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6.88 THE IMPACT OF CANNABIS USE AND EMERGING PSYCHOTIC EXPERIENCES EXPLAINED BY SLEEP PROBLEMS AND ANXIETY SYMPTOMS
NEW RESEARCH POSTERS 6.88 – 6.90
6.88 THE IMPACT OF CANNABIS USE AND EMERGING PSYCHOTIC EXPERIENCES EXPLAINED BY SLEEP PROBLEMS AND ANXIETY SYMPTOMS
Josiane Bourque, MSc, Psychiatry, Universite de Montreal and Centre Hospitalier Universitaire Sainte-Justine, 3175 Cote SainteCatherine, Montreal, QC, H3T 1C5, Canada; Maeve O’LearyBarrett, PhD; Patricia Conrod, PhD Objectives: The mechanisms by which cannabis use increases the risk for psychosis are still unclear. This study first examined the longitudinal bidirectional relationship between cannabis use and psychotic-like experiences (PLEs) in early adolescence. Second, we explored whether early cannabis use increases anxiety symptoms and sleep problems, which in turn contribute to the severity of PLEs. Methods: Substance use, clinical and behavioral data for 3,069 13-year old adolescents (mean age: 12.8, SD: 0.46, 51.6 percent boys) was collected through a confidential web-based survey at four time points, with 12 months separating each assessment. PLEs were measured with the Adolescent Psychotic Symptoms Screener, while sleep problems were assessed with different items on sleep quality in the last month. Anxiety symptoms were evaluated with the Anxiety subscale of the Brief Symptom Inventory, and cannabis use frequency was assessed with the Detection of alcohol and drug problems in adolescents (DEPADO), a validated tool to measure substance use in Quebec (Canada) youth. Autoregressive cross-lagged models were used to examine the relationships between cannabis use and PLEs, and their potential mediating factors, namely anxiety symptoms and sleep problems. Controls for sex, age and socioeconomic status at baseline were included in all analyses. Results: At 13- and 14-years old, cannabis use led to heightened PLEs, while later on, elevated PLEs promoted further cannabis use. When sleep problems and anxiety symptoms were entered as potential mediators, cannabis use predicted later sleep problems, which in turn promoted anxiety symptoms, which in turn exacerbated PLEs. Conclusions: The bidirectional pathway between cannabis use and PLEs in youth may be partially explained by increased sleep problems and anxiety symptoms. Indeed, even at low doses, cannabis use is associated with impaired sleep quality in teens. Sleep disturbances have been widely associated concurrently and longitudinally to anxiety symptoms, which may be problematic for individuals with sensitivity to the effects of stress. Altogether, these results provide important insights into potential mechanisms underlying the relationship between cannabis use and psychosis risk.
ADOL PSY Supported by CIHR grant FRN114887 http://dx.doi.org/10.1016/j.jaac.2016.09.407
6.89 DEFINING SYMPTOM DIMENSIONS AND SUBTYPES IN CHILDHOOD-ONSET SCHIZOPHRENIA Kirsten E.S. Craddock, BS, Child Psychiatry, National Institute of Mental Health, 10 Center Drive, Bethesda, MD 20814; Xueping Zhou, MS; Frances F. Loeb, BA; Judith L. Rapoport, MD; Dwight Dickinson, PhD Objectives: Clinical experience and recent research suggest that non-classical subgroups exist within the schizophrenia patient population (e.g., deficit schizophrenia). Childhood onset schizophrenia (COS) is a rare and severe form of the disorder. This study reports on symptom dimensions and subtypes in a COS population. Methods: Since 1990, patients nationwide were screened for study admission based on medical history and symptoms. Inpatient clinical observation during a 3-week medication free period was used to make a COS diagnosis. We used psychiatric symptom rating data from admission of 90 COS patients to perform first level exploratory factor analysis. The resulting composite scores were used in second level factor analysis to define integrated symptom dimensions. Linear regression was used to assess the relationship between dimension composite scores and other clinical and demographic variables. K-means cluster analysis was done using the dimension composite scores to form patient clusters, which were then compared to each other and to adult research.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Results: Second level factor analysis revealed three overarching symptom dimensions in COS data: 1) negative; 2) disorganized; and 3) mixed distress and delusional symptoms. Linear regression showed the negative factor was significantly correlated with age of onset (b¼3.85, p<0.01). Cluster analysis identified three patient groups: 1) relatively low symptoms, 2) high symptom without distress/delusion, and 3) high symptom with distress/delusion. These groups have significantly different factor (p<0.01), symptom rating (p<0.01), and child global assessment scores (F¼8.73, p¼3.5 x 10-4), as well as co-morbid ADHD diagnosis (c2 ¼15.44, p¼4.4 x 10-4). There were also trends towards differences in the percent of females in each group (c2 ¼7.48, p¼0.02) and presence of copy number variants (c2 ¼5.48, p¼0.07). Conclusions: Our analysis shows symptom dimensions and clusters exist in the COS patient cohort that closely resemble adult research and could assist in diagnosis. The presence of negative, distress, and disorganized dimensions and the separation of high symptom groups by distress scores matches work in adults. Unlike adults, our distress dimension included positive symptoms and the low symptom group had high levels of ADHD comorbidity.
NIMH PSY SZ Supported by the NIMH Intramural Research Program Protocol ID 84M-0050 http://dx.doi.org/10.1016/j.jaac.2016.09.408
6.90 UNDERSTANDING THE UNIQUE MENTAL HEALTH EXPERIENCES AND NEEDS OF HOMELESS VETERAN FAMILIES: A QUALITATIVE ANALYSIS Roya Ijadi-Maghsoodi, MD, VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073; Sophie Feller, MD; Sheryl H. Kataoka, MD; Gery Ryan, PhD; Donna Washington, MD; Lisa Altman, MD; Lillian Gelberg, MD Objectives: Family homelessness is a public health crisis. Youth in homeless families face high levels of violence exposure and are at risk for poor mental health outcomes. There is rising concern about homeless Veteran families, and the impact of deployments, PTSD, and military sexual trauma on families. Despite the commitment to end Veteran homelessness, there is a dearth of knowledge on how to care for homeless Veteran families. Our aim was to understand the strengths, experiences, and needs of homeless Veteran families, including the impact of homelessness on family mental health and parenting, perceived barriers to housing, and to provide recommendations to improve care for homeless Veteran families. Methods: We conducted in-depth individual interviews (total n¼21) with homeless Veteran parents (n¼14) and providers of homeless services (n¼7). Participants were recruited from housing facilities and homeless services associated with the Veterans Affairs Greater Los Angeles Healthcare System. Interviews probed the experiences of homelessness in areas of the family’s life, including family mental health, relationships, and parenting; barriers to housing; and recommendations to improve services. Interviews were audiorecorded, transcribed, and coded for main themes using in-depth thematic content analysis. Results: Parents described strengths, such as providing normalcy for their children. Interviews revealed mental health problems among parents that were exacerbated by homelessness, including PTSD, depression, and substance use, and child mental health issues. Parents had significant concerns about parenting, relationships with family members, and the emotional wellbeing of their children. Barriers to obtaining permanent housing related to family needs included a desire to keep youth in good schools and to live in safe neighborhoods. Participants recommended counseling and services for the whole family. Conclusions: Although homeless Veteran families have strengths, our findings suggest that these families have significant mental health and parenting needs that are worsened by homelessness, and barriers to housing that are unique to families. Understanding the experiences of homeless Veteran families might be helpful for improving mental health and housing outcomes for this important population.
www.jaacap.org
S233
6.88 THE IMPACT OF CANNABIS USE AND EMERGING PSYCHOTIC EXPERIENCES EXPLAINED BY SLEEP PROBLEMS AND ANXIETY SYMPTOMS
Josiane Bourque, MSc, Psychiatry, Universite de Montreal and Centre Hospitalier Universitaire Sainte-Justine, 3175 Cote SainteCatherine, Montreal, QC, H3T 1C5, Canada; Maeve O’LearyBarrett, PhD; Patricia Conrod, PhD Objectives: The mechanisms by which cannabis use increases the risk for psychosis are still unclear. This study first examined the longitudinal bidirectional relationship between cannabis use and psychotic-like experiences (PLEs) in early adolescence. Second, we explored whether early cannabis use increases anxiety symptoms and sleep problems, which in turn contribute to the severity of PLEs. Methods: Substance use, clinical and behavioral data for 3,069 13-year old adolescents (mean age: 12.8, SD: 0.46, 51.6 percent boys) was collected through a confidential web-based survey at four time points, with 12 months separating each assessment. PLEs were measured with the Adolescent Psychotic Symptoms Screener, while sleep problems were assessed with different items on sleep quality in the last month. Anxiety symptoms were evaluated with the Anxiety subscale of the Brief Symptom Inventory, and cannabis use frequency was assessed with the Detection of alcohol and drug problems in adolescents (DEPADO), a validated tool to measure substance use in Quebec (Canada) youth. Autoregressive cross-lagged models were used to examine the relationships between cannabis use and PLEs, and their potential mediating factors, namely anxiety symptoms and sleep problems. Controls for sex, age and socioeconomic status at baseline were included in all analyses. Results: At 13- and 14-years old, cannabis use led to heightened PLEs, while later on, elevated PLEs promoted further cannabis use. When sleep problems and anxiety symptoms were entered as potential mediators, cannabis use predicted later sleep problems, which in turn promoted anxiety symptoms, which in turn exacerbated PLEs. Conclusions: The bidirectional pathway between cannabis use and PLEs in youth may be partially explained by increased sleep problems and anxiety symptoms. Indeed, even at low doses, cannabis use is associated with impaired sleep quality in teens. Sleep disturbances have been widely associated concurrently and longitudinally to anxiety symptoms, which may be problematic for individuals with sensitivity to the effects of stress. Altogether, these results provide important insights into potential mechanisms underlying the relationship between cannabis use and psychosis risk.
ADOL PSY Supported by CIHR grant FRN114887 http://dx.doi.org/10.1016/j.jaac.2016.09.407
6.89 DEFINING SYMPTOM DIMENSIONS AND SUBTYPES IN CHILDHOOD-ONSET SCHIZOPHRENIA Kirsten E.S. Craddock, BS, Child Psychiatry, National Institute of Mental Health, 10 Center Drive, Bethesda, MD 20814; Xueping Zhou, MS; Frances F. Loeb, BA; Judith L. Rapoport, MD; Dwight Dickinson, PhD Objectives: Clinical experience and recent research suggest that non-classical subgroups exist within the schizophrenia patient population (e.g., deficit schizophrenia). Childhood onset schizophrenia (COS) is a rare and severe form of the disorder. This study reports on symptom dimensions and subtypes in a COS population. Methods: Since 1990, patients nationwide were screened for study admission based on medical history and symptoms. Inpatient clinical observation during a 3-week medication free period was used to make a COS diagnosis. We used psychiatric symptom rating data from admission of 90 COS patients to perform first level exploratory factor analysis. The resulting composite scores were used in second level factor analysis to define integrated symptom dimensions. Linear regression was used to assess the relationship between dimension composite scores and other clinical and demographic variables. K-means cluster analysis was done using the dimension composite scores to form patient clusters, which were then compared to each other and to adult research.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Results: Second level factor analysis revealed three overarching symptom dimensions in COS data: 1) negative; 2) disorganized; and 3) mixed distress and delusional symptoms. Linear regression showed the negative factor was significantly correlated with age of onset (b¼3.85, p<0.01). Cluster analysis identified three patient groups: 1) relatively low symptoms, 2) high symptom without distress/delusion, and 3) high symptom with distress/delusion. These groups have significantly different factor (p<0.01), symptom rating (p<0.01), and child global assessment scores (F¼8.73, p¼3.5 x 10-4), as well as co-morbid ADHD diagnosis (c2 ¼15.44, p¼4.4 x 10-4). There were also trends towards differences in the percent of females in each group (c2 ¼7.48, p¼0.02) and presence of copy number variants (c2 ¼5.48, p¼0.07). Conclusions: Our analysis shows symptom dimensions and clusters exist in the COS patient cohort that closely resemble adult research and could assist in diagnosis. The presence of negative, distress, and disorganized dimensions and the separation of high symptom groups by distress scores matches work in adults. Unlike adults, our distress dimension included positive symptoms and the low symptom group had high levels of ADHD comorbidity.
NIMH PSY SZ Supported by the NIMH Intramural Research Program Protocol ID 84M-0050 http://dx.doi.org/10.1016/j.jaac.2016.09.408
6.90 UNDERSTANDING THE UNIQUE MENTAL HEALTH EXPERIENCES AND NEEDS OF HOMELESS VETERAN FAMILIES: A QUALITATIVE ANALYSIS Roya Ijadi-Maghsoodi, MD, VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073; Sophie Feller, MD; Sheryl H. Kataoka, MD; Gery Ryan, PhD; Donna Washington, MD; Lisa Altman, MD; Lillian Gelberg, MD Objectives: Family homelessness is a public health crisis. Youth in homeless families face high levels of violence exposure and are at risk for poor mental health outcomes. There is rising concern about homeless Veteran families, and the impact of deployments, PTSD, and military sexual trauma on families. Despite the commitment to end Veteran homelessness, there is a dearth of knowledge on how to care for homeless Veteran families. Our aim was to understand the strengths, experiences, and needs of homeless Veteran families, including the impact of homelessness on family mental health and parenting, perceived barriers to housing, and to provide recommendations to improve care for homeless Veteran families. Methods: We conducted in-depth individual interviews (total n¼21) with homeless Veteran parents (n¼14) and providers of homeless services (n¼7). Participants were recruited from housing facilities and homeless services associated with the Veterans Affairs Greater Los Angeles Healthcare System. Interviews probed the experiences of homelessness in areas of the family’s life, including family mental health, relationships, and parenting; barriers to housing; and recommendations to improve services. Interviews were audiorecorded, transcribed, and coded for main themes using in-depth thematic content analysis. Results: Parents described strengths, such as providing normalcy for their children. Interviews revealed mental health problems among parents that were exacerbated by homelessness, including PTSD, depression, and substance use, and child mental health issues. Parents had significant concerns about parenting, relationships with family members, and the emotional wellbeing of their children. Barriers to obtaining permanent housing related to family needs included a desire to keep youth in good schools and to live in safe neighborhoods. Participants recommended counseling and services for the whole family. Conclusions: Although homeless Veteran families have strengths, our findings suggest that these families have significant mental health and parenting needs that are worsened by homelessness, and barriers to housing that are unique to families. Understanding the experiences of homeless Veteran families might be helpful for improving mental health and housing outcomes for this important population.
www.jaacap.org
S233