Inge Joa

Stavanger University Hospital · Division of Psychiatry

Purpose: Individuals with serious mental illness (SMI) might require coordinated health services to meet their healthcare needs. The overall aim of this study was to describe the perspectives of professionals (registered nurses, medical doctors, social educators, and social workers) on care coordination and measures to ensure proper and coordinate...

Background The aim of the study was to explore patients’ attitudes towards voluntary and involuntary hospitalization in Norway, and predictors for involuntary patients who wanted admission. Methods A multi-centre study of consecutively admitted patients to emergency psychiatric wards over a 3 months period in 2005–06. Data included demographics, a...

Introduction Clinical high risk for psychosis (CHR) is associated with mild cognitive impairments. Symptoms are clustered into positive, negative and disorganization symptoms. The association between specific symptom dimensions and cognitive functions remains unclear. The aim of this study was to investigate the associations between cognitive funct...

Background Cell adhesion molecules (CAM) orchestrate leukocyte trafficking and could link peripheral and neuro-inflammation in patients with severe mental illness (SMI), by promoting inflammatory and immune mediated responses and mediating signals across blood-brain-barrier (BBB). We hypothesized that CAMs would be dysregulated in SMI and evaluated...

Background Investigations of implementation factors (e.g., collegial support and sense of coherence) are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcomes, especially in later phases of an implementation effort. The aims of this study w...

Purpose The purpose of this study was to explore and interpret how frontline leaders define, experience and rationalise their approaches to the successful implementation of clinical guidelines in mental health care. Design/methodology/approach Employing an interpretative phenomenological design, the authors conducted and analysed individual interv...

Background A potential role of inflammatory pathways in the pathology of schizophrenia has been suggested for at least a subgroup of patients. Elevated levels of the inflammatory marker C-reactive protein (CRP) have been observed, with associations to pathogenesis and symptoms. The current evidence regarding effects of antipsychotics on CRP levels...

Objective: In this hypothesis-testing study, which is based on findings from a previous atheoretical machine-learning study, we test the predictive power of baseline “reduced expression of emotion” for psychosis. Method: Study participants (N = 96, mean age 16.55 years) were recruited from the Prevention of Psychosis Study in Rogaland, Norway. The...

Background: Investigations of implementation factors are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcome, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementat...

Cognitive impairment is a core aspect of psychotic disorders and difficult to treat. Atypical antipsychotics (AAs) might have differential effects on cognitive impairment, but rigid study designs and selective sampling limit the generalizability of existing findings. This pragmatic, semi-randomized, industry-independent study aimed to investigate a...

Background Clinical High Risk (CHS) for psychosis is a state in which positive symptoms are predominant but do not reach a level of severity that fulfils the criteria for a psychotic episode. The aim of this study has been to investigate whether cognition in subjects with newly detected CHR affects the longitudinal development of positive symptoms....

Background To what extent psychotic symptoms in first-episode psychosis (FEP) with a history of childhood interpersonal trauma (CIT) are less responsive to antipsychotic medication is not known. In this longitudinal study, we compare symptom trajectories and remission over the first 2 years of treatment in FEP with and without CIT and examine if di...

Background Schizophrenia (SCZ) and bipolar disorder (BD) are severe mental illnesses (SMI) that are part of a psychosis continuum, and dysregulated innate immune responses have been suggested to be involved in their pathophysiology. However, disease-specific immune mechanisms in SMI are not known yet. Recently, dyslipidemia has been linked to syste...

In this editorial we try to summarise how we, in 2021, understand mental disorders in general, and psychoses in particular. We have tried to write it in a language that is understandable for our readers, including patients, relatives, students and professionals, without reducing its scientific validity or basis. During the last decade we have gaine...

Background: Immune dysfunction has been implicated in the pathogenesis of schizophrenia and other nonaffective psychosis (SCZ), bipolar spectrum disorder (BIP) and major depressive disorder (MDD). The cytokines B cell-activating factor (BAFF) and A proliferation-inducing ligand (APRIL) belong to the tumor necrosis factor (TNF) super family and are...

Purpose Service providers need effective strategies to implement evidence-based practices (EBPs) with high fidelity. This study aimed to evaluate an intensive implementation support strategy to increase fidelity to EBP standards in treatment of patients with psychosis. Methods The study used a cluster randomized design with pairwise assignment of...

Background: Childhood interpersonal trauma (CIT) and premorbid adjustment are both associated with poor outcome in psychosis. In this study we investigate the relative impact of CIT and premorbid adjustment on symptom remission in first episode psychosis (FEP) over two years. Method: A total of 232 participants with FEP were recruited through th...

Aim The fluctuating symptoms of clinical high risk for psychosis hamper conversion prediction models. Exploring specific symptoms using machine‐learning has proven fruitful in accommodating this challenge. The aim of this study is to explore specific predictors and generate atheoretical hypotheses of onset using a close‐monitoring, machine‐learning...

Background: Most studies investigating antipsychotic effectiveness report either total psychopathology or symptom cluster findings. Studies focusing on a separate symptom, such as hallucinations, a hallmark symptom in schizophrenia, are scarce.Therefore, the current study aims to compare the antihallucinatory effectiveness of 3 pharmacologically d...

Objectives: Most individuals experience a relatively long period of sub-clinical psychotic like symptoms, known as the ultra high risk (UHR) or at risk mental states (ARMS), prior to a first episode of psychosis. Approximately 95% of individuals who will later develop psychosis are not referred to specialized clinical services and assessed during t...

Background: Remission in schizophrenia is difficult to achieve. Antipsychotic drugs are critical in the treatment of schizophrenia. International guidelines for the pharmacological treatment of schizophrenia recommend a 3-step algorithm with clozapine being the third-line antipsychotic agent. This study investigated the 1-year outcome and the appl...

To assess the implementation of effective practices, mental health programs need standardized measures. The General Organizational Index (GOI), although widely used for this purpose, has received minimal psychometric research. For this study, we assessed psychometric properties of the GOI scale administered four times over 18 months during the impl...

This study examined psychometric properties and feasibility of the Family Psychoeducation (FPE) Fidelity Scale. Fidelity assessors conducted reviews using the FPE fidelity scale four times over 18 months at five sites in Norway. After completing fidelity reviews, assessors rated feasibility of the fidelity review process. The FPE fidelity scale sho...

Background: Amisulpride, aripiprazole, and olanzapine are first-line atypical antipsychotics that have not previously been compared head-to-head in a pragmatic trial. We aimed to compare the efficacy and safety of these agents in a controlled trial. Methods: This pragmatic, rater-blind, randomised controlled trial was done in three academic cent...

Aim To identify and synthesize qualitative evaluation methods used in nursing interventions. Design A systematic qualitative review with a content analysis. Four databases were used: MEDLINE, PsycINFO, Embase and CINAHL using pre‐defined terms. The included papers were published from 2014–2018. Methods We followed the guidelines of Dixon‐Woods et...

Background Impaired insight is common among patients with schizophrenia, and a major obstacle for treatment adherence and improvement. Previous studies have investigated the effect of antipsychotics on insight, but findings are indecisive due to small or homogeneous samples, non-randomized design or short follow- up. The aim of this study was to in...

Introduction: Around 60% of carers of relatives with mental health problems report feeling unrecognised by professional health care and many report a lack of engagement, shared decision making and information sharing. There is a paucity of research examining these issues for carers who are also mental health professionals. Aim: This was an explo...

Background: Cognitive impairment is not only a core aspect of schizophrenia but also commonly observed in help-seeking youth at ultra high risk for psychosis (UHR), with potential implications for prognosis and individualized treatment. However, there is no consensus on the cognitive profile in the UHR state, partly due to lack of valid comparisons...

The aim of the present study was to investigate the use and attitudes toward standardized assessment tools among clinicians in a public mental health service in Norway. A total of 606 clinicians provided feedback on their use and attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment a...

Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clini...

Background: Individuals with psychosis are heavy consumers of social media. It is unknown to what degree measures of social functioning include measures of online social activity. Objective: To examine the inclusion of social media activity in measures of social functioning in psychosis and ultrahigh risk (UHR) for psychosis. Methods: Two independe...

Background: Prolonged duration of untreated psychosis (DUP) is associated with poor outcomes. The TIPS study halved DUP with an early detection (ED) campaign; however, conventional statistical analyses, focused on mean estimates, failed to reveal the effects of ED across the full DUP distribution, restricting inferences about ED's effectiveness. U...

Background Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are...

Background Neurocognitive deficits may be a risk factor for, but also a result of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known associations. A possible confounder is substance use, which is common among patients with psychosis and often accompanied by worse clinical outcomes....

Background Social functioning impairment is a core predictor of outcome in psychosis and a main target for interventions. Assessments reflecting social reality are thus essential. After the 2004 advent of Facebook, social networking platforms have become integral to young peoples’ social life and yet it is unclear whether this is being assessed. Th...

UNSTRUCTURED Background: Individuals with psychosis are heavy consumers of social media. It is unknown to which degree measures of social functioning include measures of online social activity. Objective: To examine the inclusion of social media activity in measures of social functioning in psychosis and ultra high-risk for psychosis. Design: Syste...

Background: Individuals with psychosis are heavy consumers of social media. It is unknown to what degree measures of social functioning include measures of online social activity. Objective: To examine the inclusion of social media activity in measures of social functioning in psychosis and ultrahigh risk (UHR) for psychosis. Methods: Two inde...

Inflammatory markers are altered in severe mental disorders independent of comorbid cardiometabolic disease risk factors – ERRATUM - Ragni H. Mørch, Ingrid Dieset, Ann Færden, Elina J. Reponen, Sigrun Hope, Eva Z. Hoseth, Erlend S. Gardsjord, Monica Aas, Trude Iversen, Inge Joa, Gunnar Morken, Ingrid Agartz, Ingrid Melle, Pål Aukrust, Srdjan Djurov...

Background: Based on a collective action from a number of Norwegian user organizations for mental health, the Norwegian government demanded the regional health authorities to establish a medication-free treatment option for patients with severe mental illnesses. This change in governmental health policy has several direct implications, including ma...

Background Inflammation and immune activation have been implicated in the pathogenesis of severe mental disorders and cardiovascular disease (CVD). Despite high level of comorbidity, many studies of the immune system in severe mental disorders have not systematically taken cardiometabolic risk factors into account. Methods We investigated if infla...

Background Despite the evidence of the importance of including service users’ views on psychotherapy after psychosis, there is a paucity of research investigating impact on full recovery. Objectives To explore what fully recovered service users found to be the working ingredients of psychotherapy in the recovery process after psychosis. Material...

Background: Subjective quality of life (S-QoL) is an important outcome measure in first-episode psychosis, but its associations with clinical predictors may vary across the illness course. In this study we examine the association pattern, including both direct and indirect effects, between specific predefined clinical predictors (insight, depressi...

Aim Individual placement and support (IPS) for first episode psychosis (FEP) has proven effective for employment and education, but yields differing results across geographical regions. Local adaptations may be necessary for various reasons, such as regional differences in employment‐ and welfare services; in educational opportunities and job marke...

Objectives: Impaired attention and language functions are common in psychosis, but have been less explored in subjects with ultra-high risk for psychosis (UHR). The aim of the study was to investigate differences in language lateralization and auditory attention in UHR subjects compared to healthy controls with a dichotic listening paradigm. In add...

Background The pre-TIPS study in 1994–95 showed that the duration of untreated psychosis (DUP) was long in our region with a mean value of 2.1 years, and median 26 weeks. This set the stage for the TIPS-study (1997–2000), reducing DUP through information campaigns targeted to the general population and other referral agents (GP’s, schools and other...

Background Prolonged duration of untreated psychosis (DUP) is associated with poor outcome. The Scandinavian TIPS study deployed an early detection (ED) campaign to halve DUP. However, while reducing DUP will improve outcomes for most patients, there are some for whom prolonged DUP is a byproduct of an insidiously illness rather than a modifiable p...

Background The pre-TIPS study in 1994–95 showed that the duration of untreated psychosis (DUP) was long in our region with a mean value of 2.1 years, and median 26 weeks. This set the stage for the TIPS-study (1997–2000), reducing DUP through information campaigns targeted to the general population and other referral agents (GP’s, schools and other...

Background The aim of this study is to examine the one-year outcome in a cohort of patients with a first-episode core schizophrenia diagnosis (schizophrenia, schizophreniform psychosis, schizoaffective disorder) and the use of clozapine in the non-remitted patients at one-year control. Methods The population studied is the patients who were includ...

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 hospitalizatio...

Abstract Purpose 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...

Violent victimization in persons with severe mental illness has long-term adverse consequences. Little is known about the long-term prevalence of victimization in first episode psychosis, or about factors affecting victimization throughout the course of illness. To assess the prevalence of violent victimization during a 10-year follow-up period in...

Background Non-adherence is a major public health problem despite treatment advances. Poor drug adherence in patients with psychosis is associated with more frequent relapse, re-hospitalization, increased consumption of health services and poor outcomes on a variety of measures. Adherence rate in patients with first episode psychosis have been foun...

Objective: We evaluated if plasma levels of inflammatory markers are persistently altered in severe mental disorders with psychotic symptoms or associated with state characteristics in a longitudinal study. Methods: Soluble tumor necrosis factor receptor 1 (sTNF-R1), interleukin-1 receptor antagonist (IL-1Ra), von Willebrand factor (VWF), and os...

Background: While the onset of many mental health problems occurs in adolescence, these problems are severely undertreated in this age group. To inform early intervention for adolescents, we investigated the effect of gender and education type on perception of barriers to help seeking, mental health literacy, and the awareness and use of mental hea...

Background Quality of life is an important outcome measure for patients with psychosis. We investigated whether going into stable symptomatic remission is associated with a more positive development of subjective quality of life (S-QoL) and if different patient characteristics are associated with S-QoL depending on remission status. Methods Three...

The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with th...

Social functioning is a conglomerate of factors central to clinical recovery after a first-episode psychosis. There is a lack of studies investigating the relative impact of factors related to social interaction. Disentangling these could facilitate improvement of psychosocial interventions. This study aims to investigate the impact of social inter...

Ved Stavanger Universitetssjukehus har en siden 1990 systematisk arbeidet med tidlig oppdagelse og intervensjon rettet mot personer med førstegangs psykotisk lidelse. Det er nå blitt et mål å undersøke om det er mulig å forebygge utvikling av psykose. Hensikten med denne studien er å få innsikt i ungdommers opplevelse av å delta i et psykoedukativt...

Background: There is lack of long-term controlled studies evaluating treatment effects of antipsychotic medication. A complete investigation should include the service user perspective. Aims: To investigate experiences of clinically recovered service users of antipsychotic medications during and after a first episode of psychosis. Method: We used...

Background: Neurocognitive impairment is a core feature of schizophrenia and is observed in the majority of patients. Substance use is common among patients with psychosis and linked to poorer outcomes. As neurocognition is one of the strongest long-term predictors of functional outcome and recovery poorer outcomes would be expected for substance u...

Background: Social functioning is a conglomerate of factors central to clinical recovery after a first-episode psychosis. There is a lack of studies investigating the relative impact of factors related to social interaction. Disentangling these could facilitate improvement of psychosocial interventions. This study aims to investigate the impact of...

Substance use is common in first-episode psychosis (FEP) and has been linked to poorer outcomes with more severe psychopathology and higher relapse rates. Early substance discontinuation appears to improve symptoms and function. However, studies vary widely in their methodology, and few have examined patients longitudinally, making it difficult to...

Bakgrunn for prosjektet I Norge dor om lag 550 mennesker av selvmord hvert ar, i Rogaland er antallet i underkant av 50. En betydelig andel av de som dor i selvmord har ikke kontakt med kommuneeller spesialisthelsetjenesten i tiden for selvmordet. Prosjektet Velg a leve kom i gang i 2013 finansiert av regionale samhandlingsmidler i Helse Vest. For...

Copy number variants (CNVs) have been strongly implicated in the genetic etiology of schizophrenia (SCZ). However, genome-wide investigation of the contribution of CNV to risk has been hampered by limited sample sizes. We sought to address this obstacle by applying a centralized analysis pipeline to a SCZ cohort of 21,094 cases and 20,227 controls....