Petter Andreas Ringen

• Gjerdalen, Oda Skancke; Aas, Erlend Marius; Lystad, June Ullevoldsæter; Ueland, Torill; Arnevik, Espen Ajo & Falkum, Erik [Show all 12 contributors for this article] (2026). A comparison of characteristics of individuals with psychosis and substance use disorders seeking vocational rehabilitation. Nordic Journal of Psychiatry. ISSN 0803-9488. 80(3), p. 177–181. doi: 10.1080/08039488.2026.2625696. Full text in Research Archive
• Fischer-Vieler, Thomas; Rokicki, Jaroslav; Kim, Milin; Leonardsen, Esten Høyland; Wolfers, Thomas & Bell, Christina [Show all 14 contributors for this article] (2025). Mapping cerebellar subregional volumes and heterogeneity in schizophrenia spectrum disorders and violence. European Archives of Psychiatry and Clinical Neuroscience. ISSN 0940-1334. doi: 10.1007/s00406-025-02081-1. Full text in Research Archive Show summary

  Cerebellar abnormalities have been linked to schizophrenia and aggressive behaviour. Subregional cerebellar morphology reflects structural organization and function and show great heterogeneity, which may be linked to shared or distinct underlying mechanisms of violence and psychosis but remain unexplored in these marginalized groups. Total and subregional cerebellar volumes were estimated from 3 T MRI scans from persons with schizophrenia spectrum disorders without (SSD-NV; n = 107) or with (SSD-V; n = 36) a history of severe violence, violent offenders without schizophrenia (NPV; n = 20), and 411 healthy controls. Group difference analyses by GLMs were complemented by novel heterogeneity analyses using pre-trained models and norm-charts of lifespan cerebellar volumes to assess individual deviation patterns. We found decreased grey matter volumes in the posterior cerebellar hemispheres and the vermal regions in both SSD-V and SSD-NV, but with a different subregional distribution. Specifically, SSD-V showed differences in the right Crus I (p = .045, Cohen’s d = .62) and Vermis IX (p < .001, Cohen’s d = .81) in the groupwise comparisons. In addition, individual-level extreme negative deviations were detected in the Vermis IX region in 11% of SSD-V and in some subregions of the posterior cerebellum and the vermis in > 10% of NPV. By applying novel analytical tools, we report different patterns of cerebellar subregion volume reductions associated with violence in individuals with or without schizophrenia spectrum disorders. The partly converging results from the group comparisons and the normative modelling analyses demonstrate the usefulness of complemental methodological approaches to disentangle the complex biological associations between violence and psychosis.

• Lunding, Synve Hoffart; Kreis, Isabel; Rødevand, Linn; Aas, Monica; Werner, Maren Caroline Frogner & Johansen, Ingrid Torp [Show all 16 contributors for this article] (2025). Self-harming behavior linked to earlier onset of cardiovascular disease in severe mental disorders. European psychiatry. ISSN 0924-9338. 68(1). doi: 10.1192/j.eurpsy.2025.10106. Full text in Research Archive Show summary

  Background People with severe mental disorders (SMDs) have about 15 years shorter life expectancy than the general population. Cardiovascular disease (CVD) is among the leading causes of premature mortality and shares genetic underpinnings with SMDs. We investigated the link between clinical traits in SMDs and time to the first CVD diagnosis. Methods The study included 1,627 well-characterized participants with schizophrenia spectrum (SCZ, N  = 998) and bipolar spectrum disorders (BDs, N  = 629), and a reference group of 1,201 healthy controls. CVD diagnoses were obtained from two Norwegian national registries (covering both primary and specialist health care) for the period of 2006–2020. Applying Cox proportional hazard models, we investigated associations between SMD clinical traits and time to first CVD diagnosis in SMD participants, adjusting for age, sex, diagnosis, and tobacco use. Results Among individuals with SMD, recurring self-harming behavior (SHB) was associated with a shorter time to first CVD diagnosis ( p  = .029) relative to those without SHB. In the subgroup with SHB and a history of attempted suicide(s), more suicide attempts were associated with shorter time to first CVD diagnosis ( p  = .041). Significant associations of time to first CVD diagnosis with age at SMD onset and comorbid substance use disorder were not demonstrated. Conclusions SHB and a history of suicide attempts in individuals with SMD seem to be associated with earlier CVD onset, and may improve the prediction of CVD, in addition to standard cardiovascular risk factors.

• Lund-Stenvold, Elisabeth Haug; Ringen, Petter Andreas; Andreassen, Ole; Gaarden, Torfinn Lødøen; Hartberg, Cecilie Bhandari & Johnsen, Erik [Show all 13 contributors for this article] (2025). Implementation of the healthy heart tool- an algorithm with potential cardiometabolic health benefits in persons with severe mental illness. BMC Psychiatry. 25. doi: 10.1186/s12888-025-06578-w. Full text in Research Archive Show summary

  Background: Cardiometabolic diseases are the main causes of death in persons with severe mental illness (SMI), highlighting the need to improve management of cardiovascular risk factors in both primary and specialized health care. The “Healthy Heart Tool” aims at helping health care workers to identify persons at risk, and to initiate proper interventions. Here we investigate if the recommendations in the Healthy Heart Tool are followed one year after implementation and whether implementation of the tool improved cardiometabolic risk factors in SMI. Methods: Data from 270 individuals with SMI from six Norwegian hospitals were collected at baseline and at 12 months after implementation of the Healthy Heart Tool throughout the health care services. Changes from baseline to 12 months follow-up were analyzed using chi-square and independent t-tests, whereas implementation effects were analyzed using logistic general linear mixed models. Results: After implementing the Healthy Heart Tool, significantly more persons received dietary advice and/or salt restriction advice (75.5% vs. 84.8%, p = 0.035). After controlling for Body Mass Index (BMI) ≥ 30 and sex, there was an odds ratio (OR) of 8.9 (95% CI 1.42–55.77) for receiving dietary advice and/or advice on salt reduction. There was a significant reduction (p = 0.016) in numbers of participants with high levels of total serum cholesterol ≥ 5 mmol/ (54.4% vs. 46.3%). Conclusions: Implementing the Healthy Heart Tool can increase awareness of cardiovascular risk factors in patients with SMI. The intervention increased the proportion of individuals who received dietary and salt reduction advice and decreased the proportion of individuals with high cholesterol levels. However, due to the small numbers, these results should be interpreted with caution. Nonetheless, the findings suggest that the Healthy Heart Tool may be an effective means for improving the management of cardiovascular risk factors in individuals with SMI in typical clinical settings.

• 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. Full text in Research Archive Show summary

  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.

• Bell, Christina; Rokicki, Jaroslav; Tesli, Natalia; Gurholt, Tiril Pedersen; Hjell, Gabriela & Fischer-Vieler, Thomas [Show all 15 contributors for this article] (2024). Hypothalamic subunit volumes and relations to violence and psychopathy in male offenders with or without a psychotic disorder. European Archives of Psychiatry and Clinical Neuroscience. ISSN 0940-1334. doi: 10.1007/s00406-023-01725-4. Full text in Research Archive Show summary

  Abstract The hypothalamus is key to body homeostasis, including regulating cortisol, testosterone, vasopressin, and oxytocin hormones, modulating aggressive behavior. Animal studies have linked the morphology and function of the hypothalamus to aggression and afliation, with a subregional pattern refecting the functional division between the hypothalamic nuclei. We explored the relationship between hypothalamic subunit volumes in violent ofenders with (PSY-V) and without (NPV) a psychotic disorder, and the association with psychopathy traits. 3T MRI scans (n=628, all male 18–70 years) were obtained from PSY-V, n=38, NPV, n=20, non-violent psychosis patients (PSY-NV), n=134, and healthy controls (HC), n=436. The total hypothalamus volume and its eleven nuclei were delineated into fve subunits using Freesurfer v7.3. Psychopathy traits were assessed with Psychopathy Checklist-revised (PCL-R). ANCOVAs and linear regressions were used to analyze associations with subunit volumes. Both groups with a history of violence exhibited smaller anterior–superior subunit volumes than HC (NPV Cohen’s d=0.56, p=0.01 and PSY-V d=0.38, p=0.01). There were no signifcant diferences between HC and PSY-NV. PCL-R scores were positively associated with the inferior tubular subunit on a trend level (uncorrected p=0.045, Cohen’s d=0.04). We found distinct hypothalamic subunit volume reductions in persons with a history of violence independent of concomitant psychotic disorder but not in persons with psychosis alone. The results provide further information about the involvement of the hypothalamus in aggression, which ultimately may lead to the development of targeted treatment for the clinical and societal challenge of aggression and violent behavior.

• Fischer-Vieler, Thomas; Ringen, Petter Andreas; Kvig, Erling Inge; Bell, Christina; Hjell, Gabriela & Tesli, Natalia [Show all 14 contributors for this article] (2024). A phenomenological approach to violence in schizophrenia spectrum disorders: examination of anomalous self-experience. Journal of Forensic Psychiatry & Psychology. ISSN 1478-9949. doi: 10.1080/14789949.2024.2428167. Full text in Research Archive
• Lunding, Synve Hoffart; Ueland, Torill; Aas, Monica; Høegh, Margrethe Collier; Werner, Maren Caroline Frogner & Rødevand, Linn [Show all 16 contributors for this article] (2023). Tobacco smoking related to childhood trauma mediated by cognitive control and impulsiveness in severe mental disorders. Schizophrenia Research. ISSN 0920-9964. 261, p. 236–244. doi: 10.1016/j.schres.2023.09.041. Full text in Research Archive Show summary

  Background People with severe mental disorders (SMDs) show an increased prevalence of tobacco smoking compared to the general population. Tobacco smoking and other adult adverse health behaviors have been associated with traumatic experiences in childhood. In the present study we investigated the relationship between childhood trauma and tobacco smoking in people with SMDs, including the possible mediating role of cognitive- and personality characteristics, i.e. cognitive control, impulsiveness, affective lability and self-esteem. Methods Enrolled in the study were 871 participants with schizophrenia (SCZ, N = 484) and bipolar (BD, N = 387) spectrum disorders. We assessed tobacco smoking behavior (yes/no and amount), and history of childhood trauma with the Childhood Trauma Questionnaire. Data on cognitive control, impulsiveness, affective lability, and self-esteem were available in subsamples. We performed linear and logistic regressions, and conducted mediation analyses in PROCESS. All analyses were as standard adjusted for age, sex, and diagnostic group. Results Experience of one or more subtypes of childhood trauma was significantly associated with smoking tobacco in SMDs (p = 0.002). There were no significant associations between childhood trauma and amount of tobacco smoking. Cognitive control and impulsiveness were significant mediators between childhood trauma and tobacco smoking. Conclusions These findings indicate the experience of childhood trauma as a predisposing factor for tobacco smoking in SMDs. Cognitive control and impulsiveness were suggested as mediating mechanisms, indicating the importance of considering inhibition related self-regulatory aspects in efforts to improve health behavior in individuals with SMDs and childhood trauma.

• 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. Full text in Research Archive Show summary

  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.

• Argote, Mathilde; Sescousse, Guillaume; Brunelin, Jérôme; Baudin, Grégoire; Schaub, Michael Patrick & Rabin, Rachel [Show all 37 contributors for this article] (2023). Association between cannabis use and symptom dimensions in schizophrenia spectrum disorders: an individual participant data meta-analysis on 3053 individuals. EClinicalMedicine. 64. doi: 10.1016/j.eclinm.2023.102199. Full text in Research Archive Show summary

  Background The association between cannabis use and positive symptoms in schizophrenia spectrum disorders is well documented, especially via meta-analyses. Yet, findings are inconsistent regarding negative symptoms, while other dimensions such as disorganization, depression, and excitement, have not been investigated. In addition, meta-analyses use aggregated data discarding important confounding variables which is a source of bias. Methods PubMed, ScienceDirect and PsycINFO were used to search for publications from inception to September 27, 2022. We contacted the authors of relevant studies to extract raw datasets and perform an Individual Participant Data meta-analysis (IPDMA). Inclusion criteria were: psychopathology of individuals with schizophrenia spectrum disorders assessed by the Positive and Negative Syndrome Scale (PANSS); cannabis-users had to either have a diagnosis of cannabis use disorder or use cannabis at least twice a week. The main outcomes were the PANSS subscores extracted via the 3-factor (positive, negative and general) and 5-factor (positive, negative, disorganization, depression, excitement) structures. Preregistration is accessible via Prospero: ID CRD42022329172. Findings Among the 1149 identified studies, 65 were eligible and 21 datasets were shared, totaling 3677 IPD and 3053 complete cases. The adjusted multivariate analysis revealed that relative to non-use, cannabis use was associated with higher severity of positive dimension (3-factor: Adjusted Mean Difference, aMD = 0.34, 95% Confidence Interval, CI = [0.03; 0.66]; 5-factor: aMD = 0.38, 95% CI = [0.08; 0.63]), lower severity of negative dimension (3-factor: aMD = −0.49, 95% CI [−0.90; −0.09]; 5-factor: aMD = −0.50, 95% CI = [−0.91; −0.08]), higher severity of excitement dimension (aMD = 0.16, 95% CI = [0.03; 0.28]). No association was found between cannabis use and disorganization (aMD = −0.13, 95% CI = [−0.42; 0.17]) or depression (aMD = −0.14, 95% CI = [−0.34; 0.06]). Interpretation No causal relationship can be inferred from the current results. The findings could be in favor of both a detrimental and beneficial effect of cannabis on positive and negative symptoms, respectively. Longitudinal designs are needed to understand the role of cannabis is this association. The reported effect sizes are small and CIs are wide, the interpretation of findings should be taken with caution. Funding This research did not receive any specific grant or funding. Primary financial support for authors was provided by Le Vinatier Psychiatric Hospital.

• Fischer-Vieler, Thomas; Ringen, Petter Andreas; Kvig, Erling Inge; Bell, Christina; Hjell, Gabriela & Tesli, Natalia [Show all 11 contributors for this article] (2023). Associations Between Clinical Insight and History of Severe Violence in Patients With Psychosis. Schizophrenia Bulletin Open. 4(1). doi: 10.1093/schizbullopen/sgad011. Full text in Research Archive Show summary

  Abstract Background and Hypothesis Violence is more prevalent in patients with psychotic disorders compared to the general population. Hence, adequate violence risk assessment is of high clinical importance. Impaired insight is suggested as a risk factor for violence in psychosis, but studies have yielded conflicting results. We hypothesized that impaired insight was associated with a history of severe violence in patients with psychotic disorders. Study Design Clinical insight was assessed both using the Birchwood Insight Scale (BIS) and the Positive and Negative Symptom Scale (PANSS) item G12 (lack of judgment and insight). The degree of impaired clinical insight was compared between psychosis patients with (N = 51) and without (N = 178) a history of severe violence. Multiple linear regression analyses were performed to investigate the effects of putative confounders. Study Results We found that a history of severe violence was significantly associated with lower insight in one of the three BIS components (the relabeling of symptoms) (P = .03, R2 = 0.02) and the PANSS item G12 (P = .03, R2 = 0.02) also after controlling for putative confounders. Conclusions The results suggest there is an association between impaired insight and severe violence in psychosis patients. We propose that examination of insight by validated instruments comprising different components may add useful information to clinical violence risk assessment in psychosis patients.

• Kan, Zhanna; Søegaard, Erik Ganesh Iyer; Siqveland, Johan; Hussain, Ajmal; Hanssen-Bauer, Ketil & Jensen, Pia [Show all 12 contributors for this article] (2022). Coping, Social Support and Loneliness during the COVID-19 Pandemic and Their Effect on Depression and Anxiety: Patients’ Experiences in Community Mental Health Centers in Norway. Healthcare. 10(5). doi: 10.3390/healthcare10050875. Full text in Research Archive Show summary

  Background: Little is known about psychiatric patients’ experiences during the COVID-19 pandemic. The purpose of this study was to investigate associations of coping strategies, social support and loneliness with mental health symptoms among these patients. Methods: We recruited 164 patients from Community Mental Health Centers in June–July 2020. Participants responded to an online questionnaire on corona-related questions, Brief Coping Orientation to Problems Experience, Crisis Support Scale, a 3-item Loneliness Scale, and Hopkins Symptom Checklist-25. We used linear regression models to investigate associations between these and symptoms of depression and anxiety. Results: Almost 51% were aged 31–50 years and 77% were females. Forty-six (28%) participants reported worsened overall mental health due to the pandemic. The reported rates of clinical depression and anxiety were 84% and 76%, respectively. Maladaptive coping was independently associated with both depression and anxiety symptoms. Loneliness was independently associated with depression symptoms. Conclusions: Patients in Community Mental Health Centers in Norway reported high rates of depression and anxiety symptoms. Many of them reported worsening of their mental health due to the pandemic, even at a time when COVID-19 infections and restrictive measures were relatively low. Maladaptive coping strategies and loneliness may be possible explanations for more distress. Keywords: anxiety; depression; COVID-19; coping; Community Mental Health Centers; loneliness; social support

• Gjerdalen, Oda Skancke; Lystad, June Ullevoldsæter; Bull, Helen; Ringen, Petter Andreas; Røssberg, Jan Ivar & Martinsen, Egil Wilhelm [Show all 9 contributors for this article] (2022). Vocational rehabilitation augmented with cognitive behavioral therapy or cognitive remediation for individuals with schizophrenia: a 5-year follow-up study. Nordic Journal of Psychiatry. ISSN 0803-9488. 77(1), p. 23–30. doi: 10.1080/08039488.2022.2042598. Full text in Research Archive Show summary

  Introduction: Although employment is an important part of recovery for individuals with schizophrenia spectrum disorders, the employment rate for this group remains low. Increasing evidence supports the use of augmented vocational rehabilitation (VR) programs to improve occupational outcome. The aim of this study is to explore 5-year follow-up registry data from the JUMP study, a VR program for individuals with schizophrenia spectrum disorders, specifically with regard to competitive employment outcome and predictors of competitive employment. The VR was augmented with either cognitive remediation (CR) or elements from cognitive behavior therapy (CBT). Methods: One hundred and forty eight participants with schizophrenia spectrum disorders from six Norwegian counties received 10 months VR augmented with either CR (n ¼ 64) or CBT (n ¼ 84). Both competitive and sheltered workplaces were used. Assessments were conducted at baseline, at post intervention and at 2-year follow-up. Data on employment status at 5-year follow-up was obtained by registry. Results: At 5-year follow-up 55.4% were engaged in working activity, of which 22.3% had obtained competitive employment. A further 18.2% had work placements in competitive workplaces. Number of received intervention hours and competitive employment at 2-year follow-up emerged as significant predictors of competitive employment. IQ and intervention type in marginal favor of CBT were predictors on trend level. Conclusion: To the best of our knowledge, this is the first study investigating competitive employment at 5-year follow-up for individuals with schizophrenia spectrum disorders. The results add to existing evidence that competitive employment is attainable for this group.

• Bell, Christina; Tesli, Natalia; Gurholt, Tiril Pedersen; Rokicki, Jaroslav; Hjell, Gabriela & Fischer-Vieler, Thomas [Show all 14 contributors for this article] (2022). Psychopathy subdomains in violent offenders with and without a psychotic disorder. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2022.2128869. Full text in Research Archive Show summary

  Background Violence in psychosis has been linked to antisocial behavior and psychopathy traits. Psychopathy comprises aspects of interpersonal, affective, lifestyle, and antisocial traits which may be differently involved in violent offending by persons with psychotic disorders. We explored psychopathy subdomains among violent offenders with and without a psychotic disorder. Methods 46 males, with a history of severe violence, with (n = 26; age 35.85 ± 10.34 years) or without (n = 20; age 39.10 ± 11.63 years) a diagnosis of a psychotic disorder, were assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R was split into subdomains following the four-facet model. Group differences in total and subdomain scores were analyzed with a general linear model with covariates. Results Total PCL-R scores did not differ between the groups (p = 0.61, Cohen’s d = 0.17). The violent offenders without psychotic disorders had higher facet 2 scores than the patient group with psychotic disorders (p = 0.029, Cohen’s d = 0.77). Facet 1, 3, or 4 scores did not differ between the groups. Controlling for age did not alter the results. Conclusion Patients with a psychotic disorder and a history of severe violence have lower affective psychopathy scores than violent offenders without psychotic disorders. This observation may point toward distinct underlying mechanisms for violence and may provide a target for focused treatment and prevention.

• Goldfarb, Michael; Hert, Marc De; Detraux, Johan; Palo, Katherine Di; Munir, Haroon & Music, Sanela [Show all 8 contributors for this article] (2022). Severe Mental Illness and Cardiovascular Disease: JACC State-of-the-Art Review. Journal of the American College of Cardiology. ISSN 0735-1097. 80(9), p. 918–933. doi: 10.1016/j.jacc.2022.06.017. Full text in Research Archive
• Ringen, Petter Andreas; Lund-Stenvold, Elisabeth Haug; Andreassen, Ole; Gaarden, Torfinn Lødøen; Hartberg, Cecilie Bhandari & Johnsen, Erik [Show all 14 contributors for this article] (2022). Quality of clinical management of cardiometabolic risk factors in patients with severe mental illness in a specialist mental health care setting. Nordic Journal of Psychiatry. ISSN 0803-9488. 76(8), p. 602–609. doi: 10.1080/08039488.2022.2039288. Full text in Research Archive Show summary

  Purpose: Cardiometabolic disease in patients with severe mental illness is a major cause of shortened life expectancy. There is sparse evidence of real-world clinical risk prevention practice. We investigated levels of assessments of cardiometabolic risk factors and risk management interventions in patients with severe mental illness in the Norwegian mental health service according to an acknowledged international standard. Methods: We collected data from 264 patients residing in six country-wide health trusts for: (a) assessments of cardiometabolic risk and (b) assessments of levels of risk reducing interventions. Logistic regressions were employed to investigate associations between risk and interventions. Results: Complete assessments of all cardiometabolic risk variables were performed in 50% of the participants and 88% thereof had risk levels requiring intervention according to the standard. Smoking cessation advice was provided to 45% of daily smokers and 4% were referred to an intervention program. Obesity was identified in 62% and was associated with lifestyle interventions. Reassessment of psychotropic medication was done in 28% of the obese patients. Women with obesity were less likely to receive dietary advice, and use of clozapine or olanzapine reduced the chances for patients with obesity of getting weight reducing interventions. Conclusions: Nearly nine out of the ten participants were identified as being at cardiometabolic high risk and only half of the participants were adequately screened. Women with obesity and patients using antipsychotics with higher levels of cardiometabolic side effects had fewer adequate interventions. The findings underscore the need for standardized recommendations for identification and provision of cardiometabolic risk reducing interventions in all patients with severe mental illness.

• Lunding, Synve Hoffart; Simonsen, Carmen Elisabeth; Aas, Monica; Rødevand, Linn; Werner, Maren Caroline Frogner & Laskemoen, Jannicke Fjæra [Show all 13 contributors for this article] (2021). Childhood trauma and cardiometabolic risk in severe mental disorders: The mediating role of cognitive control. European psychiatry. ISSN 0924-9338. 64(1). doi: 10.1192/j.eurpsy.2021.14. Full text in Research Archive Show summary

  Background Cardiometabolic risk is increased in severe mental disorders (SMDs), and there appears to be a relationship between childhood trauma and cardiometabolic risk, possibly related to adverse health behavior. The current study examined the association between childhood trauma and serum lipids and adiposity in SMDs and the potential mediating role of cognitive and personality characteristics. Methods Participants with schizophrenia and bipolar spectrum disorders (N = 819) were included, cardiometabolic risk factors (serum lipids, body mass index, and waist circumference) were measured, and history of childhood trauma was assessed by the Childhood Trauma Questionnaire. Cognitive and personality characteristics were available in subsamples, with assessments of cognitive control, impulsiveness, self-esteem, and affective lability. Linear regressions and mediation analyses with Hayes’ PROCESS were performed, adjusting for age, sex, antipsychotic agent propensity of metabolic side-effect, and diagnostic group. Results Experience of three or more subtypes of childhood trauma was positively associated with waist circumference in patients with SMDs (p = 0.014). There were no other significant associations between trauma variables and lipid or adiposity measures in the total sample. Cognitive control was a significant mediator between experience of one or two subtypes of childhood trauma and waist circumference. Conclusions The results indicate childhood trauma as a predisposing factor for increased waist circumference in individuals with SMDs. Poorer cognitive control, suggestive of adverse health behavior, might be a mediating factor of the association, and the findings indicate the potential importance of increased focus on these factors in prevention and treatment regimens targeting cardiometabolic health.

• Høilund, Hanne; Galea, David & Ringen, Petter Andreas (2019). Improving quality of antipsychotic polypharmacy: a pilot study. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2019.1690044. Full text in Research Archive
• Icick, Romain; Melle, Ingrid; Étain, Bruno; Ringen, Petter Andreas; Aminoff, Sofie Ragnhild & Leboyer, Marion. [Show all 12 contributors for this article] (2019). Tobacco smoking and other substance use disorders associated with recurrent suicide attempts in bipolar disorder. Journal of Affective Disorders. ISSN 0165-0327. 256, p. 348–357. doi: 10.1016/j.jad.2019.05.075. Full text in Research Archive
• Ringen, Petter Andreas; Reponen, Elina Johanna; Vedal, Trude Seselie Jahr; Andreassen, Ole Andreas; Steen, Nils Eiel & Melle, Ingrid (2019). Predictors for antipsychotic dosage change in the first year of treatment in schizophrenia spectrum and bipolar disorders. Frontiers in Psychiatry. 10:649, p. 1–8. doi: 10.3389/fpsyt.2019.00649. Full text in Research Archive Show summary

  Background: Use of antipsychotic medication is central in the treatment of psychotic disorders. However, there is limited knowledge about prescription practice of antipsychotics in the critical early phase of these disorders. Clinical guidelines recommend low dosages, but no discontinuation of antipsychotic medication during the first year of treatment in first episode patients. The main aim of this study was to identify clinical predictors for dosage change or discontinuation of antipsychotics during this period. Methods: A total of 426 antipsychotic-using patients with schizophrenia spectrum or bipolar disorder, including both a first treatment sample and a sample of patients with previous treated episodes (“multi-episode” sample) from the same diagnostic groups, underwent thorough clinical and sociodemographic assessment at study baseline and after 1 year. Prescribed dosage levels at baseline and follow-up and change in dosage or discontinuation of antipsychotics from baseline to follow-up were compared between groups, controlling for possible confounders. Results: We found reduced dosages over the first year in both first treatment groups across diagnoses, but not in multi-episode groups. Weight increase predicted dosage reduction in the schizophrenia group, while the level of psychotic symptoms at baseline predicted dosage reduction in the bipolar group. We found higher baseline levels of antipsychotic use in the schizophrenia group than in the bipolar group. Conclusion: We found indications of a trans-diagnostic reduction of prescribed dosages of antipsychotics over the first year in treatment, but with different predictors for this reduction in the two diagnostic groups. The findings increase the understanding of drivers of early medication change in psychotic disorder.

• Storvestre, Guttorm Breivik; Valnes, Lars Magnus; Jensen, Arvid; Nerland, Stener; Tesli, Natalia & Hymer, Knut-Erik [Show all 14 contributors for this article] (2019). A preliminary study of cortical morphology in schizophrenia patients with a history of violence. Psychiatry Research : Neuroimaging. ISSN 0925-4927. 288, p. 29–36. doi: 10.1016/j.pscychresns.2019.04.013. Full text in Research Archive Show summary

  Clinical studies of patients with schizophrenia and a history of violence are challenging both from an ethical and practical perspective, and the neurobiological underpinnings remain largely unknown. We here present a comprehensive account of the brain cortical characteristics associated with violence in schizophrenia. We obtained 3T MRI scans and thorough clinical characterization of schizophrenia patients with a history of violence (murder, attempted murder, criminal assault, SCZ-V, n=11), schizophrenia patients with no history of violence (SCZ-NV, n=17), and healthy controls (HC, n=19). Cortical thickness, area, and folding were analyzed vertexwise across the cortical mantle (FreeSurfer). SCZ-V had significantly increased cortical folding in the visual and orbitofrontal cortex, and reduced cortical thickness within the precentral-, parietal-, temporal-, and fusiform cortex compared to SCZ-NV, as well as widespread regional thinning and increased folding compared to HC. There were no group differences in cortical area. A major limitation is the small subject sample. If replicated, the results from this pilot study suggest cortical abnormalities in areas involved in sensory processing, emotion recognition, and reward to be of importance to the neurobiology of violence in schizophrenia.

• Ringen, Petter Andreas (2018). Psykiatrien – hvor står du, hvor går du? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(3), p. 1–8. doi: 10.4045/tidsskr.17.0936. Full text in Research Archive
• Færden, Ann; Lyngstad, Siv Hege; Simonsen, Carmen Elisabeth; Ringen, Petter Andreas; Papsuev, Oleg & Dieset, Ingrid [Show all 10 contributors for this article] (2018). Reliability and validity of the self-report version of the apathy evaluation scale in first-episode Psychosis: Concordance with the clinical version at baseline and 12 months follow-up. Psychiatry Research. ISSN 0165-1781. 267, p. 140–147. doi: 10.1016/j.psychres.2018.05.065. Full text in Research Archive Show summary

  Negative symptoms have traditionally been assessed based on clinicians’ observations. The subjective experience of negative symptoms in people with psychosis may bring new insight. The Apathy Evaluation Scale (AES) is commonly used to study apathy in psychosis and has corresponding self-rated (AES-S) and clinician-rated (AES-C) versions. The aim of the present study was to determine the validity and reliability of the AES-S by investigating its concordance with the AES-C. Eighty-four first-episode (FEP) patients completed the shortened 12-item AES-S and AES-C at baseline (T1) and 12 months (T2). Concordance was studied by degree of correlation, comparison of mean scores, and change and difference between diagnostic groups. The Positive and Negative Symptom Scale (PANSS) was used to study convergent and discriminative properties. High concordance was found between AES-S and AES-C at both T1 and T2 regarding mean values, change from T1 to T2, and the proportion with high levels of apathy. Both versions indicated high levels of apathy in FEP, while associations with PANSS negative symptoms were weaker for AES-S than AES-C. Controlling for depression did not significantly alter results. We concluded that self-rated apathy in FEP patients is in concordance with clinician ratings, but in need of further study.

• Ringen, Petter Andreas; Falk, Ragnhild Sørum; Antonsen, Bjørnar Torske; Færden, Ann; Mamen, Asgeir & Rognli, Eline Borger [Show all 9 contributors for this article] (2018). Using motivational techniques to reduce cardiometabolic risk factors in long term psychiatric inpatients: A naturalistic interventional study. BMC Psychiatry. 18. doi: 10.1186/s12888-018-1832-6. Full text in Research Archive Show summary

  Background People with severe mental illness have markedly reduced life expectancy; cardiometabolic disease is a major cause. Psychiatric hospital inpatients have elevated levels of cardiometabolic risk factors and are to a high degree dependent of the routines and facilities of the institutions. Studies of lifestyle interventions to reduce cardiometabolic risk in psychiatric inpatients are few. The current study aimed at assessing the feasibility and effects of a lifestyle intervention including Motivational Interviewing (MI) on physical activity levels, cardiometabolic risk status and mental health status in psychotic disorder inpatients. Methods Prospective naturalistic intervention study of 83 patients at long term inpatient psychosis treatment wards in South-Eastern Norway. Patients were assessed 3–6 months prior to, at start and 6 months after a life-style intervention program including training of staff in MI, simple changes in routines and improvements of facilities for physical exercise. Assessments were done by clinical staff and included level of physical activity, motivation, life satisfaction, symptom levels (MADRS, AES-C, PANSS, and GAF) as well as anthropometric and biochemical markers of cardiometabolic risk. A mixed model was applied to analyze change over time. Results A total of 88% of patients received MI interventions, with a mean of 2.5 MI interventions per week per patient. The physical activity level was not increased, but activity level was positively associated with motivation and negatively associated with positive symptoms. Triglyceride levels and number of smokers were significantly reduced and a significant decrease in symptom levels was observed. Conclusions The current results suggest that a simple, low cost life-style intervention program focusing on motivational change is feasible and may reduce symptoms and improve lifestyle habits in psychosis patients in long term treatment facilities. Similar programs may easily be implemented in other psychiatric hospitals.

• Holth, Fredrik; Walby, Fredrik A; Røstbakken, Thea; Lunde, Ingeborg; Ringen, Petter Andreas & Ramleth, Ruth-Kari [Show all 11 contributors for this article] (2018). Extreme challenges: psychiatric inpatients with severe self-harming behavior in Norway: a national screening investigation. Nordic Journal of Psychiatry. ISSN 0803-9488. 72(8), p. 605–612. doi: 10.1080/08039488.2018.1511751. Full text in Research Archive
• Ringen, Petter Andreas; Færden, Ann; Antonsen, Bjørnar Torske; Falk, Ragnhild Sørum; Mamen, Asgeir & Rognli, Eline Borger [Show all 9 contributors for this article] (2018). Cardiometabolic risk factors, physical activity and psychiatric status in patients in long-term psychiatric inpatient departments. Nordic Journal of Psychiatry. ISSN 0803-9488. 72(4), p. 296–302. doi: 10.1080/08039488.2018.1449012. Full text in Research Archive Show summary

  Purpose: Cardiovascular diseases are a major cause for the markedly reduced life expectancy in people with severe mental illness (SMI). Hospital departments should provide adequate prevention of cardiometabolic risk by optimizing prevention and treatment. Characteristics of cardiometabolic risk factors in inpatients are still not well known. We aimed to describe the status of cardiometabolic risk factors in inpatients with SMI and identify associations with psychiatric status and treatment. Methods: A cross sectional descriptive study of inpatients with SMI from long term psychosis treatment wards in South Eastern Norway was performed. Comprehensive assessments of cardiometabolic risk factors, physical activity, lifestyle habits, symptoms, life satisfaction and treatment were made. Associations and potential prognostic factors were analyzed using linear and logistic regressions. Results: A total of 83 patients were included in the study, but many individual datasets were incomplete. Over half of the subjects had unhealthy eating habits. Obesity (class 1–3) was found in 44%, 23% had elevated fasting triglycerides, 26% had elevated blood pressure and 78% smoked daily. Low levels of physical activity were significantly associated with higher levels of depression (p = .007). A nominal increase in cardiometabolic risk factors was found for olanzapine and clozapine users. Conclusion: Inpatients in long term psychosis treatment wards have alarmingly high cardiometabolic risk. Level of physical activity was associated with both psychiatric and somatic health. Focus on lifestyle and somatic health should be an integral part of the treatment for hospitalized SMI patients.

• Aas, Monica; Melle, Ingrid; Bettella, Francesco; Djurovic, Srdjan; Hellard, Stephanie Le & Bjella, Thomas [Show all 12 contributors for this article] (2017). Psychotic patients who used cannabis frequently before illness onset have higher genetic predisposition to schizophrenia than those who did not. Psychological Medicine. ISSN 0033-2917. 48(1), p. 43–49. doi: 10.1017/S0033291717001209. Full text in Research Archive Show summary

  Background Schizophrenia (SZ) and bipolar disorder (BD) are heritable, polygenic disorders with shared clinical and genetic components, suggesting a psychosis continuum. Cannabis use is a well-documented environmental risk factor in psychotic disorders. In the current study, we investigated the relationship between SZ genetic load and cannabis use before illness onset in SZ and BD spectrums. Since frequent early cannabis use (age <18 years) is believed to increase the risk of developing psychosis more than later use, follow-up analyses were conducted comparing early use to later use and no use. Methods We assigned a SZ-polygenic risk score (PGRS) to each individual in our independent sample (N = 381 SZ spectrum cases, 220 BD spectrum cases and 415 healthy controls), calculated from the results of the Psychiatric Genomics Consortium (PGC) SZ case–control study (N = 81 535). SZ-PGRS in patients who used cannabis weekly to daily in the period before first illness episode was compared with that of those who never or infrequently used cannabis. Results Patients with weekly to daily cannabis use before illness onset had the highest SZ-PGRS (p = 0.02, Cohen's d = 0.33). The largest difference was found between patients with daily or weekly cannabis use before illness onset <18 years of age and patients with no or infrequent use of cannabis (p = 0.003, Cohen's d = 0.42). Conclusions Our study supports an association between high SZ-PGRS and frequent cannabis use before illness onset in psychosis continuum disorders.

• Helle, Siri; Ringen, Petter Andreas; Melle, Ingrid; Larsen, Tor Ketil; Gjestad, Rolf & Johnsen, Erik [Show all 12 contributors for this article] (2016). Cannabis use is associated with 3 years earlier onset of schizophrenia spectrum disorder in a naturalistic, multi-site sample (N = 1119). Schizophrenia Research. ISSN 0920-9964. 170(1), p. 217–221. doi: 10.1016/j.schres.2015.11.027. Full text in Research Archive
• Kvitland, Levi Røstad; Ringen, Petter Andreas; Aminoff, Sofie Ragnhild; Demmo, Christine; Hellvin, Tone & Lagerberg, Trine Vik [Show all 8 contributors for this article] (2016). Duration of untreated illness in first-treatment bipolar I disorder in relation to clinical outcome and cannabis use. Psychiatry Research. ISSN 0165-1781. 246, p. 762–768. doi: 10.1016/j.psychres.2016.07.064. Full text in Research Archive
• Lagerberg, Trine Vik; Icick, R.; Andreassen, Ole Andreas; Ringen, Petter Andreas; Etain, B & Aas, Monica [Show all 10 contributors for this article] (2016). Cannabis use disorder is associated with greater illness severity in tobacco smoking patients with bipolar disorder. Journal of Affective Disorders. ISSN 0165-0327. 190, p. 286–293. doi: 10.1016/j.jad.2015.10.023. Full text in Research Archive
• Ringen, Petter Andreas; Nesvåg, Ragnar; Helle, Siri; Lagerberg, Trine Vik; Lange, Elisabeth & Løberg, Else-Marie [Show all 9 contributors for this article] (2016). Premorbid cannabis use is associated with more symptoms and poorer functioning in schizophrenia spectrum disorder. Psychological Medicine. ISSN 0033-2917. 46(15), p. 3127–3136. doi: 10.1017/S0033291716001999. Full text in Research Archive Show summary

  Cannabis use disorder is associated with an earlier age at onset and a more severe outcome of schizophrenia spectrum disorders. The role of cannabis use before the onset of illness (premorbid cannabis use) has not been fully investigated. We here examined how amount and type of premorbid cannabis use was associated with the later course of illness including current substance use, symptoms and level of functioning in schizophrenia spectrum disorder. We used a naturalistic sample of patients with DSM-IV schizophrenia spectrum disorders with a comprehensive history of illness and substance use. Data on premorbid substance use was obtained from comprehensive self-report. The relationship to outcome was investigated using regression models that included current substance use and premorbid functioning. Pre-schizophrenia cannabis use was significantly associated with more severe psychotic symptoms and impaired functioning. Higher levels of premorbid cannabis use were associated with higher levels of current psychotic symptoms. These associations were independent of current substance use and premorbid functioning. Early use of cannabis (age <17 years) was associated with earlier age at onset of psychosis, independently of potential confounders. Pre-psychosis cannabis use affects illness outcome in schizophrenia spectrum disorders, and is associated with lower age at onset of psychosis. These findings of independent negative effects of premorbid cannabis use in schizophrenia suggest that a limitation of the general use of cannabis may have beneficial health effects.

• Kvitland, Levi Røstad; Melle, Ingrid; Aminoff, Sofie Ragnhild; Lagerberg, Trine Vik; Andreassen, Ole Andreas & Ringen, Petter Andreas (2016). Cannabis use in first-treatment bipolar I disorder: Relations to clinical characteristics. Early Intervention in Psychiatry. ISSN 1751-7885. 10(1), p. 36–44. doi: 10.1111/eip.12138. Full text in Research Archive
• Kvitland, Levi Røstad; Melle, Ingrid; Aminoff, Sofie Ragnhild; Demmo, Christine; Lagerberg, Trine Vik & Andreassen, Ole Andreas [Show all 7 contributors for this article] (2015). Continued cannabis use at one year follow up is associated with elevated mood and lower global functioning in bipolar I disorder. BMC Psychiatry. 15(1). doi: 10.1186/s12888-015-0389-x. Full text in Research Archive Show summary

  Background There is limited knowledge about how environmental factors affect the course of bipolar disorder (BD). Cannabis has been proposed as a potential risk factor for poorer course of illness, but the role of cannabis use has not been studied in a first treatment BD I sample. Methods The present study examines the associations between course of illness in first treatment BD I and continued cannabis use, from baseline to one year follow up. Patients (N = 62) with first treatment DSM-IV BD I were included as part of the Thematically Organized Psychosis study (TOP), and completed interviews and self-report questionnaires at both baseline and follow up. Cannabis use within the last six months at baseline and use between baseline and follow up (“continued use”) was recorded. Results After controlling for confounders, continued cannabis use was significantly associated with elevated mood (YMRS) and inferior global functioning (GAF-F) at follow up. Elevated mood mediated the effect of cannabis use on global functioning. Conclusions These results suggest that cannabis use has clinical implications for the early course of BD by increasing mood level. More focus on reducing cannabis use in clinical settings seems to be useful for improving outcome in early phase of the disorder.

• Lange, Elisabeth; Nesvåg, Ragnar; Ringen, Petter Andreas; Hartberg, Cecilie Bhandari; Haukvik, Unn Kristin H. & Andreassen, Ole Andreas [Show all 8 contributors for this article] (2014). One year follow-up of alcohol and illicit substance use in first-episode psychosis: Does gender matter? Comprehensive Psychiatry. ISSN 0010-440X. 55(2), p. 274–282. doi: 10.1016/j.comppsych.2013.08.018. Full text in Research Archive
• Ringen, Petter Andreas; Engh, John; Birkenæs, Astrid B.; Dieset, Ingrid & Andreassen, Ole A. (2014). Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic review of epidemiology, possible causes and interventions. Frontiers in Psychiatry. 5. doi: 10.3389/fpsyt.2014.00137. Full text in Research Archive Show summary

  Background: Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed. Methods: Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors’ experience from clinical work and research in the field. Results: In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. Discussion: The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

• Lagerberg, Trine Vik; Kvitland, Levi Røstad; Aminoff, Sofie Ragnhild; Aas, Monica; Ringen, Petter Andreas & Andreassen, Ole Andreas [Show all 7 contributors for this article] (2014). Indications of a dose-response relationship between cannabis use and age at onset in bipolar disorder. Psychiatry Research. ISSN 0165-1781. 215(1), p. 101–104. doi: 10.1016/j.psychres.2013.10.029. Full text in Research Archive
• Aas, Monica; Etain, B; Bellivier, F; Henry,, C.; Lagerberg, Trine Vik & Ringen, Petter Andreas [Show all 12 contributors for this article] (2014). Additive effects of childhood abuse and cannabis abuse on clinical expressions of bipolar disorders. Psychological Medicine. ISSN 0033-2917. 44(8), p. 1653–1662. doi: 10.1017/S0033291713002316. Full text in Research Archive
• Jónsdóttir, Halldóra; Ilner, Stein E. Opjordsmoen; Birkenæs, Astrid Brate; Simonsen, Carmen Elisabeth; Engh, John & Ringen, Petter Andreas [Show all 10 contributors for this article] (2013). Predictors of medication adherence in patients with schizophrenia and bipolar disorder. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 127(1), p. 23–33. doi: 10.1111/j.1600-0447.2012.01911.x. Full text in Research Archive
• Ringen, Petter Andreas; Melle, Ingrid; Berg, Akiah Ottesen; Agartz, Ingrid; Spigset, Olav & Simonsen, Carmen Elisabeth [Show all 8 contributors for this article] (2013). Cannabis use and premorbid functioning as predictors of poorer neurocognition in schizophrenia spectrum disorder. Schizophrenia Research. ISSN 0920-9964. 143(1), p. 84–89. doi: 10.1016/j.schres.2012.10.021. Full text in Research Archive
• Simonsen, Carmen Elisabeth; Sundet, Kjetil Søren; Vaskinn, Anja; Birkenæs, Astrid Brate; Engh, John & Færden, Ann [Show all 12 contributors for this article] (2011). Neurocognitive dysfunction in bipolar and schizophrenia spectrum disorders depends on history of psychosis rather than diagnostic group. Schizophrenia Bulletin. ISSN 0586-7614. 37(1), p. 73–83. doi: 10.1093/schbul/sbp034. Full text in Research Archive
• Lagerberg, Trine Vik; Sundet, Kjetil Søren; Aminoff, Sofie Ragnhild; Berg, Akiah Ottesen; Ringen, Petter Andreas & Andreassen, Ole Andreas [Show all 7 contributors for this article] (2011). Excessive cannabis use is associated with earlier age at onset in bipolar disorder. European Archives of Psychiatry and Clinical Neuroscience. ISSN 0940-1334. 261(6), p. 397–405. doi: 10.1007/s00406-011-0188-4. Full text in Research Archive
• Jónsdóttir, Halldóra; Ilner, Stein E. Opjordsmoen; Birkenæs, Astrid Brate; Engh, John; Ringen, Petter Andreas & Vaskinn, Anja [Show all 9 contributors for this article] (2010). Medication Adherence in Outpatients With Severe Mental Disorders Relation Between Self-Reports and Serum Level. Journal of Clinical Psychopharmacology. ISSN 0271-0749. 30(2), p. 169–175. doi: 10.1097/JCP.0b013e3181d2191e. Full text in Research Archive
• Lagerberg, Trine Vik; Andreassen, Ole Andreas; Ringen, Petter Andreas; Berg, Akiah Ottesen; Larsson, Sara & Agartz, Ingrid [Show all 8 contributors for this article] (2010). Excessive substance use in bipolar disorder is associated with impaired functioning rather than clinical characteristics, a descriptive study. BMC Psychiatry. 10(9). doi: 10.1186/1471-244X-10-9. Full text in Research Archive Show summary

  Background There is a strong association between bipolar disorder (BD) and substance use disorder (SUD). The clinical and functional correlates of SUD in BD are still unclear and little is known about the role of excessive substance use that does not meet SUD criteria. Thus, the aims of the current study were to investigate lifetime rates of illicit substance use in BD relative to the normal population and if there are differences in clinical and functional features between BD patients with and without excessive substance use. Methods 125 consecutively recruited BD in- and outpatients from the Oslo University Hospitals and 327 persons randomly drawn from the population in Oslo, Norway participated. Clinical and functional variables were assessed. Excessive substance use was defined as DSM-IV SUD and/or excessive use according to predefined criteria. Results The rate of lifetime illicit substance use was significantly higher among patients compared to the reference population (OR = 3.03, CI = 1.9-4.8, p < .001). Patients with excessive substance use (45% of total) had poorer educational level, occupational status, GAF-scores and medication compliance, with a trend towards higher suicidality rates, compared to patients without. There were no significant group differences in current symptom levels or disease course between groups. Conclusion The percentage of patients with BD that had tried illicit substances was significantly higher than in the normal population. BD patients with excessive substance use clearly had impaired functioning, but not a worse course of illness compared to patients without excessive substance use. An assessment of substance use beyond SUD criteria in BD is clinically relevant.

• Ringen, Petter Andreas; Vaskinn, Anja; Sundet, Kjetil Søren; Engh, John; Jónsdóttir, Halldóra & Simonsen, Carmen Elisabeth [Show all 10 contributors for this article] (2010). Opposite relationships between cannabis use and neurocognitive functioning in bipolar disorder and schizophrenia. Psychological Medicine. ISSN 0033-2917. 40(8), p. 1337–1347. doi: 10.1017/S0033291709991620. Full text in Research Archive
• Engh, John; Friis, Svein; Birkenæs, Astrid Brate; Jónsdóttir, Halldóra; Klungsøyr, Ole & Ringen, Petter Andreas [Show all 10 contributors for this article] (2010). Delusions Are Associated With Poor Cognitive Insight in Schizophrenia. Schizophrenia Bulletin. ISSN 0586-7614. 36(4), p. 830–835. doi: 10.1093/schbul/sbn193. Full text in Research Archive
• Nesvåg, Ragnar; Lange, Elisabeth; Færden, Ann; Barrett, Elisabeth Ann; Emilsson, Bjørn & Ringen, Petter Andreas [Show all 9 contributors for this article] (2010). The use of screening instruments for detecting alcohol and other drug use disorders in first-episode psychosis. Psychiatry Research. ISSN 0165-1781. 177(1-2), p. 228–234. doi: 10.1016/j.psychres.2010.01.007. Full text in Research Archive
• Engh, John; Friis, Svein; Birkenæs, Astrid Brate; Jónsdóttir, Halldóra; Klungsøyr, Ole & Ringen, Petter Andreas [Show all 10 contributors for this article] (2009). Delusions are associated with low cognitive insight in schizophrenia. Cognitive insight, delusions and hallucinations. Schizophrenia Bulletin. ISSN 0586-7614. doi: 10.1093/schbul/sbn193. Full text in Research Archive
• Vaskinn, Anja; Sundet, Kjetil Søren; Friis, Svein; Ueland, Toril; Simonsen, Carmen Elisabeth & Birkenæs, Astrid Brate [Show all 11 contributors for this article] (2009). Using the Wisconsin Card Sorting Test to assess learning potential in normal IQ schizophrenia: Does it have potential? Nordic Journal of Psychiatry. ISSN 0803-9488. 63(5), p. 405–411. doi: 10.1080/08039480902879941. Full text in Research Archive
• Simonsen, Carmen Elisabeth; Sundet, Kjetil Søren; Vaskinn, Anja; Birkenæs, Astrid Brate; Engh, John & Hansen, Charlotte F [Show all 11 contributors for this article] (2008). Neurocognitive profiles in bipolar I and bipolar II disorder: differences in pattern and magnitude of dysfunction. Bipolar Disorders. ISSN 1398-5647. 10, p. 245–255. Full text in Research Archive
• Jónsdóttir, Halldóra; Engh, John; Friis, Svein; Birkenæs, Astrid Brate; Ringen, Petter Andreas & Vaskinn, Anja [Show all 9 contributors for this article] (2008). Measurement of insight in patients with bipolar disorder. Are self-rated scales developed for patients with schizophrenia applicable? Journal of Nervous and Mental Disease. ISSN 0022-3018. 196, p. 333–335. doi: 10.1097/NMD.0b013e31816a62b2. Full text in Research Archive
• Ringen, Petter Andreas; Lagerberg, Trine Vik; Birkenæs, Astrid Brate; Engh, JA; Færden, Ann & Jónsdóttir, Halldóra [Show all 12 contributors for this article] (2008). Differences in prevalence and patterns of substance use in schizophrenia and bipolar disorder. Psychological Medicine. ISSN 0033-2917. 38, p. 1241–1249. doi: 10.1017/S003329170700236X. Full text in Research Archive
• Birkenæs, Astrid Brate; Birkeland, Kåre I.; Færden, Ann; Jónsdóttir, Halldóra; Ringen, Petter Andreas & Friis, Svein [Show all 9 contributors for this article] (2008). Dyslipidemia independent of body mass in anti psychotic-treated patients under real-life conditions. Journal of Clinical Psychopharmacology. ISSN 0271-0749. 28(2), p. 132–137. doi: 10.1097/JCP.0b013e318166c4f7. Full text in Research Archive
• Ringen, Petter Andreas; Melle, Ingrid; Birkenæs, Astrid Brate; Engh, John; Færden, Ann & Vaskinn, Anja [Show all 9 contributors for this article] (2008). The level of illicit drug use is related to symptoms and premorbid functioning in severe mental illness. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 118, p. 297–304. doi: 10.1111/j.1600-0447.2008.01244.x. Full text in Research Archive
• Ringen, Petter Andreas; Melle, Ingrid; Birkenæs, Astrid Brate; Engh, John; Færden, Ann & Jónsdóttir, Halldóra [Show all 13 contributors for this article] (2008). Illicit drug use in patients with psychotic disorders compared with that in the general population: a cross-sectional study. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 117(2), p. 133–138. doi: 10.1111/j.1600-0447.2007.01135.x. Full text in Research Archive
• Vaskinn, Anja; Sundet, Kjetil Søren; Friis, Svein; Simonsen, Carmen Elisabeth; Birkenæs, Astrid Brate & Jónsdóttir, Halldóra [Show all 8 contributors for this article] (2008). Emotion perception and learning potential: Mediators between neurocognition and social problem-solving in schizophrenia? Journal of the International Neuropsychological Society. ISSN 1355-6177. 14, p. 279–288. doi: 10.1017/S1355017708080314. Full text in Research Archive
• Engh, John; Friis, Svein; Birkenæs, Astrid Brate; Jonsdottir, Halldora; Ringen, Petter Andreas & Ruud, Torleif [Show all 9 contributors for this article] (2007). Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study. BMC Psychiatry. doi: 10.1186/1471-244X-7-71. Full text in Research Archive Show summary

  Background Beck Cognitive Insight Scale (BCIS) has been designed for assessment of self-reflection on patients' anomalous experiences and interpretations of own beliefs. The scale has been developed and validated for patients with schizophrenia. We wanted to study the utility of the scale for patients with bipolar disorder. The relationship between the BCIS as a measure of cognitive insight and established methods for assessment of insight of illness was explored in both diagnostic groups. Methods The BCIS self-report inventory was administered to patients with schizophrenia (n = 143), bipolar disorder (n = 92) and controls (n = 64). The 15 items of the inventory form two subscales, self-reflectiveness and self-certainty. Results The internal consistency of the subscales was good for the patient groups and the controls. The mean subscale scores were not significantly different for the three groups. Four items in subscale self-reflectiveness referring to psychotic experiences gave, however, different results in the control subjects. Self-certainty and scores on insight item PANSS correlated significantly in the schizophrenia, but not in the bipolar group. Conclusion BCIS with its two subscales seems applicable for patients with bipolar disorder as well as for patients with schizophrenia. The self-report inventory can also be applied to control subjects if the items referring to psychotic experiences are omitted. In schizophrenia high scores on self-certainty is possibly associated with poor insight of illness. For the bipolar group the subscales are largely independent of traditional insight measures.

• Vaskinn, Anja; Sundet, Kjetil Søren; Friis, Svein; Simonsen, Carmen Elisabeth; Birkenæs, Astrid Brate & Engh, John [Show all 10 contributors for this article] (2007). The effect of gender on emotion perception in schizophrenia and bipolar disorder. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 116, p. 263–270. doi: 10.1111/j.1600-0447.2007.00991.x. Full text in Research Archive
• Birkenæs, Astrid Brate; Opjordsmoen, Stein; Brunborg, Cathrine; Engh, John; Jonsdottir, Halldora & Ringen, Petter Andreas [Show all 12 contributors for this article] (2007). The level of cardiovascular risk factors in bipolar disorder equals that of schizophrenia: a comparative study. Journal of Clinical Psychiatry. ISSN 0160-6689. 68, p. 917–923. Full text in Research Archive
• Birkenæs, Astrid Brate; Søgaard, Anne Johanne; Engh, John; Jonsdottir, Halldora; Ringen, Petter Andreas & Vaskinn, Anja [Show all 10 contributors for this article] (2006). Sociodemographic characteristics and cardiovascular risk factors in patients with severe mental disorders compared with the general population. Journal of Clinical Psychiatry. ISSN 0160-6689. 67, p. 425–433. Full text in Research Archive
• Melle, Ingrid & Ringen, Petter Andreas (2005). Rus og psykoser. In Rund, BR (Eds.), Schizofreni. Hertervig Akademisk. ISSN 9788292023914. p. 211–222. Full text in Research Archive Show summary

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• Ringen, Petter Andreas & Hagen, Hallvard Solbø (2025). Bevisstheten kan forstås innenfra. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(1). doi: 10.4045/tidsskr.24.0507. Full text in Research Archive
• Ringen, Petter Andreas (2020). Acute Coronary Syndrome in Patients With Schizophrenia: A Call for Cardiopsychiatry. Cardiology. ISSN 0008-6312. doi: 10.1159/000507328. Full text in Research Archive
• Kvitland, Levi Røstad; Ringen, Petter Andreas; Aminoff, Sofie Ragnhild; Haram, Marit; Hellvin, Tone & Lagerberg, Trine Vik [Show all 9 contributors for this article] (2013). Cannabis use in the early phase of bipolar disorder: clinical characteristics in a cross-sectional sample. Bipolar Disorders. ISSN 1398-5647. 15, p. 118–118. Full text in Research Archive
• Ringen, Petter Andreas; Melle, Ingrid; Berg, Akiah Ottesen; Simonsen, Carmen Elisabeth; Agartz, Ingrid & Sundet, Kjetil Søren [Show all 7 contributors for this article] (2011). THC IN URINE IN SCHIZOPHRENIA: ASSOCIATIONS WITH SYMPTOM LEVELS AND NEUROCOGNITIVE FUNCTIONING. Schizophrenia Bulletin. ISSN 0586-7614. 37, p. 279–280. Full text in Research Archive
• Simonsen, Carmen Elisabeth; Sundet, Kjetil Søren; Vaskinn, Anja; Birkenaes, A; Engh, JA & Faerden, A [Show all 12 contributors for this article] (2009). NEUROCOGNITIVE DYSFUNCTION IN BIPOLAR AND SCHIZOPHRENIA SPECTRUM DISORDERS: THE ROLE OF HISTORY OF PSYCHOSIS. Schizophrenia Bulletin. ISSN 0586-7614. 35, p. 297–297. Full text in Research Archive
• Lagerberg, Trine Vik; Sundet, Kjetil Søren; Amino, SR; Ringen, Petter Andreas; Andreassen, Ole Andreas & Melle, Ingrid (2009). Different age at onset of bipolar disorder for cannabis and alcohol abusing patients. Bipolar Disorders. ISSN 1398-5647. 11, p. 11–11. Full text in Research Archive
• Ringen, Petter Andreas; Lagerberg, Trine Vik; Birkenæs, Astrid Brate; Engh, John; Færden, Ann & Jónsdóttir, Halldóra [Show all 12 contributors for this article] (2008). Differences in prevalence and patterns of substance use in schizophrenia and bipolar disorder. Full text in Research Archive
• Sundet, Kjetil Søren; Vaskinn, Anja; Simonsen, Carmen Elisabeth; Hansen, Charlotte F; Birkenæs, Astrid Brate & Engh, John [Show all 11 contributors for this article] (2008). Timing of neurocognitive decline in schizophrenia and bipolar disorder. Schizophrenia Research. ISSN 0920-9964. 98, p. 36–36. Full text in Research Archive
• Nakstad, Per Hjalmar; Alonso, Andrès Server; Engh, J; Jensen, J; Ringen, Petter Andreas & Agatz, Ingrid [Show all 7 contributors for this article] (2007). Incidental findings in research functional magnetic resonance imaging: neuroethical and practical considerations. Neuroradiology. ISSN 0028-3940. 49, p. 79–79. Full text in Research Archive
• Ringen, Petter Andreas (2007). Medisin og psykiatri - stykkevis og delt? 127, p. 908–910. Full text in Research Archive
• Engh, John; Jonsdottir, Halldora; Birkenæs, Astrid Brate; Ringen, Petter Andreas; Vaskinn, Anja & Ilner, Opjordsmoen Stein E. [Show all 8 contributors for this article] (2006). Assessment of insight in schizophrenia and bipolar disorder. Schizophrenia Research. ISSN 0920-9964. 81. Full text in Research Archive
• Birkenæs, Astrid Brate; Søgaard, Anne Johanne; Engh, John; Jonsdottir, Halldora; Ringen, Petter Andreas & Vaskinn, Anja [Show all 10 contributors for this article] (2006). Socio-demographic characteristics and cardiovascular risk factors in patients with severe mental disorders compared with the general population. Schizophrenia Research. ISSN 0920-9964. 81, p. 39–40. Full text in Research Archive
• Vaskinn, Anja; Birkenæs, Astrid Brate; Engh, John; Jonsdottir, Halldora; Ringen, Petter Andreas & Opjordsmoen, Stein [Show all 9 contributors for this article] (2005). Learning potential as a differentiating variable in schizophrenia. Schizophrenia Bulletin. ISSN 0586-7614. 31. Full text in Research Archive

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