Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Fiona Gaughran, King's College London, UK
- Second opponent: Professor Ole Jakob Storebø, University of Southern Denmark
- Third member and chair of the evaluation committee: Associate Professor Anita Johanna Tørmoen, University of Oslo
Chair of the Defence
Associate Professor Mari Nerhus, University of Oslo
Principal Supervisor
Professor Ingrid Melle, University of Oslo
Summary
The course and outcome of first episode psychosis (FEP) varies significantly, with differing symptom presentations and outcomes in those affected. Several clinical, pre-illness, and demographic factors are known to predict treatment response. Studies indicate that the clinical development over the first years of treatment is crucial for longer-term outcomes. However, long-term data still needs to be provided.
The recent focus on patients who recover swiftly after the initial psychotic episode has led to hope and a greater attention to the fact that a diagnosis of a psychotic disorder does not necessarily imply a negative long-term outcome. Still, approximately one-third of patients with psychotic disorders do not respond to standard antipsychotic treatments. Understanding the characteristics of these different patient groups is essential for gaining insights into what contributes to recovery and a more favorable prognosis.
This doctoral thesis comprises three studies of a comprehensive prospective FEP cohort, recruited during their initial treatment, where we aimed to investigate the short (one year) - and longer-term (ten years) outcomes and their predictors. We sought to investigate whether different FEP outcome groups exhibited specific clinical characteristics, prerequisites, or had been exposed to distinct risk factors. We investigated demographic characteristics, clinical status, including diagnosis and symptoms, functional assessments at baseline and follow-up, mode of onset, received treatment, childhood trauma, premorbid adjustment, and duration of untreated psychosis.
We identified groups of participants at both the one-year and ten-year follow-ups that exhibited either recovery or treatment resistance. Additionally, we found a middle group comprising both patients who were partially in recovery, patients with a more remitting-relapsing illness course, and patients who were not improving and at the same time had not received adequate treatment. We identified several clinical characteristics associated with poor treatment response that can be detected early in the treatment process, as well as clinical features that appear to influence long-term outcomes. We found that nearly half of the participants had moderate to severe experiences of childhood trauma and that other early disease characteristics seem to mediate the relationship between childhood trauma and treatment response.
The findings of the dissertation highlight a gap between outcomes in structured clinical studies and outcomes in real-world service and treatment environments. More immediate evaluation of non-response to treatment may facilitate trials of alternative treatments suggested in treatment guidelines. We identified specific clinical characteristics that can be utilized in clinical practice to identify patients who require alternative treatment methods, which could aid further early intervention to prevent future treatment resistance. Additionally, we provided evidence for the importance of initiating trauma-focused treatments for psychosis patients early in the course of the illness to mitigate the negative effects of trauma on clinical outcomes.
The study was funded by research grants from Helse Sør-Øst and conducted at the Norwegian Center for Mental Disorders Research (NORMENT) as a collaboration between Oslo University Hospital and the Institute of Clinical Medicine at the University of Oslo.
Additional information
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