Publications
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Skoge, Mari; Støme, Linn Nathalie; Aminoff, Sofie Ragnhild; Ihler, Henrik Myhre; Kværner, Kari Jorunn & Vink, Josina
[Show all 7 contributors for this article]
(2026).
Toward hybrid mental health care: an early health technology assessment based on stakeholder analysis and economic simulations.
International Journal of Technology Assessment in Health Care.
ISSN 0266-4623.
42(1).
doi:
10.1017/S0266462326103985.
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Objectives
Combining digital and traditional treatment elements as part of a hybrid care delivery model may strengthen the sustainability of mental health care. However, implementation problems permeate efforts of digitalizing routine care. The objective of this formative study is to explore current unmet stakeholder needs and the potential value of hybrid care models for the treatment of severe mental disorders, in order to guide further research and inform practical implementation strategies.
Methods
We applied Step Up, an early health technology assessment (eHTA) framework. We performed (a) a template analysis of qualitative data from a stakeholder workshop mapping unmet needs, potential effects of hybrid care models, and conditions relevant for implementation and (b) exploratory economic simulations of the impact of increasing video consultation use in routine services on quantitative sustainability parameters.
Results
The template analysis revealed stakeholder-anticipated value from hybrid care models across all domains: patient, clinician, and next-of-kin user experiences; clinical variables; organizational setup; and economy. Two recommendations for enhancing implementation were identified: promoting nuanced perceptions of digitalized care and developing clinician incentives. The simulations demonstrated that a moderate increase in video consultations may impact clinical capacity, as well as economic and environmental sustainability.
Conclusions
This study provides early decision support concerning hybrid care models during the conceptual stage of service innovation. It reveals that conservative changes toward digitalized practices can create new opportunities for organizing services and have a substantial impact on sustainability parameters. Successful implementation across clinical contexts requires continuous consideration of the clinician user perspective, starting from the conceptual phase.
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Vink, Josina; Romm, Jonathan; Ihler, Henrik Myhre & Romm, Kristin Lie
(2026).
Staying Alive to the Possibilities of Becoming: Designing for Hope in Uncertain Futures.
DIID - Disegno Industriale Industrial Design.
ISSN 1594-8528.
p. 40–57.
doi:
10.30682/diid8826c.
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At the core of designing futures is ‘possibility’, not just predictability. While design has embraced a host of futures methods that explore what ‘might’ or ‘could’ happen, such as scenarios, there remains a tendency to ignore the discomfort that comes with embracing the unknown. A failure to attune to the tolerance for uncertainty of those involved, risks their aversion to the process and proposals of designing futures. The purpose of this research is to understand how designing futures can support actors in staying “alive to the possibilities of becoming” (Barad, 2007, p. 396), with particular regard to navigating their discomfort with uncertainty. Drawing on learnings from two attempts at designing futures within mental healthcare systems in Norway, this paper presents strategies for designing that premise future potentialities as situated within the thick, unfolding present. This research offers a pathway for stewarding emerging potentialities by working intentionally with time as nested and agency as relational to cultivate hope in uncertain futures.
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Skoge, Mari; Aminoff, Sofie Ragnhild; Ihler, Henrik Myhre; Kværner, Kari Jorunn; Støme, Linn Nathalie & Romm, Kristin Lie
(2026).
Exploring Video Consultations Across the Public and Private Sectors in Norway: Semistructured Interview Study.
JMIR Human Factors.
13.
doi:
10.2196/80812.
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Background:
Delivering therapy through video consultations can increase the reach and impact of mental health care services. However, adoption varies, and there is a lack of professional consensus about the usefulness of video consultations in therapy settings.
Objective:
This study aimed to explore mental health professionals’ experiences with and attitudes toward video consultations across different clinical environments in the private and public health care sectors in Norway to inform the design of future digitalized services.
Methods:
In this qualitative study, we recruited leaders and clinicians from public hospitals and private clinics. We conducted semistructured interviews that mapped individual experiences and attitudes concerning video consultations, as well as contextual aspects concerning the participants’ professional environments. We used reflexive thematic analysis with an inductive, essentialist, and experiential orientation to analyze the data.
Results:
A total of 24 mental health professionals (16 from public hospitals and 8 from private clinics) participated. Variations in their attitudes did not follow patterns reflecting the type of service or sector they worked in. Rather, attitudes seemed related to higher-level assumptions rooted in professional culture, societal values, and previous experiences. We generated six themes capturing and structuring the professional perspectives: (1) meta-perspectives on the digitalization of therapeutic rooms, (2) the “how” of service integration, (3) challenging therapist culture, (4) negotiating the limits of the digital therapy room, (5) creating clinical value from the digital format, and (6) adapting techniques and technology in digital therapy sessions.
Conclusions:
To strengthen the adoption and impact of video consultations, we should direct attention toward higher-level societal and cultural aspects that shape attitudes and practices. We suggest incorporating digitalized therapy in education, facilitating personal experiences with video consultations, increasing the sharing of knowledge between clinical environments, and sparking innovation of both service models and technology.
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Skoge, Mari; Aminoff, Sofie Ragnhild; Barrett, Elizabeth Ann; Bryhni, Gina Engen; Kling, Kristine & Kvaerner, Kari Jorunn
[Show all 13 contributors for this article]
(2025).
A Mobile App Designed to Promote Shared Decision-Making in the Treatment of Psychotic Disorders: Feasibility and Acceptability Study.
JMIR Human Factors.
12.
doi:
10.2196/68813.
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Abstract Background Strengthening shared decision-making in mental health care may improve the quality of services and treatment outcomes, but its implementation in services for severe mental disorders is currently lacking. Objective This study aims to explore the feasibility and acceptability of iTandem (University of Oslo), a mobile app designed to promote shared decision-making in the treatment of psychotic disorders. In addition, the study aims to investigate mechanisms that potentially contribute to the intended effect of the app. iTandem is a therapy supplement that facilitates patient involvement in decisions regarding treatment goals and focus areas. It is designed for personalized use and contains 8 optional modules: sleep, medication, recovery, mood, psychosis, activity, substance use, and feedback concerning therapy. Methods Patients undergoing assessment or treatment for psychotic disorders and their clinicians were recruited for the study. Patients and clinicians jointly used iTandem as part of standard treatment in a 6-week trial. We used a mixed-methods study design with a clear emphasis on qualitative methods. Feasibility and acceptability were assessed through descriptive statistics based on preintervention and postintervention questionnaires and app usage data, in addition to text responses to open-ended items. We conducted a reflexive thematic analysis of postintervention interviews to elaborate these measures and to explore mechanisms potentially contributing to achieving shared decision-making when using iTandem. Results A total of 9 patients and 8 clinicians completed the trial. The participants evaluated iTandem as a user-friendly and acceptable tool, but there were considerable variations in how the app was integrated into treatment and in perceptions of its clinical value. The thematic analysis suggests that iTandem has the potential to facilitate shared decision-making through supporting cognition and shifting the patient’s role. We also identified scaffolding structures, an analogy of personalized support, as a precondition for these mechanisms and for the overall feasibility and acceptability of iTandem. Conclusions iTandem was generally perceived as a feasible and acceptable tool in the treatment of patients with psychotic disorders. Our findings suggest that nonclinical aspects, such as support structures, are important to the feasibility and acceptability of such digital interventions and patients’ aptness for digitalized treatment in general. Future research should explore related nonclinical aspects further instead of defining potential target groups based on diagnoses and symptom severity alone.
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Åsbø, Gina; Haavind, Hanne; Kruse, Sindre Hembre; Wold, Kristin Fjelnseth; Hegelstad, Wenche & Romm, Kristin Lie
[Show all 10 contributors for this article]
(2025).
“Why shouldn’t I expect a lot from life?” – a qualitative study of what facilitates long-term recovery in first-episode psychosis.
BMC Psychiatry.
25.
doi:
10.1186/s12888-025-06681-y.
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Background Qualitative research frequently characterises recovery, but more knowledge on subjective experiences of facilitators of long-term recovery in psychosis is needed. This interview study aimed to explore what people with first-episode psychosis (FEP) highlight as important for their long-term recovery. Methods Interviews with 20 individuals in recovery (personal and/or clinical) participating in two follow-up studies, 10 and 20-years after treatment start for a first episode schizophrenia or bipolar spectrum disorder. Interviews were thematically analysed by a research team that included a peer researcher. Results The analysis generated that personal resources and agency were experienced as the overarching facilitators of recovery, with five themes: (1) Doing recovery in everyday life, involving agency in daily life; (2) Re-evaluating risk, involving re-evaluating limitations and stress reduction; (3) Becoming a caregiver, involving development from being cared for to taking care of others; (4) Negotiating normality, involving identity and social inclusion; (5) Owning and sharing your story, involving accepting lived experience and overcoming stigma. Discussion All participants described themselves as the main facilitators of their own recovery, and treatment as secondary to their efforts. Gradually testing limitations and taking risks, providing social support to others, as well as owning and sharing your story were crucial for promoting long-term recovery in FEP. Clinical implications include supporting service users’ agency with strength- based interventions and shared-decision making, as well as refining psychoeducation on stress reduction in a long-term perspective.
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Gjerdalen, Oda Skancke; Zucknick, Manuela; Westlie, Ingvild Tvedt; Bull, Helen; Evensen, Stig & Falkum, Erik
[Show all 17 contributors for this article]
(2025).
An exploratory study of the relevance of therapy format and therapist’ training in individual cognitive behavioral therapy for psychosis.
Frontiers in Psychiatry.
16.
doi:
10.3389/fpsyt.2025.1527549.
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Introduction: Cognitive Behavioral Therapy for psychosis (CBTp) is an evidence-based intervention that can be delivered in various formats, including as part of vocational rehabilitation. However, due to scarcity of resources, CBTp is currently accessible to only a minority of individuals with psychosis. This secondary analysis aims to explore potential differences in clinical outcomes between distinct CBTp formats and to examine whether therapist training influences treatment effect. Exploring these aspects is of importance, as they may influence the scalability and accessibility of CBTp in routine care.
Material and methods: Data in this study is sourced from two independent projects; KATOslo and JUMP, comprising a total of 200 participants with broad schizophrenia-spectrum disorders. The current study compares CBTp delivered as either symptom-focused individual therapy (KATOslo) or as an add-on to a vocational rehabilitation (VR) program (JUMP), with two reference groups; VR combined with cognitive remediation (JUMP) and treatment as usual (KATOslo). Using a series of mixed effects models for repeated measurements, we examined differences between the groups in terms of general functioning and psychiatric symptom severity. Emphasis was placed on potential differences between the two groups receiving CBTp, considering both average differences across assessment points and trajectories over time.
Results: In line with expectations, all groups demonstrated overall improvements in functioning and symptom levels. After adjusting for relevant confounders, no statistically significant differences were found between the two groups receiving CBTp following treatment initiation.
Conclusions: These findings suggest that CBTp may be effective across different delivery formats and levels of therapist training in terms of similar, positive clinical outcomes for this patient group. This has potential implications for service design and broader implementation of CBTp in real-world settings.
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Simonsen, Carmen; Åsbø, Gina; Slade, Michael; Wold, Kristin Fjelnseth; Widing, Line Hustad & Flaaten, Camilla Bärthel
[Show all 13 contributors for this article]
(2024).
A good life with psychosis: Rate of positive outcomes in first-episode psychosis at 10-year follow-up.
Psychological Medicine.
ISSN 0033-2917.
54(9),
p. 2112–2121.
doi:
10.1017/S0033291724000205.
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Background More knowledge about positive outcomes for people with first-episode psychosis (FEP) is needed. An FEP 10-year follow-up study investigated the rate of personal recovery, emotional wellbeing, and clinical recovery in the total sample and between psychotic bipolar spectrum disorders (BD) and schizophrenia spectrum disorders (SZ); and how these positive outcomes overlap. Methods FEP participants (n = 128) were re-assessed with structured clinical interviews at 10-year follow-up. Personal recovery was self-rated with the Questionnaire about the Process of Recovery-15-item scale (total score ⩾45). Emotional wellbeing was self-rated with the Life Satisfaction Scale (score ⩾5) and the Temporal Experience of Pleasure Scale (total score ⩾72). Clinical recovery was clinician-rated symptom-remission and adequate functioning (duration minimum 1 year). Results In FEP, rates of personal recovery (50.8%), life satisfaction (60.9%), and pleasure (57.5%) were higher than clinical recovery (33.6%). Despite lower rates of clinical recovery in SZ compared to BD, they had equal rates of personal recovery and emotional wellbeing. Personal recovery overlapped more with emotional wellbeing than with clinical recovery (χ2). Each participant was assigned to one of eight possible outcome groups depending on the combination of positive outcomes fulfilled. The eight groups collapsed into three equal-sized main outcome groups: 33.6% clinical recovery with personal recovery and/or emotional wellbeing; 34.4% personal recovery and/or emotional wellbeing only; and 32.0% none. Conclusions In FEP, 68% had minimum one positive outcome after 10 years, suggesting a good life with psychosis. This knowledge must be shared to instill hope and underlines that subjective and objective positive outcomes must be assessed and targeted in treatment.
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Åsbø, Gina; Haavind, Hanne; Kruse, Sindre Hembre; Wold, Kristin Fjelnseth; Hegelstad, Wenche & Romm, Kristin Lie
[Show all 10 contributors for this article]
(2024).
Taking what you get or Getting what you Need: A Qualitative Study on Experiences with Mental Health and Welfare Services in Long-Term Recovery in First-Episode Psychosis.
Community mental health journal.
ISSN 0010-3853.
24.
doi:
10.1007/s10597-024-01356-6.
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How people in long-term recovery (clinical and personal) in first-episode psychosis (schizophrenia and bipolar spectrum disorders) experience the mental health and welfare services they interact with is not frequently studied but has significant implications. We therefore aimed to explore which aspects of these services people with FEP evaluate as important for their long-term recovery. Twenty participants in clinical and/or personal recovery from two Norwegian long-term follow-up studies after FEP (TOP 10-year and TIPS 20-year) were sampled for this interview-based qualitative study. The research-team included service user experience. A deductive analysis based on personal accounts of recovery generated five service aspects. Few specific types of interventions were reported to promote recovery although medications, psychotherapy and employment support were mentioned. Participants valued services based in collaboration and that focused on their resources rather than limitations. The importance of long-term follow-up with a consistent aim was highlighted, as was the inclusion of caregivers and peers. Welfare services contributed to recovery by supporting basic needs and safety, but some experienced social exclusion when not participating in the labor market. This study is unique in exploring the role of services, including welfare, in long-term FEP recovery from service user perspectives. Participants evaluated that services played a more indirect role in long-term recovery by supporting their personal resources, although what they needed from services had frequently not been offered. Their expertise by experience contributes valuable knowledge. Better service coordination and consistent implementation of this knowledge are crucial to support recovery in FEP.
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Wold, Kristin Fjelnseth; Ottesen, Akiah; Flaaten, Camilla Bärthel; Kreis, Isabel; Lagerberg, Trine Vik & Romm, Kristin Lie
[Show all 10 contributors for this article]
(2024).
Childhood trauma and treatment resistance in first-episode psychosis: Investigating the role of premorbid adjustment and duration of untreated psychosis.
Schizophrenia Research.
ISSN 0920-9964.
270,
p. 441–450.
doi:
10.1016/j.schres.2024.07.001.
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Background Early identification of treatment non-response in first-episode psychosis (FEP) is essential to outcome. Despite indications that exposure to childhood trauma (CT) can have adverse effects on illness severity, its impact on treatment non-response and the interplay with other pre-treatment characteristics is sparsely investigated. We use a lack of clinical recovery as an early indicator of treatment resistance to investigate the relationship between CT and treatment resistance status at one-year follow-up and the potential mediation of this effect by other pre-treatment characteristics. Methods This prospective one-year follow-up study involved 141 participants recruited in their first year of treatment for a schizophrenia-spectrum disorder. We investigated clinical status, childhood trauma (CT), premorbid adjustment (PA), and duration of untreated psychosis (DUP) at baseline and clinical status at one-year follow-up. Ordinal regression analyses were conducted to investigate how PA and DUP affected the relationship between CT and one-year outcome in FEP. Results 45 % of the FEP sample reported moderate to severe CT, with significantly higher levels of CT in the early treatment resistant group compared to participants with full or partial early recovery. Ordinal regression analysis showed that CT was a significant predictor of being in a more severe outcome group (OR = 4.59). There was a partial mediation effect of PA and a full mediation effect of DUP on the effect of CT on outcome group membership. Discussion Our findings indicate that reducing treatment delays may mitigate the adverse effects of CT on clinical outcomes and support the inclusion of broad trauma assessment in FEP services.
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Langjord, Tuva; Pedersen, Geir Arild Feigum; Bovim, Tone Helene; Bremer, Kjetil; Christensen, Tore Buer & Hove, Oddbjørn
[Show all 20 contributors for this article]
(2024).
Evaluation of health services and treatment alliance among extensively hospitalized patients due to severe self-harm – results from the Extreme Challenges project.
Nordic Journal of Psychiatry.
ISSN 0803-9488.
78(7),
p. 591–602.
doi:
10.1080/08039488.2024.2376162.
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Background - Extensive psychiatric hospitalization due to repeated severe self-harm (SH), is a poorly researched area, but a challenge within health services (HS). Recent studies have demonstrated high levels of involuntary treatment among patients with severe personality disorder (PD) and complex comorbidity. Keeping focus on extensively hospitalized SH patients, this study aimed to investigate patients’ and clinicians’ evaluation of HS and treatment alliance. Method - A cross-sectional study with an inpatient sample (age >18 years) with frequent (>5) or long (>4 weeks) psychiatric hospital admissions last year due to SH or SA recruited from 12 hospitals across health regions (N = 42). Evaluation included patient and clinician report. Results - A minority of the patients (14%) were satisfied with HS before the current admission, 45% (patients) and 20% (clinicians) found the current admission helpful, and 46% (patients) and 14% (clinicians) worried about discharge. Treatment complaints were received in 38% of the cases. Outpatient mental HS were available after discharge for 68% and a majority of clinicians indicated satisfactory contact across HS. More intensive or specialized formats were unusual (structured outpatient treatment 35%, day treatment 21%, ambulatory services 32%, planned inpatient services 31%). Mutual problem understanding, aims, and confidence in therapists during the hospital stay were limited (patient-rated satisfactory mutual problem understanding: 39%, aims of stay: 50%, confidence: 50%). Patient and therapist alliance-ratings were in concordance for the majority. Conclusion - The study highlights poor HS satisfaction, poor patient–therapist coherence, limited treatment alliance and limited follow-up in structured treatments addressing SH or intermediary supportive ambulatory/day/inpatient services.
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Ihler, Henrik Myhre; Lyngstad, Siv Hege; Mørch-Johnsen, Lynn Egeland; Lagerberg, Trine Vik; Melle, Ingrid & Romm, Kristin Lie
(2023).
A transdiagnostic approach to negative symptoms: exploring factor structure and negative symptoms in bipolar disorders.
Frontiers in Psychiatry.
14.
doi:
10.3389/fpsyt.2023.1136097.
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Background Negative symptoms are increasingly recognized as transdiagnostic phenomena, linked to reduced quality of life and functioning, and often caused or worsened by amendable external factors such as depression, social deprivation, side-effects of antipsychotics or substance use. The structure of negative symptoms fits into two dimensions: diminished expression and apathy. These may differ in association with external factors that influence their severity and may thus require different treatment approaches. The dimensions are comprehensively established in non-affective psychotic disorders but are understudied in bipolar disorders. Methods We conducted exploratory and confirmatory factor analyses in a sample of 584 individuals with bipolar disorder to assess the latent factor structure of negative symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), and performed correlational analyses and multiple hierarchical regression analyses to investigate links between the two dimensions of negative symptoms and clinical and sociodemographic correlates. Results The latent factor structure of negative symptoms fits into two dimensions, i.e., diminished expression and apathy. A diagnosis of bipolar type I or a history of psychotic episodes predicted more severe levels of diminished expression. Depressive symptoms were associated with more severe negative symptoms across dimensions, yet 26.3% of euthymic individuals still displayed at least one mild or more severe negative symptom (PANSS score ≥ 3). Discussion The two-dimensional structure of negative symptoms seen in non-affective psychotic disorders reproduces in bipolar disorders indicating similarities in their phenomenology. Diminished expression was associated with a history of psychotic episodes and a diagnosis of BD-I, which may infer closer connections to psychosis liability. We found significantly less severe negative symptoms in euthymic than depressed participants. Nevertheless, more than a quarter of the euthymic individuals had at least one mild negative symptom, demonstrating some degree of persistence beyond depressed states.
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Ihler, Henrik Myhre; Lyngstad, Siv Hege; Gardsjord, Erlend Strand; Widing, Line Hustad; Flaaten, Camilla Bärthel & Åsbø, Gina
[Show all 13 contributors for this article]
(2023).
The trajectory of two negative symptom dimensions in first-episode psychosis and the role of cannabis use: A 10-year follow-up study.
Schizophrenia Research.
ISSN 0920-9964.
252,
p. 317–325.
doi:
10.1016/j.schres.2023.01.024.
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Objective To investigate the trajectories of diminished expression and apathy over 10 years. Further, to explore the effects of baseline- and persistent cannabis use on the development of diminished expression and apathy during follow-up, while controlling other potential sources and predictors of secondary negative symptoms. Methods 351 participants with a first episode of non-affective psychosis were examined at baseline and invited to follow-up at one year and 10 years. The trajectories of diminished expression and apathy were investigated using linear mixed models. Subsequently, cannabis use and other potential predictors and sources of secondary negative symptoms were added to the model to investigate the respective impact on their trajectories. Results The severity of both diminished expression and apathy decreased during the follow-up period after the first episode of psychosis, with the most improvement observed from baseline to 1-year follow-up. Cannabis use at baseline was associated with a long-lasting higher symptom load for diminished expression, but not apathy. Introducing persistent cannabis use to the model further strengthened the association with diminished expression. Conclusion Both cannabis use at baseline and persistent cannabis use after a first episode of psychosis were associated with more severe symptoms of diminished expression. Our results imply a causal relationship between cannabis use and diminished expression and suggest that measures to reduce cannabis use both before and after psychosis onset may reduce expressive negative symptoms.
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Langjord, Tuva; Pedersen, Geir Arild Feigum; Bovim, Tone Helene; Christensen, Tore Buer; Eikenæs, Ingeborg Helene Ulltveit-Moe & Hove, Oddbjørn
[Show all 21 contributors for this article]
(2023).
Mental health disorders, functioning and health-related quality of life among extensively hospitalized patients due to severe self-harm – results from the Extreme Challenges project.
Frontiers in Psychiatry.
14.
doi:
10.3389/fpsyt.2023.1258025.
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Background: Severe self-harm leading to extensive hospitalization generates extreme challenges for patients, families, and health services. Controversies regarding diagnoses and health care often follow. Most evidence-based treatments targeting self-harm are designed for borderline personality disorder (BPD). However, current knowledge about mental health status among individuals with severe self-harm is limited. Objectives: To investigate psychopathology among patients extensively hospitalized due to severe or frequent self-harming behaviors. Method: A cross sectional study (period 2019–2021) targeting psychiatric inpatients (>18 years) with frequent (>5) or long (>4 weeks) admissions last year due to self-harm. The target sample (N = 42, from 12 hospitals across all Norwegian health regions) was compared to individuals admitted to outpatient personality disorder (PD) treatment within specialist mental health services in the same period (N = 389). Clinicians performed interviews on self-harm and psychopathology, supplemented by self-report. Results: The target sample were young adults, mainly female, with considerable hospitalization and self-harming behaviors, both significantly more extensive than the comparison group. The majority in both groups reported self-harm onset <18 years. The target sample reported increasing severity of self-harm acts and suicidal intention over time. Both samples had high levels of childhood trauma, impaired personality functioning, and a majority fulfilled criteria for PD. In the target sample, comorbid depression, PTSD, anxiety disorders, and substance use occurred more frequently and in 50%, psychosis/dissociative disorder/autism spectrum disorder/ADHD was reported (outpatient comparison sample: 9%). 35% in the target sample screened over cut-off for possible intellectual disability. The target sample reported poor psychosocial functioning and health-related quality of life – greater impairment than the outpatient comparison sample. Conclusion: The study reveals that severe self-harm inpatients have complex psychopathology and highlights the importance of individualized and thorough assessment among patients with severe and/or repetitive self-harm.
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Wold, Kristin Fjelnseth; Ottesen, Akiah; Flaaten, Camilla Bärthel; Johnsen, Erik; Lagerberg, Trine Vik & Romm, Kristin Lie
[Show all 11 contributors for this article]
(2023).
Early identification of treatment non-response in first-episode psychosis.
European psychiatry.
ISSN 0924-9338.
66(1).
doi:
10.1192/j.eurpsy.2023.15.
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Background Approximately one-third of patients with psychotic disorders does not respond to standard antipsychotic treatments. Consensus criteria for treatment resistance (TR) may aid the identification of non-response and subsequent tailoring of treatments. Since consensus criteria require stability of clinical status, they are challenging to apply in first-episode psychosis (FEP). This study aims to investigate (a) if an adaptation of consensus criteria can be used to identify FEP patients with early signs of TR (no early clinical recovery—no-ECR) after 1 year in treatment and (b) to what extent differences in antipsychotic treatments differentiate between outcome groups. Methods Participants with FEP DSM-IV schizophrenia spectrum disorders were recruited during their first treatment. A total of 207 participated in the 1-year follow-up. Remission and recovery definitions were based on adaptations of the “Remission in Schizophrenia Working Group” criteria and TR on adaptations of the “Treatment Response and Resistance in Psychosis” (TRRIP) working group criteria. Results 97 participants (47%) could be classified as no-ECR, 61 (30%) as ECR, and 49 (23%) as with partial ECR (P-ECR). Statistically significant baseline predictors of no-ECR matched previously identified predictors of long-term TR. Only 35 no-ECR participants had two adequate treatment trials and met the full TRRIP criteria. 21 no-ECR participants were using the same medication over the follow-up year despite the lack of significant effects. Conclusion The difference in the percentage of FEP participants classified as no-ECR versus TR indicates that we may underestimate the prevalence of early TR when using consensus criteria.
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Saidi, Trust; Mork, Erlend; Aminoff, Sofie Ragnhild; Lobban, Fiona & Romm, Kristin Lie
(2023).
Crossing boundaries in the delivery of healthcare – a qualitative study of an eHealth intervention in relation to boundary object theory.
Digital Health.
9,
p. 1–11.
doi:
10.1177/20552076231196970.
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With the increasing trend of digitalisation in the health sector, eHealth is being deployed to facilitate interaction between health professionals and service users without physical contact or close proximity. It became prominent during the COVID-19 era when mobility for physical meetings was restricted. Focusing on a video-supported digital toolkit, REACT-NOR, this study explored the experiences of caregivers and supporters in relation to the notion of boundary object. In-depth semi-structured interviews were conducted with 10 supporters and 11 caregivers to gather first-hand experience on the use of the digital tool. It emerged from the study that the use of REACT-NOR made a huge difference for the involved parties by bridging the knowledge gap between supporters and caregivers. The use of the video in particular was useful in engaging and emotionally connecting the supporters and caregivers, resulting in an exciting digital experience. The effectiveness of the digital tool can be explained in the context of a boundary object in that it facilitated the processes of transferring, translating and transforming knowledge. The tool exhibited the attributes of dynamism, flexibility, standardisation and shared structure, which resonates with the notion of a boundary object. An understanding of how boundary objects work is crucial especially with remote care, as depicted in this study, due to the fact that the transfer of knowledge involves multiple processes such as sharing of new and existing knowledge, translation to make it accessible to others and transformation to render it usable across different boundaries.
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Aminoff, Sofie Ragnhild; Onyeka, Ifeoma Nkeiruka; Ødegaard, Marte; Simonsen, Carmen Elisabeth; Lagerberg, Trine Vik & Andreassen, Ole
[Show all 8 contributors for this article]
(2022).
Lifetime and point prevalence of psychotic symptoms in adults with bipolar disorders: a systematic review and meta-analysis.
Psychological Medicine.
ISSN 0033-2917.
52(13),
p. 2413–2425.
doi:
10.1017/S003329172200201X.
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Abstract Psychotic symptoms, that we defined as delusions or hallucinations, are common in bipolar disorders (BD). This systematic review and meta-analysis aims to synthesise the literature on both lifetime and point prevalence rates of psychotic symptoms across different BD subtypes, including both BD type I (BDI) and BD type II (BDII). We performed a systematic search of Medline, PsycINFO, Embase and Cochrane Library until 5 August 2021. Fifty-four studies ( N = 23 461) of adults with BD met the predefined inclusion criteria for evaluating lifetime prevalence, and 24 studies ( N = 6480) for evaluating point prevalence. Quality assessment and assessment of publication bias were performed. Prevalence rates were calculated using random effects meta-analysis, here expressed as percentages with a 95% confidence interval (CI). In studies of at least moderate quality, the pooled lifetime prevalence of psychotic symptoms in BDI was 63% (95% CI 57.5–68) and 22% (95% CI 14–33) in BDII. For BDI inpatients, the pooled lifetime prevalence was 71% (95% CI 61–79). There were no studies of community samples or inpatient BDII. The pooled point prevalence of psychotic symptoms in BDI was 54% (95 CI 41–67). The point prevalence was 57% (95% CI 47–66) in manic episodes and 13% (95% CI 7–23.5) in depressive episodes. There were not enough studies in BDII, BDI depression, mixed episodes and outpatient BDI. The pooled prevalence of psychotic symptoms in BDI may be higher than previously reported. More studies are needed for depressive and mixed episodes and community samples. Prospero registration number: CRD 42017052706.
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Romm, Kristin Lie; Synnes, Oddgeir & Bondevik, Hilde
(2022).
Creative writing as a means to recovery from early psychosis – Experiences from a group intervention.
Arts and Health.
ISSN 1753-3015.
doi:
10.1080/17533015.2022.2130379.
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Background: In this paper, we explore the subjective experiences of a group intervention in creative writing (CW) for young adults being treated for psychosis. Method: A qualitative and exploratory design was applied. Five out of eight patients who were offered a course in CW with two-hour weekly sessions for 12 weeks took part in this study. The five participants who followed through were interviewed after project termination. Systematic text condensation was applied to the transcribed interviews. Results: The analysis revealed three overarching themes: a) the group was valued as a creative community, b) there was safety in the structured yet flexible framing of the course, c) the participants experienced creative freedom that enabled a feeling of mastery. Conclusion: CW was well conceived. The feelings of connectedness and mastery were prominent. The participants experienced growth on several levels. Our findings support previous work on arts therapy as a means to recovery.
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Mork, Erlend; Aminoff, Sofie Ragnhild; Barrett, Elizabeth Ann; Simonsen, Carmen Elisabeth; Hegelstad, Wenche & Lagerberg, Trine Vik
[Show all 8 contributors for this article]
(2022).
COVID-19 lockdown – who cares? The first lockdown from the perspective of relatives of people with severe mental illness.
BMC Public Health.
22(1),
p. 1–12.
doi:
10.1186/s12889-022-13458-5.
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Background Informal care is vital to many people with severe mental illness under normal circumstances. Little is known about how extraordinary circumstances affect relatives with a family member with mental illness. This study investigated the consequences of the first COVID-19 lockdown in Norway from the perspective of relatives of persons with psychotic- and/or bipolar disorders: What were the challenges and for whom? Method Relatives were invited to complete an online survey shortly after the first lockdown was initiated. Both quantitative and qualitative data were collected concerning experiences of relatives’ own and their affected family members’ health and situation. Two hundred and seventy-nine relatives completed the survey, mostly mothers and partners. Results One-third of the relatives reported considerable deterioration in their family members’ mental health, and a substantial minority worried about severe self-harm or suicide. Main themes in the qualitative analyses were “Isolation and its effects on mental health”, “Worrying about the pandemic and its consequences”, “Increased symptomatology” and “Suicide”. Being a relative during the lockdown put heavy strain on the relatives’ own health, in particular disturbance of sleep, concentration, and the ability to take care of others in the family. Relatives of family members with psychotic bipolar disorder, not currently in treatment, or living with their family experienced the situation especially challenging. Conclusions Many relatives found the first lockdown hard for their family. Efforts to integrate relatives’ perspectives in health care and contingency plans under normal circumstances could potentially alleviate some of the extra burden experienced by families during extraordinary circumstances.
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Åsbø, Gina; Ueland, Torill; Haatveit, Beathe; Bjella, Thomas; Flaaten, Camilla Bärthel & Wold, Kristin Fjelnseth
[Show all 13 contributors for this article]
(2022).
The Time is Ripe for a Consensus Definition of Clinical Recovery in First-episode Psychosis: Suggestions Based on a 10-Year Follow-up Study.
Schizophrenia Bulletin.
ISSN 0586-7614.
48(4),
p. 839–849.
doi:
10.1093/schbul/sbac035.
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Abstract Objectives A consensus definition of clinical recovery in first-episode psychosis (FEP) is required to improve knowledge about recovery rates in this population. To propose criteria for a future consensus definition, this study aims to investigate rates of clinical recovery when using a standard definition (full psychotic symptom remission and adequate functioning for minimum one year) across both affective and nonaffective FEP groups (bipolar spectrum and schizophrenia spectrum disorders). Second, we aim to explore changes in rates when altering the standard definition criteria. Third, to examine the extent to which healthy controls meet the functioning criteria. Study design In total, 142 FEP participants and 117 healthy controls preselected with strict criteria, were re-assessed with structured clinical interviews at 10-year follow-up. Study results A total of 31.7% were in clinical recovery according to the standard definition, with significantly higher recovery rates in bipolar (50.0%) than in schizophrenia spectrum disorders (22.9%). Both groups’ recovery rates decreased equally when extending duration and adding affective symptom remission criteria and increased with looser functioning criteria. In healthy controls, 18.8% did not meet the standard criteria for adequate functioning, decreasing to 4.3% with looser criteria. Conclusions Findings suggest that clinical recovery is common in FEP, although more in bipolar than in schizophrenia spectrum disorders, also when altering the recovery criteria. We call for a future consensus definition of clinical recovery for FEP, and suggest it should include affective symptom remission and more reasonable criteria for functioning that are more in line with the general population.
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Barrett, Elizabeth Ann; Simonsen, Carmen Elisabeth; Aminoff, Sofie Ragnhild; Hegelstad, Wenche; Lagerberg, Trine Vik & Melle, Ingrid
[Show all 8 contributors for this article]
(2022).
The COVID-19 pandemic impact on wellbeing and mental health in people with psychotic and bipolar disorders.
Brain and Behavior.
p. 1–18.
doi:
10.1002/brb3.2559.
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Introduction The COVID-19 pandemic affects people globally, but it may affect people with psychotic and bipolar disorders disproportionally. Our aims were to investigate the pandemic impact on perceived wellbeing and mental health in this population, including which pandemic-related factors have had an impact. Methods People with psychotic and bipolar disorders (N = 520; female = 81%; psychotic disorders n = 75/bipolar disorder n = 445) completed an online survey about wellbeing and mental health in the early phase of the COVID-19 pandemic (June 5–July 5, 2020). Results Many participants experienced deteriorated wellbeing and mental health after the pandemic outbreak, especially in life satisfaction, meaning in life, positive feelings, depression, anxiety, and self-harm/suicidal ideation. Experienced recovery from mental health difficulties was significantly lower after compared to before the outbreak. Participants with psychotic disorders had significantly poorer wellbeing and mental health than participants with bipolar disorders, although they experienced significantly more worsening only of psychotic symptoms. Nearly half the participants reported coping with the situation; however, most factors potentially important to wellbeing and mental health changed adversely, including sufficiency and quality of treatment. More loneliness, low coping, insufficient mental health treatment during the COVID-19 pandemic, pandemic worry, more insomnia symptoms, and increased alcohol use predicted poor wellbeing and poor mental health. Conclusions During a pandemic, it is particularly important that mental health services strive to offer the best possible treatment under the current conditions and target loneliness, coping strategies, pandemic worry, insomnia, and increased alcohol use to uphold wellbeing and reduce mental health difficulties. For some, teletherapy is an agreeable substitute for traditional therapy.
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Aminoff, Sofie Ragnhild; Mork, Erlend; Barrett, Elizabeth Ann; Simonsen, Carmen Elisabeth; Hegelstad, Wenche & Lagerberg, Trine Vik
[Show all 8 contributors for this article]
(2022).
Locked out during COVID‑19 lockdown— an online survey of relatives of people with psychotic and bipolar disorders in Norway.
BMC Public Health.
22(294).
doi:
10.1186/s12889-022-12625-y.
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Background Many relatives of people with psychotic and bipolar disorders experience a high caregiver burden normally. During the first COVID-19 lockdown, mental health services partly shut down in many countries. The impact on relatives is unknown. Aims Explore how relatives of people with psychotic and bipolar disorders experienced changes in treatment and service availability for their family member during the first COVID-19 pandemic lockdown in the spring of 2020, and to what extent they perceived information and support to be satisfactory. To help guide future contingency plans, we were also interested in what relatives would prioritize in the event of a future crisis. Study setting We distributed an anonymous Norwegian online survey inviting relatives of individuals with psychotic and bipolar disorders. We distributed the survey using social media, through snowball sampling, collecting both quantitative and qualitative data. The survey was available between May and June 2020. We used systematic text condensation to analyse qualitative data. Results Two hundred and seventy-nine respondents replied, mostly mothers and partners. A majority experienced a reduction in health care for their family member. Most respondents did not receive any support during the lockdown. However, most found the information they received from the mental health services regarding their family members’ treatment as sufficient. The qualitative data analysis revealed that relatives experienced three major challenges: reductions in treatment for the family member; reduced organised daily activity for the family member; and an increased caretaker load. In the case of a future lockdown, they would prefer increased access to care compared with a normal situation; increased support for relatives; and enhanced information. Conclusions Mental health services in Norway did not manage to meet the needs of patients with severe mental illness and their relatives during the first COVID-19 lockdown. To be better prepared, Norwegian mental health services should consider prioritising infrastructure to ensure access to care and support for both patients and relatives. Digital tools and telephone calls are generally well accepted as substitutes for face-to-face contact.
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Ihler, Henrik Myhre; Lagerberg, Trine Vik; Lyngstad, Siv Hege; Melle, Ingrid & Romm, Kristin Lie
(2021).
Exploring the relationship between recency and frequency of cannabis use and diminished expression and apathy as two dimensions of negative symptoms in first episode psychosis. A one-year follow-up study.
Schizophrenia Research.
ISSN 0920-9964.
doi:
10.1016/j.schres.2021.08.004.
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The association between cannabis use and negative symptoms remains unclear because of inconsistent results in existing studies. In this study we aimed to investigate the association between different aspects of cannabis use and 1) diminished expression and 2) apathy as a two-dimensional model of negative symptoms in a sample of 460 participants with first-episode psychosis. Data were collected on relevant clinical and demographic factors including diagnostics and habits of drug use at baseline, with a follow-up assessment after 12-months. We found an association between the frequency of cannabis use two years prior to baseline and the severity of diminished expression and apathy at baseline, while only the association to diminished expression held after controlling for potential clinical and demographic confounders. Frequency of cannabis use at baseline also had a significant effect on the development of diminished expression over the 12-month follow-up period. In conclusion, this study suggests that the frequency of cannabis use contributes to the severity of diminished expression at baseline, and to the progression of diminished expression after 12-months follow-up. Our findings also imply a dose-response relationship between frequency of use and severity of symptoms and add evidence to an association between cannabis use and negative symptoms.
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Synnes, Oddgeir Arne; Romm, Kristin Lie & Bondevik, Hilde
(2021).
The poetics of vulnerability: creative writing among young adults in treatment for psychosis in light of Ricoeur’s and Kristeva’s philosophy of language and subjectivity.
Medicine, Health care and Philosophy.
ISSN 1386-7423.
24.
doi:
10.1007/s11019-020-09998-5.
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There is a growing interest in the application of creative writing in the treatment of mental illness. Nonpharmacological approaches have shown that access to poetic, creative language can allow for the verbalisation of illness experiences, as well as for self-expressions that can include other facets of the subject outside of the disease. In particular, creative writing in a safe group context has proven to be of particular importance. In this article, we present a pilot on a creative writing group for young adults in treatment for psychosis. We set the texts and experiences from the writing group in dialogue with Paul Ricoeur’s and Julia Kristeva’s philosophies on poetic language as meaning making and part of subject formation. The focus is on language as materiality and potentiality and on the patient’s inherent linguistic resources as founded in a group dynamic. As a whole, the project seeks to give an increased theoretical and empirical understanding of the potentiality of language and creativity for healing experiences, participation and meaning-making processes among vulnerable people. Furthermore, a practice founded in poetic language might critically address both the general and biomedical understanding of the subject and disease.
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Værnes, Tor Gunnar; Røssberg, Jan Ivar; Melle, Ingrid; Nelson, Barnaby; Romm, Kristin Lie & Møller, Paul
(2021).
Basic self-disturbance in subjects at clinical high risk for psychosis: Relationship with clinical and functional outcomes at one year follow-up.
Psychiatry Research.
ISSN 0165-1781.
300.
doi:
10.1016/j.psychres.2021.113942.
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Basic self-disturbance (BSD) is assumed to drive symptom development in schizophrenia spectrum disorders and in clinical high-risk (CHR) for psychosis. We investigated the relationship between BSD at baseline, assessed with the Examination of Anomalous Self-Experience (EASE), and symptoms and functional outcome after one year in 32 patients, including 26 CHR and six with non-progressive attenuated psychotic symptoms. Correlations between baseline BSD levels and positive, negative and disorganization symptoms, and global functioning level at follow-up were significant. Hierarchical regression analyses revealed that higher levels of baseline BSD predicted more severe positive symptoms and lower global functioning at follow-up, after adjusting for baseline positive symptoms and functioning. Subjects who were not in symptomatic and functional remission after one year had higher levels of BSD and negative symptoms, and lower functioning level, at baseline. Baseline BSD in participants with schizophrenia spectrum diagnoses at follow-up (9 of 12 were schizotypal personality disorder) were at the levels seen in schizotypal disorders in previous studies, but not significantly different from the other participants. Early identification and assessment of BSD may constitute a useful prognostic tool and a signal for therapeutic targets in CHR conditions. Further CHR studies investigating these relationships with larger samples are recommended.
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Værnes, Tor Gunnar; Røssberg, Jan Ivar; Melle, Ingrid; Nelson, Barnaby; Romm, Kristin Lie & Møller, Paul
(2021).
Basic self-disturbance trajectories in clinical high risk for psychosis: a one-year follow-up study.
European Archives of Psychiatry and Clinical Neuroscience.
ISSN 0940-1334.
p. 1–13.
doi:
10.1007/s00406-021-01349-6.
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Abstract Basic self-disturbance (BSD) has been proposed as a driver of symptom development in schizophrenia spectrum disorders (SSDs). In a one-year follow-up of 32 patients (15–30 years) at putative risk for psychosis, we investigated trajectories of BSD levels from baseline to follow-up, and associations between clinical characteristics at baseline and follow-up, including follow-up levels of BSD (assessed with the EASE). Clinical high risk (CHR) for psychosis status and symptom severity were assessed with the SIPS/SOPS scales and also according to the cognitive basic symptoms high-risk criteria (COGDIS). DSM-IV diagnoses, functioning and other clinical characteristics were assessed with standard clinical instruments. Higher severity of negative symptoms and meeting COGDIS criteria at baseline were associated with higher BSD levels at follow-up. All measured at follow-up, higher BSD levels correlated with higher severity of positive, negative, disorganization and general symptoms, and with a lower level of global functioning. We found higher BSD levels at follow-up in subjects with schizotypal personality disorder (SPD) at baseline ( n = 5) and in SSDs at follow-up ( n = 12, including nine with SPD). Mean BSD levels decreased significantly from baseline to follow-up, but individual trajectories varied considerably. Increased BSD levels were associated with higher baseline BSD levels, non-remission of positive symptoms and functional decline. Overall, the current study indicates that subgroups in the CHR population with a higher risk of non-remission or deterioration may be identified by supplementing CHR criteria with assessment of BSD and negative symptoms.
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Romm, Kristin Lie; Nilsen, Liv; Gjermundsen, Kristine; Holter, Marit; Fjell, Anne & Melle, Ingrid
[Show all 8 contributors for this article]
(2020).
Remote care for caregivers of people with psychosis: Mixed methods pilot study.
JMIR Mental health.
7(7),
p. 1–11.
doi:
10.2196/19497.
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Background A reduced availability of resources has hampered the implementation of family work in psychosis. Web-based support programs have the potential to increase access to high-quality, standardized resources. This pilot study tested the Norwegian version of the Relatives Education and Coping Toolkit (REACT), a web-based United Kingdom National Health Service program in combination with phone-based support by trained family therapists. Objective We investigated how the program was perceived by its users and identified the facilitators and barriers to its clinical implementation. Methods Relatives of people with psychosis were offered access to REACT and to weekly family therapist support (with 1 of 2 trained family therapists) for 26 weeks. Level of distress and level of expressed emotion data were collected at baseline and after 26 weeks using the Family Questionnaire and the Relatives Stress Scale. Both family therapists and a subset of the relatives were interviewed about their experiences after completing the program. Results During the program, relatives (n=19) had a median of 8 (range 4-11) consultations with the family therapists. Postintervention, there was a significant reduction in stress and in expressed emotions in the relatives of people with psychosis. Interviews with the relatives (n=7) and the family therapists (n=2) indicated the following themes as important—the intervention turned knowledge into action; the intervention strengthened the feeling of being involved and taken seriously by the health services; and management support and the ability for self-referral were important, while lack of reimbursement and clinician resistance to technology were barriers to implementation. Conclusions The service was found to offer a valued clinical benefit; however, strategies that aim to engage clinicians and increase organizational support toward new technology need to be developed.
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Barrett, Elizabeth Ann; Aminoff, Sofie Ragnhild; Simonsen, Carmen Elisabeth & Romm, Kristin Lie
(2020).
Opening the curtains for better sleep in psychotic disorders - considerations for improving sleep treatment.
Comprehensive Psychiatry.
ISSN 0010-440X.
103.
doi:
10.1016/j.comppsych.2020.152207.
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Background Sleep disturbances are prevalent in people with psychosis and are related to several negative outcomes. Recent research indicates that sleep disturbances contribute to the development of psychosis and is therefore an important treatment target. Despite this, a study found that sleep problems in people with psychosis were mostly assessed informally and treated with non-recommended interventions. However, it is uncertain whether these findings reflect local practise or rather status quo for how sleep disturbances in the context of psychosis are approached across different treatment sites. We aimed to replicate this study and investigate how sleep disturbances in people with psychosis are viewed, assessed and treated by clinicians across several mental health services, and the clinicians' perceived barriers to sleep treatment. Methods A total of 204 clinicians completed an e-mail survey about sleep problems and psychosis. Results The main findings were highly consistent with previous research; the clinicians found sleep problems in patients with psychosis to be highly prevalent and with negative consequences. However, structured assessments and the use of recommended treatment interventions were rare. This apparent paradox may at least partly be explained by the clinicians' perceived barriers to sleep treatment, including their declared lack of knowledge about sleep assessment and sleep treatment, and beliefs that sleep treatment is (too) demanding in this population. Conclusion Many patients with psychosis across several treatment sites receive less than optimal sleep treatment. Increasing clinicians' knowledge about adequate sleep treatment and its feasibility for patients with psychotic disorders is therefore imperative.
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Sønmez, Nasrettin; Romm, Kristin Lie; Østefjells, Tiril; Grande, Marit; Jensen, Lene Hunnicke & Hummelen, Benjamin
[Show all 9 contributors for this article]
(2019).
Cognitive behavior therapy in early psychosis with a focus on depression and low self-esteem: A randomized controlled trial.
Comprehensive Psychiatry.
ISSN 0010-440X.
97.
doi:
10.1016/j.comppsych.2019.152157.
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Background Patients in early phases of psychosis often struggle with depressive symptoms and low self-esteem. The main aims of the present study were to examine whether cognitive behavior therapy (CBT) compared to treatment as usual (TAU) would reduce depressive symptoms (primary outcome) and increase self-esteem (secondary outcome). Furthermore, we wanted to examine whether CBT reduces symptoms measured with the PANSS (positive, negative, cognitive, or excited symptoms) or increases general functioning compared to TAU. Methods A total of 63 early psychosis patients were included and randomly assigned to receive either CBT (maximum 26 sessions) or TAU for a period of up to six months. A linear mixed model was used for longitudinal analysis, with a focus on whether patients in the CBT group or the TAU group changed differently to one another between the baseline and 15-month follow-up. Results There were no differences between the CBT group and TAU group regarding improvements in depressive symptoms measured with the Calgary Depression Scale for Schizophrenia (P = 0.188) or self-esteem measured with the Rosenberg Self-Esteem Scale (P = 0.580). However, patients in the CBT group improved significantly more on negative symptoms (P = 0.002) and social functioning (P = 0.001). Conclusions We did not find CBT to be more effective than TAU in reducing depressive symptoms or increasing self-esteem in patients with early psychosis. However, CBT seems to improve negative symptoms and functioning. These results still need to be replicated in further studies as the present one was merely an exploratory analysis.
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Romm, Kristin Lie; Gardsjord, Erlend Strand; Gjermundsen, Kristine; Aguirre, Manuela; Berentzen, Lars-Christian & Melle, Ingrid
(2019).
Designing easy access to care for first-episode psychosis in complex organizations.
Early Intervention in Psychiatry.
ISSN 1751-7885.
13(5),
p. 1276–1282.
doi:
10.1111/eip.12802.
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Aims Developing early intervention services (EIS) in healthcare organizations (HCOs) is difficult because it is necessary to integrate service approaches across units. To accommodate the needs of patients and relatives, Oslo University Hospital (OUH) chose to use service design (SD) to redesign their first‐episode services with an emphasis on easy access to care. This paper discusses the results and how SD can help to overcome known barriers to change in complex organizations. Method SD is a method that relies on principles of participation, innovation and visualization to develop coherent services. The method emphasizes the exploration of a problem area from the perspective of multiple stakeholders to create a shared understanding of the complexity. Idea generation, visualization and early modelling of possible solutions are employed to test alternatives involving stakeholders. Results A low threshold EIS was developed. A helpline with a specialist managing the phone was established. High‐quality assessment regarding possible psychosis development was thus made available to patients, relatives and professionals, eliminating the need for paper referral. This approach was supported by a communication strategy that includes web‐based information. A dedicated cross‐specialist team was established to increase collaboration in complex cases. Finally, outreach services were improved. Conclusion SD is a suitable method to incorporate the views of different stakeholders (patients, relatives and professionals) to develop EIS services in complex organizations and can help overcome known barriers to change in HCOs.
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Simonsen, Carmen Elisabeth; Aminoff, Sofie Ragnhild; Vaskinn, Anja; Barrett, Elizabeth Ann; Færden, Ann & Ueland, Torill
[Show all 9 contributors for this article]
(2019).
Perceived and experienced stigma in first-episode psychosis: A 1-year follow-up study.
Comprehensive Psychiatry.
ISSN 0010-440X.
95:152134,
p. 1–8.
doi:
10.1016/j.comppsych.2019.152134.
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Objectives Perceived/experienced stigma and its relationship with clinical outcome were investigated across the first year of treatment in a large sample with first-episode psychosis (FEP). Methods FEP participants (n = 112) in the TOP study were investigated at baseline and 1-year follow-up. Perceived/experienced stigma was measured with items from the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), assessing problems because of barriers and hindrances, and living with dignity because of attitudes and actions of others. Clinical outcome included: symptoms, global functioning, self-rated disability and self-rated life satisfaction. Results In the total sample, 46% perceived/experienced stigma at baseline, which decreased significantly to 32% at 1-year follow-up. Perceived/experienced stigma was present in 1/5 at both time-points (Sustained stigma), in 2/5 at only one time-point (Transient stigma), and in 2/5 it was not present at either time-point (No stigma). Compared to the No stigma group, the Sustained stigma group had significantly higher levels of positive, excited and depressive symptoms and self-rated disability, as well as lower levels of global functioning and life satisfaction at 1 year follow-up, while the Transient stigma group only had poorer functioning and higher self-rated disability. Yet the outcome variables improved across the first year of treatment in all three stigma groups. Conclusion Perceived/experienced stigma was common in FEP, yet the rate decreased across the first year of treatment. Although there was some clinical improvement across the first year of treatment irrespective of stigma, stigma was related to poorer clinical outcome in a bidirectional manner. This suggests that perceived/experienced stigma is an important target in the early stages of treatment.
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Simonsen, Carmen Elisabeth; Færden, Ann; Ueland, Torill; Vaskinn, Anja; Bjella, Thomas & Andreassen, Ole Andreas
[Show all 8 contributors for this article]
(2018).
Self-rated disability in first treated episode of psychosis: A 1-year follow-up study.
Comprehensive Psychiatry.
ISSN 0010-440X.
85,
p. 48–54.
doi:
10.1016/j.comppsych.2018.06.004.
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Objectives: Knowledge about self-rated disability over time in psychotic disorders is limited. How self-rateddisability relates to clinician-rated global functioning, self-rated life satisfaction and symptomatology wasinvestigated across thefirst year of treatment in early psychosis. Methods: Participants withfirst treated episode of psychosis (n= 115) were investigated at baseline and 1-yearfollow-up. Self-rated Disability was measured with World Health Organization- Disability Assessment Schedule2.0. Clinician-rated global functioning, self-rated life satisfaction, and symptomatology were measured withappropriate scales. Results: Average self-rated disability infirst-treated episode of psychosis was high, corresponding with the 10%highest in a general population sample. However, 37% werenotdisabled at a clinically significant level afterone year. Self-rated disability was highest in the two social domains (Getting along with people and Participationin society), but improved significantly from baseline to 1-year. At 1-year follow-up self-rated disability hadsignificant weak to medium correlations with clinician-rated global functioning and positive symptoms,and mainly medium to strong correlations with life satisfaction and depressive symptoms. Yet only baselinedepression significantly predicted disability after one year. Conclusion: Self-rated disability infirst treated episode of psychosis is high, but improves across thefirst year,indicating signs of early recovery. Moreover,self-rateddisability isrelated, but distinct fromclinician-ratedglobalfunctioning and self-rated life satisfaction, suggesting that self-rated disability should also be assessed in order tomore fully describe outcomes infirst episode psychosis. Thefindings highlight the need for specialised treatmentof depression and social disability in early psychosis.
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Aas, Monica; Andreassen, Ole Andreas; Aminoff, Sofie Ragnhild; Færden, Ann; Romm, Kristin Lie & Nesvåg, Ragnar
[Show all 10 contributors for this article]
(2016).
A history of childhood trauma is associated with slower improvement rates: Findings from a one-year follow-up study of patients with a first-episode psychosis.
BMC Psychiatry.
16.
doi:
10.1186/s12888-016-0827-4.
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Background The aim of this study was to investigate whether childhood trauma was associated with more severe clinical features in patients with first-episode psychosis, both at the initial assessment and after one year. Methods Ninety-six patients with a first-episode of a DSM-IV diagnosis of psychosis, in addition to 264 healthy controls from the same catchment area, were recruited to the TOP NORMENT study. A history of childhood trauma was obtained using the Childhood Trauma Questionnaire (CTQ). Function and symptom severity were measured using the Global Assessment of Functioning (GAF) Scale divided into function (GAF-F) and symptoms (GAF-S), the Positive and Negative Syndrome Scale (PANSS) and the Young Mania Rating Scale (YMRS). All clinical assessments were completed at two time points: At an initial assessment within the first year of initiating treatment for psychosis and after one year. Results Childhood trauma was associated with significantly reduced global functioning and more severe clinical symptoms at both baseline and follow-up, whereas emotional neglect was associated with a significantly reduced improvement rate for global functioning (GAF-F) over the follow-up period. Conclusion Our data indicate that patients with first-episode psychosis who report a history of childhood trauma constitute a subgroup characterized by more severe clinical features over the first year of treatment, as well as slower improvement rates.
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Nerhus, Mari; Berg, Akiah Ottesen; Kvitland, Levi Røstad; Dieset, Ingrid; Hope, Sigrun & Dahl, Sandra Rinne
[Show all 11 contributors for this article]
(2016).
Low vitamin D is associated with negative and depressive symptoms in psychotic disorders.
Schizophrenia Research.
ISSN 0920-9964.
178(1-3),
p. 44–49.
doi:
10.1016/j.schres.2016.08.024.
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BACKGROUND:
There are indications that low S-25(OH)D is associated with increased disease severity in psychotic disorder. Our first aim was to investigate the relations between low S-25(OH)D and positive, negative and depressive symptoms. Our second aim was to explore if associations between S-25(OH)D and symptoms were influenced by levels of inflammatory markers.
METHODS:
Participants (N=358) with a medical history of one or more psychotic episodes were recruited. Current symptomatology was assessed by The Structured Interview for the Positive and Negative Syndrome Scaleanalyzed by a five-factor model. The Calgary Depression Scale for Schizophrenia was used to assess depression and suicidal ideation. Blood samples were analyzed for S-25(OH)D, CRP, sTNF-R1, IL-Ra and OPG. We performed bivariate correlations and multiple regression models to evaluate the effect of S-25(OH)D on the outcomes.
RESULTS:
Low S-25(OH)D was significantly associated with negative symptoms (adjusted R2=0.113, F(6,357)=8.58, p<0.001) and with depression (adjusted R2=0.045, F(4,357)=5.233, p<0.001) when adjusting for possible confounding factors (i.e. gender, education, diagnose, hospitalization status, ethnicity, season and thyroid status). CRP was correlated with both S-25(OH)D (rho=-0.13, p=0.02) and negative symptoms (rho=0.14, p=0.01), but did not act as a mediator. The correlations between S-25(OH)D and the inflammatory markers sTNF-R1, IL-Ra and OPG were not significant.
CONCLUSION:
There is a strong association between low S-25(OH)D and higher negative and depressive symptoms in psychotic disorders. Randomized controlled trials should be performed to investigate the effect of vitamin D supplementation as adjuvant treatment strategy in patients with prominent negative or depressive symptoms.
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Berg, Akiah Ottesen; Andreassen, Ole Andreas; Aminoff, Sofie Ragnhild; Romm, Kristin Lie; Hauff, Edvard & Melle, Ingrid
(2014).
The impact of immigration and visible minority status on psychosis symptom profile.
Social Psychiatry and Psychiatric Epidemiology.
ISSN 0933-7954.
49(11),
p. 1747–1757.
doi:
10.1007/s00127-014-0897-x.
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Purpose Immigrants have heightened risks of psychotic disorders, and it is proposed that migration influences symptom profiles. The purpose of this study was to investigate if either migration experience and/or visible minority status affected symptom profiles, using a cross-culturally validated five-factor model of the Positive and Negative Syndrome Scale (PANSS), in patients with broadly defined psychotic disorders. Methods PANSS was assessed in a large catchment area based sample of patients with psychotic disorders verified with the Structured Clinical Interview for DSM-IV (n = 1,081). Symptom profiles based on Wallwork et al. five-factor model were compared for Norwegians (73 %), white immigrants (10.5 %), and visible minority groups (16.5 %). Results Visible minorities were significantly younger, had less education, more often a schizophrenia diagnosis and higher PANSS positive, negative and disorganized/concrete factor scores than Norwegians and white immigrants. After controlling for confounders only the items “Delusions” and “Difficulty in abstract thinking” differed between groups. Multivariate analyses indicated that these items were not associated with immigration per se, but rather belonging to a visible minority. Conclusion We found mostly similarities in psychotic symptoms between immigrants and Norwegians when using a cross-culturally validated five-factor model of the PANSS. Immigration did not directly influence psychotic symptom profiles but visible minority groups had higher levels of “Delusions” and “Difficulty in abstract thinking”, both symptoms that are partially context dependent. The final publication is available at Springer.
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Sønmez, Nasrettin; Hagen, Roger; Andreassen, Ole Andreas; Romm, Kristin Lie; Grande, Marit & Jensen, Lene Hunnicke
[Show all 9 contributors for this article]
(2013).
Cognitive Behavior Therapy in First-Episode Psychosis With a Focus on Depression, Anxiety, and Self-Esteem.
Cognitive and Behavioral Practice.
ISSN 1077-7229.
21(1),
p. 43–54.
doi:
10.1016/j.cbpra.2013.06.001.
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Although several reviews show that cognitive behavioral therapy (CBT) is an effective treatment for patients with chronic psychosis, the effects of CBT on patients with a first-episode psychosis are less clear. Patients undergoing a first-episode psychosis are unique in that not only are they struggling with the symptoms of the disease, but also the realization of the diagnosis. Understanding how the disease will impact their lives with respect to changes in social goals, roles, and status can also lead to depression, anxiety and low self-esteem. The main aim of the present study is to describe two clinical cases in order to demonstrate the application of CBT in first-episode psychosis patients in an early stage of their psychosis. The two cases are individuals who were in an ongoing CBT trial for first-episode psychosis patients with symptoms of social anxiety, depression, and low self-esteem. Individual case formulations based on these symptoms were developed. Psychoeducation, normalizing, evaluation of negative automatic thoughts and dysfunctional schematic beliefs, and focusing on the negative consequences of safety behavior were the main treatment targets in attempting to improve the patients' symptoms and functioning. Both patients showed improvement in depressive symptoms, self-esteem, and general functioning. The cases described suggest that treatment designed to target depression, anxiety, and self-esteem in patients with first-episode psychosis could have potential beneficial effects; specific studies of this approach are recommended
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Sønmez, Nasrettin; Romm, Kristin Lie; Andreassen, Ole Andreas; Melle, Ingrid & Røssberg, Jan Ivar
(2013).
Depressive symptoms in first episode psychosis: a one-year follow-up study.
BMC Psychiatry.
13.
doi:
10.1186/1471-244X-13-106.
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Background Depressive symptoms are common in patients with first episode psychosis (FEP) and have serious consequences for them. The main aims of this study were to examine the course of depression in FEP patients and explore whether any patient characteristics at baseline predicts depressive symptoms after one year. Method A total of 198 FEP patients with schizophrenia spectrum disorders were assessed for depressive symptoms with Calgary Depression Scale for Schizophrenia (CDSS) at baseline and 127 were followed for one year. A CDSS score [greater than or equal to] 6 was used as a cut-off score for depression. Results Approximately 50% of the patients were depressed (CDSS[greater than or equal to]6) at baseline. At follow-up approximately 35% had depression. The course of depressive symptoms varied, 26% was depressed at both baseline and follow-up, 9% became depressed during the follow-up, 22% remitted from depression during the 12 months and 43% was neither depressed at baseline nor at follow-up. Poor childhood social functioning, long duration of untreated psychosis (DUP) and depressive symptoms at baseline predicted depression at 12 months follow-up. Conclusion Depressive symptoms are frequent in the first year after onset of psychosis. Patients with poor social functioning in childhood, long DUP and depressive symptoms at baseline are more prone to have depressive symptoms after one year. These patients should be identified and proper treatment provided.
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Romm, Kristin Lie; Melle, Ingrid; Thoresen, Christian; Andreassen, Ole Andreas & Røssberg, Jan Ivar
(2012).
Severe social anxiety in early psychosis is associated with poor premorbid functioning, depression, and reduced quality of life.
Comprehensive Psychiatry.
ISSN 0010-440X.
53(5),
p. 434–440.
doi:
10.1016/j.comppsych.2011.06.002.
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Romm, Kristin Lie; Røssberg, Jan Ivar; Hansen, Charlotte F; Haug, Elisabeth; Andreassen, Ole Andreas & Melle, Ingrid
(2011).
Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis.
BMC Psychiatry.
11.
doi:
10.1186/1471-244X-11-136.
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Romm, Kristin Lie; Røssberg, Jan Ivar; Berg, Akiah Ottesen; Hansen, Charlotte F; Andreassen, Ole Andreas & Melle, Ingrid
(2011).
Assessment of social anxiety in first episode psychosis using the Liebowitz Social Anxiety scale as a self-report measure.
European psychiatry.
ISSN 0924-9338.
26(2),
p. 115–121.
doi:
10.1016/j.eurpsy.2010.08.014.
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Berg, Akiah Ottesen; Melle, Ingrid; Røssberg, Jan Ivar; Romm, Kristin Lie; Larsson, Sara & Lagerberg, Trine Vik
[Show all 8 contributors for this article]
(2011).
Perceived discrimination is associated with severity of positive and depression/anxiety symptoms in immigrants with psychosis: a cross-sectional study.
BMC Psychiatry.
11.
doi:
10.1186/1471-244X-11-77.
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Background Immigration status is a significant risk factor for psychotic disorders, and a number of studies have reported more severe positive and affective symptoms among immigrant and ethnic minority groups. We investigated if perceived discrimination was associated with the severity of these symptoms among immigrants in Norway with psychotic disorders. Methods Cross-sectional analyses of 90 immigrant patients (66% first-generation, 68% from Asia/Africa) in treatment for psychotic disorders were assessed for DSM-IV diagnoses with the Structured Clinical Interview for DSM Disorders (SCID-I, sections A-E) and for present symptom severity by The Structured Positive and Negative Syndrome Scale (SCI-PANSS). Perceived discrimination was assessed by a self-report questionnaire developed for the Immigrant Youth in Cultural Transition Study. Results Perceived discrimination correlated with positive psychotic (r = 0.264, p < 0.05) and depression/anxiety symptoms (r = 0.282, p < 0.01), but not negative, cognitive, or excitement symptoms. Perceived discrimination also functioned as a partial mediator for symptom severity in African immigrants. Multiple linear regression analyses controlling for possible confounders revealed that perceived discrimination explained approximately 10% of the variance in positive and depression/anxiety symptoms in the statistical model. Conclusions Among immigrants with psychotic disorders, visible minority status was associated with perceived discrimination and with more severe positive and depression/anxiety symptoms. These results suggest that context-specific stressful environmental factors influence specific symptom patterns and severity. This has important implications for preventive strategies and treatment of this vulnerable patient group.
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Støme, Linn Nathalie; Aminoff, Sofie Ragnhild; Ihler, Henrik Myhre; Romm, Kristin Lie; Skoge, Mari & Kvaerner, Kari Jorunn
(2025).
Slik lykkes vi med digitalisering i mental helse.
Dagens medisin.
ISSN 1501-4290.
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Å dele gode resultater på tvers av helseforetakene og ha tydelige gevinstrealiseringsmål vil være avgjørende for å drive digitaliseringen fremover.
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Romm, Kristin Lie; Skoge, Mari; Ihler, Henrik Myhre; Kvaerner, Kari Jorunn; Støme, Linn Nathalie & Aminoff, Sofie Ragnhild
(2025).
How to Draw a Better Future for Video Consultations in Mental Health Care.
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Aminoff, Sofie Ragnhild; Kverneland, Magnhild; Romm, Kristin Lie & Mork, Erlend
(2025).
Building the Norwegian Relatives Education and Coping Toolkit for Bipolar disorders (REACT NORV Bipolar).
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Skoge, Mari; Aminoff, Sofie Ragnhild; Ihler, Henrik Myhre; Kvaerner, Kari Jorunn; Støme, Linn Nathalie & Romm, Kristin Lie
(2025).
Behind the screen: a qualitative study exploring video consultations across the public and private sectors in Norway.
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Aminoff, Sofie Ragnhild; Romm, Kristin Lie & Barth, Claudia
(2025).
Hvordan påvirkes bipolar lidelse av menstruasjonssyklusen?
Ekspertsykehuset OUS.
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Synnes, Oddgeir; Romm, Kristin Lie & Bondevik, Hilde
(2025).
Tekster rundt langbordet.
In Johns, Unni Tanum; Landmark, Anders Flekøy & Stänicke, Line Indrevoll (Ed.),
Kreativitet i terapirommet.
Gyldendal akademiske.
ISSN 9788205613133.
p. 188–203.
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Lundkvist, Nina Beate Tørum; Romm, Kristin Lie; Synnes, Oddgeir & Bondevik, Hilde
(2024).
Kreativ skriving i psykisk helsevern. En psykiater, en litteraturviter og en idéhistoriker utforsker potensialet i kreativ skriving som døråpner for unge voksne med psykose.
[Journal].
Dialog.
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Kling, Kristine; Mork, Erlend; Romm, Kristin Lie; Skoge, Mari & Szabo, Hilde Kristin Aam
(2024).
Digitale hemmeligheter: Verktøy for forståelse og behandling av psykose (parallellsesjon).
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Romm, Kristin Lie; Skoge, Mari; Aminoff, Sofie Ragnhild; Vink, Josina; Støme, Linn Nathalie & Kværner, Kari Jorunn
(2024).
Skal videosamtaler fortsette å være en B-løsning i psykisk helsevern?
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Kling, Kristine; Romm, Kristin Lie; Skoge, Mari & Szabo, Hilde Kristin Aam
(2024).
Digital balansekunst: Hvordan digitale verktøy kan gi verdi i vår kliniske hverdag? (parallellsesjon).
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Getz, Linn Okkenhaug; Linnestad, Lina & Romm, Kristin Lie
(2022).
Podcast om helse: Kropp og sjel i dagens medisin.
[Internet].
Podcast Kaffedoktor.
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Østefjells, Tiril; Melle, Ingrid; Romm, Kristin Lie; Sønmez, Nasrettin & Røssberg, Jan Ivar
(2019).
Metacognitive Beliefs in Psychosis: A 15-Month Follow Up Study.
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Sonmez, Nasrettin; Melle, Ingrid; Romm, Kristin Lie; Andreassen, Ole Andreas & Rossberg, Jan
(2012).
Depressive symptoms in first episode psychosis: A one-year follow-up study.
Early Intervention in Psychiatry.
ISSN 1751-7885.
6,
p. 71–71.
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Romm, Kristin Lie; Rossberg, JI; Andreassen, Ole Andreas; Barrett, Elisabeth Ann; Faerden, A & Melle, Ingrid
(2009).
MAJOR DEPRESSIVE EPISODES IN FIRST EPISODE PSYCHOSIS.
Schizophrenia Bulletin.
ISSN 0586-7614.
35,
p. 1–2.
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Published
Jan. 21, 2016 6:03 PM
- Last modified
Nov. 28, 2018 1:00 PM
