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Early Predictors of Ten-Year Course in First-Episode Psychosis.

https://arctichealth.org/en/permalink/ahliterature279449
Source
Psychiatr Serv. 2016 Apr 01;67(4):438-43
Publication Type
Article
Date
Apr-01-2016
Author
Svein Friis
Ingrid Melle
Jan Olav Johannessen
Jan Ivar Røssberg
Helene Eidsmo Barder
Julie Horgen Evensen
Ulrik Haahr
Wenche Ten Velden Hegelstad
Inge Joa
Johannes Langeveld
Tor Ketil Larsen
Stein Opjordsmoen
Bjørn Rishovd Rund
Erik Simonsen
Per Wiggen Vaglum
Thomas H McGlashan
Source
Psychiatr Serv. 2016 Apr 01;67(4):438-43
Date
Apr-01-2016
Language
English
Publication Type
Article
Keywords
Adult
Denmark - epidemiology
Disease Progression
Female
Humans
Longitudinal Studies
Male
Middle Aged
Norway - epidemiology
Outcome Assessment (Health Care) - statistics & numerical data
Prognosis
Psychotic Disorders - diagnosis - drug therapy - epidemiology
Remission Induction
Schizophrenia - diagnosis - drug therapy - epidemiology
Social Skills
Time Factors
Abstract
Identifying patients at risk of poor outcome at an early stage of illness can aid in treatment planning. This study sought to create a best-fit statistical model of known baseline and early-course risk factors to predict time in psychosis during a ten-year follow-up period after a first psychotic episode.
Between 1997 and 2000, 301 patients with DSM-IV nonorganic, nonaffective first-episode psychosis were recruited consecutively from catchment area-based sectors in Norway and Denmark. Specialized mental health personnel evaluated patients at baseline, three months, and one, two, five, and ten years (N=186 at ten years). Time in psychosis was defined as time with scores =4 on any of the Positive and Negative Syndrome Scale items P1, P3, P5, P6, and G9. Evaluations were retrospective, based on clinical interviews and all available clinical information. During the first two years, patients were also evaluated by their clinicians at least biweekly. Baseline and early-course predictors of long-term course were identified with linear mixed-model analyses.
Four variables provided significant, additive predictions of longer time in psychosis during the ten-year follow-up: deterioration in premorbid social functioning, duration of untreated psychosis (DUP) of =26 weeks, core schizophrenia spectrum disorder, and no remission within three months.
First-episode psychosis patients should be followed carefully after the start of treatment. If symptoms do not remit within three months with adequate treatment, there is a considerable risk of a poor long-term outcome, particularly for patients with a deterioration in premorbid social functioning, a DUP of at least half a year, and a diagnosis within the core schizophrenia spectrum.
PubMed ID
26567932 View in PubMed
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Pathways to care for first-episode psychosis in an early detection healthcare sector: part of the Scandinavian TIPS study.

https://arctichealth.org/en/permalink/ahliterature70615
Source
Br J Psychiatry Suppl. 2005 Aug;48:s24-8
Publication Type
Article
Date
Aug-2005
Author
Jan Olav Johannessen
Tor K Larsen
Inge Joa
Ingrid Melle
Svein Friis
Stein Opjordsmoen
Bjørn Rishovd Rund
Erik Simonsen
Per Vaglum
Thomas H McGlashan
Author Affiliation
Division of Psychiatry, General Hospital of Rogaland, Armauer Hanssens vei 20, 4000 Stavanger, Norway. jojo@sir.no
Source
Br J Psychiatry Suppl. 2005 Aug;48:s24-8
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Critical Pathways - organization & administration
Delivery of Health Care - organization & administration - standards
Early Diagnosis
Female
Health Services Accessibility
Humans
Male
Middle Aged
Norway
Patient Acceptance of Health Care
Patient Care Team - organization & administration
Psychotic Disorders - diagnosis - therapy
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Abstract
BACKGROUND: Early detection programmes aim to reduce the duration of untreated psychosis (DUP) by public education and by prompt access to treatment via active outreach detection teams. AIMS: To determine whether those with first-episode psychosis in an early detection healthcare area with existing referral channels differ from those who access care via detection teams. METHOD: Those with first-episode psychosis recruited via detection teams were compared with those accessing treatment via conventional channels, at baseline and after 3 months of acute treatment. RESULTS: Patients recruited via detection teams are younger males with a longer DUP, a less dramatic symptom picture and better functioning; however they recover more slowly, and have more symptoms at 3-month follow-up. CONCLUSIONS: After establishing low threshold active case-seeking detection teams, we found clear differences between those patients entering treatment via detection teams v. those obtaining treatment via the usual channels. Such profiling may be informative for early detection service development.
PubMed ID
16055803 View in PubMed
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Predictors of involuntary hospitalizations to acute psychiatry.

https://arctichealth.org/en/permalink/ahliterature116463
Source
Int J Law Psychiatry. 2013 Mar-Apr;36(2):136-43
Publication Type
Article
Author
Kjetil Hustoft
Tor Ketil Larsen
Bjørn Auestad
Inge Joa
Jan Olav Johannessen
Torleif Ruud
Author Affiliation
Stavanger University Hospital, Division of Psychiatry, Armauer Hansensvei 20, Post Office Box 8100, N-4068 Stavanger, Norway. khu2@sus.no
Source
Int J Law Psychiatry. 2013 Mar-Apr;36(2):136-43
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aggression - psychology
Commitment of Mentally Ill - legislation & jurisprudence
Community Mental Health Centers - legislation & jurisprudence
Female
General Practice - legislation & jurisprudence
Humans
Male
Mental Disorders - diagnosis - psychology - rehabilitation
Middle Aged
Motivation
Norway
Personality Assessment - statistics & numerical data
Psychiatric Department, Hospital - legislation & jurisprudence
Psychometrics - statistics & numerical data
Referral and Consultation - legislation & jurisprudence
Sex Factors
Social Adjustment
Substance-Related Disorders - diagnosis - psychology - rehabilitation
Young Adult
Abstract
There is little knowledge of predictors for involuntary hospitalizations in acute psychiatric units.
The Multi-center study of Acute Psychiatry included all cases of acute consecutive psychiatric admissions in twenty acute psychiatric units in Norway, representing about 75% of the acute psychiatric units during 2005-2006. Data included admission process, rating of Global Assessment of Functioning and Health of the Nation Outcome Scales.
Fifty-six percent were voluntary and 44% involuntary hospitalized. Regression analysis identified contact with police, referral by physicians who did not know the patient, contact with health services within the last 48 h, not living in own apartment or house, high scores for aggression, level of hallucinations and delusions, and contact with an out-of office clinic within the last 48 h and low GAF symptom score as predictors for involuntary hospitalization. Involuntary patients were older, more often male, non-Norwegian, unmarried and had lower level of education. They more often had disability pension or received social benefits, and were more often admitted during evenings and nights, found to have more frequent substance abuse and less often responsible for children and were less frequently motivated for admission. Involuntary patients had less contact with psychiatric services before admission. Most patients were referred because of a deterioration of their psychiatric illness.
Involuntary hospitalization seems to be guided by the severity of psychiatric symptoms and factors "surrounding" the referred patient. Important factors seem to be male gender, substance abuse, contact with own GP, aggressive behavior, and low level of social functioning and lack of motivation. There was a need for assistance by the police in a significant number of cases. This complicated picture offers some important challenges to the organization of primary and psychiatric health services and a need to consider better pathways to care.
PubMed ID
23395506 View in PubMed
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Public attitudes towards involuntary admission and treatment by mental health services in Norway.

https://arctichealth.org/en/permalink/ahliterature294910
Source
Int J Law Psychiatry. 2017 Nov - Dec; 55:1-7
Publication Type
Journal Article
Author
Inge Joa
Kjetil Hustoft
Liss Gøril Anda
Kolbjørn Brønnick
Olav Nielssen
Jan Olav Johannessen
Johannes H Langeveld
Author Affiliation
Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Norway; Network for Medical Sciences, Faculty of Social Sciences, University of Stavanger, Norway. Electronic address: ijo@sus.no.
Source
Int J Law Psychiatry. 2017 Nov - Dec; 55:1-7
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Analysis of Variance
Attitude to Health
Commitment of Mentally Ill
Female
Hospitalization
Humans
Interviews as Topic
Male
Mental Disorders - psychology - therapy
Mental health services
Middle Aged
Norway
Public Opinion
Surveys and Questionnaires
Young Adult
Abstract
The role of compulsory treatment of serious mental disorders has been the topic of ongoing public debate involving among others mental health professionals, service providers, service user advocates, relatives of service users, media commentators and politicians. However, relatively little is known about general public attitudes towards involuntary admission and compulsory treatment of people with various mental disorders. This article examines the attitudes in a representative sample of Norway's population towards the use of involuntary admission and treatment, and under which circumstances does the general public consider compulsory treatment to be justified in the Norwegian mental health care services.
Data were collected from a representative sample of the population in Norway aged 18 and older. The sample was stratified for gender, geographical region and age distribution (n=2001). The survey was performed in the months of May 2009 (n=1000) and May 2011 (n=1001), using Computer Assisted Telephone Interviews (CATI) by an independent polling company. All respondents were provided a general definition of coercive intervention before the interview was conducted.
Univariate descriptions and bivariate analyses were performed by means of cross-tabulation, analysis of variance (one-way ANOVA) and comparing of group of means. Cohen's d was used as the measure for effect size.
Between 87% and 97% of those surveyed expressed strong or partial agreement with the use of involuntary admissions or compulsory treatment related to specified cases and situations. The majority of interviewees (56%) expressed the opinion that overall, current levels are acceptable. A further, 34% were of the opinion that current levels are too low, while only 9.9% of respondents supported a reduction in the level of involuntary treatment. Lower levels of education were associated with a more positive attitude towards involuntary admission and treatment. There was stronger support for admission to prevent suicide than the possibility of violence by the mentally ill.
The Norwegian adult population largely supports current legislation and practices regarding involuntary admission and compulsory treatment in the mental health services.
PubMed ID
29157507 View in PubMed
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[Schizophrenia--incidence and significance]

https://arctichealth.org/en/permalink/ahliterature18649
Source
Tidsskr Nor Laegeforen. 2002 Aug 30;122(20):2011-4
Publication Type
Article
Date
Aug-30-2002
Author
Jan Olav Johannessen
Author Affiliation
Rogaland psykiatriske sjukehus Armauer Hansens vei 20 4011 Stavanger. jojo@sir.no
Source
Tidsskr Nor Laegeforen. 2002 Aug 30;122(20):2011-4
Date
Aug-30-2002
Language
Norwegian
Publication Type
Article
Keywords
Cost of Illness
English Abstract
Health Care Costs
Health Priorities
Humans
Incidence
Norway - epidemiology
Schizophrenia - economics - epidemiology - therapy
World Health
Abstract
The human suffering associated with schizophrenia is enormous--for patients, families, and in society at large. 10% of all disabled citizens in Norway have schizophrenia, although the yearly incidence is low (about 7-15 per 100,000). This variance in incidence is found in most countries. There is an increased risk for schizophrenia among the urban born compared with those born in rural areas, a declining incidence over time, and increased risk in offspring of migrants. In Norway, the total cost per year for schizophrenia is estimated at 4 billion NOK (1995). In western countries costs are estimated to exceed 1% of the national budget. There is no other disorder with comparable costs. Schizophrenia alone costs more than all types of cancer and more than all cardiovascular diseases. There are reasons to believe that not all patients with schizophrenia are given treatment that is in accordance with good clinical practice. The time lag from on set of manifest psychosis and to appropriate treatment is often long--in most western countries up to 2-3 years. Early detection and treatment of schizophrenia is an important challenge.
PubMed ID
12555448 View in PubMed
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Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area.

https://arctichealth.org/en/permalink/ahliterature105958
Source
BMC Psychiatry. 2013;13:319
Publication Type
Article
Date
2013
Author
Melissa A Weibell
Inge Joa
Jørgen Bramness
Jan Olav Johannessen
Patrick D McGorry
Wenche Ten Velden Hegelstad
Tor Ketil Larsen
Author Affiliation
Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway. weim@sus.no.
Source
BMC Psychiatry. 2013;13:319
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Comorbidity
Female
Humans
Incidence
Male
Middle Aged
Norway - epidemiology
Psychoses, Substance-Induced - diagnosis - epidemiology - therapy
Psychotic Disorders - diagnosis - epidemiology
Substance-Related Disorders - diagnosis - epidemiology
Abstract
Substance misuse is a well-recognized co-morbidity to psychosis and has been linked to poor prognostic outcomes in patients. Researchers have yet to investigate the difference in rates and characteristics between first-episode Substance Induced Psychosis (SIP) and primary psychosis. We aimed at comparing patients with SIP to primary psychosis patients with or without substance misuse at baseline.
Thirty SIP patients, 45 primary psychosis patients with substance misuse (PS) and 66 primary psychosis patients without substance misuse (PNS) in a well-defined Norwegian catchment area were included from 2007-2011. Assessments included symptom levels (PANSS), diagnostic interviews (SCID), premorbid function scale (PAS) and global functioning (GAF f/s).
Treated incidence for SIP was found to be 6.5/100 000 persons per year, 9.7/100 000 persons per year for PS and 24.1/100 000 persons per year for PNS (15-65 yrs). Patients who had substance misuse (PS and SIP) were more likely to be male. Duration of Untreated Psychosis (DUP) was significantly shorter in the SIP group (5.0 wks., p?=?0.003) and these had more positive symptoms on the PANSS (p?=?0.049). SIP patients also did poorer on early youth academic levels on the PAS.
Yearly treated incidence of SIP is 6.5/100 000 persons per year in a Norwegian catchment area. SIP patients have short DUPs, are more likely to be male, have more positive symptoms at baseline and poorer premorbid academic scores in early adolescence. Follow-up will evaluate stability of diagnosis and characteristics.
PubMed ID
24279887 View in PubMed
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Treatment and violent behavior in persons with first episode psychosis during a 10-year prospective follow-up study.

https://arctichealth.org/en/permalink/ahliterature259887
Source
Schizophr Res. 2014 Jul;156(2-3):272-6
Publication Type
Article
Date
Jul-2014
Author
Johannes Langeveld
Stål Bjørkly
Bjørn Auestad
Helene Barder
Julie Evensen
Wenche Ten Velden Hegelstad
Inge Joa
Jan Olav Johannessen
Tor Ketil Larsen
Ingrid Melle
Stein Opjordsmoen
Jan Ivar Røssberg
Bjørn Rishovd Rund
Erik Simonsen
Per Vaglum
Thomas McGlashan
Svein Friis
Source
Schizophr Res. 2014 Jul;156(2-3):272-6
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - therapeutic use
Crime
Denmark - epidemiology
Follow-Up Studies
Humans
Logistic Models
Middle Aged
Multivariate Analysis
Norway - epidemiology
Prevalence
Prospective Studies
Psychiatric Status Rating Scales
Psychotherapy
Psychotic Disorders - diagnosis - epidemiology - therapy
Risk
Substance-Related Disorders - epidemiology
Violence
Young Adult
Abstract
First episode psychosis (FEP) patients have an increased risk for violence and criminal activity prior to initial treatment. However, little is known about the prevalence of criminality and acts of violence many years after implementation of treatment for a first episode psychosis.
To assess the prevalence of criminal and violent behaviors during a 10-year follow-up period after the debut of a first psychosis episode, and to identify early predictors and concomitant risk factors of violent behavior.
A prospective design was used with comprehensive assessments of criminal behavior, drug abuse, clinical, social and treatment variables at baseline, five, and 10-year follow-up. Additionally, threatening and violent behavior was assessed at 10-year follow-up. A clinical epidemiological sample of first-episode psychosis patients (n=178) was studied.
During the 10-year follow-up period, 20% of subjects had been apprehended or incarcerated. At 10-year follow-up, 15% of subjects had exposed others to threats or violence during the year before assessment. Illegal drug use at baseline and five-year follow-up, and a longer duration of psychotic symptoms were found to be predictive of violent behavior during the year preceding the 10-year follow-up.
After treatment initiation, the overall prevalence of violence in psychotic patients drops gradually to rates close to those of the general population. However, persistent illicit drug abuse is a serious risk factor for violent behavior, even long after the start of treatment. Achieving remission early and reducing substance abuse may contribute to a lower long-term risk for violent behavior in FEP patients.
PubMed ID
24837683 View in PubMed
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Voluntary or involuntary acute psychiatric hospitalization in Norway: A 24h follow up study.

https://arctichealth.org/en/permalink/ahliterature298276
Source
Int J Law Psychiatry. 2018 Jan - Feb; 56:27-34
Publication Type
Journal Article
Observational Study
Author
Kjetil Hustoft
Tor Ketil Larsen
Kolbjørn Brønnick
Inge Joa
Jan Olav Johannessen
Torleif Ruud
Author Affiliation
Division of Psychiatry, Center of Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway. Electronic address: kjetil.hustoft@sus.no.
Source
Int J Law Psychiatry. 2018 Jan - Feb; 56:27-34
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Acute Disease
Adolescent
Adult
Coercion
Commitment of Mentally Ill - legislation & jurisprudence
Female
Follow-Up Studies
Hospitalization
Humans
Male
Middle Aged
Norway
Patient Rights
Prospective Studies
Young Adult
Abstract
The Norwegian Mental Health Care Act states that patients who are involuntarily admitted to a hospital must be reevaluated by a psychiatrist or a specialist in clinical psychology within 24h to assess whether the patient fulfills the legal criteria for the psychiatric status and symptoms. International research on the use of coercive hospitalization in psychiatry is scarce, and an investigation of Norway's routine re-evaluation of involuntarily referred patients may expand knowledge about this aspect of psychiatric treatment. The aim of this study was to investigate the extent to which Involuntarily Hospitalized (IH) patients were converted to a Voluntary Hospitalization (VH), and to identify predictive factors leading to conversion. The Multi-center Acute Psychiatry study (MAP) included all cases of acute consecutive psychiatric admissions across twenty Norwegian acute psychiatric units in health trusts in Norway across 3months in 2005-06, representing about 75% of the psychiatric acute emergency units in Norway. The incident of conversion from involuntarily hospitalization (IH) to voluntary hospitalization (VH) was analyzed using generalized linear mixed modeling. Out of 3338 patients referred for admission, 1468 were IH (44%) and 1870 were VH. After re-evaluation, 1148 (78.2%) remained on involuntary hospitalization, while 320 patients (21.8%) were converted to voluntary hospitalization. The predictors of conversion from involuntary to voluntary hospitalization after re-evaluation of a specialist included patients wanting admission, better scores on Global Assessment of Symptom scale, fewer hallucinations and delusions and higher alcohol intake.
The 24h re-evaluation period for patients referred for involuntary hospitalization, as stipulated by the Norwegian Mental Health Care Act, appeared to give adequate opportunity to reduce unnecessary involuntary hospitalization, while safeguarding the patient's right to VH.
PubMed ID
29701596 View in PubMed
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8 records – page 1 of 1.