Illness trajectories and outcome prediction
The aim of this research group is to identify symptom trajectories and their correlates through prospective longitudinal studies of first-treatment participants with psychotic disorders.
Psychotic disorders show large variations in course and outcome. The disorders take a relapsing-remitting course after onset with outcomes ranging from full recovery to continuous severe symptoms and risk of premature death. Recent research has given clues to their etiology, boosting studies of the mechanisms behind cross-sectional defined symptoms.
However, as much as 80% of first-treatment patients experience full symptom remission, and the long-term costs are thus primarily related to relapses and residual symptoms. The rates of stable long-term symptomatic remissions and functional recovery are on the other hand higher than previously thought. Early course parameters, including length of untreated illness and initial treatment response, are among the most important predictors of long-term outcome.
Recent studies have identified a range of genetic loci associated with schizophrenia and bipolar disorder, and environmental risk factors that include urban upbringing, trauma, migration and substance use. Etiological models for psychotic disorders depict clinical illness as prompted by environmental hits, on the basis of an underlying (genetic) vulnerability.
To what extent are vulnerability factors primarily operating during brain maturation, shaping a stable and change-resistant susceptibility?
To what extent are they still active processes, driving symptom formation and amenable to interventions after onset?
Increased knowledge about what drives different illness trajectories will here aid the development of personalized treatment approaches.
The aim of the group is to identify symptom trajectories and their correlates through prospective longitudinal studies of first-treatment participants. The group studies the longitudinal development of negative and psychotic symptoms, on the opposite outcomes of full functional recovery versus treatment resistance and suicide with a specific focus on the clinical correlates of environmental risk factors such as early trauma, migration, urbanicity and substance use.
In collaboration with other research groups in NORMENT we will include molecular genetic, gene expression and methylation data with cognitive and brain imaging data to improve prediction of long-term outcome.
The group has the primary responsibility for NORMENT’s long-term follow-up studies, and based on the focus on early treatment response also collaborate with clinical early psychosis units at Oslo University Hospital and with the TIPS competence centre for early intervention.