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Poster #S7 META-ANALYSIS OF CHANGES IN BRAIN STRUCTURE IN HEALTHY INDIVIDUALS WITH A HISTORY OF CHILDHOOD ADVERSITY
S90
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
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
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
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