive symptoms are predominant but do not reach a level of severity that fulfils the criteria for a psychotic episode. The aim of this study has been to investigate whether cognition in subjects with newly detected CHR affects the longitudinal development of positive symptoms. Methods Fifty-three CHR individuals fulfilling the criteria for attenuated positive syndrome in the Structural Interview for Prodromal Syndromes (SIPS) were included. At inclusion, all participants completed a neurocognitive battery consisting of tests measuring attention, verbal memory, verbal fluency, executive functions and general intelligence. Cognitive domain z-scores were defined by contrasting with observed scores of a group of matched healthy controls (n = 40). Associations between cognitive performance at inclusion and longitudinal measures of positive symptoms were assessed by using generalised linear models including non-linear effects of time. All regression models were adjusted for age and gender. Results Overall, SIPS positive symptoms declined over the time period, with a steeper decline during the first six months. Deficits in executive functions were assossiated witn a higher load of positive symptoms at baseline (p=0.006), but also to a faster improvement (p=0.030), wheras those with poor verbal fluency improved more slowly (p=0.018). Conclusion To our knowledge, this is the first study that follows CHR subjects by means of frequent clinical interviews over a sustained period of time. The study provides evidence of an association between executive functions, including verbal fluency, with the evolvement of positive symptoms.
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Affiliation(s)
- Ingvild Aase
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Hendrik Langeveld
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Inge Joa
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Ingvild Dalen
- Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway.,Research Department, Stavanger University Hospital, P. O. 8100, 4068 Stavanger, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
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Hegelstad WTV, Berg AO, Bjornestad J, Gismervik K, Johannessen JO, Melle I, Stain HJ, Joa I. Childhood interpersonal trauma and premorbid social adjustment as predictors of symptom remission in first episode psychosis. Schizophr Res 2021; 232:87-94. [PMID: 34029946 DOI: 10.1016/j.schres.2021.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/11/2021] [Accepted: 05/12/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Childhood interpersonal trauma (CIT) and premorbid adjustment are both associated with poor outcome in psychosis. In this study we investigate the relative impact of CIT and premorbid adjustment on symptom remission in first episode psychosis (FEP) over two years. METHOD A total of 232 participants with FEP were recruited through the early detection program of the The early detection and Intervention in Psychosis (TIPS)-2 study and followed up after two years. Symptom remission was according to consensus criteria. CIT was assessed with the semi-structured interview Freyd Goldberg Brief Betrayal Trauma Survey, and premorbid adjustment with the Premorbid Adjustment Scale. Generalized estimating equations and multivariate models were used to analyze the associations between remission, symptom levels over time, CIT and premorbid adjustment; and a path analysis of mediation effects of CIT through premorbid adjustment on remission. RESULTS In this sample with 57% males and a mean age of 26.6 years (SD 10.2), a third of participants had experienced CIT. The participants with CIT had poorer premorbid adjustment compared to those without. Statistical analyses found independent effects of CIT and an interaction effect of CIT with premorbid adjustment on remission after two years, suggesting that CIT moderates the effect of premorbid adjustment. However contrary to expectations, premorbid adjustment did not mediate the effect of CIT. CONCLUSION Our findings indicate a complex interplay between effects of interpersonal trauma and premorbid social adjustment on remission in psychosis. CIT appeared to moderate the effect of premorbid adjustment such that individuals with CIT and who had poor social functioning in childhood are at greater risk of non-remission. Findings indicate that better premorbid social relations could provide a buffer for the effects of trauma on symptom course.
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Affiliation(s)
- Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
| | - Akiah Ottesen Berg
- NORMENT Centre, Division of Mental Health and Addiction Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jone Bjornestad
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kristina Gismervik
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Network for Medical Sciences, Faculty of Health, University of Stavanger, 4036 Stavanger, Norway
| | - Ingrid Melle
- NORMENT Centre, Division of Mental Health and Addiction Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helen J Stain
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; School of Arts and Humanities, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Inge Joa
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Network for Medical Sciences, Faculty of Health, University of Stavanger, 4036 Stavanger, Norway
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Joa I, Bjornestad J, Johannessen JO, Langeveld J, Stain HJ, Weibell M, Hegelstad WTV. Early Detection of Ultra High Risk for Psychosis in a Norwegian Catchment Area: The Two Year Follow-Up of the Prevention of Psychosis Study. Front Psychiatry 2021; 12:573905. [PMID: 33716805 PMCID: PMC7943837 DOI: 10.3389/fpsyt.2021.573905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/03/2021] [Indexed: 02/02/2023] Open
Abstract
Objectives: Most individuals experience a relatively long period of sub-clinical psychotic like symptoms, known as the ultra high risk (UHR) or at risk mental states (ARMS), prior to a first episode of psychosis. Approximately 95% of individuals who will later develop psychosis are not referred to specialized clinical services and assessed during the UHR phase. The study aimed to investigate whether a systematic early detection program, modeled after the successful early detection of psychosis program TIPS, would improve the detection of help-seeking UHR individuals. The secondary aim was to examine the rates and predictors of conversion to psychosis after 2 years. Method: The overall study design was a prospective (2012-2018), follow- up study of individuals fulfilling UHR inclusion criteria as assessed by the structural interview for prodromal syndromes (SIPS). Help-seeking UHR individuals were recruited through systematic early detection strategies in a Norwegian catchment area and treated in the public mental health services. Results: In the study period 141 UHR help-seeking individuals were identified. This averages an incidence of 7 per 100,000 people per year. The baseline assessment was completed by 99 of these and the 2 year psychosis conversion rate was 20%. A linear mixed-model regression analysis found that the significant predictors of conversion were the course of positive (0.038) and negative symptoms (0.017). Age was also a significant predictor and showed an interaction with female gender (<0.000). Conclusion: We managed to detect a proportion of UHR individuals in the upper range of the expected prediction by the population statistics and further case enrichment would improve this rate. Negative symptoms were significant predictors. As a risk factor for adverse functional outcomes and social marginalization, this could offer opportunities for earlier psychosocial intervention.
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Affiliation(s)
- Inge Joa
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Jone Bjornestad
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jan Olav Johannessen
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Johannes Langeveld
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Helen J Stain
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
| | - Melissa Weibell
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
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11
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Bjønness S, Viksveen P, Johannessen JO, Storm M. User participation and shared decision-making in adolescent mental healthcare: a qualitative study of healthcare professionals' perspectives. Child Adolesc Psychiatry Ment Health 2020; 14:2. [PMID: 31988656 PMCID: PMC6969458 DOI: 10.1186/s13034-020-0310-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/07/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Most mental health problems occur in adolescence. There is increasing recognition of user participation and shared decision-making in adolescents' mental healthcare. However, research in this field of clinical practice is still sparse. The objective of this study was to explore healthcare professionals' perspectives on user participation, and opportunities for shared decision-making in Child and Adolescent Mental Health Service (CAMHS) inpatient units. METHODS Healthcare professionals at CAMHS inpatient units participated in three focus group interviews. Fifteen participants with experience with user participation and shared decision-making were recruited from five hospitals in Norway. RESULTS Five themes emerged: (1) involvement before admission; (2) sufficient time to feel safe; (3) individualized therapy; (4) access to meetings where decisions are made; and (5) changing professionals' attitudes and practices. CONCLUSION User participation and shared decision-making require changes in workplace culture, and routines that allow for individualized mental health services that are adapted to adolescents' needs. This calls for a flexible approach that challenges clinical pathways and short-stay hospital policies. The results of this study may inform further work on strengthening user participation and the implementation of shared decision-making.Trial registration Norwegian Regional Committees for Medical and Health Research Ethics, reference number 2017/1195.
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Affiliation(s)
- Stig Bjønness
- Centre for Resilience in Healthcare (SHARE), Department for Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Petter Viksveen
- Centre for Resilience in Healthcare (SHARE), Department for Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department for Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marianne Storm
- Department for Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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12
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Mehlum L, Walby F, Johannessen JO, Melle I, Andreassen O. Sterke påstander – svakt grunnlag. Tidsskriftet 2020; 140:20-0744. [DOI: 10.4045/tidsskr.20.0744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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13
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Hegelstad WTV, Joa I, Heitmann L, Johannessen JO, Langeveld J. Job- and schoolprescription: A local adaptation to individual placement and support for first episode psychosis. Early Interv Psychiatry 2019; 13:859-866. [PMID: 29888528 DOI: 10.1111/eip.12686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 03/05/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
AIM Individual placement and support (IPS) for first episode psychosis (FEP) has proven effective for employment and education, but yields differing results across geographical regions. Local adaptations may be necessary for various reasons, such as regional differences in employment- and welfare services; in educational opportunities and job markets. The aim of this study was to investigate the efficacy of an adapted Norwegian intervention offering early IPS for education and employment to persons with FEP. METHOD Matched control (N = 66) study with a 1-year early IPS intervention and a 2-year follow up. A rating of fidelity to the IPS model was conducted. RESULTS Fidelity was "good." Adaptations to the model included the use of internships and flexible combinations of education and employment. Thirty out of 33 participants completed the intervention. Fourteen were in competitive employment >20 h/wk post intervention, compared to 2 in the control group. Fifteen participants were enrolled in education >20 h/wk, 10 of whom also had employment >20 h/wk and 3 < 20 h/wk, compared to 5 in the control group, with 2 having employment <20 h/wk on the side. Symptom levels did not predict outcome. CONCLUSION The School- and JobPrescription adaptation of IPS, allowing for temporary internships as a step towards obtaining the goal of paid competitive employment and facilitating flexible combinations of employment and education, showed encouraging results. These were however not sustained after closure of the intervention. At the 2-year follow up, Job- and SchoolPrescription advantages had waned, underscoring the point in IPS that support should be time-unlimited.
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Affiliation(s)
- Wenche Ten Velden Hegelstad
- TIPS, Network for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- TIPS, Network for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Network for medical sciences, University of Stavanger, Stavanger, Norway
| | - Lena Heitmann
- Job- and SchoolPrescription, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS, Network for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Network for medical sciences, University of Stavanger, Stavanger, Norway
| | - Johannes Langeveld
- TIPS, Network for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
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14
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Ferrara M, Guloksuz S, Li F, Burke S, Tek C, Friis S, Ten Velden Hegelstad W, Joa I, Johannessen JO, Melle I, Simonsen E, Srihari VH. Parsing the impact of early detection on duration of untreated psychosis (DUP): Applying quantile regression to data from the Scandinavian TIPS study. Schizophr Res 2019; 210:128-134. [PMID: 31204063 DOI: 10.1016/j.schres.2019.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/14/2019] [Accepted: 05/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prolonged duration of untreated psychosis (DUP) is associated with poor outcomes. The TIPS study halved DUP with an early detection (ED) campaign; however, conventional statistical analyses, focused on mean estimates, failed to reveal the effects of ED across the full DUP distribution, restricting inferences about ED's effectiveness. Utilizing a novel quantile regression based analysis, we examined the differential impact of ED across DUP. Secondary analysis explored possible predictors of DUP, and moderators of the effect of the campaign. METHODS The TIPS ED campaign was conducted in two health care sectors in Norway, with two equivalent health care sectors serving as controls. Quantile regression analysis was performed to analyze ED campaign's effect. RESULTS 281 patients with first episode psychosis were recruited, including 141 from the ED area. ED had no effect on the first quartile (Q1) of DUP, whereas a significant reduction in Q2 (11weeks), and Q3 (41weeks) of DUP was observed. The effect of ED was significantly stronger on reducing Q3 than Q1 or Q2, suggesting that the campaign was more effective in longer DUP samples. Male gender and single status predicted longer DUP in Q3: by 38 and 27weeks, respectively. Single status, but not gender, emerged as a significant moderator of ED campaign effect. CONCLUSIONS Quantile regression provided in depth information about the non-uniformity, and moderators, of TIPS's ED effort across the full distribution of DUP, demonstrating the value of this analytic approach to re-examine prior, and plan analyses for future, early detection efforts.
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Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, viale Muratori 201, 41121 Modena, Italy.
| | - Sinan Guloksuz
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Fangyong Li
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Yale University Center for Science and Social Science Information, PO Box 208111, 06520 New Haven, CT, USA.
| | - Shadie Burke
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
| | - Cenk Tek
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Postbox 1039, Blindern, 0315 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway.
| | - Wenche Ten Velden Hegelstad
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway.
| | - Inge Joa
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway.
| | - Jan Olav Johannessen
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway.
| | - Ingrid Melle
- NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, Building 49, P.O. Box 4956, Nydalen, N-0424, University of Oslo, Oslo, Norway.
| | - Erik Simonsen
- Psychiatric Research Unit, Faelledvej 8, 4200 Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Vinod H Srihari
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
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15
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Bjornestad J, Hegelstad WTV, Berg H, Davidson L, Joa I, Johannessen JO, Melle I, Stain HJ, Pallesen S. Social Media and Social Functioning in Psychosis: A Systematic Review. J Med Internet Res 2019; 21:e13957. [PMID: 31254338 PMCID: PMC6625220 DOI: 10.2196/13957] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Individuals with psychosis are heavy consumers of social media. It is unknown to what degree measures of social functioning include measures of online social activity. OBJECTIVE To examine the inclusion of social media activity in measures of social functioning in psychosis and ultrahigh risk (UHR) for psychosis. METHODS Two independent authors conducted a search using the following electronic databases: Epistemonikos, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Embase, and PsycINFO. The included articles were required to meet all of the following criteria: (1) an empirical study published in the English language in a peer-reviewed journal; (2) the study included a measure of objective or subjective offline (ie, non-Web-mediated contact) and/or online social functioning (ie, Web-mediated contact); (3) the social functioning measure had to be used in samples meeting criteria (ie, Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases) for a psychotic disorder or UHR for psychosis; and (4) the study was published between January 2004 and February 2019. Facebook was launched as the first large-scale social media platform in 2004 and, therefore, it is highly improbable that studies conducted prior to 2004 would have included measures of social media activity. RESULTS The electronic search resulted in 11,844 distinct articles. Full-text evaluation was conducted on 719 articles, of which 597 articles met inclusion criteria. A total of 58 social functioning measures were identified. With some exceptions, reports on reliability and validity were scarce, and only one measure integrated social media social activity. CONCLUSIONS The ecological validity of social functioning measures is challenged by the lack of assessment of social media activity, as it fails to reflect an important aspect of the current social reality of persons with psychosis. Measures should be revised to include social media activity and thus avoid the clinical consequences of inadequate assessment of social functioning. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42017058514; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017058514.
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Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | | | - Henrik Berg
- Norsk Lærer Akademi, University College, Bergen, Norway
| | - Larry Davidson
- School of Medicine, Yale University, New Haven, CT, United States
- Institution for Social and Policy Studies, Yale University, New Haven, CT, United States
| | - Inge Joa
- Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helen J Stain
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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16
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Hansen H, Stige SH, Moltu C, Johannessen JO, Joa I, Dybvig S, Veseth M. "We all have a responsibility": a narrative discourse analysis of an information campaign targeting help-seeking in first episode psychosis. Int J Ment Health Syst 2019; 13:32. [PMID: 31086563 PMCID: PMC6507175 DOI: 10.1186/s13033-019-0289-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are considered important tools within early detection and intervention strategies. In this study, we aimed to explore which discursive meaning content, including roles and actors, such information campaigns build on and construct. Our intention was not to provide objective answers, but to contribute to a discursive debate about potential conflicts in messages conveyed in such campaigns. METHODS A broad sample of information material utilized by TIPS Stavanger University Hospital (Norway) was examined. The material consisted of posters, booklets and brochures, newspaper ads, Facebook ads, and TIPS Info's website, representing various campaigns from 1996 to April 2018. A narrative discursive approach was applied at an epistemological level. At a practical level, a team-based thematic analysis was utilized to identify patterns across data. RESULTS Diversity and several changes in strategy were recognized throughout the information material. Furthermore, three main themes and four subthemes were found to constitute the meaning content built in the information campaigns: knowledge is key; (almost) an illness among illnesses; and we all have a responsibility (comprising of the subthemes; to respond quickly; to step in; to provide an answer; and to tag along). CONCLUSION Our findings pointed to common dilemmas in mental health services: How to combine professional expert knowledge with collaborative practices that emphasize shared decision-making and active roles on behalf of patients? How to combine a focus on symptoms and illness and simultaneously express the importance of addressing patients' recourses? And how can we ask for societal responsibility in help-seeking when professionals are placed in expert positions which may not be optimal for dialogue with potential patients or their network? We discuss whether highlighting practices with more weight on resources and active roles for patients and their surroundings in information campaigns could promote earlier help-seeking.
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Affiliation(s)
- Hege Hansen
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Postbox 7030, 5020 Bergen, Norway
| | | | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jan Olav Johannessen
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Sveinung Dybvig
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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17
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Abstract
BACKGROUND Based on a collective action from a number of Norwegian user organizations for mental health, the Norwegian government demanded the regional health authorities to establish a medication-free treatment option for patients with severe mental illnesses. This change in governmental health policy has several direct implications, including making antipsychotic medication to a greater extent optional for patients with active psychosis. AIMS The sim of this study was to investigate psychiatrists' reflections on the public medication-free program and how they think it will affect patients' adherence to antipsychotics generally. METHOD We used a thematic analytic approach within an interpretative phenomenological framework. Consecutively semi-structured qualitative interviews were conducted with 23 psychiatrists (16 female, with 4-35 years of specialist experience). RESULTS Thematic analysis revealed four main interrelated themes. Psychiatrists considered medication-free treatment as an unscientific option for a stigmatized patient group; they believed that the advent of such a program is due to proposals from some dissatisfied users and their supporters and not from the majority of patients; in spite of active psychotic symptoms and lack of insight, patients had a crucial impact on choice of treatment and accordingly on adherence to medication; and psychiatrists reported that they in spite of governmental instructions utilized professionalism against unscientific ideology. CONCLUSIONS Despite all the internal and external pressure that the psychiatrists reported being exposed to, this did not affect their professional integrity in medical decisions based on guidelines, expertise and research studies. They believed that this treatment option would exacerbate negative attitudes towards medication and further worsen already existing adherence issues.
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Affiliation(s)
- Rafal Ah Yeisen
- 1 Stavanger Hospital Pharmacy, Western Norway Pharmaceutical Trust, Stavanger, Norway.,2 Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway
| | - Jone Bjørnestad
- 3 Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- 2 Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,4 Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- 2 Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,4 Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Stein Opjordsmoen
- 2 Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,5 Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,6 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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18
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Johannessen JO, Vaglum P, Stokkeland JM. Eivind Haga. Tidsskriftet 2019. [DOI: 10.4045/tidsskr.19.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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19
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Anda L, Brønnick KK, Johannessen JO, Joa I, Kroken RA, Johnsen E, Rettenbacher M, Fathian F, Løberg EM. Cognitive Profile in Ultra High Risk for Psychosis and Schizophrenia: A Comparison Using Coordinated Norms. Front Psychiatry 2019; 10:695. [PMID: 31632305 PMCID: PMC6779770 DOI: 10.3389/fpsyt.2019.00695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/28/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Cognitive impairment is not only a core aspect of schizophrenia but also commonly observed in help-seeking youth at ultra high risk for psychosis (UHR), with potential implications for prognosis and individualized treatment. However, there is no consensus on the cognitive profile in the UHR state, partly due to lack of valid comparisons of performance in established schizophrenia and UHR. Objectives: To compare the cognitive functioning and profile of UHR subjects to a sample with schizophrenia, they were split into two groups based on duration of illness. Comparisons were made using coordinated norms based on healthy controls reflecting the younger UHR age spectrum. Methods: Participants for UHR (n = 51) and schizophrenia groups (n = 19 and n = 22) were included from the Prevention of Psychosis and Bergen Psychosis 2 projects. All subjects completed a comprehensive neurocognitive test battery aiming to measure speed of processing, working memory, verbal learning, reasoning, and problem solving, as well as visual problem solving. Cognitive functioning was compared between groups based on coordinated norms using z-scores derived by regression modeling from an age-matched healthy control group (n = 61). Results: UHR subjects showed significantly impaired speed of processing (p < 0.001) working memory (p = 0.042) and verbal learning, reasoning, and problem solving (p = 0.007) as compared to the control group. Visual problem-solving skills appeared unimpaired. UHR subjects significantly outperformed the schizophrenia group with duration of illness >3 years for speed of processing and working memory (both p < 0.001). There were no significant differences in performance between the UHR group and the group with duration of schizophrenia <3 years. Conclusion: Cognitive performance is impaired in UHR subjects as compared to healthy controls and should thus be monitored when a person is deemed at high risk of psychotic illness. Spatial skills, as measured by tests using physical objects, appear less affected than other domains. The pattern of impairment is similar to that of a group with recent onset schizophrenia but is less severe than in a group with duration of illness <3 years.
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Affiliation(s)
- Liss Anda
- TIPS Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kolbjørn K Brønnick
- SESAM Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- TIPS Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Rune A Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Norwegian Centre for Mental Disorders Research, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Norwegian Centre for Mental Disorders Research, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Farivar Fathian
- Outpatient Department, NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Norwegian Centre for Mental Disorders Research, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
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20
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Weibell MA, Johannessen JO, Auestad B, Bramness J, Brønnick K, Haahr U, Joa I, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Vaglum P, Stain H, Friis S, Hegelstad WTV. Early Substance Use Cessation Improves Cognition-10 Years Outcome in First-Episode Psychosis Patients. Front Psychiatry 2019; 10:495. [PMID: 31354551 PMCID: PMC6640174 DOI: 10.3389/fpsyt.2019.00495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.
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Affiliation(s)
- Melissa A Weibell
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorder, Innland Hospital Trust, Hamar, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kolbjørn Brønnick
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Ulrik Haahr
- Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Helen Stain
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
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21
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Gardsjord ES, Romm KL, Røssberg JI, Friis S, Barder HE, Evensen J, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, Melle I. Depression and functioning are important to subjective quality of life after a first episode psychosis. Compr Psychiatry 2018; 86:107-114. [PMID: 30114656 DOI: 10.1016/j.comppsych.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/05/2018] [Accepted: 07/26/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subjective quality of life (S-QoL) is an important outcome measure in first-episode psychosis, but its associations with clinical predictors may vary across the illness course. In this study we examine the association pattern, including both direct and indirect effects, between specific predefined clinical predictors (insight, depression, positive psychotic symptoms and global functioning) and S-QoL the first ten years after a first-episode psychosis. METHODS Three hundred and one patients with a first-episode psychosis were included at first treatment, and reassessed at 3 months, 1 year, 2 years, 5 years and 10 years after inclusion. At 10-year follow-up 186 participated. S-QoL was assessed with Lehman's Quality of Life Interview. Applying a structural equation model, we investigated cross-sectional association patterns at all assessments between the predefined clinical predictors and S-QoL. RESULTS At baseline, only depression was significantly associated with S-QoL. At all follow-up assessments, depression and functioning showed significant associations with S-QoL. Insight was not associated with S-QoL at any of the assessments. Better insight, less depressive symptoms and less positive psychotic symptoms were all associated with higher functioning at all assessments. Functioning seems to mediate a smaller indirect inverse association between positive psychotic symptoms and S-QoL. The association pattern was stable across all follow-up assessments. CONCLUSIONS Together with depression, functioning seems to be important for S-QoL. Functioning seems to be a mediating factor between positive symptoms and S-QoL. A focus on functional outcome continues to be important.
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Affiliation(s)
- Erlend Strand Gardsjord
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
| | - Kristin Lie Romm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | | | - Julie Evensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Adult Psychiatric Department Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark
| | - Wenche Ten Velden Hegelstad
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Inge Joa
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Langeveld
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Tor Ketil Larsen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, Section Psychiatry, University of Bergen, 5021 Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
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22
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Bjornestad J, Veseth M, Davidson L, Joa I, Johannessen JO, Larsen TK, Melle I, Hegelstad WTV. Psychotherapy in Psychosis: Experiences of Fully Recovered Service Users. Front Psychol 2018; 9:1675. [PMID: 30233476 PMCID: PMC6131645 DOI: 10.3389/fpsyg.2018.01675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 08/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Despite the evidence of the importance of including service users' views on psychotherapy after psychosis, there is a paucity of research investigating impact on full recovery. Objectives: To explore what fully recovered service users found to be the working ingredients of psychotherapy in the recovery process after psychosis. Materials and Methods: The study was designed as a phenomenological investigation with thematic analysis as the practical tool for analysis. Twenty fully recovered service users were interviewed. Results: Themes: (1) Help with the basics, (2) Having a companion when moving through chaotic turf, (3) Creating a common language, (4) Putting psychosis in brackets and cultivate all that is healthy, and (5) Building a bridge from the psychotic state to the outside world. Conclusion: Therapeutic approaches sensitive to stage specific functional challenges seemed crucial for counteracting social isolation and achieving full recovery. Findings indicate that psychotherapy focusing on early readjustment to everyday activities, to what are perceived as meaningful and recovery-oriented, seems to be what is preferred and called for by service users.
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Affiliation(s)
- Jone Bjornestad
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Larry Davidson
- School of Medicine and Institution for Social and Policy Studies, Yale University, New Haven, CT, United States
| | - Inge Joa
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, University of Oslo, Oslo, Norway
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23
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Haahr UH, Larsen TK, Simonsen E, Rund BR, Joa I, Rossberg JI, Johannessen JO, Langeveld J, Evensen J, Trauelsen AMH, Vaglum P, Opjordsmoen S, Hegelstad WTV, Friis S, McGlashan T, Melle I. Relation between premorbid adjustment, duration of untreated psychosis and close interpersonal trauma in first-episode psychosis. Early Interv Psychiatry 2018; 12:316-323. [PMID: 26800653 DOI: 10.1111/eip.12315] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/15/2015] [Indexed: 01/22/2023]
Abstract
AIM Interpersonal traumas are highly prevalent in patients with psychotic disorders. Trauma caused by those close to the patient might have a more profound impact than other types of trauma and may influence early life social functioning. The aim is to investigate the associations between different types of trauma, in particular close interpersonal traumas experienced before the age of 18, premorbid factors and baseline clinical characteristics in a sample of first-episode psychosis patients. METHODS A total of 191 patients from the 'TIPS' cohort completed assessment with the Brief Betrayal Trauma Survey at their 5 years follow-up interview. RESULTS Half of the patients reported that they had experienced interpersonal trauma and one-third reported having experienced close interpersonal trauma before the age of 18. Women reported more sexual abuse, physical attacks and emotional and physical maltreatment than men. There were significant associations between early interpersonal trauma and premorbid adjustment and duration of untreated psychosis, but no significant associations with length of education, comorbid substance use or baseline clinical symptomatology. CONCLUSIONS Close interpersonal trauma before the age of 18 is associated with poorer premorbid adjustment and a longer duration of untreated psychosis. This may indicate that traumatic experiences delay help-seeking behaviour.
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Affiliation(s)
- Ulrik Helt Haahr
- Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Roskilde, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, Section Psychiatry, University of Bergen, Bergen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Roskilde, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Vestre Viken Hospital Trust, Drammen, Norway
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Ivar Rossberg
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Johannes Langeveld
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Marie Hyldgaard Trauelsen
- Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Roskilde, Denmark.,Psychiatry South, Region Zealand, Vordingborg, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Stein Opjordsmoen
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Wenche Ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Thomas McGlashan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ingrid Melle
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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24
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Gardsjord ES, Romm KL, Røssberg JI, Friis S, Barder HE, Evensen J, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, Melle I. Is going into stable symptomatic remission associated with a more positive development of life satisfaction? A 10-year follow-up study of first episode psychosis. Schizophr Res 2018; 193:364-369. [PMID: 28701275 DOI: 10.1016/j.schres.2017.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/16/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Quality of life is an important outcome measure for patients with psychosis. We investigated whether going into stable symptomatic remission is associated with a more positive development of subjective quality of life (S-QoL) and if different patient characteristics are associated with S-QoL depending on remission status. METHODS Three hundred and one patients with a first-episode psychosis were included at baseline. At 10-year follow-up 186 were reassessed. QoL was assessed by Lehman's Quality of Life Interview. Remission was defined according to criteria proposed by the Remission in Schizophrenia Working Group. One-way ANOVA, mixed model analysis, bivariate correlations and multiple regression analyses were performed. RESULTS Patients going into stable symptomatic remission showed a more positive S-QoL-development over the follow-up period and reported higher life satisfaction at 10-year follow-up compared to non-remission. At 10-year follow-up, depressive symptoms and alcohol abuse or dependence explained a significant amount of variance in S-QoL among patients in remission. Among patients in non-remission, PANSS excitative component explained a significant amount of variance in S-QoL. All significant effects were negative. CONCLUSIONS Stable symptomatic remission is associated with a more positive development of overall life satisfaction. Furthermore, different symptoms influence life satisfaction depending on status of remission. This has important clinical implications. While patients in remission might need treatment for depressive symptoms to increase S-QoL, in non-remission measures aiming to decrease hostility and uncooperativeness should be part of the treatment approach. Alcohol problems should be treated regardless of remission status.
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Affiliation(s)
- Erlend Strand Gardsjord
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, NORMENT: Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
| | - Kristin Lie Romm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | | | - Julie Evensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Adult Psychiatric Department Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark
| | - Wenche Ten Velden Hegelstad
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Inge Joa
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Langeveld
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Tor Ketil Larsen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, Section Psychiatry, University of Bergen, 5021 Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, 0318 Oslo, Norway
| | - Thomas McGlashan
- Department of Social and Behavioural Health, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ingrid Melle
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, NORMENT: Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
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25
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Abstract
Few countries (if any) have experienced the abundance of material welfare Norway has had for the last decades. The report of the Organisation for Economic Co-operation and Development (OECD) for 2004 places Norway on the very top of the list of ‘best countries to live in’. One might therefore expect that mental disorders would not thrive in Norway, but this is not so.
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26
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Friis S, Vaglum P, Haahr U, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, McGlashan TH. Effect of an early detection programme on duration of untreated psychosis. Br J Psychiatry 2018; 48:s29-32. [PMID: 16055804 DOI: 10.1192/bjp.187.48.s29] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundIt is unclear whether an early detection programme increases or decreases the number of patients with a long duration of untreated psychosis (DUP), and whether these differ from other patients with a long DUP.AimsTo investigate whether the number and characteristics of patients with a long DUP in the early detection programme differ from those with along DUP in the non-earlydetection programme.MethodWe compared the number and characteristics of patients with a DUP $2 years in an early detection area and a non-early detection area.ResultsThe early detection programme recruited slightly fewer patients with a long DUP than the non-early detection programme. The patients in the early detection programme had lower PANSS scores, but more frequently had a deteriorating course of premorbid social functioning.ConclusionsAn early detection programme does not seem to drain a pool of previously undetected patients with a long DUP. The patients in the early detection programme seem to have a lower symptom level at baseline and to have had a deteriorating premorbid social course.
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Affiliation(s)
- Svein Friis
- Department of Research and Education, Division of Psychiatry, Ullevål University Hospital, Oslo N-0407, Norway.
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27
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Langeveld J, Bjørkly S, Evensen J, Joa I, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Røssberg JI, Rund BR, Simonsen E, Vaglum P, Velden WT, McGlashan T, Friis S. A 10-year follow-up study of violent victimization in first episode psychosis: Risk and protective factors. Psychiatry Res 2018; 259:545-549. [PMID: 29172178 DOI: 10.1016/j.psychres.2017.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/26/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022]
Abstract
Violent victimization in persons with severe mental illness has long-term adverse consequences. Little is known about the long-term prevalence of victimization in first episode psychosis, or about factors affecting victimization throughout the course of illness. To assess the prevalence of violent victimization during a 10-year follow-up period in a group of first episode psychosis (FEP) patients, and to identify early predictors and risk factors for victimization. A prospective design was used with comprehensive assessments of violent victimization, treatment variables and functioning at baseline and during 10-year follow-up. A clinical epidemiological sample of FEP patients (n = 298) was studied. FEP patients in our study were at a 3.5 times greater risk of victimization as compared to the normal population. During the 10-year follow-up period, 23% of subjects fell victim to one or more violent assaults. Victimized patients were younger and reported less occupational activity. At 10-year follow-up, victimization was associated with more concomitant drug use, alcohol misuse and violent behavior, but not with a worse clinical or functional outcome. Treatment programs should focus on risk factors for victimization and develop behavioral alternatives to mitigate risk in FEP patients.
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Affiliation(s)
- Johannes Langeveld
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway; Department of Research and Development, Rogaland A-senter, 4028 Stavanger, Norway.
| | - Stål Bjørkly
- Molde University College, PO.Box 2110, 6402 Molde, Norway; Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Inge Joa
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway; Network for Medical Sciences, Faculty of Social Sciences, University of 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway; Network for Medical Sciences, Faculty of Social Sciences, University of 4036 Stavanger, Norway
| | - Tor Ketil Larsen
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Stein Opjordsmoen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Faelledvej 6, 4200 Slagelse, Denmark; University of Copenhagen, P.O. box 2177, Copenhagen, Denmark
| | - Per Vaglum
- Department of Behavioral Sciences in Medicine, University of Oslo, P.O. 1130 Blindern, 0318 Oslo, Norway
| | - Wenche Ten Velden
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway
| | - Tom McGlashan
- Department of Psychiatry, Yale University School of Medicine, Yale Psychiatric Research at Congress Place, 301 Cedar St., New Haven, CT 06519, USA
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
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Hustoft K, Larsen TK, Brønnick K, Joa I, Johannessen JO, Ruud T. Voluntary or involuntary acute psychiatric hospitalization in Norway: A 24h follow up study. Int J Law Psychiatry 2018; 56:27-34. [PMID: 29701596 DOI: 10.1016/j.ijlp.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 06/08/2023]
Abstract
UNLABELLED The Norwegian Mental Health Care Act states that patients who are involuntarily admitted to a hospital must be reevaluated by a psychiatrist or a specialist in clinical psychology within 24h to assess whether the patient fulfills the legal criteria for the psychiatric status and symptoms. International research on the use of coercive hospitalization in psychiatry is scarce, and an investigation of Norway's routine re-evaluation of involuntarily referred patients may expand knowledge about this aspect of psychiatric treatment. The aim of this study was to investigate the extent to which Involuntarily Hospitalized (IH) patients were converted to a Voluntary Hospitalization (VH), and to identify predictive factors leading to conversion. The Multi-center Acute Psychiatry study (MAP) included all cases of acute consecutive psychiatric admissions across twenty Norwegian acute psychiatric units in health trusts in Norway across 3months in 2005-06, representing about 75% of the psychiatric acute emergency units in Norway. The incident of conversion from involuntarily hospitalization (IH) to voluntary hospitalization (VH) was analyzed using generalized linear mixed modeling. Out of 3338 patients referred for admission, 1468 were IH (44%) and 1870 were VH. After re-evaluation, 1148 (78.2%) remained on involuntary hospitalization, while 320 patients (21.8%) were converted to voluntary hospitalization. The predictors of conversion from involuntary to voluntary hospitalization after re-evaluation of a specialist included patients wanting admission, better scores on Global Assessment of Symptom scale, fewer hallucinations and delusions and higher alcohol intake. CONCLUSION The 24h re-evaluation period for patients referred for involuntary hospitalization, as stipulated by the Norwegian Mental Health Care Act, appeared to give adequate opportunity to reduce unnecessary involuntary hospitalization, while safeguarding the patient's right to VH.
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Affiliation(s)
- Kjetil Hustoft
- Division of Psychiatry, Center of Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.
| | - Tor Ketil Larsen
- Division of Psychiatry, Center of Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Kolbjørn Brønnick
- Division of Psychiatry, Center of Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Inge Joa
- Division of Psychiatry, Center of Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway.
| | - Jan Olav Johannessen
- Division of Psychiatry, Center of Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway.
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Joa I, Hustoft K, Anda LG, Brønnick K, Nielssen O, Johannessen JO, Langeveld JH. Public attitudes towards involuntary admission and treatment by mental health services in Norway. Int J Law Psychiatry 2017; 55:1-7. [PMID: 29157507 DOI: 10.1016/j.ijlp.2017.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/16/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The role of compulsory treatment of serious mental disorders has been the topic of ongoing public debate involving among others mental health professionals, service providers, service user advocates, relatives of service users, media commentators and politicians. However, relatively little is known about general public attitudes towards involuntary admission and compulsory treatment of people with various mental disorders. This article examines the attitudes in a representative sample of Norway's population towards the use of involuntary admission and treatment, and under which circumstances does the general public consider compulsory treatment to be justified in the Norwegian mental health care services. METHOD Data were collected from a representative sample of the population in Norway aged 18 and older. The sample was stratified for gender, geographical region and age distribution (n=2001). The survey was performed in the months of May 2009 (n=1000) and May 2011 (n=1001), using Computer Assisted Telephone Interviews (CATI) by an independent polling company. All respondents were provided a general definition of coercive intervention before the interview was conducted. ANALYSIS Univariate descriptions and bivariate analyses were performed by means of cross-tabulation, analysis of variance (one-way ANOVA) and comparing of group of means. Cohen's d was used as the measure for effect size. RESULTS Between 87% and 97% of those surveyed expressed strong or partial agreement with the use of involuntary admissions or compulsory treatment related to specified cases and situations. The majority of interviewees (56%) expressed the opinion that overall, current levels are acceptable. A further, 34% were of the opinion that current levels are too low, while only 9.9% of respondents supported a reduction in the level of involuntary treatment. Lower levels of education were associated with a more positive attitude towards involuntary admission and treatment. There was stronger support for admission to prevent suicide than the possibility of violence by the mentally ill. CONCLUSION The Norwegian adult population largely supports current legislation and practices regarding involuntary admission and compulsory treatment in the mental health services.
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Affiliation(s)
- Inge Joa
- Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Norway; Network for Medical Sciences, Faculty of Social Sciences, University of Stavanger, Norway.
| | - Kjetil Hustoft
- Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Norway
| | - Liss Gøril Anda
- Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Norway
| | - Kolbjørn Brønnick
- Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Norway; Network for Medical Sciences, Faculty of Social Sciences, University of Stavanger, Norway
| | - Olav Nielssen
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jan Olav Johannessen
- Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Norway; Network for Medical Sciences, Faculty of Social Sciences, University of Stavanger, Norway
| | - Johannes H Langeveld
- Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Norway
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Yeisen RAH, Bjornestad J, Joa I, Johannessen JO, Opjordsmoen S. Experiences of antipsychotic use in patients with early psychosis: a two-year follow-up study. BMC Psychiatry 2017; 17:299. [PMID: 28830453 PMCID: PMC5567881 DOI: 10.1186/s12888-017-1425-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/06/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-adherence is a major public health problem despite treatment advances. Poor drug adherence in patients with psychosis is associated with more frequent relapse, re-hospitalization, increased consumption of health services and poor outcomes on a variety of measures. Adherence rate in patients with first episode psychosis have been found to vary from 40 to 60%. However, most previous studies have addressed the consequences of non-adherence rather than its potential causes. The purpose of this study was, therefore, to investigate experiential factors which may affect adherence to medication in adults with psychotic disorders, during the 24-month period after the onset of treatment. METHODS Twenty first episode patients (7 male, 13 female) were included in our qualitative sub-study from the ongoing TIPS2 (Early Intervention in Psychosis study). Each person participated in semi-structured interviews at 2-year follow-up. All had used antipsychotics, with some still using them. Data were analyzed within an interpretative-phenomenological framework using an established meaning condensation procedure. RESULTS The textual analysis revealed four main themes that affected adherence largely: 1) Positive experiences of admission, 2) Sufficient timely information, 3) Shared decision-making and 4) Changed attitudes to antipsychotics due to their beneficial effects and improved insight into illness. CONCLUSION Patients reported several factors to have a prominent impact on adherence to their antipsychotics. The patients do not independently choose to jeopardize their medication regime. Health care staff play an important role in maintaining good adherence by being empathetic and supportive in the admission phase, giving tailored information according to patients' condition and involving patients when making treatment decisions.
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Affiliation(s)
- Rafal A. H. Yeisen
- Centre for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Stavanger Hospital pharmacy, Western Norway Pharmaceutical Trust, Stavanger, Norway
| | - Jone Bjornestad
- Centre for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- Centre for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Network for medical sciences, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Centre for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Network for medical sciences, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Stein Opjordsmoen
- Centre for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Weibell MA, Hegelstad WTV, Auestad B, Bramness J, Evensen J, Haahr U, Joa I, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, McGorry P, Friis S. The Effect of Substance Use on 10-Year Outcome in First-Episode Psychosis. Schizophr Bull 2017; 43:843-851. [PMID: 28199703 PMCID: PMC5472130 DOI: 10.1093/schbul/sbw179] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Substance use is common in first-episode psychosis (FEP) and has been linked to poorer outcomes with more severe psychopathology and higher relapse rates. Early substance discontinuation appears to improve symptoms and function. However, studies vary widely in their methodology, and few have examined patients longitudinally, making it difficult to draw conclusions for practice and treatment. We aimed to investigate the relationship between substance use and early abstinence and the long-term course of illness in a representative sample of FEP patients. Out of 301 included patients, 266 could be divided into 4 groups based on substance use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users and nonusers. Differences in clinical and functional measures during the follow-up period were assessed using linear mixed effects models for the analysis of repeated measures data. Patients who stopped using substances within the first 2 years after diagnosis had outcomes similar to those who had never used with fewer symptoms than episodic or persistent users. Both episodic and persistent users had lower rates of symptom remission than nonusers, and persistent users also had more negative symptoms than those who stopped using. Our findings emerge from one of very few long-term longitudinal studies examining substance use cessation in FEP with 10-year follow-up. The results convey hope that the detrimental effects of substance abuse on mental health may be significantly reversed if one stops the abuse in time. This can help patients who struggle with addiction with their motivation to embrace abstinence.
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Affiliation(s)
- Melissa A. Weibell
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway;,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- SERAF, Norwegian Centre for Addiction Research, Oslo, Norway;,Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Zealand Region, Psychiatry East and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway;,Vestre Viken Hospital Trust, Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Zealand Region, Psychiatry East and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark;,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Per Vaglum
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia;,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Svein Friis
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Bjornestad J, Davidson L, Joa I, Larsen TK, Hegelstad WTV, Langeveld J, Veseth M, Melle I, Johannessen JO, Bronnick K. Antipsychotic treatment: experiences of fully recovered service users. J Ment Health 2017; 26:264-270. [PMID: 28602144 DOI: 10.1080/09638237.2017.1294735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND There is lack of long-term controlled studies evaluating treatment effects of antipsychotic medication. A complete investigation should include the service user perspective. AIMS To investigate experiences of clinically recovered service users of antipsychotic medications during and after a first episode of psychosis. METHOD We used a thematic analytic approach within an interpretative-phenomenological framework. 20 clinically recovered service users were interviewed. RESULTS Themes: (1) Antipsychotic drugs reduce mental chaos during the acute phase, (2) Non-stigmatizing environments were perceived to increase chances of successful use, (3) Antipsychotic drugs beyond the acute phase - considered to compromise the contribution of individual effort in recovery, (4) Prolonged use - perceived to reduce likelihood of functional recovery, (5) Antipsychotic medication was considered as a supplement to trustful relationships. CONCLUSIONS Acute phase antipsychotic treatment was mostly perceived as advantageous by this sample, who was in clinical recovery. However, costs were often seen as outweighing benefits beyond the acute stage. Findings clearly emphasize the need for a collaborative approach to be integrated across all phases of care. This study underscores the need to investigate sub-group differences with regard to long-term antipsychotic treatment.
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Affiliation(s)
- Jone Bjornestad
- a TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital , Stavanger , Norway
| | - Larry Davidson
- b Yale University, School of Medicine and Institution for Social and Policy Studies , New Haven , CT , USA
| | - Inge Joa
- a TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital , Stavanger , Norway.,c Network for Medical Sciences, University of Stavanger , Stavanger , Norway
| | - Tor Ketil Larsen
- a TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital , Stavanger , Norway.,d Department of Clinical Medicine , Section of Psychiatry, University of Bergen , Bergen, Norway
| | | | - Johannes Langeveld
- a TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital , Stavanger , Norway
| | - Marius Veseth
- e Faculty of Health and Social Sciences , Bergen University College , Bergen , Norway , and
| | - Ingrid Melle
- f Norwegian Centre for Mental Disorders Research, University of Oslo , Oslo , Norway
| | - Jan Olav Johannessen
- a TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital , Stavanger , Norway.,c Network for Medical Sciences, University of Stavanger , Stavanger , Norway
| | - Kolbjorn Bronnick
- a TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital , Stavanger , Norway.,c Network for Medical Sciences, University of Stavanger , Stavanger , Norway
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Thorsen O, Hartveit M, Johannessen JO, Fosse L, Eide GE, Schulz J, Bærheim A. Erratum to: Typologies in GPs' referral practice. BMC Fam Pract 2017; 18:11. [PMID: 28143436 PMCID: PMC5286772 DOI: 10.1186/s12875-016-0572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Olav Thorsen
- Department of Global Public Health and Primary Care, University of Bergen, Box 7800, Bergen, N-5020, Norway. .,Department of Research, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway.
| | - Miriam Hartveit
- Department of Global Public Health and Primary Care, University of Bergen, Box 7800, Bergen, N-5020, Norway.,Section for Research and Innovation, Helse Fonna HF, Box 2170, Haugesund, N-5504, Norway
| | - Jan Olav Johannessen
- Centre for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway.,Faculty of Social Sciences, University of Stavanger, Box 8100, Stavanger, N-4068, Norway
| | - Lars Fosse
- Department of Orthopaedics, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Box 7800, Bergen, N-5020, Norway.,Centre for Clinical Research, Haukeland University Hospital, Box 1400, Bergen, N-5021, Norway
| | - Jörn Schulz
- Department of Research, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway.,Section of Biostatistics, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, University of Bergen, Box 7800, Bergen, N-5020, Norway
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Johannessen JO. Kjedelig og lite nyttig. Tidsskriftet 2017; 137:17-0474. [DOI: 10.4045/tidsskr.17.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Hegelstad WTV, Bronnick KS, Barder HE, Evensen JH, Haahr U, Joa I, Johannessen JO, Langeveld J, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Rossberg JI, Simonsen E, Vaglum PW, McGlashan TH, Friis S. Preventing Poor Vocational Functioning in Psychosis Through Early Intervention. Psychiatr Serv 2017; 68:100-103. [PMID: 27582238 DOI: 10.1176/appi.ps.201500451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study tested the hypothesis that early detection of psychosis improves long-term vocational functioning through the prevention of negative symptom development. METHODS Generalized estimating equations and mediation analysis were conducted to examine the association between employment and negative symptoms over ten years among patients in geographic areas characterized by usual detection (N=140) or early detection (N=141) of psychosis. RESULTS Improved vocational outcome after ten years among patients in the early-detection area was mediated by lower levels of negative symptoms during the first five years. Regardless of symptoms, rates of full-time employment or study were lower among patients in the usual-detection versus the early-detection area. CONCLUSIONS Patients from an early-detection area attained lower negative symptom levels earlier compared with patients from a usual-detection area, which seemed to have facilitated vocational careers.
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Affiliation(s)
- Wenche Ten Velden Hegelstad
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Kolbjorn S Bronnick
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Helene Eidsmo Barder
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Julie Horgen Evensen
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Ulrik Haahr
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Inge Joa
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Jan Olav Johannessen
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Johannes Langeveld
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Tor Ketil Larsen
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Ingrid Melle
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Stein Opjordsmoen
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Bjørn Rishovd Rund
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Jan Ivar Rossberg
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Erik Simonsen
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Per Wiggen Vaglum
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Thomas H McGlashan
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
| | - Svein Friis
- Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut
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Yeisen RAH, Joa I, Johannessen JO, Opjordsmoen S. Use of medication algorithms in first episode psychosis: a naturalistic observational study. Early Interv Psychiatry 2016; 10:503-510. [PMID: 25588989 DOI: 10.1111/eip.12203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
AIMS Medical algorithms are evidence-based guidelines which help physicians to make their decisions regarding treatment. Non-adherence to medical algorithms is a matter of concern. The aims of this study were to investigate physicians' adherence to an algorithm for antipsychotics, patients' adherence to the physicians' recommendations and whether these factors influence one year outcome. METHOD An extensive file audit survey was conducted among 55 consecutively first admitted inpatients and outpatients from three units of a university hospital; looking at the prescription of antipsychotics to patients (15-65 years) experiencing first episode psychosis (F19.5, F20.0-F29.0 according to ICD-10). Inclusion period was 2 years. Data on clinical condition and use of drugs were collected from the electronic patient administrative record system and from each patient's medical record for 12 months. RESULTS Only 62% of the physicians adhered to the medical algorithm, although all first choices of drugs were made according to international standards. Fifty-six percent of patients used their medicine more than 75% of the time, 22% had between 26% and 74% adherence and 22% adhered less than 25%. Patient adherence was significantly associated with good outcome. Older patients and inpatients had more favourable outcomes than younger patients and outpatients. Physicians at inpatient wards initiated pharmacological treatment significantly earlier than physicians in outpatient departments. The most common first antipsychotic drug to prescribe was olanzapine followed by risperidone. CONCLUSION Initial medical intervention followed international standards, but the physicians failed to adhere to algorithms in their follow-up of medication regimes. Adherence was associated with outcome.
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Affiliation(s)
- Rafal A H Yeisen
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.
| | - Inge Joa
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Stein Opjordsmoen
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Bjornestad J, Bronnick K, Davidson L, Hegelstad WTV, Joa I, Kandal O, Larsen TK, Langeveld J, Veseth M, Melle I, Johannessen JO. The central role of self-agency in clinical recovery from first episode psychosis. Psychosis 2016. [DOI: 10.1080/17522439.2016.1198828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jone Bjornestad
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Kolbjorn Bronnick
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Larry Davidson
- School of Medicine and Institution for Social and Policy Studies, Yale University, CT New Haven, USA
| | | | - Inge Joa
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Oyvind Kandal
- Department of Forensic Psychiatry, Bergen University Hospital, Bergen, Norway
| | - Tor Ketil Larsen
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway
| | - Johannes Langeveld
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Marius Veseth
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Jan Olav Johannessen
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
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Thorsen O, Hartveit M, Johannessen JO, Fosse L, Eide GE, Schulz J, Bærheim A. Typologies in GPs' referral practice. BMC Fam Pract 2016; 17:76. [PMID: 27430983 PMCID: PMC4949760 DOI: 10.1186/s12875-016-0495-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/13/2016] [Indexed: 12/04/2022]
Abstract
Background GPs’ individual decisions to refer and the various ways of working when they refer are important determinants of secondary care use. The objective of this study was to explore and describe potential characteristics of GPs’ referral practice by investigating their opinions about referring and their self-reported experiences of what they do when they refer. Methods Observational cross-sectional study using data from 128 Norwegian GPs who filled in a questionnaire with statements on how they regarded the referral process, and who were invited to collect data when they actually referred to hospital during one month. Only elective referrals were recorded. The 57 participants (44,5 %) recorded data from 691 referrals. The variables were included in a principal component analysis. A multiple linear regression analysis was conducted to identify typologies with GP’s age, gender, specialty in family medicine and location as independent variables. Results Eight principal components describe the different ways GPs think and work when they refer. Two typologies summarize these components: confidence characterizing specialists in family medicine, mainly female, who reported a more patient-centred practice making priority decisions when they refer, who confer easily with hospital consultants and who complete the referrals during the consultation; uncertainty characterizing young, mainly male non-specialists in family medicine, experiencing patients’ pressure to be referred, heavy workload, having reluctance to cooperate with the patient and reporting sparse contact with hospital colleagues. Conclusions Training specialists in family medicine in patient-centred method, easy conference with hospital consultant and cooperation with patients while making the referral may foster both self-reflections on own competences and increased levels of confidence. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0495-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olav Thorsen
- Department of Global Public Health and Primary Care, University of Bergen, Box 7800, Bergen, N-5020, Norway. .,Department of Research, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway.
| | - Miriam Hartveit
- Department of Global Public Health and Primary Care, University of Bergen, Box 7800, Bergen, N-5020, Norway.,Section for Research and Innovation, Helse Fonna HF, Box 2170, Haugesund, N-5504, Norway
| | - Jan Olav Johannessen
- Centre for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway.,Faculty of Social Sciences, University of Stavanger, Box 8100, Stavanger, N-4068, Norway
| | - Lars Fosse
- Department of Orthopaedics, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Box 7800, Bergen, N-5020, Norway.,Centre for Clinical Research, Haukeland University Hospital, Box 1400, Bergen, N-5021, Norway
| | - Jörn Schulz
- Department of Research, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway.,Section of Biostatistics, Stavanger University Hospital, Box 8100, Stavanger, N-4068, Norway
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, University of Bergen, Box 7800, Bergen, N-5020, Norway
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39
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Sönmez N, Røssberg JI, Evensen J, Barder HE, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld H, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, Friis S. Depressive symptoms in first-episode psychosis: a 10-year follow-up study. Early Interv Psychiatry 2016; 10:227-33. [PMID: 24956976 DOI: 10.1111/eip.12163] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022]
Abstract
AIMS The present study examined if any patient characteristics at baseline predicted depressive symptoms at 10 years and whether patients prone to depressive symptoms in the first year of treatment had a different prognosis in the following years. METHOD A total of 299 first-episode psychosis (FEP) patients with schizophrenia spectrum disorders were assessed for depressive symptoms with PANSS depression item (g6) at baseline, and 1, 2, 5 and 10 years of follow up. At 10 years, depressive symptoms were also assessed with Calgary Depression Scale for Schizophrenia (CDSS). A PANSS g6 ≥ 4 and CDSS score ≥ 6 were used as a cut-off score for depression. RESULTS A total of 122 (41%) patients were scored as depressed at baseline, 75 (28%) at 1 year, 50 (20%) at 2 years, 33 (16%) at 5 years, and 35 (19%) at 10 years of follow up. Poor childhood social functioning and alcohol use at baseline predicted depression at 10 years of follow up. Thirty-eight patients were depressed at both baseline and 1 year follow up. This group had poorer symptomatic and functional outcome in the follow-up period compared to a group of patients with no depression in the first year of treatment. CONCLUSION Depressive symptoms are frequent among FEP patients at baseline but decrease after treatment because their general symptoms have been initiated. Patients with poor social functioning in childhood and alcohol use at baseline are more prone to have depressive symptoms at 10 years of follow up. Patients struggling with depressive symptoms in the first year of treatment should be identified as having poorer long-term prognosis.
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Affiliation(s)
- Nasrettin Sönmez
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helene Eidsmo Barder
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Departments of Psychology, University of Oslo, Oslo, Norway
| | - Ulrik Haahr
- Early Psychosis Intervention Center, Psychiatry Roskilde, Region Zealand, Roskilde, Denmark
| | - Wenche Ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Hans Langeveld
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stein Opjordsmoen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Rishovd Rund
- Departments of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Zealand Region, Psychiatry Roskilde, Roskilde University and University of Copenhagen, Roskilde, Denmark
| | - Per Vaglum
- Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Thomas McGlashan
- Department of Psychiatry, Yale University School of Medicine, Yale Psychiatric Research at Congress Place, New Haven, Connecticut, USA
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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40
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Gardsjord ES, Romm KL, Friis S, Barder HE, Evensen J, Haahr U, ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, Melle I, Røssberg JI. Subjective quality of life in first-episode psychosis. A ten year follow-up study. Schizophr Res 2016; 172:23-8. [PMID: 26947210 DOI: 10.1016/j.schres.2016.02.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Subjective quality of life (S-QoL) is an important outcome measure in first episode psychosis (FEP). The aims of this study were to describe S-QoL-development the first 10-years in FEP patients and to identify predictors of this development. METHODS A representative sample of 272 patients with a first episode psychotic disorder was included from 1997 through 2000. At 10 year follow-up 186 patients participated. QoL was measured by the Lehman's Quality of Life Interview. Linear mixed model analyses were performed to investigate longitudinal effects of baseline psychiatric symptoms and socio-economic variables and the effects of changes in the same variables on S-QoL-development. RESULTS S-QoL improved significantly over the follow-up period. More contact with family and a better financial situation at baseline had a positive and longstanding effect on S-QoL-development, but changes in these variables were not associated with S-QoL-development. Higher depressive symptoms and less daily activities at baseline both had a negative independent effect, but a positive interaction effect with time on S-QoL-development indicating that the independent negative effect diminished over time. In the change analysis, increased daily activities and a decrease in depressive symptoms were associated with a positive S-QoL-development. CONCLUSIONS Treatment of depressive symptoms and measures aimed at increasing daily activities seem important to improve S-QoL in patients with psychosis. More contact with family and a better financial situation at baseline have a long-standing effect on S-QoL-development in FEP patients.
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Affiliation(s)
| | - Kristin Lie Romm
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | | | - Julie Evensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Adult Psychiatric Department Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Ulrik Haahr
- Early Psychosis Intervention Center, Psychiatry East-Region Zealand, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Wenche ten Velden Hegelstad
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Inge Joa
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Langeveld
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Tor Ketil Larsen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, Section Psychiatry, University of Bergen, 5021 Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094, Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark; Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, 0318 Oslo, Norway
| | - Thomas McGlashan
- Department of Social and Behavioural Health, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
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41
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Friis S, Melle I, Johannessen JO, Røssberg JI, Barder HE, Evensen JH, Haahr U, Ten Velden Hegelstad W, Joa I, Langeveld J, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum PW, McGlashan TH. Early Predictors of Ten-Year Course in First-Episode Psychosis. Psychiatr Serv 2016; 67:438-43. [PMID: 26567932 DOI: 10.1176/appi.ps.201400558] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Identifying patients at risk of poor outcome at an early stage of illness can aid in treatment planning. This study sought to create a best-fit statistical model of known baseline and early-course risk factors to predict time in psychosis during a ten-year follow-up period after a first psychotic episode. METHODS Between 1997 and 2000, 301 patients with DSM-IV nonorganic, nonaffective first-episode psychosis were recruited consecutively from catchment area-based sectors in Norway and Denmark. Specialized mental health personnel evaluated patients at baseline, three months, and one, two, five, and ten years (N=186 at ten years). Time in psychosis was defined as time with scores ≥4 on any of the Positive and Negative Syndrome Scale items P1, P3, P5, P6, and G9. Evaluations were retrospective, based on clinical interviews and all available clinical information. During the first two years, patients were also evaluated by their clinicians at least biweekly. Baseline and early-course predictors of long-term course were identified with linear mixed-model analyses. RESULTS Four variables provided significant, additive predictions of longer time in psychosis during the ten-year follow-up: deterioration in premorbid social functioning, duration of untreated psychosis (DUP) of ≥26 weeks, core schizophrenia spectrum disorder, and no remission within three months. CONCLUSIONS First-episode psychosis patients should be followed carefully after the start of treatment. If symptoms do not remit within three months with adequate treatment, there is a considerable risk of a poor long-term outcome, particularly for patients with a deterioration in premorbid social functioning, a DUP of at least half a year, and a diagnosis within the core schizophrenia spectrum.
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Affiliation(s)
- Svein Friis
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Ingrid Melle
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Jan Olav Johannessen
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Jan Ivar Røssberg
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Helene Eidsmo Barder
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Julie Horgen Evensen
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Ulrik Haahr
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Wenche Ten Velden Hegelstad
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Inge Joa
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Johannes Langeveld
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Tor Ketil Larsen
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Stein Opjordsmoen
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Bjørn Rishovd Rund
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Erik Simonsen
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Per Wiggen Vaglum
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Thomas H McGlashan
- Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut
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Rund BR, Barder HE, Evensen J, Haahr U, Hegelstad WTV, Joa I, Johannessen JO, Langeveld J, Larsen TK, Melle I, Opjordsmoen S, Røssberg JI, Simonsen E, Sundet K, Vaglum P, McGlashan T, Friis S. Neurocognition and Duration of Psychosis: A 10-year Follow-up of First-Episode Patients. Schizophr Bull 2016; 42:87-95. [PMID: 26101305 PMCID: PMC4681546 DOI: 10.1093/schbul/sbv083] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A substantial proportion of schizophrenia-spectrum patients exhibit a cognitive impairment at illness onset. However, the long-term course of neurocognition and a possible neurotoxic effect of time spent in active psychosis, is a topic of controversy. Furthermore, it is of importance to find out what predicts the long-term course of neurocognition. Duration of untreated psychosis (DUP), accumulated time in psychosis the first year after start of treatment, relapse rates and symptoms are potential predictors of the long-term course. In this study, 261 first-episode psychosis patients were assessed neuropsychologically on one or more occasions. Patients were tested after remission of psychotic symptoms and reassessed 1, 2, 5, and 10 years after inclusion. The neurocognitive battery consisted of California Verbal Learning Test, Wisconsin Card Sorting Test, Controlled Oral Word Association Task, Trail Making A and B, and Finger Tapping. We calculated a composite score by adding the z-scores of 4 tests that were only moderately inter-correlated, not including Finger Tapping. Data were analyzed by a linear mixed model. The composite score was stable over 10 years. No significant relationship between psychosis before (DUP) or after start of treatment and the composite score was found, providing no support for the neurotoxicity hypothesis, and indicating that psychosis before start of treatment has no significant impact on the course and outcome in psychosis. We found no association between symptoms and the neurocognitive trajectory. Stable remission during the first year predicted neurocognitive functioning, suggesting that the early clinical course is a good predictor for the long-term course.
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Affiliation(s)
- Bjørn Rishovd Rund
- Vestre Viken Hospital Trust, Drammen, Norway; Department of Psychology, University of Oslo, Oslo, Norway;
| | | | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ulrik Haahr
- Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Roskilde, Denmark;,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Wenche ten Velden Hegelstad
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Science,University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Science,University of Stavanger, Stavanger, Norway
| | - Johannes Langeveld
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Tor Ketil Larsen
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway;,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway;,NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | | | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Simonsen
- Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Roskilde, Denmark;,Psychiatric Research Unit, Psychiatry Region Zealand, Roskilde, Denmark
| | - Kjetil Sundet
- Department of Psychology, University of Oslo, Oslo, Norway;,NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Thomas McGlashan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Austad G, Joa I, Johannessen JO, Larsen TK. Gender differences in suicidal behaviour in patients with first-episode psychosis. Early Interv Psychiatry 2015; 9:300-7. [PMID: 24304682 DOI: 10.1111/eip.12113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/25/2013] [Indexed: 11/29/2022]
Abstract
AIM Prior research shows contradictory gender patterns in suicidal behaviour among patients with first-episode psychosis. The aim of this study was to investigate gender differences in the prevalence of suicidal behaviour (suicidal ideation, suicide plans and suicide attempts) and to delineate risk factors for suicidal behaviour among consecutively included male and female patients with first-episode psychosis in the TIPS II early detection study. METHODS Patients with first-episode psychosis (n = 246) from a hospital catchment area with a system for early detection were assessed and compared on baseline sociodemographical and clinical variables according to gender. Current (past 1 month) and lifetime prevalence of suicidal behaviour were assessed. RESULTS Current and lifetime rates of suicidal behaviour were high (50.8% and 65.9%, respectively) and higher among females (lifetime: 78.3 %, past month: 64.2 %) versus males (lifetime: 56.4 %, past month: 40.7 %). Depressive symptoms and female gender were associated with both lifetime and current risk for suicidal behaviour. Lifetime prevalence was also associated with a longer duration of untreated psychosis and young age after controlling for other risk factors. CONCLUSIONS Suicidal behaviour was frequent among patients with first-episode psychosis, with a higher prevalence of suicidal behaviour in females. Depressive symptoms and female gender were significantly associated with suicidal behaviour.
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Affiliation(s)
- Gudrun Austad
- Psychiatric Division, Regional Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- Psychiatric Division, Regional Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Resource Centre for Violence, Traumatic Stress and Suicide Prevention, Western Norway (RVTS West), Haukeland University, Bergen, Norway
| | - Jan Olav Johannessen
- Psychiatric Division, Regional Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Resource Centre for Violence, Traumatic Stress and Suicide Prevention, Western Norway (RVTS West), Haukeland University, Bergen, Norway
| | - Tor Ketil Larsen
- Psychiatric Division, Regional Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, University of Bergen, Bergen, Norway
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Joa I, Gisselgård J, Brønnick K, McGlashan T, Johannessen JO. Primary prevention of psychosis through interventions in the symptomatic prodromal phase, a pragmatic Norwegian Ultra High Risk study. BMC Psychiatry 2015; 15:89. [PMID: 25897797 PMCID: PMC4422504 DOI: 10.1186/s12888-015-0470-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 04/08/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence has been accumulating that it may be possible to achieve prevention in psychotic disorders. The aim of the Prevention Of Psychosis (POP) study is to reduce the annual incidence of psychotic disorders in a catchment area population through detection and intervention in the prodromal phase of disorder. Prodromal patients will be recruited through information campaigns modelled on the Scandinavian early Treatment and Intervention in Psychosis (TIPS) study and assessed by low-threshold detection teams. METHODS/DESIGN The study will use a parallel control design comparing the incidence of first episode psychotic disorders between two Norwegian catchment areas with prodromal detection and treatment (Stavanger and Fonna) with two catchment areas without a prodromal intervention program (Bergen and Østfold). The primary aim of the current study is to test the effect of a Prodromal Detection and Treatment program at the health care systems level. The study will investigate: 1) If the combination of information campaigns and detection teams modelled will help in identifying individuals (age 13-65, fulfilling study inclusion criteria) at high risk of developing psychosis early, and 2) If a graded, multi-modal treatment program will reduce rates of conversion compared to the rates seen in follow-along assessments. DISCUSSION Positive results could potentially revolutionize therapy by treating risk earlier rather than disorder later and could open a new era of early detection and intervention in psychosis. Negative results will suggest that the potential for psychosis is determined early in life and that research should focus more on genetically linked neurodevelopmental processes. If we can identify people about to become psychotic with high accuracy, we can track them to understand more about how psychosis unfolds. Appropriate intervention at this stage could also prevent or delay the onset of psychosis and/or subsequent deterioration, i.e., social and instrumental disability, suicide, aggressive behavior, affective- and cognitive deficits. TRIAL REGISTRATION Current Controlled Trials ISRCTN20328848 . Registered 02 November 2014.
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Affiliation(s)
- Inge Joa
- Psychiatric Division, Stavanger University Hospital, TIPS- Centre for Clinical Research in Psychosis, Armauer Hansensvei 20, N-4011, Stavanger, Norway. .,Network for medical sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Jens Gisselgård
- Psychiatric Division, Stavanger University Hospital, TIPS- Centre for Clinical Research in Psychosis, Armauer Hansensvei 20, N-4011, Stavanger, Norway.
| | - Kolbjørn Brønnick
- Psychiatric Division, Stavanger University Hospital, TIPS- Centre for Clinical Research in Psychosis, Armauer Hansensvei 20, N-4011, Stavanger, Norway. .,Network for medical sciences, University of Stavanger, 4036, Stavanger, Norway.
| | | | - Jan Olav Johannessen
- Psychiatric Division, Stavanger University Hospital, TIPS- Centre for Clinical Research in Psychosis, Armauer Hansensvei 20, N-4011, Stavanger, Norway. .,Network for medical sciences, University of Stavanger, 4036, Stavanger, Norway.
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Barder HE, Sundet K, Rund BR, Evensen J, Haahr U, ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Melle I, Opjordsmoen S, Røssberg JI, Simonsen E, Vaglum P, McGlashan T, Friis SPI. 10 year course of IQ in first-episode psychosis: relationship between duration of psychosis and long-term intellectual trajectories. Psychiatry Res 2015; 225:515-21. [PMID: 25535007 DOI: 10.1016/j.psychres.2014.11.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 08/28/2014] [Accepted: 11/26/2014] [Indexed: 11/30/2022]
Abstract
A substantial proportion of patients suffering from schizophrenia-spectrum disorders (SSDs) exhibit a general intellectual impairment at illness onset, but the subsequent intellectual course remains unclear. Relationships between accumulated time in psychosis and long-term intellectual functioning are largely uninvestigated, but may identify subgroups with different intellectual trajectories. Eighty-nine first-episode psychosis patients were investigated on IQ at baseline and at 10-years follow-up. Total time in psychosis was defined as two separate variables; Duration of psychosis before start of treatment (i.e. duration of untreated psychosis: DUP), and duration of psychosis after start of treatment (DAT). The sample was divided in three equal groups based on DUP and DAT, respectively. To investigate if diagnosis could separate IQ-trajectories beyond that of psychotic duration, two diagnostic categories were defined: core versus non-core SSDs. No significant change in IQ was found for the total sample. Intellectual course was not related to DUP or stringency of diagnostic category. However, a subgroup with long DAT demonstrated a significant intellectual decline, mainly associated with a weaker performance on test of immediate verbal recall/working memory (WAIS-R Digit Span). This indicates a relationship between accumulated duration of psychosis and long-term intellectual course, irrespective of diagnostic category, in a significant subgroup of patients.
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Affiliation(s)
- Helene Eidsmo Barder
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407 Oslo, Norway; Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway.
| | - Kjetil Sundet
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407 Oslo, Norway; Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004, Drammen, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Ulrik Haahr
- Early Psychosis Intervention Center, Psychiatry Roskilde, Region Zealand, Smedegade 1-16, 4000 Roskilde, Denmark
| | - Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway; Faculty of social sciences, University of Stavanger, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway; Faculty of social sciences, University of Stavanger, Norway
| | - Johannes Langeveld
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway; Institute of Psychiatry, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Stein Opjordsmoen
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Zealand Region, Psychiatry Roskilde, Roskilde University and University of Copenhagen, Smedegade 10-16, 4000 Roskilde, Denmark
| | - Per Vaglum
- Department of Behavioral Sciences in Medicine, University of Oslo, P.O. 1130 Blindern, 0318 Oslo, Norway
| | - Thomas McGlashan
- Department of Psychiatry, Yale University School of Medicine, Yale Psychiatric Research at Congress Place, 301 Cedar Street, New Haven, CT 06519, USA
| | - Svein P I Friis
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
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Lien L, Johannessen JO. Re: Flere og gale diagnoser med kriteriebasert diagnostikk. Tidsskriftet 2015; 135:1712. [DOI: 10.4045/tidsskr.15.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Langeveld J, Bjørkly S, Auestad B, Barder H, Evensen J, Ten Velden Hegelstad W, Joa I, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Røssberg JI, Rund BR, Simonsen E, Vaglum P, McGlashan T, Friis S. Treatment and violent behavior in persons with first episode psychosis during a 10-year prospective follow-up study. Schizophr Res 2014; 156:272-6. [PMID: 24837683 DOI: 10.1016/j.schres.2014.04.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/05/2014] [Accepted: 04/02/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND First episode psychosis (FEP) patients have an increased risk for violence and criminal activity prior to initial treatment. However, little is known about the prevalence of criminality and acts of violence many years after implementation of treatment for a first episode psychosis. AIM To assess the prevalence of criminal and violent behaviors during a 10-year follow-up period after the debut of a first psychosis episode, and to identify early predictors and concomitant risk factors of violent behavior. METHOD A prospective design was used with comprehensive assessments of criminal behavior, drug abuse, clinical, social and treatment variables at baseline, five, and 10-year follow-up. Additionally, threatening and violent behavior was assessed at 10-year follow-up. A clinical epidemiological sample of first-episode psychosis patients (n=178) was studied. RESULTS During the 10-year follow-up period, 20% of subjects had been apprehended or incarcerated. At 10-year follow-up, 15% of subjects had exposed others to threats or violence during the year before assessment. Illegal drug use at baseline and five-year follow-up, and a longer duration of psychotic symptoms were found to be predictive of violent behavior during the year preceding the 10-year follow-up. CONCLUSION After treatment initiation, the overall prevalence of violence in psychotic patients drops gradually to rates close to those of the general population. However, persistent illicit drug abuse is a serious risk factor for violent behavior, even long after the start of treatment. Achieving remission early and reducing substance abuse may contribute to a lower long-term risk for violent behavior in FEP patients.
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Affiliation(s)
- Johannes Langeveld
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.
| | - Stål Bjørkly
- Molde University College, PO. Box 2110, 6402 Molde, Norway; Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway
| | - Bjørn Auestad
- Faculty of Science and Mathematics, University of Stavanger, 4036 Stavanger, Norway
| | - Helene Barder
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Wenche Ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway; Institute of Psychiatry, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Stein Opjordsmoen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Zealand Region, Toftebakken 9, 4000 Roskilde, Denmark; University of Copenhagen, P.O. box 2177, Copenhagen, Denmark
| | - Per Vaglum
- Department of Behavioral Sciences in Medicine, University of Oslo, P.O. 1130 Blindern, 0318 Oslo, Norway
| | - Thomas McGlashan
- Department of Psychiatry, Yale University School of Medicine, Yale Psychiatric Research at Congress Place, 301 Cedar St., New Haven, CT 06519, USA
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
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Gisselgård J, Anda LG, Brønnick K, Langeveld J, Ten Velden Hegelstad W, Joa I, Johannessen JO, Larsen TK. Verbal working memory deficits predict levels of auditory hallucination in first-episode psychosis. Schizophr Res 2014; 153:38-41. [PMID: 24457037 DOI: 10.1016/j.schres.2013.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/19/2013] [Accepted: 12/20/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Auditory verbal hallucinations are a characteristic symptom in schizophrenia. Recent causal models of auditory verbal hallucinations propose that cognitive mechanisms involving verbal working memory are involved in the genesis of auditory verbal hallucinations. Thus, in the present study, we investigate the hypothesis that verbal working memory is a specific factor behind auditory verbal hallucinations. METHODS In the present study, we investigated the association between verbal working memory manipulation (Backward Digit Span and Letter-Number Sequencing) and auditory verbal hallucinations in a population study (N=52) of first episode psychosis. The degree of auditory verbal hallucination as reported in the P3-subscale of the PANSS interview was included as dependent variable using sequential multiple regression, while controlling for age, psychosis symptom severity, executive cognitive functions and simple auditory working memory span. RESULTS Multiple sequential regression analyses revealed verbal working memory manipulation to be the only significant predictor of verbal hallucination severity. CONCLUSIONS Consistent with cognitive data from auditory verbal hallucinations in healthy individuals, the present results suggest a specific association between auditory verbal hallucinations, and cognitive processes involving the manipulation of phonological representations during a verbal working memory task.
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Affiliation(s)
- Jens Gisselgård
- Stavanger University Hospital, TIPS, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway.
| | - Liss Gøril Anda
- Stavanger University Hospital, TIPS, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway
| | - Kolbjørn Brønnick
- Stavanger University Hospital, TIPS, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Langeveld
- Stavanger University Hospital, TIPS, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway
| | | | - Inge Joa
- Stavanger University Hospital, TIPS, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Stavanger University Hospital, TIPS, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Tor Ketil Larsen
- Stavanger University Hospital, TIPS, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway
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Weibell MA, Joa I, Bramness J, Johannessen JO, McGorry PD, ten Velden Hegelstad W, Larsen TK. Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area. BMC Psychiatry 2013; 13:319. [PMID: 24279887 PMCID: PMC4222718 DOI: 10.1186/1471-244x-13-319] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/18/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Substance misuse is a well-recognized co-morbidity to psychosis and has been linked to poor prognostic outcomes in patients. Researchers have yet to investigate the difference in rates and characteristics between first-episode Substance Induced Psychosis (SIP) and primary psychosis. We aimed at comparing patients with SIP to primary psychosis patients with or without substance misuse at baseline. METHODS Thirty SIP patients, 45 primary psychosis patients with substance misuse (PS) and 66 primary psychosis patients without substance misuse (PNS) in a well-defined Norwegian catchment area were included from 2007-2011. Assessments included symptom levels (PANSS), diagnostic interviews (SCID), premorbid function scale (PAS) and global functioning (GAF f/s). RESULTS Treated incidence for SIP was found to be 6.5/100 000 persons per year, 9.7/100 000 persons per year for PS and 24.1/100 000 persons per year for PNS (15-65 yrs). Patients who had substance misuse (PS and SIP) were more likely to be male. Duration of Untreated Psychosis (DUP) was significantly shorter in the SIP group (5.0 wks., p = 0.003) and these had more positive symptoms on the PANSS (p = 0.049). SIP patients also did poorer on early youth academic levels on the PAS. CONCLUSIONS Yearly treated incidence of SIP is 6.5/100 000 persons per year in a Norwegian catchment area. SIP patients have short DUPs, are more likely to be male, have more positive symptoms at baseline and poorer premorbid academic scores in early adolescence. Follow-up will evaluate stability of diagnosis and characteristics.
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Affiliation(s)
- Melissa A Weibell
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway.
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway,Faculty of Social Sciences, Institute of Health, University of Stavanger, Kjell Arholmsgt 41, 4021 Stavanger, Norway
| | - Jørgen Bramness
- Norwegian Centre for Addiction Research, University of Oslo, P.O box 1039, 0315 Oslo, Norway,Norwegian Institute of Public Health, P.O. box 4404, 0403 Oslo, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway,Faculty of Social Sciences, Institute of Health, University of Stavanger, Kjell Arholmsgt 41, 4021 Stavanger, Norway
| | - Patrick D McGorry
- ORYGEN Research Centre, University of Melbourne, Locked bag 10, Parkville, Melbourne, VIC 3052, Australia
| | - Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway
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50
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Barder HE, Sundet K, Rund BR, Evensen J, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld H, Larsen TK, Melle I, Opjordsmoen S, Røssberg JI, Simonsen E, Vaglum P, McGlashan T, Friis S. Neurocognitive development in first episode psychosis 5 years follow-up: associations between illness severity and cognitive course. Schizophr Res 2013; 149:63-9. [PMID: 23810121 DOI: 10.1016/j.schres.2013.06.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 05/24/2013] [Accepted: 06/04/2013] [Indexed: 12/01/2022]
Abstract
Cognitive deficits are documented in first-episode psychosis (FEP), but the continuing course is not fully understood. The present study examines the longitudinal development of neurocognitive function in a five year follow-up of FEP-patients, focusing on the relation to illness severity, as measured by relapses and diagnostic subgroups. The study is an extension of previous findings from the TIPS-project, reporting stability over the first two years. Sixty-two FEP patients (53% male, age 28 ± 9 years) were neuropsychologically examined at baseline and at 1, 2, and 5 year follow-ups. The test battery was divided into five indices; Verbal Learning, Executive Function, Impulsivity, Motor Speed, and Working Memory. To investigate the effect of illness severity, the sample was divided in groups based on number of relapses, and diagnostic subgroups, respectively. Impulsivity and Working Memory improved significantly in the first two years, followed by no change over the next three years. Motor Speed decreased significantly from 2 to 5 years. Number of relapses was significantly related to Verbal Learning and Working Memory, showing a small decrease and less improvement, respectively, in patients with two or more episodes. No significant association was found with diagnostic group. Neurocognitive stability as well as change was found in a sample of FEP-patients examined repeatedly over 5 years. Of potential greater importance for understanding how psychotic illnesses progress, is the finding of significant associations between neurocognition and number of relapses but not diagnostic group, indicating that neurocognition is more related to recurring psychotic episodes than to the descriptive diagnosis per se.
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Affiliation(s)
- Helene Eidsmo Barder
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407 Oslo, Norway.
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