Jan Røssberg - Academia.edu (original) (raw)

Papers by Jan Røssberg

Psychiatric services (Washington, D.C.), 2003

This study examined the relationship between the characteristics of inpatients and staff members&... more This study examined the relationship between the characteristics of inpatients and staff members' emotional reactions to the patients, particularly the extent to which the reactions were related to patients' aggressive or suicidal behavior. The Feeling Word Checklist-58 was used to measure staff members' feelings. Two positive and five negative feeling dimensions were examined: important, confident, rejected, on guard, bored, overwhelmed, and inadequate. A total of 253 staff members from a wide variety of psychiatric wards at a university-affiliated hospital in Oslo, Norway, completed a total of 2473 checklists about their emotional reactions to 207 patients. For each patient, a member of the research team used information from ward staff who knew the patient to complete a Social Dysfunction and Aggression Scale measuring whether the patient had been aggressive (outward aggression) or suicidal (inward aggression). Staff reported positive feelings about patients much more...

Psychiatry Research, 2010

The main aim of this study was to examine the relationship between patients' psychiatric symptoms... more The main aim of this study was to examine the relationship between patients' psychiatric symptoms and therapists' countertransference reactions. Additionally, we wanted to examine the relationship between symptom improvement and countertransference reactions. Eleven therapists completed the Feeling Word Checklist 58 for each patient admitted to a day treatment program. Forty-two patients met the inclusion criteria. The patients completed the Symptom Checklist-90 Revised (SCL-90R) upon admission and at discharge. The study revealed several specific and significant correlations between the therapists' countertransference reactions and the patients' self-reported symptoms. At the end of treatment, notable findings included negative correlations between higher patient scores on the symptom dimensions and the therapists' feelings of being important and confident, and positive correlations between higher patient scores on the symptom dimensions and the therapists' feelings of being bored, on guard, overwhelmed and inadequate. Symptom change was positively correlated with positive countertransference feelings and negatively correlated with negative countertransference feelings. The study revealed that the patients' levels of self-reported symptoms were significantly associated with the therapists' countertransference feelings. This empirical study confirmed findings from the clinical literature of a specific relationship between symptom improvement and countertransference reactions.

Psychiatry Research, 2015

A substantial proportion of patients suffering from schizophrenia-spectrum disorders (SSDs) exhib... more 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.

Frontiers in Human Neuroscience, 2013

Neurocognitive impairment is commonly reported at onset of psychotic disorders. However, the long... more Neurocognitive impairment is commonly reported at onset of psychotic disorders. However, the long-term neurocognitive course remains largely uninvestigated in first episode psychosis (FEP) and the relationship to clinically significant subgroups even more so. We report 10 year longitudinal neurocognitive development in a sample of FEP patients, and explore whether the trajectories of cognitive course are related to presence of relapse to psychosis, especially within the first year, with a focus on the course of verbal memory. Method: Forty-three FEP subjects (51% male, 28 ± 9 years) were followed-up neurocognitively over five assessments spanning 10 years. The test battery was divided into four neurocognitive indices; Executive Function, Verbal Learning, Motor Speed, and Verbal Fluency. The sample was grouped into those relapsing or not within the first, second and fifth year. Results: The four neurocognitive indices showed overall stability over the 10 year period. Significant relapse by index interactions were found for all indices except Executive Function. Follow-up analyses identified a larger significant decrease over time for the encoding measure within Verbal Memory for patients with psychotic relapse in the first year [F 2 (4, 38) = 5.8, p = 0.001, η = 0.40]. Conclusions: Main findings are long-term stability in neurocognitive functioning in FEP patients, with the exception of verbal memory in patients with psychotic relapse or non-remission early in the course of illness. We conclude that worsening of specific parts of cognitive function may be expected for patients with ongoing psychosis, but that the majority of patients do not show significant change in cognitive performance during the first 10 years after being diagnosed.

Schizophrenia Research, 2014

Background: First episode psychosis (FEP) patients have an increased risk for violence and crimin... more 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.

Scandinavian Journal of Caring Sciences, 2009

Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a ... more Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a forensic psychiatric hospital? A pilot study Objective: The main aim of the study was to describe whether staff training and lectures on milieu therapy to nursing staff can change the treatment environment, as perceived by the patients, in a desirable direction. The study was approved by the Regional Ethics Committee for Medical Research. Method: To measure the patients' perceptions of the treatment environment we used the Ward Atmosphere Scale (WAS). The ward atmosphere was evaluated three times during a 12-month period. Additionally, the patients completed five questions concerning satisfaction with the treatment environment. Between the first and the second ward evaluation the nursing staff was given 3 weeks of lectures on different aspects of milieu therapy. The nursing staff completed the WAS and three satisfaction items. Results: The study revealed a change in desired direction after education in five of the six key subscales of the WAS (Involvement, Support, Practical orientation, Angry and aggressive behaviour and Order and organization). Staff control was the only subscale with no changes. The patients also reported an increase in satisfaction. The study revealed no major changes in the staff scores. The present study included only a small number of patients and examined the changes in only one psychiatric department; hence it could be argued that the results cannot be generalized to equivalent populations within the forensic services. Conclusions: The study indicated that it is possible to improve the ward atmosphere in a desirable direction by a 3-week training programme for nursing staff about important aspects of milieu therapy.

Schizophrenia Research, 2013

Poor symptom outcome remains a challenge in psychosis: At least 50% of first-episode patients con... more Poor symptom outcome remains a challenge in psychosis: At least 50% of first-episode patients continue to have positive and/or negative symptoms after ten years. To investigate rates, early predictors and early symptom progression of long-term non-remitted psychosis in an early detection study. Symptomatic remission according to new international criteria was assessed in 174 patients at ten-year follow-up. Remitted and non-remitted patients were compared on early symptom progression, and logistic regression was applied to predict non-remission. At ten years, 50% of patients were in symptomatic remission. Non-remission was predicted by positive symptoms at inclusion and during the first year of treatment. Of individual symptoms only hallucinations were significantly predictive of ten-year non-remission. Early symptom differences were not reflected by differences in treatment. Long-term symptomatic non-remission is associated with early positive symptoms. More assertive intervention may be needed in patients who do not respond robustly in the first year of treatment, whether or not they have been detected "early".

Psychiatric Services, 2004

This study examined the extent to which patients&... more This study examined the extent to which patients' and staff's perceptions of the psychiatric ward atmosphere and the working conditions of staff influence patient and staff satisfaction. A total of 640 staff members on 42 wards completed the Ward Atmosphere Scale (WAS) and the Working Environment Scale-10 (WES-10). A total of 424 patients on the same wards completed the WAS. Both patients and staff members answered three questions about their general satisfaction with the ward. The ward means were used as the unit of analysis. The staff members had significantly higher scores than the patients on nine of the 11 WAS subscales. Patients' and staff's WAS scores were moderately correlated. No significant correlation was found between patients' and staff's scores on the three satisfaction items. Patient satisfaction was strongly correlated with patients' WAS scores and was moderately correlated with staff's WAS scores but was not significantly correlated with staff's WES-10 scores. Staff satisfaction was moderately correlated with staff's WAS and WES-10 scores but was not correlated with patients' WAS scores. Different aspects of the treatment climate seem to be important for patient and staff satisfaction. The ward atmosphere seems to be more important for patient satisfaction than for staff satisfaction. The working environment is strongly related to staff satisfaction but seems to be unrelated to patient satisfaction.

Schizophrenia Research, 2010

Suicidal behaviour is prevalent in psychotic disorders. Insight has been found to be associated w... more Suicidal behaviour is prevalent in psychotic disorders. Insight has been found to be associated with increased risk for suicidal behaviour, but not consistently. A possible explanation for this is that insight has different consequences for patients depending on their beliefs about psychosis. The present study investigated whether a relationship between insight, negative beliefs about psychosis and suicidality was mediated by depressive symptoms, and if negative beliefs about psychosis moderated the relationship between insight and suicidality in patients with a first episode of psychosis (FEP). One hundred ninety-four FEP-patients were assessed with a clinical interview for diagnosis, symptoms, functioning, substance use, suicidality, insight, and beliefs about psychosis. Nearly 46% of the patients were currently suicidal. Depressive symptoms, having a schizophrenia spectrum disorder, insight, and beliefs about negative outcomes for psychosis were independently associated with current suicidality; contradicting a mediating effect of depressive symptoms. Negative beliefs about psychosis did not moderate the effect of insight on current suicidality. The results indicate that more depressive symptoms, higher insight, and negative beliefs about psychosis increase the risk for suicidality in FEP-patients. The findings imply that monitoring insight should be part of assessing the suicide risk in patients with FEP, and that treating depression and counteracting negative beliefs about psychosis may possibly reduce the risk for suicidality.

Journal of Nervous & Mental Disease, 2008

Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2010

Objective: Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is documented in bipolar ... more Objective: Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is documented in bipolar disorder and schizophrenia, but the mechanism is unclear; recently, increased activity of cortisol metabolizing enzymes was indicated in these disorders. We investigated whether five genes involved in cortisol metabolism were associated with altered activity of cortisol metabolizing enzymes in bipolar disorder (BD) and schizophrenia spectrum disorders (SCZ). Methods: A case-control sample of subjects with BD (N = 213), SCZ (N = 274) and healthy controls (N = 370) from Oslo, Norway, were included and genotyped from 2003 to 2008. A sub-sample (healthy controls: N = 151; SCZ: N = 40; BD: N = 39) had estimated enzyme activities based on measurements of urinary free cortisol, urinary free cortisone and metabolites. A total of 102 single nucleotide polymorphisms (SNPs) in the SRD5A1, SRD5A2, AKR1D1, HSD11B1 and HSD11B2 genes were genotyped, and significant SNPs analyzed in the sub-sample. Results: There was a significant association of rs6732223 in SRD5A2 (5α-reductase) with SCZ (p = 0.0043, Bonferroni corrected p = 0.030, T risk allele). There was a significantly increased 5α-reductase activity associated with rs6732223 (T allele) within the SCZ group (p = 0.011). Conclusions: The present data suggest an interaction between SCZ and SRD5A2 variants coding for the enzyme 5α-reductase, giving rise to increased 5α-reductase activity in SCZ. The findings may have implications for cortisol metabolizing enzymes as possible drug targets.

European Psychiatry, 2011

European Psychiatry, 2008

BackgroundRecently there has been a renewed interest in defining the boundaries and subdomains of... more BackgroundRecently there has been a renewed interest in defining the boundaries and subdomains of the negative syndrome in schizophrenia and new scales have been asked for. Apathy is one of the symptoms in focus. The Apathy Evaluation Scale (AES) with its clinical version (AES-C) is one of the most used scales in an interdisciplinary context, but it has never previously been used in a population with first episode psychosis. The main aims of this study were to examine the psychometric properties of the AES-C and its relationship to the Positive and Negative Syndrome Scale (PANSS).MethodsA total of 104 patients with first episode psychosis from the ongoing Thematic Organized Psychosis Research (TOP) study were included.ResultsA factor analysis of the AES-C identified three subscales: Apathy, Insight and Social Contacts. Only the Apathy subscale showed satisfactory psychometric properties and showed acceptable convergent and discriminate properties by correlating strongly with the apa...

Comprehensive Psychiatry, 2007

Objective: The study examined to what extent patients with cluster A + B personality disorders (P... more Objective: The study examined to what extent patients with cluster A + B personality disorders (PDs) evoked other countertransference reactions among psychotherapists compared with patients with cluster C PDs as well as the relationship between the different countertransference reactions and outcome.

Early Intervention in Psychiatry, 2013

Background-The Scandinavian TIPS project engineered an early detection of psychosis program that ... more Background-The Scandinavian TIPS project engineered an early detection of psychosis program that sought to reduce the duration of untreated psychosis (DUP) through early detection teams and extensive information campaigns since 1997. In 1997-2000, DUP was reduced from 26 to 4.5 weeks median. The program was continued beyond the initial project in modified forms for over 13 years.

Comprehensive Psychiatry, 2012

The main aim of the present study was to examine whether patients with first-episode psychosis (F... more The main aim of the present study was to examine whether patients with first-episode psychosis (FEP) with severe social anxiety show poorer premorbid and current functioning, higher level of current clinical symptoms, and better "insight into illness." Furthermore, we wanted to explore whether social anxiety is associated with reduced quality of life (QoL). A sample of 144 individuals with an FEP was divided into 3 groups depending on current level of social anxiety symptoms measured by the Liebowitz Social Anxiety Scale. Analysis of variance was performed including measures of demographic and clinical characteristics. A hierarchical regression analysis was performed to explore possible predictors of QoL. The most severe social anxiety group revealed poorer premorbid adjustment, lower social functioning, and higher levels of depression. Furthermore, this group revealed a higher awareness of illness and experienced reduced QoL. Overall, social anxiety was associated with reduced QoL even after adjusting for psychotic symptoms and depression. Severe social anxiety in FEP is associated with poor premorbid functioning and distinct clinical characteristics, besides being a possible predictor of QoL.

Comprehensive Psychiatry, 2012

The main aim of the present study was to examine whether patients with first-episode psychosis (F... more The main aim of the present study was to examine whether patients with first-episode psychosis (FEP) with severe social anxiety show poorer premorbid and current functioning, higher level of current clinical symptoms, and better "insight into illness." Furthermore, we wanted to explore whether social anxiety is associated with reduced quality of life (QoL). A sample of 144 individuals with an FEP was divided into 3 groups depending on current level of social anxiety symptoms measured by the Liebowitz Social Anxiety Scale. Analysis of variance was performed including measures of demographic and clinical characteristics. A hierarchical regression analysis was performed to explore possible predictors of QoL. The most severe social anxiety group revealed poorer premorbid adjustment, lower social functioning, and higher levels of depression. Furthermore, this group revealed a higher awareness of illness and experienced reduced QoL. Overall, social anxiety was associated with reduced QoL even after adjusting for psychotic symptoms and depression. Severe social anxiety in FEP is associated with poor premorbid functioning and distinct clinical characteristics, besides being a possible predictor of QoL.

Australian & New Zealand Journal of Psychiatry, 2012

Australian & New Zealand Journal of Psychiatry, 46(9) alongside mine, that was critical of EI... more Australian & New Zealand Journal of Psychiatry, 46(9) alongside mine, that was critical of EI. There is much to question in Professor Castle’s article, yet it seemingly escapes the scientific scepticism of Dr Amos. If Dr Amos’s agenda were to solely promote rigorous evaluation of evidence, one would think he would subject both sides of the argument to the same assessment. Yet this is not the case. Perhaps Dr Amos could have queried why Professor Castle asks the question of who is being treated and whether they actually need treatment, when the answers to his questions lie in one of the papers Professor Castle cites (Cheng et al., 2011). In this article, Cheng et al. conducted a rigorous epidemiological study of people being treated at EI services in Cambridgeshire. The authors state explicitly that their services manage patients with first episode psychosis and do not treat people with subclinical psychotic symptoms from the general population or even individuals with an At Risk Mental States (that is, people meeting Ultra High Risk criteria, considered to be at high shortterm risk of developing psychotic disorder (Yung, 2011)). They note that there was no increase in incidence of psychotic disorders in the area after the establishment of an EI service. The authors point these findings out directly in response to Professor Castle’s assertion that EI services pathologize normal developmental processes (Bosanac et al., 2010). Yet Professor Castle chooses to ignore this evidence in favour of repeating his own position. Furthermore, Professor Castle refers to his own estimate of the incidence rate of psychosis in the Early Psychosis Prevention and Intervention Centre (EPPIC) but supplies no evidence to back this up, his only reference in support of his finding being a line in a similar opinion piece (Castle, 2011). Finally in a selective omission, Professor Castle discusses the effects of duration of untreated psychosis (DUP) without reference to the biggest trial of early detection to reduce DUP, the Norwegian TIPS study, referred to above. All this escapes the attention of Dr Amos. My article recognized that there are research gaps in the EI area. It stated that there are patients who will experience poor outcomes despite receiving EI. It is important to recognize both of these aspects so that we can continue to create knowledge, evaluate new systems of managing our patients and identify those that need additional treatment. Debate is important so that treatment, services and policy are evidence-based. But dismissing all evidence in favour of early detection and intervention by selectively quoting the literature and uncritically accepting the claims of the EI critics fails our patients and their families.

Acta Psychiatrica Scandinavica, 2010

T. Are multi family groups appropriate for patients with first episode psychosis? A 5-year natura... more T. Are multi family groups appropriate for patients with first episode psychosis? A 5-year naturalistic follow-up study. Objective: To compare outcome over 5 years for patients who participated in multi family groups (MFGs) to those who refused or were not offered participation. Method: Of 301 first episode psychotic patients aged 15-65 years, 147 participated in MFGs. Outcome was measured by drop-out rates, positive and negative syndrome scale (PANSS) symptom scores, and duration of psychotic episodes during the follow-up period. Results: Multi family group participants had a significantly lower drop-out rates at 5-year follow-up than patients who did not participate. However, the MFG participants had significantly less improvement in PANSS positive and excitative symptoms and had significantly longer duration of psychotic symptoms during the followup period. Conclusion: Multi family groups appear to increase the chance of retaining patients in a follow-up study, but adjustment of the programme may be necessary with first episode psychosis patients to meet their needs better.

Australian & New Zealand Journal of Psychiatry, 2012

Australian & New Zealand Journal of Psychiatry, 46(9) alongside mine, that was critical of EI... more Australian & New Zealand Journal of Psychiatry, 46(9) alongside mine, that was critical of EI. There is much to question in Professor Castle’s article, yet it seemingly escapes the scientific scepticism of Dr Amos. If Dr Amos’s agenda were to solely promote rigorous evaluation of evidence, one would think he would subject both sides of the argument to the same assessment. Yet this is not the case. Perhaps Dr Amos could have queried why Professor Castle asks the question of who is being treated and whether they actually need treatment, when the answers to his questions lie in one of the papers Professor Castle cites (Cheng et al., 2011). In this article, Cheng et al. conducted a rigorous epidemiological study of people being treated at EI services in Cambridgeshire. The authors state explicitly that their services manage patients with first episode psychosis and do not treat people with subclinical psychotic symptoms from the general population or even individuals with an At Risk Mental States (that is, people meeting Ultra High Risk criteria, considered to be at high shortterm risk of developing psychotic disorder (Yung, 2011)). They note that there was no increase in incidence of psychotic disorders in the area after the establishment of an EI service. The authors point these findings out directly in response to Professor Castle’s assertion that EI services pathologize normal developmental processes (Bosanac et al., 2010). Yet Professor Castle chooses to ignore this evidence in favour of repeating his own position. Furthermore, Professor Castle refers to his own estimate of the incidence rate of psychosis in the Early Psychosis Prevention and Intervention Centre (EPPIC) but supplies no evidence to back this up, his only reference in support of his finding being a line in a similar opinion piece (Castle, 2011). Finally in a selective omission, Professor Castle discusses the effects of duration of untreated psychosis (DUP) without reference to the biggest trial of early detection to reduce DUP, the Norwegian TIPS study, referred to above. All this escapes the attention of Dr Amos. My article recognized that there are research gaps in the EI area. It stated that there are patients who will experience poor outcomes despite receiving EI. It is important to recognize both of these aspects so that we can continue to create knowledge, evaluate new systems of managing our patients and identify those that need additional treatment. Debate is important so that treatment, services and policy are evidence-based. But dismissing all evidence in favour of early detection and intervention by selectively quoting the literature and uncritically accepting the claims of the EI critics fails our patients and their families.

Psychiatric services (Washington, D.C.), 2003

This study examined the relationship between the characteristics of inpatients and staff members&... more This study examined the relationship between the characteristics of inpatients and staff members' emotional reactions to the patients, particularly the extent to which the reactions were related to patients' aggressive or suicidal behavior. The Feeling Word Checklist-58 was used to measure staff members' feelings. Two positive and five negative feeling dimensions were examined: important, confident, rejected, on guard, bored, overwhelmed, and inadequate. A total of 253 staff members from a wide variety of psychiatric wards at a university-affiliated hospital in Oslo, Norway, completed a total of 2473 checklists about their emotional reactions to 207 patients. For each patient, a member of the research team used information from ward staff who knew the patient to complete a Social Dysfunction and Aggression Scale measuring whether the patient had been aggressive (outward aggression) or suicidal (inward aggression). Staff reported positive feelings about patients much more...

Psychiatry Research, 2010

The main aim of this study was to examine the relationship between patients' psychiatric symptoms... more The main aim of this study was to examine the relationship between patients' psychiatric symptoms and therapists' countertransference reactions. Additionally, we wanted to examine the relationship between symptom improvement and countertransference reactions. Eleven therapists completed the Feeling Word Checklist 58 for each patient admitted to a day treatment program. Forty-two patients met the inclusion criteria. The patients completed the Symptom Checklist-90 Revised (SCL-90R) upon admission and at discharge. The study revealed several specific and significant correlations between the therapists' countertransference reactions and the patients' self-reported symptoms. At the end of treatment, notable findings included negative correlations between higher patient scores on the symptom dimensions and the therapists' feelings of being important and confident, and positive correlations between higher patient scores on the symptom dimensions and the therapists' feelings of being bored, on guard, overwhelmed and inadequate. Symptom change was positively correlated with positive countertransference feelings and negatively correlated with negative countertransference feelings. The study revealed that the patients' levels of self-reported symptoms were significantly associated with the therapists' countertransference feelings. This empirical study confirmed findings from the clinical literature of a specific relationship between symptom improvement and countertransference reactions.

Psychiatry Research, 2015

A substantial proportion of patients suffering from schizophrenia-spectrum disorders (SSDs) exhib... more 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.

Frontiers in Human Neuroscience, 2013

Neurocognitive impairment is commonly reported at onset of psychotic disorders. However, the long... more Neurocognitive impairment is commonly reported at onset of psychotic disorders. However, the long-term neurocognitive course remains largely uninvestigated in first episode psychosis (FEP) and the relationship to clinically significant subgroups even more so. We report 10 year longitudinal neurocognitive development in a sample of FEP patients, and explore whether the trajectories of cognitive course are related to presence of relapse to psychosis, especially within the first year, with a focus on the course of verbal memory. Method: Forty-three FEP subjects (51% male, 28 ± 9 years) were followed-up neurocognitively over five assessments spanning 10 years. The test battery was divided into four neurocognitive indices; Executive Function, Verbal Learning, Motor Speed, and Verbal Fluency. The sample was grouped into those relapsing or not within the first, second and fifth year. Results: The four neurocognitive indices showed overall stability over the 10 year period. Significant relapse by index interactions were found for all indices except Executive Function. Follow-up analyses identified a larger significant decrease over time for the encoding measure within Verbal Memory for patients with psychotic relapse in the first year [F 2 (4, 38) = 5.8, p = 0.001, η = 0.40]. Conclusions: Main findings are long-term stability in neurocognitive functioning in FEP patients, with the exception of verbal memory in patients with psychotic relapse or non-remission early in the course of illness. We conclude that worsening of specific parts of cognitive function may be expected for patients with ongoing psychosis, but that the majority of patients do not show significant change in cognitive performance during the first 10 years after being diagnosed.

Schizophrenia Research, 2014

Background: First episode psychosis (FEP) patients have an increased risk for violence and crimin... more 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.

Scandinavian Journal of Caring Sciences, 2009

Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a ... more Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a forensic psychiatric hospital? A pilot study Objective: The main aim of the study was to describe whether staff training and lectures on milieu therapy to nursing staff can change the treatment environment, as perceived by the patients, in a desirable direction. The study was approved by the Regional Ethics Committee for Medical Research. Method: To measure the patients' perceptions of the treatment environment we used the Ward Atmosphere Scale (WAS). The ward atmosphere was evaluated three times during a 12-month period. Additionally, the patients completed five questions concerning satisfaction with the treatment environment. Between the first and the second ward evaluation the nursing staff was given 3 weeks of lectures on different aspects of milieu therapy. The nursing staff completed the WAS and three satisfaction items. Results: The study revealed a change in desired direction after education in five of the six key subscales of the WAS (Involvement, Support, Practical orientation, Angry and aggressive behaviour and Order and organization). Staff control was the only subscale with no changes. The patients also reported an increase in satisfaction. The study revealed no major changes in the staff scores. The present study included only a small number of patients and examined the changes in only one psychiatric department; hence it could be argued that the results cannot be generalized to equivalent populations within the forensic services. Conclusions: The study indicated that it is possible to improve the ward atmosphere in a desirable direction by a 3-week training programme for nursing staff about important aspects of milieu therapy.

Schizophrenia Research, 2013

Poor symptom outcome remains a challenge in psychosis: At least 50% of first-episode patients con... more Poor symptom outcome remains a challenge in psychosis: At least 50% of first-episode patients continue to have positive and/or negative symptoms after ten years. To investigate rates, early predictors and early symptom progression of long-term non-remitted psychosis in an early detection study. Symptomatic remission according to new international criteria was assessed in 174 patients at ten-year follow-up. Remitted and non-remitted patients were compared on early symptom progression, and logistic regression was applied to predict non-remission. At ten years, 50% of patients were in symptomatic remission. Non-remission was predicted by positive symptoms at inclusion and during the first year of treatment. Of individual symptoms only hallucinations were significantly predictive of ten-year non-remission. Early symptom differences were not reflected by differences in treatment. Long-term symptomatic non-remission is associated with early positive symptoms. More assertive intervention may be needed in patients who do not respond robustly in the first year of treatment, whether or not they have been detected "early".

Psychiatric Services, 2004

This study examined the extent to which patients&... more This study examined the extent to which patients' and staff's perceptions of the psychiatric ward atmosphere and the working conditions of staff influence patient and staff satisfaction. A total of 640 staff members on 42 wards completed the Ward Atmosphere Scale (WAS) and the Working Environment Scale-10 (WES-10). A total of 424 patients on the same wards completed the WAS. Both patients and staff members answered three questions about their general satisfaction with the ward. The ward means were used as the unit of analysis. The staff members had significantly higher scores than the patients on nine of the 11 WAS subscales. Patients' and staff's WAS scores were moderately correlated. No significant correlation was found between patients' and staff's scores on the three satisfaction items. Patient satisfaction was strongly correlated with patients' WAS scores and was moderately correlated with staff's WAS scores but was not significantly correlated with staff's WES-10 scores. Staff satisfaction was moderately correlated with staff's WAS and WES-10 scores but was not correlated with patients' WAS scores. Different aspects of the treatment climate seem to be important for patient and staff satisfaction. The ward atmosphere seems to be more important for patient satisfaction than for staff satisfaction. The working environment is strongly related to staff satisfaction but seems to be unrelated to patient satisfaction.

Schizophrenia Research, 2010

Suicidal behaviour is prevalent in psychotic disorders. Insight has been found to be associated w... more Suicidal behaviour is prevalent in psychotic disorders. Insight has been found to be associated with increased risk for suicidal behaviour, but not consistently. A possible explanation for this is that insight has different consequences for patients depending on their beliefs about psychosis. The present study investigated whether a relationship between insight, negative beliefs about psychosis and suicidality was mediated by depressive symptoms, and if negative beliefs about psychosis moderated the relationship between insight and suicidality in patients with a first episode of psychosis (FEP). One hundred ninety-four FEP-patients were assessed with a clinical interview for diagnosis, symptoms, functioning, substance use, suicidality, insight, and beliefs about psychosis. Nearly 46% of the patients were currently suicidal. Depressive symptoms, having a schizophrenia spectrum disorder, insight, and beliefs about negative outcomes for psychosis were independently associated with current suicidality; contradicting a mediating effect of depressive symptoms. Negative beliefs about psychosis did not moderate the effect of insight on current suicidality. The results indicate that more depressive symptoms, higher insight, and negative beliefs about psychosis increase the risk for suicidality in FEP-patients. The findings imply that monitoring insight should be part of assessing the suicide risk in patients with FEP, and that treating depression and counteracting negative beliefs about psychosis may possibly reduce the risk for suicidality.

Journal of Nervous & Mental Disease, 2008

Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2010

Objective: Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is documented in bipolar ... more Objective: Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is documented in bipolar disorder and schizophrenia, but the mechanism is unclear; recently, increased activity of cortisol metabolizing enzymes was indicated in these disorders. We investigated whether five genes involved in cortisol metabolism were associated with altered activity of cortisol metabolizing enzymes in bipolar disorder (BD) and schizophrenia spectrum disorders (SCZ). Methods: A case-control sample of subjects with BD (N = 213), SCZ (N = 274) and healthy controls (N = 370) from Oslo, Norway, were included and genotyped from 2003 to 2008. A sub-sample (healthy controls: N = 151; SCZ: N = 40; BD: N = 39) had estimated enzyme activities based on measurements of urinary free cortisol, urinary free cortisone and metabolites. A total of 102 single nucleotide polymorphisms (SNPs) in the SRD5A1, SRD5A2, AKR1D1, HSD11B1 and HSD11B2 genes were genotyped, and significant SNPs analyzed in the sub-sample. Results: There was a significant association of rs6732223 in SRD5A2 (5α-reductase) with SCZ (p = 0.0043, Bonferroni corrected p = 0.030, T risk allele). There was a significantly increased 5α-reductase activity associated with rs6732223 (T allele) within the SCZ group (p = 0.011). Conclusions: The present data suggest an interaction between SCZ and SRD5A2 variants coding for the enzyme 5α-reductase, giving rise to increased 5α-reductase activity in SCZ. The findings may have implications for cortisol metabolizing enzymes as possible drug targets.

European Psychiatry, 2011

European Psychiatry, 2008

BackgroundRecently there has been a renewed interest in defining the boundaries and subdomains of... more BackgroundRecently there has been a renewed interest in defining the boundaries and subdomains of the negative syndrome in schizophrenia and new scales have been asked for. Apathy is one of the symptoms in focus. The Apathy Evaluation Scale (AES) with its clinical version (AES-C) is one of the most used scales in an interdisciplinary context, but it has never previously been used in a population with first episode psychosis. The main aims of this study were to examine the psychometric properties of the AES-C and its relationship to the Positive and Negative Syndrome Scale (PANSS).MethodsA total of 104 patients with first episode psychosis from the ongoing Thematic Organized Psychosis Research (TOP) study were included.ResultsA factor analysis of the AES-C identified three subscales: Apathy, Insight and Social Contacts. Only the Apathy subscale showed satisfactory psychometric properties and showed acceptable convergent and discriminate properties by correlating strongly with the apa...

Comprehensive Psychiatry, 2007

Objective: The study examined to what extent patients with cluster A + B personality disorders (P... more Objective: The study examined to what extent patients with cluster A + B personality disorders (PDs) evoked other countertransference reactions among psychotherapists compared with patients with cluster C PDs as well as the relationship between the different countertransference reactions and outcome.

Early Intervention in Psychiatry, 2013

Background-The Scandinavian TIPS project engineered an early detection of psychosis program that ... more Background-The Scandinavian TIPS project engineered an early detection of psychosis program that sought to reduce the duration of untreated psychosis (DUP) through early detection teams and extensive information campaigns since 1997. In 1997-2000, DUP was reduced from 26 to 4.5 weeks median. The program was continued beyond the initial project in modified forms for over 13 years.

Comprehensive Psychiatry, 2012

The main aim of the present study was to examine whether patients with first-episode psychosis (F... more The main aim of the present study was to examine whether patients with first-episode psychosis (FEP) with severe social anxiety show poorer premorbid and current functioning, higher level of current clinical symptoms, and better "insight into illness." Furthermore, we wanted to explore whether social anxiety is associated with reduced quality of life (QoL). A sample of 144 individuals with an FEP was divided into 3 groups depending on current level of social anxiety symptoms measured by the Liebowitz Social Anxiety Scale. Analysis of variance was performed including measures of demographic and clinical characteristics. A hierarchical regression analysis was performed to explore possible predictors of QoL. The most severe social anxiety group revealed poorer premorbid adjustment, lower social functioning, and higher levels of depression. Furthermore, this group revealed a higher awareness of illness and experienced reduced QoL. Overall, social anxiety was associated with reduced QoL even after adjusting for psychotic symptoms and depression. Severe social anxiety in FEP is associated with poor premorbid functioning and distinct clinical characteristics, besides being a possible predictor of QoL.

Comprehensive Psychiatry, 2012

The main aim of the present study was to examine whether patients with first-episode psychosis (F... more The main aim of the present study was to examine whether patients with first-episode psychosis (FEP) with severe social anxiety show poorer premorbid and current functioning, higher level of current clinical symptoms, and better "insight into illness." Furthermore, we wanted to explore whether social anxiety is associated with reduced quality of life (QoL). A sample of 144 individuals with an FEP was divided into 3 groups depending on current level of social anxiety symptoms measured by the Liebowitz Social Anxiety Scale. Analysis of variance was performed including measures of demographic and clinical characteristics. A hierarchical regression analysis was performed to explore possible predictors of QoL. The most severe social anxiety group revealed poorer premorbid adjustment, lower social functioning, and higher levels of depression. Furthermore, this group revealed a higher awareness of illness and experienced reduced QoL. Overall, social anxiety was associated with reduced QoL even after adjusting for psychotic symptoms and depression. Severe social anxiety in FEP is associated with poor premorbid functioning and distinct clinical characteristics, besides being a possible predictor of QoL.

Australian & New Zealand Journal of Psychiatry, 2012

Australian & New Zealand Journal of Psychiatry, 46(9) alongside mine, that was critical of EI... more Australian & New Zealand Journal of Psychiatry, 46(9) alongside mine, that was critical of EI. There is much to question in Professor Castle’s article, yet it seemingly escapes the scientific scepticism of Dr Amos. If Dr Amos’s agenda were to solely promote rigorous evaluation of evidence, one would think he would subject both sides of the argument to the same assessment. Yet this is not the case. Perhaps Dr Amos could have queried why Professor Castle asks the question of who is being treated and whether they actually need treatment, when the answers to his questions lie in one of the papers Professor Castle cites (Cheng et al., 2011). In this article, Cheng et al. conducted a rigorous epidemiological study of people being treated at EI services in Cambridgeshire. The authors state explicitly that their services manage patients with first episode psychosis and do not treat people with subclinical psychotic symptoms from the general population or even individuals with an At Risk Mental States (that is, people meeting Ultra High Risk criteria, considered to be at high shortterm risk of developing psychotic disorder (Yung, 2011)). They note that there was no increase in incidence of psychotic disorders in the area after the establishment of an EI service. The authors point these findings out directly in response to Professor Castle’s assertion that EI services pathologize normal developmental processes (Bosanac et al., 2010). Yet Professor Castle chooses to ignore this evidence in favour of repeating his own position. Furthermore, Professor Castle refers to his own estimate of the incidence rate of psychosis in the Early Psychosis Prevention and Intervention Centre (EPPIC) but supplies no evidence to back this up, his only reference in support of his finding being a line in a similar opinion piece (Castle, 2011). Finally in a selective omission, Professor Castle discusses the effects of duration of untreated psychosis (DUP) without reference to the biggest trial of early detection to reduce DUP, the Norwegian TIPS study, referred to above. All this escapes the attention of Dr Amos. My article recognized that there are research gaps in the EI area. It stated that there are patients who will experience poor outcomes despite receiving EI. It is important to recognize both of these aspects so that we can continue to create knowledge, evaluate new systems of managing our patients and identify those that need additional treatment. Debate is important so that treatment, services and policy are evidence-based. But dismissing all evidence in favour of early detection and intervention by selectively quoting the literature and uncritically accepting the claims of the EI critics fails our patients and their families.

Acta Psychiatrica Scandinavica, 2010

T. Are multi family groups appropriate for patients with first episode psychosis? A 5-year natura... more T. Are multi family groups appropriate for patients with first episode psychosis? A 5-year naturalistic follow-up study. Objective: To compare outcome over 5 years for patients who participated in multi family groups (MFGs) to those who refused or were not offered participation. Method: Of 301 first episode psychotic patients aged 15-65 years, 147 participated in MFGs. Outcome was measured by drop-out rates, positive and negative syndrome scale (PANSS) symptom scores, and duration of psychotic episodes during the follow-up period. Results: Multi family group participants had a significantly lower drop-out rates at 5-year follow-up than patients who did not participate. However, the MFG participants had significantly less improvement in PANSS positive and excitative symptoms and had significantly longer duration of psychotic symptoms during the followup period. Conclusion: Multi family groups appear to increase the chance of retaining patients in a follow-up study, but adjustment of the programme may be necessary with first episode psychosis patients to meet their needs better.

Australian & New Zealand Journal of Psychiatry, 2012

Australian & New Zealand Journal of Psychiatry, 46(9) alongside mine, that was critical of EI... more Australian & New Zealand Journal of Psychiatry, 46(9) alongside mine, that was critical of EI. There is much to question in Professor Castle’s article, yet it seemingly escapes the scientific scepticism of Dr Amos. If Dr Amos’s agenda were to solely promote rigorous evaluation of evidence, one would think he would subject both sides of the argument to the same assessment. Yet this is not the case. Perhaps Dr Amos could have queried why Professor Castle asks the question of who is being treated and whether they actually need treatment, when the answers to his questions lie in one of the papers Professor Castle cites (Cheng et al., 2011). In this article, Cheng et al. conducted a rigorous epidemiological study of people being treated at EI services in Cambridgeshire. The authors state explicitly that their services manage patients with first episode psychosis and do not treat people with subclinical psychotic symptoms from the general population or even individuals with an At Risk Mental States (that is, people meeting Ultra High Risk criteria, considered to be at high shortterm risk of developing psychotic disorder (Yung, 2011)). They note that there was no increase in incidence of psychotic disorders in the area after the establishment of an EI service. The authors point these findings out directly in response to Professor Castle’s assertion that EI services pathologize normal developmental processes (Bosanac et al., 2010). Yet Professor Castle chooses to ignore this evidence in favour of repeating his own position. Furthermore, Professor Castle refers to his own estimate of the incidence rate of psychosis in the Early Psychosis Prevention and Intervention Centre (EPPIC) but supplies no evidence to back this up, his only reference in support of his finding being a line in a similar opinion piece (Castle, 2011). Finally in a selective omission, Professor Castle discusses the effects of duration of untreated psychosis (DUP) without reference to the biggest trial of early detection to reduce DUP, the Norwegian TIPS study, referred to above. All this escapes the attention of Dr Amos. My article recognized that there are research gaps in the EI area. It stated that there are patients who will experience poor outcomes despite receiving EI. It is important to recognize both of these aspects so that we can continue to create knowledge, evaluate new systems of managing our patients and identify those that need additional treatment. Debate is important so that treatment, services and policy are evidence-based. But dismissing all evidence in favour of early detection and intervention by selectively quoting the literature and uncritically accepting the claims of the EI critics fails our patients and their families.