Effect of Semaglutide versus placebo on psychotic symptoms and quality of life - a pre-specified secondary analysis of HISTORI: A randomized clinical trial in people with pre-diabetes and schizophrenia

Introduction

Life expectancy of people with schizophrenia is reduced by 10-20 years compared to the general population. The excess mortality is part due to an increased prevalence of cardiovascular disease, prediabetes and obesity, which are in part due to antipsychotic treatment. Gaining weight is associated with reduced quality of life and also among the most frequently reported reasons for the discontinuation of treatment. Lifestyle changes have a time limited effect, and therefore, interest has focused on Glucagon-Like Peptide 1 receptor agonist treatment. Semaglutide, currently used to treat type 2-diabetes in doses up to 1.0 mg once-weekly, has shown promising results regarding weight loss in doses up to 2.4 mg once-weekly. It may also be able to reduce the risk of developing diabetes and cardiovascular disease.

Objectives

The HISTORI Trial aims to reduce risk of developing diabetes and cardiovascular disease in people with schizophrenia, prediabetes and overweight and to investigate for an indirect effect of Semaglutide on psychotic symptoms and quality of life through a weight loss.

Methods

A 30 weeks randomized, placebo-controlled, double-blinded study with once-weekly injections of Semaglutide 1.0 mg. Primary inclusion criteria are age 18-40 years, schizophrenia, prediabetes, overweight and treatment with antipsychotics. Questionnaires and interviews regarding psychotic symptoms, quality of life, medication adherence and physical activity will be applied either monthly or every third month.

Results

will not be ready for the congress. A poster outlining the feasibility challenges will be presented.

Conclusions

Perspective: Through weight loss, Semaglutide may indirectly be able to improve quality of life, medication adherence and psychotic symptoms.

Disclosure

No significant relationships.

Maternal prenatal stress and postnatal depressive symptoms: discrepancy between mother and teacher reports of toddler psychological problems

PURPOSE

Maternal prenatal stress and postnatal depression are reported to increase the risk for early offspring psychological problems. We examined whether these two stressors predicted toddler emotional or behavioral problems based on the mother and teacher reports, respectively.

METHODS

A longitudinal study within the Odense Child Cohort (OCC). Prenatal stress was assessed (gestation week 28) using Cohen's Perceived Stress Scale (PSS). Depressive symptoms were assessed (3 months after birth) using the Edinburgh Postnatal Depression Scale (EPDS). Behavioral and emotional problems were assessed by mothers using the preschool version of Child Behaviour Checklist (CBCL) and by teachers using the caregiver-teacher report form (CTR-F).

RESULTS

N = 1302 mother-child dyads were included. CBCL (N = 1302) was collected at 29 months (SD 5.3) and C-TRF (N = 989) at 32.6 months (SD 6.9). N = 70 mothers (5.4%) were at high risk for postnatal depression (EPDS score > 12). Generalized additive models showed that prenatal stress (increase of + 1 on PSS-10 total score) predicted an increase in CBCL (+ 0.011) and C-TRF (+ 0.015) total scores. Postnatal depressive symptoms (increase of + 1 on EPDS total score) only predicted an increase in CBCL total score (+ 0.026).

CONCLUSION

Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms.

Oxidative stress – A promising candidate in explaining the neurobiology of autism spectrum disorders

Introduction

The diagnoses of autism spectrum disorders (ASDs) are based on a phenotype, characterized by impaired social interaction and communication and by repetitive and restricted interests. However, this might not represent a single clinical entity, but a behavioral manifestation of different neurodevelopmental deficits with a multifactorial etiology. Small studies have shown elevated levels of oxidative stress and lower levels of anti-oxidants in patients with ASD, and correlations with the severity of ASD. Therapies targeting oxidative stress have shown improvements regarding behavior, social interaction and verbal communication in patients with ASD, supporting the oxidative stress theory.

Objectives

To evaluate the importance of oxidative stress in the neurobiology of adults with ASD.

Aims

There is a need to understand the neurobiology of ASD, therefore this study analyzes the level of oxidative stress in a larger cohort of patients with ASD and compares to controls.

Methods

The study includes 350 patients over 18 years of age diagnosed with ICD-10 diagnoses F84.0, F84.1, F84.5 or F84.8 and compared to gender and age matched neurotypical controls. The included probands will have their serum and plasma analyzed for levels of oxidative stress (superoxide dismutase 1 and 2, catalase, glutathioneperoxidase, malonialdehyde, thiobarbituric acid reactive substances and xanthinoxidase).

Results

The preliminary results will be presented at the EPA in March 2016 in Madrid.

Conclusion

With this study we aim to elucidate some of the neurobiology in ASD. This could lead to new potential targets for treatment and prevention of the disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Early Screening for Autism Spectrum Disorder

Introduction

Most parents to children with Autism Spectrum Disorder (ASD) can report concerns about their child's development within the first year of life. In spite of this, children with ASD are rarely diagnosed before the age of 3–4 years. Early identification allows early intervention, which seems to be substantial for improvement of core behavioural symptoms in children with ASD. The Child Behaviour Checklist for ages 1½ to 5 (CBCL/1½–5) have shown promising utility for early detection of children with ASD.

Objectives

This study will estimate the positive predictive value of CBCL/1½–5 Pervasive Developmental Problems (PDP) scale in a 2 phase screening study. Furthermore, it will analyse the stability of the CBCL/1½–5 PDP-score in pre-school children from 2½ to 5 years.

Aims

The present study aims to validate CBCL/1½–5 for early screening of ASD in a general population sample.

Methods

Parents, enrolled in the Odense Child Cohort (OCC), answered the CBCL/1½–5 when the child reached 27 months of age. Parents with children above the age of four and a raw score ≥5 (90th percentile) on the PDP scale, received the Social Responsiveness Scale (SRS) questionnaire. Children with a high score on the SRS were invited to a clinical examination consisting of ADOS and ADI-R. Children in OCC were re-assessed with CBCL/1½–5 again at age five years.

Results

Results will be presented at the EPA conference 2017 in Florence.

Conclusions

The results may contribute to enhance the outcome of treatment by detecting children with ASD at an earlier age.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Disturbed Sleep and Activity in Toddlers with Early Signs of ADHD

Introduction

Attention-deficit-hyperactivity-disorder (ADHD) is a frequent psychiatric disorder present in childhood, where sleep-problems are a prominent, pervasive and clinically important feature. However, our understanding of whether sleep-problems mimic or exacerbate daytime ADHD-symptom expression remains insufficient.

Objective

Research examining sleep and daily activity in toddlers with early signs of ADHD might help identify early risk factors.

Aims

To investigate whether disturbed sleep patterns and daily activity level is associated with early signs of ADHD in toddlers.

Methods

Twenty-four toddlers from the Danish Odense Child Cohort scoring above the 93rd percentile on the ADHD scale of the Child Behaviour Checklist for ages 1½–5 were categorized as cases and compared to 25 age and gender-matched controls scoring below the 50th percentile. Daytime and nocturnal activity for 49 toddlers were assessed through seven days of actigraphy. Parents completed Children's Sleep Habits Questionnaire (CSHQ) and the ADHD Rating Scale IV Preschool Version (ADHD-RS).

Results

Actigraphic data revealed an increased night-to-night variability, prolonged total sleep time, fewer sleep interruptions and fewer minutes in moderate-to-vigorous-physical activity (MVPA) in cases compared to controls. Increased night-to-night variability was found significantly associated with higher total scores on both the CSHQ and ADHD-RS. Further, fewer minutes in MVPA were associated with a higher parent-reported motor activity on the ADHD-RS.

Conclusion

Findings show that early signs of ADHD are associated with irregular sleep patterns and lower daytime activity, as illustrated by actigraphy. Studies investigating early ADHD risk factors could lead to a preschool ADHD risk index to help guide future early intervention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Adult with autism – oxidative stress, co-morbidity and predisposition

Introduction

The etiology of autism spectrum disorder (ASD) is unclear. Studies involving children with ASD suggest that oxidative stress could explain some of the pathology. Few reports have investigated the role of oxidative stress into adulthood. Furthermore, the knowledge on psychiatric and somatic comorbidities, as well as socio-economic status in a trajectory across lifespan is sparse.

Objectives

Investigating oxidative stress related markers in ASD, along with trajectories in socio-economic functioning and comorbidities.

Aims

To evaluate the importance of oxidative stress in the neurobiology of adults with ASD and assess the socio-economic level of functioning and comorbidities.

Methods

Plasma levels of antioxidant super-oxide-dismutase isoenzymes (SOD1 and SOD2) and pro-oxidant xanthineoxidase (XO) were measured in 56 patients ≥18 years of age, diagnosed in childhood with ASD (F84.0, F84.1, F84.5 or F84.8), along with gender and age matched controls. Participants were interviewed regarding their health, familial predisposition and social status.

Results

Cases showed higher levels of SOD1 (268.2 ng/mL vs. 205.6 ng/mL). We found no differences regarding SOD2 and XO. Patients had a higher BMI (27 vs. 24), fewer drank alcohol (40% vs. 75%), more had a psychiatric co-morbidity (50% vs. 2%), more had family member with a psychiatric diagnosis (80% vs. 50%). None of the bio-psycho-social factors showed association with biomarker levels.

Conclusion

Oxidative stress seems to play a role in ASD. Furthermore, patients with ASD often have psychiatric comorbidities; more often have a family history of psychiatric diagnoses, and are less healthy physically.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A validation study of the Mood and Feelings Questionnaire, Danish version

Introduction

The Mood and Feelings Questionnaire (MFQ) was developed to measure depressive symptoms in children and adolescents. It includes a child self-report part and a parent report on child part. The MFQ has been validated and proven clinical useful in several countries.

Objectives

To validate the MFQ in a population of Danish children and adolescents.

Aims

There is a need of a standardized questionnaire for Danish children and adolescents tapping into affective symptoms. Before routine use the MFQ must have been validated in Denmark. This study examines the validity of MFQ in Danish children and adolescents.

Methods

The study included two samples of probands aged 8–18 years. A population-based sample of school children and their parents, and a clinical sample including two subsamples:

– patients referred for Child and Adolescent Mental Health Services with depressive symptoms;

– in-patients at the paediatric department of a University Hospital.

All included probands and their parents filled out the MFQ and the clinical samples in addition answered the depression section of the Beck Youth Inventories, and were interviewed using the depression part of “K-SADS-PL”.

Results

Preliminary results from both samples will be presented at the EPA 2017 in Florence.

Conclusions

Depending on the results of this study, the MFQ might be used as a screening instrument and as a clinical tool to monitor depressive symptoms in Danish children and adolescents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Disturbed sleep and activity as early signs of ADHD in preschool children

Introduction

Attention-deficit-hyperactivity-disorder (ADHD) is the most frequent psychiatric disorder present in childhood, and sleep-problems are a prominent, pervasive and clinically important feature of ADHD. Our understanding of whether sleep-problems mimic or exacerbate daytime ADHD-symptom expression remains insufficient. Furthermore we lack knowledge about the connection between objective measuring and subjective observations in children with early symptoms of ADHD.

Objective

Future research that examines sleep-problems and daily activity in very young children with and without ADHD-like symptoms might help us identify early risk factors and achieve a better understanding of the importance of sleep in ADHD.

Aims

To investigate if sleep-problems and activity level during day time is associated with early signs of ADHD.

Methods

A sample of 50 preschool children ages 2–3 and their parents recruited in a birth cohort are invited to participate and divided into two groups of 25 cases and 25 controls based on ADHD-symptom score. An actigraph on the child's non-dominant wrist measures sleep and daily activity. Sleep-latency, total sleep time and awakenings are examined. Moderate-to-vigorous-activity (MVPA) is the measure for daily activity. Subjective observations from parents are provided through questionnaires. Furthermore we examine the stability of the sleep problem score from child behavior checklist, which parents fulfilled when their child was 27 months old and again at the age of 5.

Results

The results will be presented at the EPA March 2016 in Madrid.

Conclusion

Results from this study together with other findings of risk factors in the cohort may lead to a preschool ADHD risk-index, which can guide future early intervention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Second-generation antipsychotics and the metabolic syndrome in drug-naive adolescents

Introduction

Poor physical health and shorter life expectancy often follows from mental illness. If the disorder starts in childhood/adolescence, the risk of this outcome is even higher. Second generation antipsychotics (SGAs) are suspected to increase cardiovascular risk factors through the development of the metabolic syndrome.

Objective

We investigated all the aspects of the metabolic syndrome in drug-naive youth, over a period of 12 months of treatment with SGAs.

Aims

This study examines drug-naive youth in their first year of treatment with SGAs, and the possible development of markers of the metabolic syndrome, in a naturalistic setting. We also look at aspects of the patient's disease and environment that may predict which patients are the most at risk for these metabolic derangements.

Methods

Thirty-five drug-naive adolescents were recruited after their contact with the Psychosis Team at Department of Child and Adolescent Psychiatry in Odense, Denmark. Measurements were taken at different times over the course of their first year of treatment. The markers included, among others: body mass index, waist circumference, blood pressure, fasting blood glucose, as well as high density, low density and total cholesterol. Factors of the patients’ lifestyle and development were recorded as well.

Results

The results will be presented at the EPA March 2016 in Madrid.

Conclusions

This is, to our knowledge, the first study to include all of the aforementioned aspects in drug-naive adolescents over a 12-month period. Because of this, it may provide us with a unique insight into how, and in which patients, these metabolic changes develop.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Gender-age interaction in incidence rates of childhood emotional disorders

BACKGROUND

The post-pubertal association of female gender with emotional disorder is a robust finding. However, studies exploring the association of gender and emotional disorders before puberty are few and present diverging results. The aim of this study was to present gender-specific incidence rates of emotional disorders throughout childhood.

METHOD

This is a population-based cohort study of 907,806 Danish 3- to 18-year-olds. The outcome was assignment of an emotional disorder diagnosis based on in-patient and out-patient data from The Danish Psychiatric Central Register. Outcome measures were incidence rates and cumulative incidences for unipolar depressive disorder (ICD-10: F32-F33), anxiety disorders (ICD-10: F40-F42), and emotional disorders with onset specific to childhood (ICD-10: F93).

RESULTS

Pre-pubertal incidence rates for depressive and anxiety disorders were higher for boys than girls. At age 12 years the pattern reversed. The cumulative incidence for any emotional disorder (F32-F33, F40-F42, F93) on the 11th birthday was 0.52% (95% CI 0.50-0.55) for boys and 0.31% (95% CI 0.29-0.33) for girls. On the 19th birthday cumulative incidence was 2.33% (95% CI 2.24-2.43) for boys and 3.77% (95% CI 3.64-3.90) for girls. The pre-pubertal male preponderance was also significant for depressive disorders (F32-F33, p = 0.00144) and anxiety disorders (F40-F42, F93, p < 0.00001) separately.

CONCLUSIONS

Emotional disorders seem to display a male preponderance before the age of 12 years and a female preponderance thereafter. Studies exploring this gender-age interaction are needed. Still, the results question the general assumption that females throughout the lifespan are more at risk for emotional disorders than males.

Validity and clinical feasibility of the ADHD rating scale (ADHD-RS) A Danish Nationwide Multicenter Study

AIM

To establish the validity of a Danish version of the Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS), secondly to present national norm scores compared to that of United States and other European data and thirdly to evaluate ADHD-RS when used for monitoring treatment effectiveness.

METHODS

A Danish translation of the ADHD-RS was used on a normative sample of 837 children. Two clinical samples, 138 hyperkinetic disorder (HKD) cases and 110 clinical controls were recruited from eleven Danish Child and Adolescent Mental Health (CAMH) centres and assessed according to usual clinical standards. The HKD children were rated by parents and teachers at baseline and at follow-up 3 months later.

RESULTS

Internal validity of ADHD-RS was high and the factor structure supported the diagnostic classification system ICD-10. The questionnaire discriminated HKD patients in a mixed clinical sample, and was sensitive to change in symptom load as measured before and after commencing of the treatment.

CONCLUSION

The Danish version of ADHD-RS is valid and clinically feasible when measuring HKD symptom load in a CAMH-setting. The questionnaire provides useful data in patient management, quality improvement and service planning as well as in effectiveness studies of different interventions for patients with HKD and related disorders in routine clinical settings.

The prevalence of child-psychiatric disorders among 8-9-year-old children in Danish mainstream schools

OBJECTIVE

Prevalence rates for child psychopathology in Denmark are unknown; and efficient screening and non-respondent analyses are essential for epidemiological purposes.

METHOD

A multi-method strategy involving a two-step design: first screening of 621 children between the ages of 8-9 years attending mainstream education using the Child Behaviour Checklist (CBCL). Second, screen-positive probands and a sample of screen-negative probands were given in-depth child-psychiatric assessment. In cases of non-respondents, children were assessed by teachers.

RESULTS

CBCL screening results were compared with case status in clinical assessment. A positive predictive value of 0.25 and a correct classification rate (CCR) of 0.72 were obtained. The teacher interviews, used in cases of non-respondents, had a CCR of 0.87. According to DSM-IV criteria, the prevalence rate of psychiatric disorders was 10.l% [95% CI; 7.0-13.2].

CONCLUSIONS

The CBCL proved an effective screening tool. The brief interview with teachers is a valid assessment of psychiatric disorders among non-respondents.

Behavioural and emotional problems in children of alcoholic mothers and fathers

The Child Behavior Check List (CBCL) was used to compare a sample of 103 Danish children of alcoholics (CoA) to a Danish population-based sample (N = 780). The CoA had a significantly greater incidence of symptoms on 17 of the 118 CBCL items. Compared to the reference population, daughters of alcoholics were more impaired than sons of alcoholics on most CBCL measures. In families with maternal alcoholism daughters had higher internalising and depression scores than sons, and in families with paternal alcoholism, sons had higher internalising and depression scores than daughters. The CoA also had a significantly greater risk of scoring above the 95th percentile on internalising behaviour, depression symptoms and socially deviant behaviour. On all CBCL dimensions, almost half of the CoA samples functioned as well as the average of the reference population. The results from this study suggest that CoA should be regarded as a risk group but with very heterogeneous consequences in response to parental alcoholism.

The Child Behavior Checklist (CBCL) and related material: standardization and validation in Danish population based and clinically based samples

The Child Behavior Checklist (CBCL) and related material, developed by Achenbach and Edelbrock in Vermont, was validated in a mailed survey. A population based sample of 779 children between the age of four and 17 years was compared to a sample of 146 children referred for child psychiatric service. Danish children scored very much like our Scandinavian and German neighbours, but low compared to most others. The CBCL mean 'total behavior problem score' in the population was 17.7. The checklists, especially the parent and teacher versions, provided good construct validity. Youths generally reported more emotional problem behavior than their parents and teachers did about them. In general, parents and youths agree more, reporting emotional problems, and parents and teachers agree more, when scattering externalizing behavior. Short screening constructs are introduced, and by the use of latent trait analysis, four clinically relevant sub-scales were generated. Predictive value, sensitivity, specificity and clinical validity must be undertaken in a future two-phase study.

[Behavioral symptoms among children and adolescents. Screening with the help of a questionnaire in a group of children aged 4 to 17 years]

A Danish translation of "The Child Behavior Checklist" (CBCL), developed by Achenbach and Edelbrock in Vermont, was standardized on 1,300 children aged between four and 17 years in the county of Fyn. The response rate was 61.4% and lowest among boys. Responders were compared to non-responders on different variables generated by the Danish Statistical Institute. No significant differences emerged across the two groups with respect to analysed confounders. We found a mean total CBCL score of 15-20 out of 232 possible points with considerable variation. The 95 percentile reflects a possible cut-off score for behavioural deviance or "psychiatric abnormality". This varied from 35 points in four to five years old girls to 58 points in six to ten years old boys. Parents reported hyperactivity and restlessness in 6.8% of six to ten year-old boys. Depression and sadness were reported in about 2% of all children six years or older. Six point three percent of all girls of 11-16 years selfreported obsessions. The 11-16 year-olds generally reported more symptomatic behaviour than their parents and teachers did about them.