- Email: [email protected]
P.7.f.002 The affective dimension of early-onset first episode of psychosis
P.7.f. Child and adolescent disorders and treatment − Other (clinical) DA agents such as MPH are dependent on age. In our ongoing trail we will obtain evidence whether chronic treatment with MPH also affects the developing brain differently than the developed adult brain. References [1] Posner, J., Maia, T.V., Fair, D., Peterson, B.S., Sonuga-Barke, E.J., Nagel, B.J., 2011 The attenuation of dysfunctional emotional processing with stimulant medication: an fMRI study of adolescents with ADHD. Psychiatry Research: Neuroimaging 193, 151−60. [2] Rapport, L.J., Friedman, S.L., Tzelepis, A., Van Voorhis, A., 2002. Experienced emotion and affect recognition in adult attention-deficit hyperactivity disorder. Neuropsychology 16, 102–110. [3] Salgado-Pineda, P., Delaveau, P., Blin, O., Nieoullon, A., 2005. Dopaminergic contribution to the regulation of emotional perception. Clinical Neuropharmacology 28, 228–237.
P.7.f. Child and adolescent disorders and treatment − Other (clinical) P.7.f.001 Turkish validation and adaptation of Children’s Chronotype Questionnaire (CCTQ) O. Dursun1 , I. Esin1 , H. Og¨utl¨u1 ° 1 Ataturk Univercity, Child and Adolescent Psychiatry, Erzurum, Turkey Objective: Chronotype refers to the time of the day that a person’s physical functions and cognitive functions are active. The study of circadian rhythms, known as chronobiology, is all about the differences between chronotypes: ‘larks’ (so called morning people) and ‘owls’ (or night people). As long as some people choose to wake up early in the morning and are most active in the first part of the day, others prefer to wake up later, as their peak time of the day is in the evening, and they prefer to sleep late at night. Morningness-eveningness changes during the lifespan. Although most of children are morning people, adolescents become more evening orientated. The switch towards eveningness seems to be associated with pubertal development. At the end of adolescence, a switch back to morningness occurs. In recent studies; personal differences in chronotype are linked to sleep schedule variability, psychosocial activity and specific properties of the circadian clock. Moreover, chronotype, at least in young adults, has recently been linked with specific personality traits. Girls tend to be more morningness person than boys at the same age groups. The CCTQ is a parent-report, 27-item mixed format questionnaire measuring chronotype of children in multiple domains: the midsleep point on free days (MSF), a morningness/ eveningness scale (M/E) score, and a five-point chronotype (CT) score. The aim of this study is adaptating Children’s Chronotype Questionnaire (CCTQ) into Turkish Language and validating the instrument in Turkish population. Method: 101 children aged nine through eighteen constitude the sample of the study. We compared the CCTQ and MESC [1] scores of children to examine the validity of CCTQ. To assess the test retest reliability we also wanted the parents to re-fill the test 15 days after the first aplication. Results: The results of this study shows that Turkish CCTQ was a reliable test. Because of the Cronbach alpha of Turkish CCTQ was 0.653 and the stability of the test was provided by test-retest phenomenon. The findings of the current study were consistent with those of Werner et al [2]. who found that Cronbach Alpha of CCTQ was 0.81. It was similar to that for the adolescent version of Carskadon and colleagues [3]. MESCTurkish (MECS-T) is a reliable and valid questionnaire [1]. There
S729
was a significant negative correlation between CCTQ M/E and MESC-T scores. When M/E score was low, MESC-T score was high in the same type. This situation suggest that Turkish CCTQ provides external validity. The internal consistency and external validity of the Turkish CCTQ was sufficient to compare MESCTurkish. As a result of this research carried out in accordance with methodological research principles, correlation between the M/E scores of CCTQ and MESC was significant. Discussion: The Turkish version of CCTQ has been found to be valid and reliable in Turkish children. References ¨ [1] Onder, I. and S. Besoluk, Adaptation of the morningness eveningness scale for children into Turkish. Biological Rhythm Research, 2013. 44(2): p. 313–323. [2] Werner, H., et al., Assessment of Chronotype in Four- to Eleven-YearOld Children: Reliability and Validity of the Children’s ChronoType Questionnaire (CCTQ). Chronobiology International, 2009. 26(5): p. 992–1014. [3] Carskadon, M.A., C. Vieira, and C. Acebo, Association between puberty and delayed phase preference. Sleep (New York), 1993. 16: p. 258–258.
P.7.f.002 The affective dimension of early-onset first episode of psychosis V. Sanchez-Gistau1 ° , I. Baeza2 , C. Arango3 , A. Gonz´alezPinto4 , E. De la Serna5 , M. Parellada3 , M. Graell6 , B. Paya7 , C. Llorente3 , F. Castro-Fornieles8 1 Hospital Clinic. CIBERSAM, Child and Adolescent psychiatry and psychology department. University of Barcelona, Barcelona, Spain; 2 Hospital Clinic. CIBERSAM, Child and Adolescent psychiatry and psychology department, Barcelona, Spain; 3 Hospital Gregorio Mara˜non CIBERSAM, Adolescent Unit Department of Psychiatry, Madrid, Spain; 4 Hospital Santiago Ap´ostol, Department of Psychiatry, Vitoria, Spain; 5 CIBERSAM, child and adolescent psychiatry and psychology, Barcelona, Spain; 6 Hospital Infantil Universitario Ni˜no Jes´us CIBERSAM, Child and Adolescent psychiatry and psychology department, Madrid, Spain; 7 Hospital Universitario Marqu´es de Valdecilla CIBERSAM, Child and Adolescent Mental Health Unit Department of Psychiatry and Psychology, Santander, Spain; 8 Hospital Clinic. CIBERSAM, Child and Adolescent psychiatry and psychology department. University of Barcelona, Barcelona, Spain Background: Advances in molecular genetics over the last decade have overlapping findings in the neurobiological basis of schizophrenia and bipolar disorder These findings have challenged the categorical division of psychoses, leading to calls for a dimensional approach to the classification of disorders. The study of the affective dimension in psychosis, regardless of DSM diagnosis, is a now thriving area of research [1]. Studies with adult psychotic samples, have mainly been focused in the study depressive symptoms, which have been reported to be especially prominent in the early stages of the illness [2]. Besides depression, very few first episode of psychosis studies have investigated whether other affective dimensions, such as mania or mixed states, are prominent in the acute phase [3]. Purpose: Given that the affective dimension has been even less studied in early than adult-onset psychosis, our may aim was to investigate the prevalence and type of affective symptoms in the prodromal and acute phases of early-onset psychosis. Whether the presence of affective symptoms during the prodromal and acute phase predicts a later diagnosis of bipolar disorder or schizophrenia was also investigated.
S730
P.7.f. Child and adolescent disorders and treatment − Other (clinical)
Method: Participants were 95 youths, aged 9 to 17 years, experiencing a first episode of a psychotic disorder according to DSM-IV criteria. Prodromal affective symptoms in the year prior to the onset of full-blown psychosis were assessed by means of. The Schedule for Affective Disorders and Schizophrenia for School-Age Children − Present and Lifetime version Affective symptoms during the acute episode were evaluated using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Given the difficulty of establishing a definitive diagnosis in the acute episode, the most accurate DSM-IV diagnosis at 12 months was taken. Results: Half of the patients experienced affective symptoms during the prodrome, with depressive symptoms being the most frequently reported. During the acute episode, 23.2% presented depressive symptoms, 41.4% mixed symptoms and 18.9% manic symptoms. Neither the prevalence of affective symptoms nor the severity of psychotic symptoms during the first episode of psychosis predicted a diagnosis of Bipolar Disorder or schizophrenia at 12 months. However, in comparison with Schizophrenia prodromal affective symptoms were associated with a later diagnosis of Bipolar Disorder (OR = 7.56; 95% CI, 2.06–27.47, p = 0.002) in logistic regression analysis. Specifically, both depressive and manic prodromal symptoms were significantly more frequent in Bipolar Disorder than Schizophrenia. Conclusions: Affective symptoms are frequent during the prodromal and acute phases of early-onset psychosis as only 17.8% of the whole sample did not suffer clinically relevant affective symptoms during these phases. Mixed symptoms the most prevalent affective symptoms accompanying the acute psychotic episode, however prevalence or type of affective symptoms at acute phase did not differentiate bipolar disorder than schizophrenia. Only depressive and manic prodromal symptoms were more frequently associated with bipolar disorder than schizophrenia. References [1] Keshavan, M.S. Morris, D.W., Sweeney, J.A., Pearlson, G., Thaker, G., Seidman, L.J., Eack, S.M. and Tamminga, C. (2011). A dimensional approach to the psychosis spectrum between bipolar disorder and schizophrenia: the Schizo-Bipolar Scale. Schizophrenia Research, 133, 250–254. [2] Upthegrove, R Birchwood, M., Ross, K., Brunett, K., McCollum, R. and Jones, L. (2010). The evolution of depression and suicidality in first episode psychosis. Acta Psychiatrica Scandinavica, 122, 211–218. [3] Aspiazu, S., Mosquera, F., Ibanez, B., Vega, P., Barbeito, S., Lopez, P., Ruiz, D.A., Ugarte, A., Vieta, E. and Gonzalez-Pinto, A. (2010). Manic and depressive symptoms and insight in first episode psychosis. Psychiatry Research, 178, 480–486. Disclosure statement: Instituto de Salud Carlos III, ERDF, (RETICS)G03/032, Alicia Koplowitz Foundation, 2009SGR1119 and (S2010/BMD2422 AGES).
P.7.f.003 Mental disorders in children with HIV/AIDS P. Kestelman1 ° , C. Kutnowski1 Mental, CABA, Argentina
1 Hospital
J.P. Garrahan, Salud
Introduction: As a result of advances in treatment, HIV infection has become a chronic disease that may affect the personality of the patient and lead to family dysfunction related to the natural course of the disease and to individual, family, and social characteristics [1]. A considerable body of evidence shows that children with chronic diseases are more likely to suffer from mental disorders. This risk is increased by physical symptoms that invade daily life, the type of treatment and its consequences, uncertain prognosis,
existence of relatives who died because of the same disease, the sense of being different, and frequent hospital admissions [2]. Aims: The aim of this study was to determine the distribution of behavioral and emotional difficulties in children between 6 and 11 years of age infected with HIV/AIDS and to compare this distribution with the distribution in the normative population. Methods: The sample consisted of 31 children (31% of the patient population of that age being followed-up at our center), of whom 13 were boys (34.5%) and 18 were girls (65.5%). Increased incidence of fathers with only primary-school education, mothers who were housewives, large families (more than 6 family members), and high levels of overcrowding were found. Children were assessed using the Child Behavior Checklist (CBCL), a standardized form for identifying emotional and behavioral difficulties in children, developed by Achenbach and validated for Argentina [3]. The questionnaire has 8 narrow-band syndrome scales and two broad-band scales. SPSS 10.0 was used for statistical analysis. Results: The average score for age was calculated separately for boys and for girls. The results were compared to those obtained in a normative population from a study conducted in our country. In the children of the study group, both the scores on the individual scales and the total scores were higher than those of the normative population, with the difference significant in all cases (p < 0.05). Table: Comparison of CBCL scores of study and normative groups Population Girls
Total score Attention problems Antisocial behavior Withdrawn Anxious/Depressed Social problems Thought problems Aggressive behavior Internalizing behavior Externalizing behavior
Boys
Study group (n = 18)
Normative population
Study group (n = 13)
Normative population
51 7.5 2 6 9 4 0.4 13 18 16
34 5 1 3 5 2 0.05 10 10 11
56 8.5 4 4.5 8.5 4 0.2 19 16 21
35 5 2 3 5 2 0.05 10 9.5 12
Conclusions: These results show that the children in the study population have more behavioral and emotional difficulties than children in the normative population. The difference was statistically significant in all scales for the boys, and in all scales except Aggressiveness, Antisocial behavior and Externalizing behavior for the girls. These findings may be associated with factors related to the disease itself, the chronicity, social stigma, and the life conditions of the patients and their families. The results of this study confirm the importance to conduct this type of studies to increase the knowledge on children suffering from HIV/AIDS and their life conditions and difficulties to improve the comprehensive management of these children and their families. References [1] Mellins C, Brackis-Cott E, Leu C; Elkington K, Dolezal K, Wiznia A, McKay M, Bamji M, 4 and Abrams E ‘Rates and types of psychiatric disorders in perinatally human immunodeficiency virus-infected youth and seroreverters’ Journal of Child Psychology and Psychiatry 50:9 (2009), pp 1131–1138.
P.7.f. Child and adolescent disorders and treatment − Other (clinical) P.7.f.001 Turkish validation and adaptation of Children’s Chronotype Questionnaire (CCTQ) O. Dursun1 , I. Esin1 , H. Og¨utl¨u1 ° 1 Ataturk Univercity, Child and Adolescent Psychiatry, Erzurum, Turkey Objective: Chronotype refers to the time of the day that a person’s physical functions and cognitive functions are active. The study of circadian rhythms, known as chronobiology, is all about the differences between chronotypes: ‘larks’ (so called morning people) and ‘owls’ (or night people). As long as some people choose to wake up early in the morning and are most active in the first part of the day, others prefer to wake up later, as their peak time of the day is in the evening, and they prefer to sleep late at night. Morningness-eveningness changes during the lifespan. Although most of children are morning people, adolescents become more evening orientated. The switch towards eveningness seems to be associated with pubertal development. At the end of adolescence, a switch back to morningness occurs. In recent studies; personal differences in chronotype are linked to sleep schedule variability, psychosocial activity and specific properties of the circadian clock. Moreover, chronotype, at least in young adults, has recently been linked with specific personality traits. Girls tend to be more morningness person than boys at the same age groups. The CCTQ is a parent-report, 27-item mixed format questionnaire measuring chronotype of children in multiple domains: the midsleep point on free days (MSF), a morningness/ eveningness scale (M/E) score, and a five-point chronotype (CT) score. The aim of this study is adaptating Children’s Chronotype Questionnaire (CCTQ) into Turkish Language and validating the instrument in Turkish population. Method: 101 children aged nine through eighteen constitude the sample of the study. We compared the CCTQ and MESC [1] scores of children to examine the validity of CCTQ. To assess the test retest reliability we also wanted the parents to re-fill the test 15 days after the first aplication. Results: The results of this study shows that Turkish CCTQ was a reliable test. Because of the Cronbach alpha of Turkish CCTQ was 0.653 and the stability of the test was provided by test-retest phenomenon. The findings of the current study were consistent with those of Werner et al [2]. who found that Cronbach Alpha of CCTQ was 0.81. It was similar to that for the adolescent version of Carskadon and colleagues [3]. MESCTurkish (MECS-T) is a reliable and valid questionnaire [1]. There
S729
was a significant negative correlation between CCTQ M/E and MESC-T scores. When M/E score was low, MESC-T score was high in the same type. This situation suggest that Turkish CCTQ provides external validity. The internal consistency and external validity of the Turkish CCTQ was sufficient to compare MESCTurkish. As a result of this research carried out in accordance with methodological research principles, correlation between the M/E scores of CCTQ and MESC was significant. Discussion: The Turkish version of CCTQ has been found to be valid and reliable in Turkish children. References ¨ [1] Onder, I. and S. Besoluk, Adaptation of the morningness eveningness scale for children into Turkish. Biological Rhythm Research, 2013. 44(2): p. 313–323. [2] Werner, H., et al., Assessment of Chronotype in Four- to Eleven-YearOld Children: Reliability and Validity of the Children’s ChronoType Questionnaire (CCTQ). Chronobiology International, 2009. 26(5): p. 992–1014. [3] Carskadon, M.A., C. Vieira, and C. Acebo, Association between puberty and delayed phase preference. Sleep (New York), 1993. 16: p. 258–258.
P.7.f.002 The affective dimension of early-onset first episode of psychosis V. Sanchez-Gistau1 ° , I. Baeza2 , C. Arango3 , A. Gonz´alezPinto4 , E. De la Serna5 , M. Parellada3 , M. Graell6 , B. Paya7 , C. Llorente3 , F. Castro-Fornieles8 1 Hospital Clinic. CIBERSAM, Child and Adolescent psychiatry and psychology department. University of Barcelona, Barcelona, Spain; 2 Hospital Clinic. CIBERSAM, Child and Adolescent psychiatry and psychology department, Barcelona, Spain; 3 Hospital Gregorio Mara˜non CIBERSAM, Adolescent Unit Department of Psychiatry, Madrid, Spain; 4 Hospital Santiago Ap´ostol, Department of Psychiatry, Vitoria, Spain; 5 CIBERSAM, child and adolescent psychiatry and psychology, Barcelona, Spain; 6 Hospital Infantil Universitario Ni˜no Jes´us CIBERSAM, Child and Adolescent psychiatry and psychology department, Madrid, Spain; 7 Hospital Universitario Marqu´es de Valdecilla CIBERSAM, Child and Adolescent Mental Health Unit Department of Psychiatry and Psychology, Santander, Spain; 8 Hospital Clinic. CIBERSAM, Child and Adolescent psychiatry and psychology department. University of Barcelona, Barcelona, Spain Background: Advances in molecular genetics over the last decade have overlapping findings in the neurobiological basis of schizophrenia and bipolar disorder These findings have challenged the categorical division of psychoses, leading to calls for a dimensional approach to the classification of disorders. The study of the affective dimension in psychosis, regardless of DSM diagnosis, is a now thriving area of research [1]. Studies with adult psychotic samples, have mainly been focused in the study depressive symptoms, which have been reported to be especially prominent in the early stages of the illness [2]. Besides depression, very few first episode of psychosis studies have investigated whether other affective dimensions, such as mania or mixed states, are prominent in the acute phase [3]. Purpose: Given that the affective dimension has been even less studied in early than adult-onset psychosis, our may aim was to investigate the prevalence and type of affective symptoms in the prodromal and acute phases of early-onset psychosis. Whether the presence of affective symptoms during the prodromal and acute phase predicts a later diagnosis of bipolar disorder or schizophrenia was also investigated.
S730
P.7.f. Child and adolescent disorders and treatment − Other (clinical)
Method: Participants were 95 youths, aged 9 to 17 years, experiencing a first episode of a psychotic disorder according to DSM-IV criteria. Prodromal affective symptoms in the year prior to the onset of full-blown psychosis were assessed by means of. The Schedule for Affective Disorders and Schizophrenia for School-Age Children − Present and Lifetime version Affective symptoms during the acute episode were evaluated using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Given the difficulty of establishing a definitive diagnosis in the acute episode, the most accurate DSM-IV diagnosis at 12 months was taken. Results: Half of the patients experienced affective symptoms during the prodrome, with depressive symptoms being the most frequently reported. During the acute episode, 23.2% presented depressive symptoms, 41.4% mixed symptoms and 18.9% manic symptoms. Neither the prevalence of affective symptoms nor the severity of psychotic symptoms during the first episode of psychosis predicted a diagnosis of Bipolar Disorder or schizophrenia at 12 months. However, in comparison with Schizophrenia prodromal affective symptoms were associated with a later diagnosis of Bipolar Disorder (OR = 7.56; 95% CI, 2.06–27.47, p = 0.002) in logistic regression analysis. Specifically, both depressive and manic prodromal symptoms were significantly more frequent in Bipolar Disorder than Schizophrenia. Conclusions: Affective symptoms are frequent during the prodromal and acute phases of early-onset psychosis as only 17.8% of the whole sample did not suffer clinically relevant affective symptoms during these phases. Mixed symptoms the most prevalent affective symptoms accompanying the acute psychotic episode, however prevalence or type of affective symptoms at acute phase did not differentiate bipolar disorder than schizophrenia. Only depressive and manic prodromal symptoms were more frequently associated with bipolar disorder than schizophrenia. References [1] Keshavan, M.S. Morris, D.W., Sweeney, J.A., Pearlson, G., Thaker, G., Seidman, L.J., Eack, S.M. and Tamminga, C. (2011). A dimensional approach to the psychosis spectrum between bipolar disorder and schizophrenia: the Schizo-Bipolar Scale. Schizophrenia Research, 133, 250–254. [2] Upthegrove, R Birchwood, M., Ross, K., Brunett, K., McCollum, R. and Jones, L. (2010). The evolution of depression and suicidality in first episode psychosis. Acta Psychiatrica Scandinavica, 122, 211–218. [3] Aspiazu, S., Mosquera, F., Ibanez, B., Vega, P., Barbeito, S., Lopez, P., Ruiz, D.A., Ugarte, A., Vieta, E. and Gonzalez-Pinto, A. (2010). Manic and depressive symptoms and insight in first episode psychosis. Psychiatry Research, 178, 480–486. Disclosure statement: Instituto de Salud Carlos III, ERDF, (RETICS)G03/032, Alicia Koplowitz Foundation, 2009SGR1119 and (S2010/BMD2422 AGES).
P.7.f.003 Mental disorders in children with HIV/AIDS P. Kestelman1 ° , C. Kutnowski1 Mental, CABA, Argentina
1 Hospital
J.P. Garrahan, Salud
Introduction: As a result of advances in treatment, HIV infection has become a chronic disease that may affect the personality of the patient and lead to family dysfunction related to the natural course of the disease and to individual, family, and social characteristics [1]. A considerable body of evidence shows that children with chronic diseases are more likely to suffer from mental disorders. This risk is increased by physical symptoms that invade daily life, the type of treatment and its consequences, uncertain prognosis,
existence of relatives who died because of the same disease, the sense of being different, and frequent hospital admissions [2]. Aims: The aim of this study was to determine the distribution of behavioral and emotional difficulties in children between 6 and 11 years of age infected with HIV/AIDS and to compare this distribution with the distribution in the normative population. Methods: The sample consisted of 31 children (31% of the patient population of that age being followed-up at our center), of whom 13 were boys (34.5%) and 18 were girls (65.5%). Increased incidence of fathers with only primary-school education, mothers who were housewives, large families (more than 6 family members), and high levels of overcrowding were found. Children were assessed using the Child Behavior Checklist (CBCL), a standardized form for identifying emotional and behavioral difficulties in children, developed by Achenbach and validated for Argentina [3]. The questionnaire has 8 narrow-band syndrome scales and two broad-band scales. SPSS 10.0 was used for statistical analysis. Results: The average score for age was calculated separately for boys and for girls. The results were compared to those obtained in a normative population from a study conducted in our country. In the children of the study group, both the scores on the individual scales and the total scores were higher than those of the normative population, with the difference significant in all cases (p < 0.05). Table: Comparison of CBCL scores of study and normative groups Population Girls
Total score Attention problems Antisocial behavior Withdrawn Anxious/Depressed Social problems Thought problems Aggressive behavior Internalizing behavior Externalizing behavior
Boys
Study group (n = 18)
Normative population
Study group (n = 13)
Normative population
51 7.5 2 6 9 4 0.4 13 18 16
34 5 1 3 5 2 0.05 10 10 11
56 8.5 4 4.5 8.5 4 0.2 19 16 21
35 5 2 3 5 2 0.05 10 9.5 12
Conclusions: These results show that the children in the study population have more behavioral and emotional difficulties than children in the normative population. The difference was statistically significant in all scales for the boys, and in all scales except Aggressiveness, Antisocial behavior and Externalizing behavior for the girls. These findings may be associated with factors related to the disease itself, the chronicity, social stigma, and the life conditions of the patients and their families. The results of this study confirm the importance to conduct this type of studies to increase the knowledge on children suffering from HIV/AIDS and their life conditions and difficulties to improve the comprehensive management of these children and their families. References [1] Mellins C, Brackis-Cott E, Leu C; Elkington K, Dolezal K, Wiznia A, McKay M, Bamji M, 4 and Abrams E ‘Rates and types of psychiatric disorders in perinatally human immunodeficiency virus-infected youth and seroreverters’ Journal of Child Psychology and Psychiatry 50:9 (2009), pp 1131–1138.