Gina Åsbø

• Kreis, Isabel; Wold, Kristin Fjelnseth; Åsbø, Gina; Flaaten, Camilla Bärthel; Engen, Magnus Johan & Lyngstad, Siv Hege [Show all 13 contributors for this article] (2025). Recent cannabis use affects the association between baseline immune markers and long-term outcomes in psychosis. Translational Psychiatry. 15(1). doi: 10.1038/s41398-025-03498-x. Full text in Research Archive Show summary

  Aberrant levels of blood markers reflecting inflammation and immune system activation have been implicated in psychotic disorders and linked to psychotic symptom severity. However, their predictive value for the long-term course of psychotic symptoms as well as the potential confounding and moderating role of cannabis use remain underexplored. We tested if baseline levels of immune markers previously linked to psychotic symptoms or treatment response (CRP, IL-1RA, sIL-2R, sTNFR1, sgp130) predicted 10-year outcomes in a first-episode psychosis sample (N = 320), and whether associations were moderated by baseline cannabis use. We assessed psychiatric (re)admissions and number of psychotic episodes during each year of the follow-up period, as well as change in positive psychotic symptom severity from baseline. Apart from sTNFR1, none of the immune markers significantly predicted psychosis outcomes independently of cannabis use. Baseline sTNFR1 was linked to lower risk of both (re)admissions and psychotic episodes, with an increasingly negative association over time. The statistical effects of CRP, IL-1RA, and sgp130 were all dependent on cannabis use. Specifically, negative (CRP, IL-1RA) or positive associations (sgp130) with psychiatric (re)admission risk or psychotic episode risk were observed in cannabis users only. Similarly, sgp130 was negatively associated with symptom change in cannabis users only. Some of these associations varied by follow-up year of the measured outcome (sgp130, IL-1RA). These findings challenge the prognostic and etiological significance of baseline immune markers for the course of positive psychotic symptoms and emphasize the importance of accounting for cannabis use.

• Åsbø, Gina; Haavind, Hanne; Kruse, Sindre Hembre; Wold, Kristin Fjelnseth; Hegelstad, Wenche & Romm, Kristin Lie [Show all 10 contributors for this article] (2025). “Why shouldn’t I expect a lot from life?” – a qualitative study of what facilitates long-term recovery in first-episode psychosis. BMC Psychiatry. 25. doi: 10.1186/s12888-025-06681-y. Full text in Research Archive Show summary

  Background Qualitative research frequently characterises recovery, but more knowledge on subjective experiences of facilitators of long-term recovery in psychosis is needed. This interview study aimed to explore what people with first-episode psychosis (FEP) highlight as important for their long-term recovery. Methods Interviews with 20 individuals in recovery (personal and/or clinical) participating in two follow-up studies, 10 and 20-years after treatment start for a first episode schizophrenia or bipolar spectrum disorder. Interviews were thematically analysed by a research team that included a peer researcher. Results The analysis generated that personal resources and agency were experienced as the overarching facilitators of recovery, with five themes: (1) Doing recovery in everyday life, involving agency in daily life; (2) Re-evaluating risk, involving re-evaluating limitations and stress reduction; (3) Becoming a caregiver, involving development from being cared for to taking care of others; (4) Negotiating normality, involving identity and social inclusion; (5) Owning and sharing your story, involving accepting lived experience and overcoming stigma. Discussion All participants described themselves as the main facilitators of their own recovery, and treatment as secondary to their efforts. Gradually testing limitations and taking risks, providing social support to others, as well as owning and sharing your story were crucial for promoting long-term recovery in FEP. Clinical implications include supporting service users’ agency with strength- based interventions and shared-decision making, as well as refining psychoeducation on stress reduction in a long-term perspective.

• Simonsen, Carmen; Åsbø, Gina; Slade, Michael; Wold, Kristin Fjelnseth; Widing, Line Hustad & Flaaten, Camilla Bärthel [Show all 13 contributors for this article] (2024). A good life with psychosis: Rate of positive outcomes in first-episode psychosis at 10-year follow-up. Psychological Medicine. ISSN 0033-2917. 54(9), p. 2112–2121. doi: 10.1017/S0033291724000205. Full text in Research Archive Show summary

  Background More knowledge about positive outcomes for people with first-episode psychosis (FEP) is needed. An FEP 10-year follow-up study investigated the rate of personal recovery, emotional wellbeing, and clinical recovery in the total sample and between psychotic bipolar spectrum disorders (BD) and schizophrenia spectrum disorders (SZ); and how these positive outcomes overlap. Methods FEP participants (n = 128) were re-assessed with structured clinical interviews at 10-year follow-up. Personal recovery was self-rated with the Questionnaire about the Process of Recovery-15-item scale (total score ⩾45). Emotional wellbeing was self-rated with the Life Satisfaction Scale (score ⩾5) and the Temporal Experience of Pleasure Scale (total score ⩾72). Clinical recovery was clinician-rated symptom-remission and adequate functioning (duration minimum 1 year). Results In FEP, rates of personal recovery (50.8%), life satisfaction (60.9%), and pleasure (57.5%) were higher than clinical recovery (33.6%). Despite lower rates of clinical recovery in SZ compared to BD, they had equal rates of personal recovery and emotional wellbeing. Personal recovery overlapped more with emotional wellbeing than with clinical recovery (χ2). Each participant was assigned to one of eight possible outcome groups depending on the combination of positive outcomes fulfilled. The eight groups collapsed into three equal-sized main outcome groups: 33.6% clinical recovery with personal recovery and/or emotional wellbeing; 34.4% personal recovery and/or emotional wellbeing only; and 32.0% none. Conclusions In FEP, 68% had minimum one positive outcome after 10 years, suggesting a good life with psychosis. This knowledge must be shared to instill hope and underlines that subjective and objective positive outcomes must be assessed and targeted in treatment.

• Kreis, Isabel; Wold, Kristin Fjelnseth; Åsbø, Gina; Simonsen, Carmen; Flaaten, Camilla Bärthel & Engen, Magnus Johan [Show all 10 contributors for this article] (2024). The relationship between visual hallucinations, functioning, and suicidality over the course of illness: a 10-year follow-up study in first-episode psychosis. Schizophrenia. 10(1). doi: 10.1038/s41537-024-00450-8. Full text in Research Archive Show summary

  Visual hallucinations in psychosis are under-researched despite associations with increased illness severity, functional impairments, and suicidality in the few existing studies. Further, there are no long-term longitudinal studies, making it impossible to conclude if these associations are state or trait phenomena. In the current prospective longitudinal study, 184 individuals with first-episode psychosis were assessed with semi-structured clinical interviews and self-report questionnaires at baseline and 10-year follow-up. Participants were grouped based on lifetime experience of visual hallucinations: before or at baseline (VH+/+), first during follow-up (VH−/+), or never (VH−/−). Associations with functioning, suicide attempts, childhood trauma and other markers of illness severity were tested using multinomial logistic regression analysis. At baseline, the VH+/+ group (37.5%), but not VH−/+ (12.5%), had poorer functioning, higher symptom severity, a lower age at onset, and included more individuals with a history of multiple suicide attempts than the VH−/− group (50%). At follow-up, the VH−/+ group, but not VH+/+, had poorer functioning and higher symptom severity than the VH−/− group. However, the number of participants who committed multiple suicide attempts during the follow-up period was again significantly higher in the VH+/+ group. There was no association with childhood trauma. Hence, visual hallucinations are associated with impaired functioning and higher symptom severity, but only in the short-term. However, visual hallucinations that arise early in the course of illness are a risk indicator for repeated suicide attempts throughout the illness course. These findings highlight the relevance of assessing visual hallucinations and monitoring their development over time.

• Åsbø, Gina; Haavind, Hanne; Kruse, Sindre Hembre; Wold, Kristin Fjelnseth; Hegelstad, Wenche & Romm, Kristin Lie [Show all 10 contributors for this article] (2024). Taking what you get or Getting what you Need: A Qualitative Study on Experiences with Mental Health and Welfare Services in Long-Term Recovery in First-Episode Psychosis. Community mental health journal. ISSN 0010-3853. 24. doi: 10.1007/s10597-024-01356-6. Full text in Research Archive Show summary

  How people in long-term recovery (clinical and personal) in first-episode psychosis (schizophrenia and bipolar spectrum disorders) experience the mental health and welfare services they interact with is not frequently studied but has significant implications. We therefore aimed to explore which aspects of these services people with FEP evaluate as important for their long-term recovery. Twenty participants in clinical and/or personal recovery from two Norwegian long-term follow-up studies after FEP (TOP 10-year and TIPS 20-year) were sampled for this interview-based qualitative study. The research-team included service user experience. A deductive analysis based on personal accounts of recovery generated five service aspects. Few specific types of interventions were reported to promote recovery although medications, psychotherapy and employment support were mentioned. Participants valued services based in collaboration and that focused on their resources rather than limitations. The importance of long-term follow-up with a consistent aim was highlighted, as was the inclusion of caregivers and peers. Welfare services contributed to recovery by supporting basic needs and safety, but some experienced social exclusion when not participating in the labor market. This study is unique in exploring the role of services, including welfare, in long-term FEP recovery from service user perspectives. Participants evaluated that services played a more indirect role in long-term recovery by supporting their personal resources, although what they needed from services had frequently not been offered. Their expertise by experience contributes valuable knowledge. Better service coordination and consistent implementation of this knowledge are crucial to support recovery in FEP.

• Wold, Kristin Fjelnseth; Ottesen, Akiah; Flaaten, Camilla Bärthel; Kreis, Isabel; Lagerberg, Trine Vik & Romm, Kristin Lie [Show all 10 contributors for this article] (2024). Childhood trauma and treatment resistance in first-episode psychosis: Investigating the role of premorbid adjustment and duration of untreated psychosis. Schizophrenia Research. ISSN 0920-9964. 270, p. 441–450. doi: 10.1016/j.schres.2024.07.001. Full text in Research Archive Show summary

  Background Early identification of treatment non-response in first-episode psychosis (FEP) is essential to outcome. Despite indications that exposure to childhood trauma (CT) can have adverse effects on illness severity, its impact on treatment non-response and the interplay with other pre-treatment characteristics is sparsely investigated. We use a lack of clinical recovery as an early indicator of treatment resistance to investigate the relationship between CT and treatment resistance status at one-year follow-up and the potential mediation of this effect by other pre-treatment characteristics. Methods This prospective one-year follow-up study involved 141 participants recruited in their first year of treatment for a schizophrenia-spectrum disorder. We investigated clinical status, childhood trauma (CT), premorbid adjustment (PA), and duration of untreated psychosis (DUP) at baseline and clinical status at one-year follow-up. Ordinal regression analyses were conducted to investigate how PA and DUP affected the relationship between CT and one-year outcome in FEP. Results 45 % of the FEP sample reported moderate to severe CT, with significantly higher levels of CT in the early treatment resistant group compared to participants with full or partial early recovery. Ordinal regression analysis showed that CT was a significant predictor of being in a more severe outcome group (OR = 4.59). There was a partial mediation effect of PA and a full mediation effect of DUP on the effect of CT on outcome group membership. Discussion Our findings indicate that reducing treatment delays may mitigate the adverse effects of CT on clinical outcomes and support the inclusion of broad trauma assessment in FEP services.

• Kreis, Isabel; Lagerberg, Trine Vik; Wold, Kristin Fjelnseth; Åsbø, Gina; Simonsen, Carmen & Flaaten, Camilla Bärthel [Show all 11 contributors for this article] (2024). Behind the heterogeneity in the long-term course of first-episode psychosis: Different psychotic symptom trajectories are associated with different patterns of cannabis and stimulant use. Schizophrenia Research. ISSN 0920-9964. 271, p. 91–99. doi: 10.1016/j.schres.2024.07.006. Full text in Research Archive Show summary

  Background Data-driven classification of long-term psychotic symptom trajectories and identification of associated risk factors could assist treatment planning and improve long-term outcomes in psychosis. However, few studies have used this approach, and knowledge about underlying mechanisms is limited. Here, we identify long-term psychotic symptom trajectories and investigate the role of illness-concurrent cannabis and stimulant use. Methods 192 participants with first-episode psychosis were followed up after 10 years. Psychotic symptom trajectories were estimated using growth mixture modeling and tested for associations with baseline characteristics and cannabis and stimulant use during the follow-up (FU) period. Results Four trajectories emerged: (1) Stable Psychotic Remission (54.2 %), (2) Delayed Psychotic Remission (15.6 %), (3) Psychotic Relapse (7.8 %), (4) Persistent Psychotic Symptoms (22.4 %). At baseline, all unfavorable trajectories (2–4) were characterized by more schizophrenia diagnoses, higher symptom severity, and longer duration of untreated psychosis. Compared to the Stable Psychotic Remission trajectory, unstable trajectories (2,3) showed distinct associations with cannabis/stimulant use during the FU-period, with dose-dependent effects for cannabis but not stimulants (Delayed Psychotic Remission: higher rates of frequent cannabis and stimulant use during the first 5 FU-years; Psychotic Relapse: higher rates of sporadic stimulant use throughout the entire FU-period). The Persistent Psychosis trajectory was less clearly linked to substance use during the FU-period. Conclusions The risk for an adverse long-term course could be mitigated by treatment of substance use, where particular attention should be devoted to preventing the use of stimulants while the use reduction of cannabis may already yield positive effects.

• Wold, Kristin Fjelnseth; Kreis, Isabel; Åsbø, Gina; Flaaten, Camilla Bärthel; Widing, Line Hustad & Engen, Magnus Johan [Show all 11 contributors for this article] (2024). Long-term clinical recovery and treatment resistance in first-episode psychosis: a 10-year follow-up study. Schizophrenia. 10(1). doi: 10.1038/s41537-024-00489-7. Full text in Research Archive Show summary

  Illness trajectories in people with first-episode psychosis (FEP) vary significantly over time. Identifying early-course parameters predicting outcomes is essential, but long-term data still needs to be provided. We conducted a 10-year follow-up study of a comprehensive first-episode psychosis (FEP) cohort investigating the prevalence of clinical recovery (CR) and treatment resistance (TR) after ten years, as well as clinical, demographic, and pre-illness predictors of long-term outcomes. 102 participants with FEP DSM-IV Schizophrenia spectrum disorders were recruited within their first year of treatment. The Treatment Response and Resistance in Psychosis Working Group (TRRIP) and the Remission in Schizophrenia Working Group (RSWG) criteria were used to define TR and CR, respectively. At 10-year follow-up, 29 (29%) of the participants were classified as in CR, while 32 (31%) were classified as TR. We also identified a larger middle group (n = 41, 40%) consisting of participants in partial recovery. 7% of all participants had tried Clozapine at the 10-year follow-up. Logistic regression analyses identified insidious onset (OR = 4.16) and baseline disorganized symptoms (OR = 2.96) as significantly associated with an increased risk of developing TR. Good premorbid academic adjustment (OR = 1.60) and acute onset (OR = 3.40) were associated with an increased chance of CR. We identified three long-term outcome groups by using recent consensus definitions. We also identified the potential importance of assessing baseline disorganized symptoms and monitoring patients with insidious onset more closely. Further, the findings suggest that clinicians should pay close attention to early-course parameters and provide adequate treatment to improve long-term outcomes of FEP.

• Ihler, Henrik Myhre; Lyngstad, Siv Hege; Gardsjord, Erlend Strand; Widing, Line Hustad; Flaaten, Camilla Bärthel & Åsbø, Gina [Show all 13 contributors for this article] (2023). The trajectory of two negative symptom dimensions in first-episode psychosis and the role of cannabis use: A 10-year follow-up study. Schizophrenia Research. ISSN 0920-9964. 252, p. 317–325. doi: 10.1016/j.schres.2023.01.024. Full text in Research Archive Show summary

  Objective To investigate the trajectories of diminished expression and apathy over 10 years. Further, to explore the effects of baseline- and persistent cannabis use on the development of diminished expression and apathy during follow-up, while controlling other potential sources and predictors of secondary negative symptoms. Methods 351 participants with a first episode of non-affective psychosis were examined at baseline and invited to follow-up at one year and 10 years. The trajectories of diminished expression and apathy were investigated using linear mixed models. Subsequently, cannabis use and other potential predictors and sources of secondary negative symptoms were added to the model to investigate the respective impact on their trajectories. Results The severity of both diminished expression and apathy decreased during the follow-up period after the first episode of psychosis, with the most improvement observed from baseline to 1-year follow-up. Cannabis use at baseline was associated with a long-lasting higher symptom load for diminished expression, but not apathy. Introducing persistent cannabis use to the model further strengthened the association with diminished expression. Conclusion Both cannabis use at baseline and persistent cannabis use after a first episode of psychosis were associated with more severe symptoms of diminished expression. Our results imply a causal relationship between cannabis use and diminished expression and suggest that measures to reduce cannabis use both before and after psychosis onset may reduce expressive negative symptoms.

• Widing, Line Hustad; Simonsen, Carmen; Bjella, Thomas; Engen, Magnus Johan; Flaaten, Camilla Bärthel & Gardsjord, Erlend Strand [Show all 15 contributors for this article] (2023). Long-term Outcomes of People With DSM Psychotic Disorder NOS. Schizophrenia Bulletin Open. 4(1). doi: 10.1093/schizbullopen/sgad005. Full text in Research Archive Show summary

  Introduction: The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic category “Psychotic disorder not otherwise specified” (PNOS) is seldom investigated, and we lack knowledge about longterm outcomes. We examined long-term symptom severity, global functioning, remission/recovery rates, and diagnostic stability after the first treatment for PNOS. Methods: Participants with first-treatment PNOS (n = 32) were reassessed with structured interviews after 7 to 10 years. The sample also included narrow schizophrenia spectrum disorders (SSD, n = 94) and psychotic bipolar disorders (PBD, n = 54). Symptomatic remission was defined based on the Remission in Schizophrenia Working Group criteria. Clinical recovery was defined as meeting the criteria for symptomatic remission and having adequate functioning for the last 12 months. Results: Participants with baseline PNOS or PBD had lower symptom severity and better global functioning at follow-up than those with SSD. More participants with PNOS and PBD were in symptomatic remission and clinical recovery compared to participants with SSD. Seventeen (53%) PNOS participants retained the diagnosis, while 15 participants were diagnosed with either SSD (22%), affective disorders (19%), or substanceinduced psychotic disorders (6%). Those rediagnosed with SSD did not differ from the other PNOS participants regarding baseline clinical characteristics. Conclusions: Long-term outcomes are more favorable in PNOS and PBD than in SSD. Our findings confirm diagnostic instability but also stability for a subgroup of participants with PNOS. However, it is challenging to predict diagnostic outcomes of PNOS based on clinical characteristics at first treatment.

• Wold, Kristin Fjelnseth; Ottesen, Akiah; Flaaten, Camilla Bärthel; Johnsen, Erik; Lagerberg, Trine Vik & Romm, Kristin Lie [Show all 11 contributors for this article] (2023). Early identification of treatment non-response in first-episode psychosis. European psychiatry. ISSN 0924-9338. 66(1). doi: 10.1192/j.eurpsy.2023.15. Full text in Research Archive Show summary

  Background Approximately one-third of patients with psychotic disorders does not respond to standard antipsychotic treatments. Consensus criteria for treatment resistance (TR) may aid the identification of non-response and subsequent tailoring of treatments. Since consensus criteria require stability of clinical status, they are challenging to apply in first-episode psychosis (FEP). This study aims to investigate (a) if an adaptation of consensus criteria can be used to identify FEP patients with early signs of TR (no early clinical recovery—no-ECR) after 1 year in treatment and (b) to what extent differences in antipsychotic treatments differentiate between outcome groups. Methods Participants with FEP DSM-IV schizophrenia spectrum disorders were recruited during their first treatment. A total of 207 participated in the 1-year follow-up. Remission and recovery definitions were based on adaptations of the “Remission in Schizophrenia Working Group” criteria and TR on adaptations of the “Treatment Response and Resistance in Psychosis” (TRRIP) working group criteria. Results 97 participants (47%) could be classified as no-ECR, 61 (30%) as ECR, and 49 (23%) as with partial ECR (P-ECR). Statistically significant baseline predictors of no-ECR matched previously identified predictors of long-term TR. Only 35 no-ECR participants had two adequate treatment trials and met the full TRRIP criteria. 21 no-ECR participants were using the same medication over the follow-up year despite the lack of significant effects. Conclusion The difference in the percentage of FEP participants classified as no-ECR versus TR indicates that we may underestimate the prevalence of early TR when using consensus criteria.

• Flaaten, Camilla Bärthel; Melle, Ingrid; Bjella, Thomas; Engen, Magnus Johan; Åsbø, Gina & Wold, Kristin Fjelnseth [Show all 13 contributors for this article] (2023). Long-term course of cognitive functioning in bipolar disorder: A ten-year follow-up study. Bipolar Disorders. ISSN 1398-5647. doi: 10.1111/bdi.13364. Full text in Research Archive Show summary

  Abstract Introduction Cognitive impairments are common in bipolar disorder (BD), but the long‐term course remains understudied. Longitudinal data on cognitive functioning from the start of the first treatment could help clarify pathophysiological processes that shape the illness outcome. We here aim to investigate the 10‐year cognitive course in BD compared to healthy controls (HC) and the effects of clinical symptoms on cognitive trajectories. Methods Fifty‐six BD participants recruited within their first year of treatment and 108 HC completed clinical and cognitive assessments at baseline and 10‐year follow‐up. We derived eight cognitive domain scores and a cognitive composite score, which were further investigated using linear mixed model analyses. Correlation analyses were used to assess associations between the composite score and depressive, manic and psychotic symptoms. Results BD participants performed poorer than HCs in all domains except mental speed and verbal fluency. Verbal learning and memory, verbal fluency and the composite score improved over time in both BD participants and HC, while short‐term memory, mental speed, psychomotor speed and working memory were stable. We found no significant correlations between cognition and symptom level at either time point in BD participants. Conclusions We found evidence of long‐term cognitive stability or improvement in BD participants from first treatment to 10‐year follow‐up. Though the BD group was impaired in all domains except mental speed and verbal fluency, the change in cognitive functioning was parallel to that of HCs. These findings are not consistent with the notion of neuroprogression in BD.

• Flaaten, Camilla Bärthel; Melle, Ingrid; Gardsjord, Erlend Strand; Bjella, Thomas; Engen, Magnus Johan & Vaskinn, Anja [Show all 13 contributors for this article] (2022). Course of intellectual functioning in schizophrenia and bipolar disorder: A 10-year follow-up study. Psychological Medicine. ISSN 0033-2917. p. 1–9. doi: 10.1017/S0033291721004645. Full text in Research Archive Show summary

  Background Intellectual functioning (IQ) is lower in schizophrenia patients compared to healthy controls, with bipolar patients intermediate between the two. Declines in IQ mark the onset of schizophrenia, while stability is generally found post-onset. There are to date few studies on long-term IQ development in bipolar disorder. This study presents 10-year follow-up data on IQ, including premorbid IQ estimates, to track the developmental course from pre-onset levels to long-term outcomes in both patient groups compared to healthy controls. Methods We included 139 participants with schizophrenia, 76 with bipolar disorder and 125 healthy controls. Mixed model analyses were used to estimate developmental slopes for IQ scores from estimated premorbid level (NART IQ) through baseline (WASI IQ) measured within 12 months post-onset, to 10-year follow-up (WASI IQ), with pairwise group comparisons. The best fit was found using a model with a breakpoint at baseline assessment. Results Only the schizophrenia group had significant declines from estimated premorbid to baseline IQ levels compared to controls. When comparing patient groups, schizophrenia patients had steeper declines than the bipolar group. Increases in IQ were found in all groups over the follow-up period. Conclusions Trajectories of IQ from premorbid level to 10-year follow-up indicated declines from estimated premorbid level to illness onset in both patient groups, followed by increases during the follow-up period. Schizophrenia patients had a steeper decline than bipolar patients. During follow-up, increases indicate developmental improvement for both patient groups, but with a maintained lag compared to healthy controls due to lower premorbid levels.

• Flaaten, Camilla Bärthel; Melle, Ingrid; Bjella, Thomas; Engen, Magnus Johan; Åsbø, Gina & Wold, Kristin Fjelnseth [Show all 14 contributors for this article] (2022). Domain-specific cognitive course in schizophrenia: Group- and individual-level changes over 10 years. Schizophrenia Research: Cognition. 30, p. 1–8. doi: 10.1016/j.scog.2022.100263. Full text in Research Archive Show summary

  Cognitive impairments in schizophrenia are well-documented, present across several cognitive domains and found to be relatively stable over time. However, there is a high degree of heterogeneity and indications of domain-specific developmental courses. The present study investigated the 10-year cognitive course in participants with first-episode schizophrenia (FES) and healthy controls on eight cognitive domains and a composite score, looking at group- and individual-level changes. A total of 75 FES participants and 91 healthy controls underwent cognitive assessment at baseline and follow-up. Linear mixed models were used for group-level analyses and reliable change index (RCI) analyses were used to investigate individual change. The prevalence of clinically significant impairment was explored at both time points, using a cut-off of < −1.5 SD, with significant cognitive impairment defined as impairment on ≥2 domains. Group-level analyses found main effects of group and time, and time by group interactions. Memory, psychomotor processing speed and verbal fluency improved, while learning, mental processing speed and working memory were stable in both groups. FES participants showed deteriorations in attention and cognitive control. Individual-level analyses mainly indicated stability in both FES and controls, except for a higher prevalence of decline in cognitive control in FES. At baseline, 68.8 % of FES participants had clinically significant impairment, compared to 62.3 % at follow-up. We mainly found long-term stability and modest increases in cognition over time in FES, as well as a high degree of within-group heterogeneity. We also found indications of deterioration in participants with worse cognitive performance at baseline.

• Widing, Line Hustad; Simonsen, Carmen Elisabeth; Flaaten, Camilla Bärthel; Haatveit, Beathe; Vik, Ruth Kristine & Wold, Kristin Fjelnseth [Show all 9 contributors for this article] (2022). Premorbid characteristics of patients with DSM-IV psychotic disorders. Comprehensive Psychiatry. ISSN 0010-440X. 115, p. 1–7. doi: 10.1016/j.comppsych.2022.152310. Full text in Research Archive Show summary

  Introduction Psychotic disorder not otherwise specified (PNOS) is considered part of the psychosis spectrum, together with schizophrenia spectrum disorders (SSD) and psychotic bipolar spectrum disorders (PBD). The atypical clinical presentations of PNOS conditions may lead to uncertainty regarding treatment choices and expected outcomes. PNOS is understudied, and little is known about patients' premorbid characteristics including premorbid adjustment, prevalence of early cannabis use and childhood trauma. Knowledge about early illness phases can increase our understanding of this diagnostic group. Methods We included 1099 participants from the Norwegian TOP-study; 688 with narrow SSD diagnoses (schizophrenia, schizoaffective disorder, schizophreniform disorder), 274 with PBD (psychotic bipolar 1 and bipolar NOS) and 137 with PNOS diagnosed with the SCID-I for DSM-IV. Participants were assessed with the Premorbid Adjustment Scale (PAS) divided into the areas of premorbid academic and social functioning. We obtained information on age at first exposure to cannabis and use of cannabis before the age of 16. The participants also provided information regarding early traumatic experiences using the Childhood Trauma Questionnaire (CTQ). Results Participants with PNOS and SSD had poorer premorbid academic functioning than those with PBD (F2, 1029 = 7.81, p < 0.001, pη2 = 0.015). Premorbid social adjustment was significantly worse in the SSD group compared to the PBD group (F2, 1024 = 3.10, p = 0.045, pη2 = 0.006), with PNOS in the middle position. Significantly more of the participants with PNOS (17.5%) and SSD (11.5%) used cannabis before the age of 16 compared with PBD (5.3%, Wald χ2 = 6.86, p = 0.03). There were no significant differences between the three groups regarding mean CTQ scores or in the proportion of participants who had experienced at least one type of childhood adversity. Conclusions Participants with PNOS appear as more similar to participants with SSD than to those with PBD regarding early premorbid adjustment and early cannabis use. The results indicate that many conditions classified as PNOS have functional impairments and problematic substance use from an early age. The prevalence of childhood adversities are high in all three groups.

• Åsbø, Gina; Ueland, Torill; Haatveit, Beathe; Bjella, Thomas; Flaaten, Camilla Bärthel & Wold, Kristin Fjelnseth [Show all 13 contributors for this article] (2022). The Time is Ripe for a Consensus Definition of Clinical Recovery in First-episode Psychosis: Suggestions Based on a 10-Year Follow-up Study. Schizophrenia Bulletin. ISSN 0586-7614. 48(4), p. 839–849. doi: 10.1093/schbul/sbac035. Full text in Research Archive Show summary

  Abstract Objectives A consensus definition of clinical recovery in first-episode psychosis (FEP) is required to improve knowledge about recovery rates in this population. To propose criteria for a future consensus definition, this study aims to investigate rates of clinical recovery when using a standard definition (full psychotic symptom remission and adequate functioning for minimum one year) across both affective and nonaffective FEP groups (bipolar spectrum and schizophrenia spectrum disorders). Second, we aim to explore changes in rates when altering the standard definition criteria. Third, to examine the extent to which healthy controls meet the functioning criteria. Study design In total, 142 FEP participants and 117 healthy controls preselected with strict criteria, were re-assessed with structured clinical interviews at 10-year follow-up. Study results A total of 31.7% were in clinical recovery according to the standard definition, with significantly higher recovery rates in bipolar (50.0%) than in schizophrenia spectrum disorders (22.9%). Both groups’ recovery rates decreased equally when extending duration and adding affective symptom remission criteria and increased with looser functioning criteria. In healthy controls, 18.8% did not meet the standard criteria for adequate functioning, decreasing to 4.3% with looser criteria. Conclusions Findings suggest that clinical recovery is common in FEP, although more in bipolar than in schizophrenia spectrum disorders, also when altering the recovery criteria. We call for a future consensus definition of clinical recovery for FEP, and suggest it should include affective symptom remission and more reasonable criteria for functioning that are more in line with the general population.

• Engen, Magnus Johan; Vaskinn, Anja; Melle, Ingrid; Færden, Ann; Lyngstad, Siv Hege & Flaaten, Camilla Bärthel [Show all 12 contributors for this article] (2022). Cognitive and Global Functioning in Patients With First-Episode Psychosis Stratified by Level of Negative Symptoms. A 10-Year Follow-Up Study. Frontiers in Psychiatry. 13:841057, p. 1–13. doi: 10.3389/fpsyt.2022.841057. Full text in Research Archive Show summary

  Negative and cognitive symptoms are core features of schizophrenia that are correlated in cross-sectional designs. To further explore the relationship between these critical symptom dimensions we use a method for stratifying participants based on level and persistence of negative symptoms from absent to sustained levels over a 10-year follow-up period. We investigate associations with cognitive performance and level of global functioning. First-episode psychosis (FEP) participants ( n = 102) and healthy controls ( n = 116) were assessed at baseline and follow-up. A cognitive battery consisting of 14 tests derived into four domains and a composite score were used in the analyses. FEP participants were stratified based on negative symptom items from the Positive and Negative Syndrome Scale (PANSS-R) into four groups with either no, mild, transitory or sustained symptoms over the 10-year follow-up period. Global functioning was measured with Global Assessment of Functioning Scale-Split version. Multivariate and univariate analyses of variance were used to explore between-group differences in level and course of cognitive performance as global functioning. A multivariate analysis with four cognitive domains as dependent variables, showed significant group differences in performance when including healthy controls and the negative symptom groups. The groups with no and mild negative symptoms outperformed the group with sustained levels of negative symptoms on verbal learning and memory. The group with no negative symptoms also outperformed the group with sustained negative symptoms on the cognitive composite score. Significant improvements on verbal learning and memory, executive functioning and the cognitive composite were detected for the entire sample. No differences in cognitive course were detected. There was a significant improvement in global functioning as measured by the GAF-F over the follow-up period ( p &amp;lt; 0.001), without any time x group interactions ( p = 0.25). Participants with sustained negative symptoms had a significantly lower level of global functioning at 10-year follow-up with an additional independent effect of the cognitive composite score, compared to all other groups. Individuals with an early illness course characterized by absence of negative symptoms form a group with better cognitive and functional outcomes than the impairments typically associated with schizophrenia. Individuals with sustained levels of negative symptoms on the other hand may require a combined focus on both negative and cognitive symptoms.

• Widing, Line Hustad; Simonsen, Carmen Elisabeth; Flaaten, Camilla Bärthel; Haatveit, Beathe; Vik, Ruth Kristine & Wold, Kristin Fjelnseth [Show all 9 contributors for this article] (2020). Symptom Profiles in Psychotic Disorder Not Otherwise Specified. Frontiers in Psychiatry. 11. doi: 10.3389/fpsyt.2020.580444. Full text in Research Archive Show summary

  Introduction: Approximately 10% of patients with psychotic disorders receive the diagnosis “Psychotic disorder not otherwise specified” (PNOS). However, there is a lack of knowledge about the clinical presentations captured by this diagnosis in the mental health services. Therefore, we examined the symptom profiles of participants with PNOS compared to participants with bipolar disorder (BD) and schizophrenia spectrum disorder (SZ) diagnoses. Methods: We here included 1,221 participants from the Thematically Organized Psychosis-study at Oslo University Hospital; 792 with SZ, 283 with BD, and 146 with PNOS, assessed with SCID-I for DSM-IV. The participants with PNOS were categorized into subgroups based on SCID information. The GAF, PANSS, Alcohol Use Disorders Identification Test (AUDIT), and Drug Use Disorders Identification Test (DUDIT) were used to assess function, clinical symptoms, and substance use. Results: In the PNOS group, 44% did not meet the criteria for any specific psychotic disorder, 35.5% had contradictory information making a specific diagnosis difficult, and 20.5% had inadequate information to make a specific diagnosis. The most frequent reason for a PNOS diagnosis was difficulty ruling out a substance-induced psychotic disorder (n = 41, 28%). Participants with PNOS were younger and more often first-episode than participants with BD and SZ. They were intermediate between BD and SZ for GAF scores (BD>PNOS>SZ) and PANSS scores (BD<PNOS<SZ) and more often scored above the clinical cut-off for substance misuse as measured by the AUDIT (BD = PNOS<SZ), DUDIT (BD = SZ<PNOS) and for the combination of both these measures. Conclusions: A PNOS diagnosis is more common in first-episode than in multi-episode patients. The diagnosis captures a heterogeneous group of psychotic syndromes, with a severity of symptoms and functional loss that is intermediate between BD and SZ.

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• Åsbø, Gina (2025). Long-term recovery in first-episode psychosis from clinical and personal perspectives. Universitetet i Oslo. Full text in Research Archive Show summary

  Psychotic disorders have traditionally been viewed as chronic illnesses, which has led to feelings of hopelessness for people with lived experience of psychosis, their families, and health professionals, as well as significant public stigma. More knowledge is therefore needed regarding long-term positive outcomes in psychosis, particularly the ultimate positive outcome, recovery. However, recovery is a broad construct which is often divided into two different perspectives. Clinical recovery involves an objective measure of stable symptom remission and adequate functioning. Personal recovery involves a subjective process of finding a good and meaningful life with potential symptoms or disability. Nevertheless, there is no consensus definition of clinical recovery in psychotic disorders and clinical recovery rates vary across studies. Personal recovery, on the other hand, is often described as a vague construct, and there are few studies on personal recovery in the long-term. Furthermore, these two perspectives stem from separate research fields, quantitative psychiatric research and qualitative service user-oriented research. Clinical and personal recovery are therefore rarely investigated together in long-term (10 years or more) follow-up studies. These issues have led to unanswered questions about what constitutes a good outcome, who should make that judgment and how many will experience positive outcomes in the long-term. Lastly, what is experienced as important for long-term recovery in psychosis is rarely explored from first-person perspectives. The primary aim of this thesis was therefore to provide more comprehensive knowledge about long-term positive outcomes, especially recovery, in psychotic disorders. In the TOP (Thematically Organized Psychosis) study, a large follow-up study of people with first-episode psychosis (FEP; including schizophrenia and bipolar spectrum disorders with psychosis), the rate of objective and subjective positive outcomes 10 years after treatment start was investigated. Moreover, what has facilitated long-term recovery from the perspective of a smaller group of participants in recovery (personal and/or clinical) was explored with qualitative interviews. These participants were sampled from both the TOP 10-year follow-up and the 20-year follow-up of another large FEP study, the TIPS (The Treatment and Intervention in Psychosis) study. In the first paper, the rate of clinical recovery when using different criteria was investigated in 142 FEP participants and 117 healthy controls at 10-year follow-up. From the analyses, one-third of FEP participants were in clinical recovery using strict criteria, which included symptom remission, full-time employment and weekly social activity. For all participants, it was employment, not symptoms, which was the largest barrier to meeting clinical recovery criteria. There is less research on clinical recovery in bipolar disorder. A positive finding was thus that half of all participants with bipolar disorders were in clinical recovery, compared to one in four with schizophrenia. Almost one-fifth of controls did not meet the standard adequate functioning criteria. Based on these findings, alternative and more reasonable recovery criteria were suggested to facilitate a discussion about the lack of a consensus definition of clinical recovery in psychotic disorders. In the second paper, the rate and overlap of both objective and subjective positive outcomes were investigated in 128 FEP participants at 10-year follow-up. The majority of participants experienced at least one positive outcome, which included clinical recovery, personal recovery, and emotional wellbeing. As many as half of the total sample experienced personal recovery and two-thirds reported emotional wellbeing, with no significant difference between diagnostic groups. Thus, another positive finding was that although only one in four with schizophrenia were rated as in clinical recovery, around half experienced subjective positive outcomes. Finally, in the total sample, personal recovery and emotional wellbeing were more related to each other than to clinical recovery. In the third paper, 20 participants were interviewed about what was important for their long-term recovery. From the thematic team-based analysis, the overarching theme was that participants described themselves as the main facilitators of their recovery, above services. Five personal resource themes important for long-term recovery in psychosis were generated from the analysis: 1. Doing recovery in everyday life (agency in everyday life); 2. Re-evaluating risk (reconsidering limitations and stress reduction to take positive risks); 3. Becoming a caregiver (developing from being taken care of, to taking care of others); 4. Negotiating normality (experiencing identity formation and social inclusion); 5. Owning and sharing your story (overcoming stigma by accepting and sharing lived experience). In the fourth paper, these interviews were analyzed again to explore which aspects of both mental health and welfare services participants evaluated as important for recovery. The main finding was that participants were more concerned with how services related to them than specific interventions. Furthermore, services appeared to influence their recovery more indirectly in the long-term, through supporting their resources, rather than focusing on their limitations. The analysis generated five aspects of services deemed important for long-term recovery in psychosis: 1. Resource-focused services (focusing on personal strengths rather than limitations); 2. Collaborative services (based on shared decision-making and transparency); 3. Welfare services (offering safety through basic resources and employment); 4. Caregivers and peers in services (including social support in treatment); 5. Consistent services (providing continuity and long-term follow-up). In sum, the results of this study demonstrate that psychotic disorders are not necessarily chronic and that there are many ways to experience recovery. Furthermore, they highlight that people with psychotic disorders have both considerable resources and important knowledge, which should be better utilized in services. The results also imply that it is particularly important to consistently implement employment support, shared decision-making and more nuanced psychoeducation on stress reduction in services. Ultimately, the results presented in this thesis are significant research contributions that can increase hope for a good life and reduce stigma for people with psychotic disorders.

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