- Email: [email protected]
Poster #S5 GENDER DIFFERENCES IN THE EFFECT OF CHILDHOOD TRAUMA EXPERIENCES ON PRODROMAL SYMPTOMS AND PERSONALITY DISORDER TRAITS IN YOUNG ADULTS AT HIGH-RISK FOR PSYCHOSIS
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
for tardive dystonia. Two-thirds of the participants displayed at least one type of persistent movement disorder. Yearly incidence rates of persistent movement disorders were 19.6% for TD, 21.6% for parkinsonism, 3.5% for akathisia and 0% for tardive dystonia. Fluctuating TD was positively associated with age (hazard ratio (HR) per year exposure=1.04, 95% CI=1.02-1.06). Fluctuating parkinsonism was positively associated with age (HR=1.03, 95% CI=1.02-1.04) and the total antipsychotic defined daily dose (DDD) (HR=1.07, 95% CI=1.03-1.11). Risk factors did not predict akathisia and tardive dystonia. Discussion: The findings were that (i) having persistent drug-induced movement disorders seems to be the norm for long-stay patients with chronic mental illness and long-term antipsychotic treatment; (ii) these patients have a high risk of incident movement disorder, in particular TD and parkinsonism; (iii) higher age is an important predictor of TD and parkinsonism; and (iv) total antipsychotic defined daily dose (DDD) is an important predictor of parkinsonism. Measures are required to remedy this situation. References: [1] Bakker, P.R., de Groot, I.W., van Os, J. and van Harten, P.N., 2011. Long-stay psychiatric patients: A prospective study revealing persistent antipsychotic-induced movement disorder. PLoS ONE 6, e25588. [2] Bakker, P.R., de Groot, I.W., van Os, J. and van Harten, P.N., 2013. Predicting the incidence of antipsychotic-induced movement disorders in long-stay patients: A prospective study. The Epidemiology and Psychiatric Sciences.
Poster #S4 TWO CANDIDATE GENE-BASED ASSOCIATION STUDIES OF ANTIPSYCHOTIC-INDUCED MOVEMENT DISORDERS IN LONG-STAY PSYCHIATRIC PATIENTS: PROSPECTIVE STUDIES P.R. Bakker 1,2 , Egbert Bakker 3 , Asmar F.Y. Al Hadithy 4 , Najaf Amin 5 , Cornelia M. van Duijn 5 , Jim van Os 6 , Peter N. van Harten 7 1 Maastricht University; 2 Psychiatric Centre GGZ Centraal; 3 Leiden University Medical Center; 4 Parnassia Psychiatric Centre; 5 Erasmus MC; 6 Maastricht University Medical Centre/King’s College London; 7 Maastricht University Medical Centre/Psychiatric Centre GGZ Centraal Background: Four types of antipsychotic-induced movement disorders: tardive dyskinesia (TD), parkinsonism, akathisia and tardive dystonia, subtypes of TD (orofacial and limb truncal dyskinesia), subtypes of parkinsonism (rest tremor, rigidity, and bradykinesia), as well as a principal-factor of the movement disorders and their subtypes, were examined for association with variations (SNPs) in 2 studies; one in 10 candidate genes (PPP1R1B, BDNF, DRD3, DRD2, HTR2A, HTR2C, COMT, MnSOD, CYP1A2, and RGS2) and another one in 7 candidate genes (GRIN2B, GRIN2A, HSPG2, DRD3, DRD4, HTR2C, and NQO1). Methods: Naturalistic study of 168 white long-stay patients with chronic mental illness requiring long-term antipsychotic treatment, examined by the same rater at least twice over a 4-year period, with a mean follow-up time of 1.1 years, with validated scales for TD, parkinsonism, akathisia, and tardive dystonia. The authors genotyped 31 SNPs in 10 candidate genes and 45 tag SNPs in 7 candidate genes, associated with movement disorders or schizophrenia in previous studies. In both studies genotype and allele frequency comparisons were performed with multiple regression methods for continuous movement disorders. Results: In the first study, various SNPs reached nominal significance: TD and orofacial dyskinesia with rs6265 and rs988748; limb truncal dyskinesia with rs6314; rest tremor with rs6275; rigidity with rs6265 and rs4680; bradykinesia with rs4795390; akathisia with rs4680; tardive dystonia with rs1799732, rs4880 and rs1152746. In the second study, various tag SNPs reached nominal significance: TD with rs1345423, rs7192557, rs1650420, and rs11644461; orofacial dyskinesia with rs7192557, rs1650420, and rs4911871; limb truncal dyskinesia with rs1345423, rs7192557, rs1650420, and rs11866328; bradykinesia with rs2192970; akathisia with rs324035; and the principal-factor with rs10772715. After controlling for multiple testing, all of the found association lost their statistical significance. Discussion: The findings suggest that selected SNPs are not associated with a susceptibility to movement disorders. However, as the sample size was small and previous studies show inconsistent results, definite conclusions cannot be made. Replication is needed in larger study samples, preferably in longitudinal studies which take the fluctuating course of movement disorders and gene-environment interactions into account.
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References: [1] Bakker, P.R., Bakker, E., Amin, N., van Duijn, C.M., van Os, J. and van Harten, P.N., 2012a. Candidate gene-based association study of antipsychotic-induced movement disorders in long-stay psychiatric patients: A prospective study. PLoS ONE 7, e36561. [2] Bakker, P.R., Al Hadithy, A.F., Amin, N., van Duijn, C.M., van Os, J. and van Harten, P.N., 2012b. Antipsychotic-induced movement disorders in long-stay psychiatric patients and 45 tag SNPs in 7 candidate genes: A prospective study. PLoS ONE 7, e50970.
Poster #S5 GENDER DIFFERENCES IN THE EFFECT OF CHILDHOOD TRAUMA EXPERIENCES ON PRODROMAL SYMPTOMS AND PERSONALITY DISORDER TRAITS IN YOUNG ADULTS AT HIGH-RISK FOR PSYCHOSIS Neus Barrantes-Vidal 1,2 , Tecelli Domínguez-Martínez 3 , Paula Cristobal 3 , Tamara Sheinbaum 1 , Thomas R. Kwapil 4 , Neus Barrantes-Vidal 1,2 1 Department of Clinical and Health Psychology, Autonomous University of Barcelona; 2 Department of Mental Health, Health Foundation Sant Pere Claver (Barcelona); 3 Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona; 4 Department of Psychology, University of North Carolina at Greensboro Background: Childhood trauma experiences (CTE) represent a socioenvironmental risk factor for the development of schizophrenia spectrum disorders and have a negative impact on the course and outcome of psychotic disorders (Bendall et al., 2008). Few studies have addressed trauma in people at ultra-high-risk (UHR) of psychosis (e.g. Addington et al., 2013; Velthorst et al., 2013). Their findings suggested that CTE are highly prevalent in populations at UHR of psychosis and related to attenuated positive symptoms. Moreover, it has been found that a history of sexual abuse increases the rates of conversion to psychosis (Bechdolf et al., 2010; Thompson et al., 2009) and that females are more likely to report CTE than males (Addington et al., 2013). This study aimed to explore: 1) the presence of CTE in At-Risk Mental State (ARMS) patients and whether it differed according to gender, and 2) the association of CTE with prodromal symptoms and personality disorder traits and the possible moderating role of gender on these associations. Methods: 35 ARMS patients (91.4% met criteria for Attenuated Psychotic Symptoms group according to UHR criteria; Yung et al., 2005) were assessed for psychopathology, personality disorder traits, and history of CTE as assessed by the CTQ-B (Berstein et al., 1994). The mean age of patients was 20.9 years and 60% were male. Results: Overall, ARMS patients reported low-moderate scores (5≥12) on emotional abuse (EA), sexual abuse (SA), and emotional neglect (EN), according to CTQ norms. 48.6% reported having experienced a separation or loss of a parent before the age of 17 (41.2% separation of parents, the father of 2 patients died and one patient was abandoned). Females showed significantly higher levels of SA (moderate-severe) and parental separation/loss but lower levels of EN than males. EA predicted negative and general symptoms, behavioral and motor/physical changes, and borderline personality disorder traits. Physical abuse (PA) predicted positive and negative symptoms, cognitive and motor/physical changes, and schizotypal personality traits. SA predicted positive, negative, and general symptoms as well as cognitive changes. Physical neglect (PN) predicted behavioral changes, whereas parental separation/loss predicted motor/physical change. EN did not predict prodromal symptoms or personality disorder traits. Furthermore, gender moderated the effects of PA and SA on prodromal symptoms, showing a greater impact in females than in males. The associations of EA, PN, and parental separation with symptoms and personality disorder traits were not moderated by gender. Discussion: Findings showed strong associations between CTE and several symptom dimensions of ARMS patients despite the small sample size of this preliminary report. Consistent with previous studies, SA was related with positive attenuated psychotic symptoms (Velthorst et al., 2013) and females showed higher levels of SA than males (Addington et al., 2013). The results suggest that different experiences of childhood abuse (EA, PA and SA) have an effect on symptom severity even before the onset of the first psychosis episode, and that they exert a stronger effect in females than in males. This study supports the importance of CTE as a relevant psychosocial factor at the early stages of psychosis. Even if trauma was self-reported and assessed concurrently with prodromal symptoms, the association of
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patients’ subjective appraisal of CTE and symptoms is in itself a critical issue to understand and highly relevant for its potential impact on the outcome of the at-risk status.
Poster #S6 CHILDHOOD TRAUMA MEDIATES THE ASSOCIATION BETWEEN ETHNIC MINORITY STATUS AND MORE SEVERE HALLUCINATIONS IN PSYCHOTIC DISORDER Akiah A.O. Berg 1,2 , Monica Aas 3,4 , Ole A. Andreassen 5 , Ingrid Melle 6 1 University of Oslo, Inst of Psychiatry; 2 Oslo University Hospital, Division of Mental health and Addiction; 3 NORMENT; 4 Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; 5 University of Oslo; 6 Oslo University Hospital and NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo, Norway Background: Both ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are also found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma among ethnic minorities with psychosis, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations. We also hypothesized that childhood trauma would mediate a possible association between ethnic minorities and hallucinations. Methods: In this cross-sectional study 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorders were included. Current hallucinations were measured with the Positive and Negative Syndrome Scale (item P3; Hallucinatory Behavior). Lifetime hallucinations were assessed with the Structured Clinical Interview for DSM-IV (SCID-I) items auditory hallucinations (B16), voices commenting (B17) and two or more voices conversing (B18). Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version. The ethnic minority group (n=69) consisted of non-Caucasian first- and second-generation immigrants who were primarily from Asia (n=39, 57%) and Africa (n=27, 39%). Results: The ethnic minority group reported significantly more childhood trauma (T-test = −3.866, df 405, p<0.001), specifically physical abuse (Mann Whitney U = 8.170, p<0.001), physical neglect (Mann Whitney U = 9.427, p<0.001), and sexual abuse (Mann Whitney U = 10.156, p<0.003) than the majority group. They also had significantly more current hallucinatory behavior (Mann Whitney U = 10.942, p<0.013). Over 30% of the ethnic minority group reported auditory hallucinations of two or more voices conversing, which was significantly higher than the 19% seen in the majority group (χ2 =4.692, df1, p<0.03). Multivariate regression analyses indicated that childhood trauma mediated the association between ethnic minority status and more severe current hallucinations, and lifetime hallucinations of two or more voices conversing. Discussion: More childhood trauma among ethnic minorities with psychosis partially explains findings of more current and lifetime hallucinations in this group. The association between childhood trauma and first rank symptoms may in part explain the heightened risk of being diagnosed with a schizophrenia-spectrum diagnosis in certain ethnic minorities. The present findings show the importance of childhood trauma not only as a risk factor for schizophrenia but also as experiences that influence specific psychotic symptoms directly. Further of clinical relevance we are reminded to assess and treat the effects of childhood trauma in ethnic minority groups presenting with psychotic disorders.
Poster #S7 META-ANALYSIS OF CHANGES IN BRAIN STRUCTURE IN HEALTHY INDIVIDUALS WITH A HISTORY OF CHILDHOOD ADVERSITY Maria Calem, Matthew Kempton Institute of Psychiatry, King’s College London Background: Childhood adversity is a risk factor for psychosis with an estimated population attributable risk of 33% (Varese et al, 2012). The main biological system thought to underlie this association is the HypothalamicPituitary-Adrenal (HPA) axis, which moderates the stress response in humans. This is supported by findings that HPA-axis-related structures
such as the hippocampus and amygdala are altered in psychosis, and particularly in people with psychosis who have experienced childhood adversity. Research comparing healthy people with and without a history of childhood adversity allows for the disentangling of the effect of psychiatric conditions from the effect of childhood adversity itself. The traumagenic neurodevelopmental model suggests that childhood adversity increases vulnerability to psychosis by creating hypersensitivity to stress. By extension, people that experienced childhood adversity and did not develop a psychiatric condition represent a particularly stress-resilient population. Unlike in psychiatric populations, experiencing childhood adversity may not have led to significant overactivation of the HPA-axis and subsequent abnormal volumetric development. The aim of this meta-analysis was to investigate associations between childhood adversity and hippocampal and amygdala volume in psychiatrically healthy adults. Methods: The MEDLINE database was searched for studies using magnetic resonance imaging that had measured brain structure in healthy adults with and without childhood adversity. We identified seven eligible papers (1,322 participants) reporting hippocampal volumes and three eligible papers (803 participants) reporting amygdala volumes. Effect sizes were calculated from each study and pooled using a random effects meta-analysis. Results: No significant differences in hippocampal (effect size = −0.116; 95% confidence interval −0.375 to 0.043; p=0.119) or amygdala volume (effect size = −0.002; 95% confidence interval −0.168 to 0.165; p=0.984) were found between healthy participants with and without childhood adversity. A study determining hippocampal volume in elderly participants was then excluded. In the remaining six studies participants with a history of childhood adversity were found to have a significantly greater hippocampal volume than those without such a history (effect size = −0.028; 95% confidence interval −0.436 to −0.019; p<0.05). Discussion: The lack of association between childhood adversity and amygdala volume supports the notion that healthy controls that experienced adversity in childhood and did not develop a psychiatric illness have a greater resilience to stress than people who went on to develop a psychiatric illness. However, when we excluded a study including only elderly participants, the overall association between childhood adversity and hippocampal volume was significant, suggesting some vulnerability to the effects of childhood traumatic experiences. Apfel et al (2011) found that associations between trauma and hippocampal volume only in people currently experiencing PTSD, and not in those with only a past history of PTSD. This suggests that volumetric abnormalities associated with exposure to traumatic experiences may lessen over the lifespan.
Poster #S8 GLUCOMETABOLIC HORMONES AND CARDIOVASCULAR RISK MARKERS IN ANTIPSYCHOTIC-TREATED PATIENTS Bjørn H. Ebdrup 1 , Filip K. Knop 2 , Anna Madsen 3 , Henrik B. Mortensen 4 , Birgitte Søgaard 5 , Jens J. Holst 6 , Pal B. Szecsi 7 , Henrik Lublin 8 1 CNSR and CINS, Psychiatric Center Glostrup, Copenhagen University Hospital; 2 Diabetes Research Division, Department of Internal Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; 3 Psychiatric Centre Glostrup, Copenhagen University Hospitals, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark; 4 Department of Paediatrics, Herlev Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 5 Department of Clinical Pharmacology, Lundbeck A/S, Valby, Denmark; 6 Department of Biomedical Sciences, NNF Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; 7 Department of Clinical Biochemistry, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; 8 Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Psychiatric Centre Glostrup, Glostrup, Denmark Background: Treatment with antipsychotic drugs is widely associated with metabolic side-effects such as overweight and disturbed glucose metabolism, but the pathophysiological mechanisms are unclear. Methods: Fifty-one non-diabetic, antipsychotic-treated male patients ((mean±standard deviation) age: 33.1±6.7 years; body mass index (BMI) 26.0±4.7 kg/m2 ; waist circumference: 95.8±13.2 cm; glycated hemoglobin (HbA1c): 5.7±0.3%) and 93 age and waist circumference-matched healthy male controls (age: 33±7.3 years; BMI: 26.1±3.9 kg/m2 ; waist circumference: 94.6±11.9 cm; HbA1c: 5.7±0.3%) participated in this cross-sectional
for tardive dystonia. Two-thirds of the participants displayed at least one type of persistent movement disorder. Yearly incidence rates of persistent movement disorders were 19.6% for TD, 21.6% for parkinsonism, 3.5% for akathisia and 0% for tardive dystonia. Fluctuating TD was positively associated with age (hazard ratio (HR) per year exposure=1.04, 95% CI=1.02-1.06). Fluctuating parkinsonism was positively associated with age (HR=1.03, 95% CI=1.02-1.04) and the total antipsychotic defined daily dose (DDD) (HR=1.07, 95% CI=1.03-1.11). Risk factors did not predict akathisia and tardive dystonia. Discussion: The findings were that (i) having persistent drug-induced movement disorders seems to be the norm for long-stay patients with chronic mental illness and long-term antipsychotic treatment; (ii) these patients have a high risk of incident movement disorder, in particular TD and parkinsonism; (iii) higher age is an important predictor of TD and parkinsonism; and (iv) total antipsychotic defined daily dose (DDD) is an important predictor of parkinsonism. Measures are required to remedy this situation. References: [1] Bakker, P.R., de Groot, I.W., van Os, J. and van Harten, P.N., 2011. Long-stay psychiatric patients: A prospective study revealing persistent antipsychotic-induced movement disorder. PLoS ONE 6, e25588. [2] Bakker, P.R., de Groot, I.W., van Os, J. and van Harten, P.N., 2013. Predicting the incidence of antipsychotic-induced movement disorders in long-stay patients: A prospective study. The Epidemiology and Psychiatric Sciences.
Poster #S4 TWO CANDIDATE GENE-BASED ASSOCIATION STUDIES OF ANTIPSYCHOTIC-INDUCED MOVEMENT DISORDERS IN LONG-STAY PSYCHIATRIC PATIENTS: PROSPECTIVE STUDIES P.R. Bakker 1,2 , Egbert Bakker 3 , Asmar F.Y. Al Hadithy 4 , Najaf Amin 5 , Cornelia M. van Duijn 5 , Jim van Os 6 , Peter N. van Harten 7 1 Maastricht University; 2 Psychiatric Centre GGZ Centraal; 3 Leiden University Medical Center; 4 Parnassia Psychiatric Centre; 5 Erasmus MC; 6 Maastricht University Medical Centre/King’s College London; 7 Maastricht University Medical Centre/Psychiatric Centre GGZ Centraal Background: Four types of antipsychotic-induced movement disorders: tardive dyskinesia (TD), parkinsonism, akathisia and tardive dystonia, subtypes of TD (orofacial and limb truncal dyskinesia), subtypes of parkinsonism (rest tremor, rigidity, and bradykinesia), as well as a principal-factor of the movement disorders and their subtypes, were examined for association with variations (SNPs) in 2 studies; one in 10 candidate genes (PPP1R1B, BDNF, DRD3, DRD2, HTR2A, HTR2C, COMT, MnSOD, CYP1A2, and RGS2) and another one in 7 candidate genes (GRIN2B, GRIN2A, HSPG2, DRD3, DRD4, HTR2C, and NQO1). Methods: Naturalistic study of 168 white long-stay patients with chronic mental illness requiring long-term antipsychotic treatment, examined by the same rater at least twice over a 4-year period, with a mean follow-up time of 1.1 years, with validated scales for TD, parkinsonism, akathisia, and tardive dystonia. The authors genotyped 31 SNPs in 10 candidate genes and 45 tag SNPs in 7 candidate genes, associated with movement disorders or schizophrenia in previous studies. In both studies genotype and allele frequency comparisons were performed with multiple regression methods for continuous movement disorders. Results: In the first study, various SNPs reached nominal significance: TD and orofacial dyskinesia with rs6265 and rs988748; limb truncal dyskinesia with rs6314; rest tremor with rs6275; rigidity with rs6265 and rs4680; bradykinesia with rs4795390; akathisia with rs4680; tardive dystonia with rs1799732, rs4880 and rs1152746. In the second study, various tag SNPs reached nominal significance: TD with rs1345423, rs7192557, rs1650420, and rs11644461; orofacial dyskinesia with rs7192557, rs1650420, and rs4911871; limb truncal dyskinesia with rs1345423, rs7192557, rs1650420, and rs11866328; bradykinesia with rs2192970; akathisia with rs324035; and the principal-factor with rs10772715. After controlling for multiple testing, all of the found association lost their statistical significance. Discussion: The findings suggest that selected SNPs are not associated with a susceptibility to movement disorders. However, as the sample size was small and previous studies show inconsistent results, definite conclusions cannot be made. Replication is needed in larger study samples, preferably in longitudinal studies which take the fluctuating course of movement disorders and gene-environment interactions into account.
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References: [1] Bakker, P.R., Bakker, E., Amin, N., van Duijn, C.M., van Os, J. and van Harten, P.N., 2012a. Candidate gene-based association study of antipsychotic-induced movement disorders in long-stay psychiatric patients: A prospective study. PLoS ONE 7, e36561. [2] Bakker, P.R., Al Hadithy, A.F., Amin, N., van Duijn, C.M., van Os, J. and van Harten, P.N., 2012b. Antipsychotic-induced movement disorders in long-stay psychiatric patients and 45 tag SNPs in 7 candidate genes: A prospective study. PLoS ONE 7, e50970.
Poster #S5 GENDER DIFFERENCES IN THE EFFECT OF CHILDHOOD TRAUMA EXPERIENCES ON PRODROMAL SYMPTOMS AND PERSONALITY DISORDER TRAITS IN YOUNG ADULTS AT HIGH-RISK FOR PSYCHOSIS Neus Barrantes-Vidal 1,2 , Tecelli Domínguez-Martínez 3 , Paula Cristobal 3 , Tamara Sheinbaum 1 , Thomas R. Kwapil 4 , Neus Barrantes-Vidal 1,2 1 Department of Clinical and Health Psychology, Autonomous University of Barcelona; 2 Department of Mental Health, Health Foundation Sant Pere Claver (Barcelona); 3 Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona; 4 Department of Psychology, University of North Carolina at Greensboro Background: Childhood trauma experiences (CTE) represent a socioenvironmental risk factor for the development of schizophrenia spectrum disorders and have a negative impact on the course and outcome of psychotic disorders (Bendall et al., 2008). Few studies have addressed trauma in people at ultra-high-risk (UHR) of psychosis (e.g. Addington et al., 2013; Velthorst et al., 2013). Their findings suggested that CTE are highly prevalent in populations at UHR of psychosis and related to attenuated positive symptoms. Moreover, it has been found that a history of sexual abuse increases the rates of conversion to psychosis (Bechdolf et al., 2010; Thompson et al., 2009) and that females are more likely to report CTE than males (Addington et al., 2013). This study aimed to explore: 1) the presence of CTE in At-Risk Mental State (ARMS) patients and whether it differed according to gender, and 2) the association of CTE with prodromal symptoms and personality disorder traits and the possible moderating role of gender on these associations. Methods: 35 ARMS patients (91.4% met criteria for Attenuated Psychotic Symptoms group according to UHR criteria; Yung et al., 2005) were assessed for psychopathology, personality disorder traits, and history of CTE as assessed by the CTQ-B (Berstein et al., 1994). The mean age of patients was 20.9 years and 60% were male. Results: Overall, ARMS patients reported low-moderate scores (5≥12) on emotional abuse (EA), sexual abuse (SA), and emotional neglect (EN), according to CTQ norms. 48.6% reported having experienced a separation or loss of a parent before the age of 17 (41.2% separation of parents, the father of 2 patients died and one patient was abandoned). Females showed significantly higher levels of SA (moderate-severe) and parental separation/loss but lower levels of EN than males. EA predicted negative and general symptoms, behavioral and motor/physical changes, and borderline personality disorder traits. Physical abuse (PA) predicted positive and negative symptoms, cognitive and motor/physical changes, and schizotypal personality traits. SA predicted positive, negative, and general symptoms as well as cognitive changes. Physical neglect (PN) predicted behavioral changes, whereas parental separation/loss predicted motor/physical change. EN did not predict prodromal symptoms or personality disorder traits. Furthermore, gender moderated the effects of PA and SA on prodromal symptoms, showing a greater impact in females than in males. The associations of EA, PN, and parental separation with symptoms and personality disorder traits were not moderated by gender. Discussion: Findings showed strong associations between CTE and several symptom dimensions of ARMS patients despite the small sample size of this preliminary report. Consistent with previous studies, SA was related with positive attenuated psychotic symptoms (Velthorst et al., 2013) and females showed higher levels of SA than males (Addington et al., 2013). The results suggest that different experiences of childhood abuse (EA, PA and SA) have an effect on symptom severity even before the onset of the first psychosis episode, and that they exert a stronger effect in females than in males. This study supports the importance of CTE as a relevant psychosocial factor at the early stages of psychosis. Even if trauma was self-reported and assessed concurrently with prodromal symptoms, the association of
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patients’ subjective appraisal of CTE and symptoms is in itself a critical issue to understand and highly relevant for its potential impact on the outcome of the at-risk status.
Poster #S6 CHILDHOOD TRAUMA MEDIATES THE ASSOCIATION BETWEEN ETHNIC MINORITY STATUS AND MORE SEVERE HALLUCINATIONS IN PSYCHOTIC DISORDER Akiah A.O. Berg 1,2 , Monica Aas 3,4 , Ole A. Andreassen 5 , Ingrid Melle 6 1 University of Oslo, Inst of Psychiatry; 2 Oslo University Hospital, Division of Mental health and Addiction; 3 NORMENT; 4 Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; 5 University of Oslo; 6 Oslo University Hospital and NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo, Norway Background: Both ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are also found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma among ethnic minorities with psychosis, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations. We also hypothesized that childhood trauma would mediate a possible association between ethnic minorities and hallucinations. Methods: In this cross-sectional study 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorders were included. Current hallucinations were measured with the Positive and Negative Syndrome Scale (item P3; Hallucinatory Behavior). Lifetime hallucinations were assessed with the Structured Clinical Interview for DSM-IV (SCID-I) items auditory hallucinations (B16), voices commenting (B17) and two or more voices conversing (B18). Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version. The ethnic minority group (n=69) consisted of non-Caucasian first- and second-generation immigrants who were primarily from Asia (n=39, 57%) and Africa (n=27, 39%). Results: The ethnic minority group reported significantly more childhood trauma (T-test = −3.866, df 405, p<0.001), specifically physical abuse (Mann Whitney U = 8.170, p<0.001), physical neglect (Mann Whitney U = 9.427, p<0.001), and sexual abuse (Mann Whitney U = 10.156, p<0.003) than the majority group. They also had significantly more current hallucinatory behavior (Mann Whitney U = 10.942, p<0.013). Over 30% of the ethnic minority group reported auditory hallucinations of two or more voices conversing, which was significantly higher than the 19% seen in the majority group (χ2 =4.692, df1, p<0.03). Multivariate regression analyses indicated that childhood trauma mediated the association between ethnic minority status and more severe current hallucinations, and lifetime hallucinations of two or more voices conversing. Discussion: More childhood trauma among ethnic minorities with psychosis partially explains findings of more current and lifetime hallucinations in this group. The association between childhood trauma and first rank symptoms may in part explain the heightened risk of being diagnosed with a schizophrenia-spectrum diagnosis in certain ethnic minorities. The present findings show the importance of childhood trauma not only as a risk factor for schizophrenia but also as experiences that influence specific psychotic symptoms directly. Further of clinical relevance we are reminded to assess and treat the effects of childhood trauma in ethnic minority groups presenting with psychotic disorders.
Poster #S7 META-ANALYSIS OF CHANGES IN BRAIN STRUCTURE IN HEALTHY INDIVIDUALS WITH A HISTORY OF CHILDHOOD ADVERSITY Maria Calem, Matthew Kempton Institute of Psychiatry, King’s College London Background: Childhood adversity is a risk factor for psychosis with an estimated population attributable risk of 33% (Varese et al, 2012). The main biological system thought to underlie this association is the HypothalamicPituitary-Adrenal (HPA) axis, which moderates the stress response in humans. This is supported by findings that HPA-axis-related structures
such as the hippocampus and amygdala are altered in psychosis, and particularly in people with psychosis who have experienced childhood adversity. Research comparing healthy people with and without a history of childhood adversity allows for the disentangling of the effect of psychiatric conditions from the effect of childhood adversity itself. The traumagenic neurodevelopmental model suggests that childhood adversity increases vulnerability to psychosis by creating hypersensitivity to stress. By extension, people that experienced childhood adversity and did not develop a psychiatric condition represent a particularly stress-resilient population. Unlike in psychiatric populations, experiencing childhood adversity may not have led to significant overactivation of the HPA-axis and subsequent abnormal volumetric development. The aim of this meta-analysis was to investigate associations between childhood adversity and hippocampal and amygdala volume in psychiatrically healthy adults. Methods: The MEDLINE database was searched for studies using magnetic resonance imaging that had measured brain structure in healthy adults with and without childhood adversity. We identified seven eligible papers (1,322 participants) reporting hippocampal volumes and three eligible papers (803 participants) reporting amygdala volumes. Effect sizes were calculated from each study and pooled using a random effects meta-analysis. Results: No significant differences in hippocampal (effect size = −0.116; 95% confidence interval −0.375 to 0.043; p=0.119) or amygdala volume (effect size = −0.002; 95% confidence interval −0.168 to 0.165; p=0.984) were found between healthy participants with and without childhood adversity. A study determining hippocampal volume in elderly participants was then excluded. In the remaining six studies participants with a history of childhood adversity were found to have a significantly greater hippocampal volume than those without such a history (effect size = −0.028; 95% confidence interval −0.436 to −0.019; p<0.05). Discussion: The lack of association between childhood adversity and amygdala volume supports the notion that healthy controls that experienced adversity in childhood and did not develop a psychiatric illness have a greater resilience to stress than people who went on to develop a psychiatric illness. However, when we excluded a study including only elderly participants, the overall association between childhood adversity and hippocampal volume was significant, suggesting some vulnerability to the effects of childhood traumatic experiences. Apfel et al (2011) found that associations between trauma and hippocampal volume only in people currently experiencing PTSD, and not in those with only a past history of PTSD. This suggests that volumetric abnormalities associated with exposure to traumatic experiences may lessen over the lifespan.
Poster #S8 GLUCOMETABOLIC HORMONES AND CARDIOVASCULAR RISK MARKERS IN ANTIPSYCHOTIC-TREATED PATIENTS Bjørn H. Ebdrup 1 , Filip K. Knop 2 , Anna Madsen 3 , Henrik B. Mortensen 4 , Birgitte Søgaard 5 , Jens J. Holst 6 , Pal B. Szecsi 7 , Henrik Lublin 8 1 CNSR and CINS, Psychiatric Center Glostrup, Copenhagen University Hospital; 2 Diabetes Research Division, Department of Internal Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; 3 Psychiatric Centre Glostrup, Copenhagen University Hospitals, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark; 4 Department of Paediatrics, Herlev Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 5 Department of Clinical Pharmacology, Lundbeck A/S, Valby, Denmark; 6 Department of Biomedical Sciences, NNF Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; 7 Department of Clinical Biochemistry, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; 8 Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Psychiatric Centre Glostrup, Glostrup, Denmark Background: Treatment with antipsychotic drugs is widely associated with metabolic side-effects such as overweight and disturbed glucose metabolism, but the pathophysiological mechanisms are unclear. Methods: Fifty-one non-diabetic, antipsychotic-treated male patients ((mean±standard deviation) age: 33.1±6.7 years; body mass index (BMI) 26.0±4.7 kg/m2 ; waist circumference: 95.8±13.2 cm; glycated hemoglobin (HbA1c): 5.7±0.3%) and 93 age and waist circumference-matched healthy male controls (age: 33±7.3 years; BMI: 26.1±3.9 kg/m2 ; waist circumference: 94.6±11.9 cm; HbA1c: 5.7±0.3%) participated in this cross-sectional