P.7.b. Child and adolescent disorders and treatment − Disorders (clinical) S709

predicted lower PT. In addition, higher parental global severityindex was associated with lower FC.

Conclusions: Better understanding of the influences of bothchildren and adolescent’s and parents’ psychopathology on health-related quality of life may lead to effective clinical interventionstrategies for children and adolescentw with precocious puberty.We suggest that the regular assessment of mental health problemsand health-related quality of life in both children and adolescentsand parents and familial functioning would be essential for clinicaltrials as well as clinical practices.

References

[1] Kim, E.Y., Lee, M.I., 2012. Psychosocial Aspects in Girls with Idio-pathic Precocious Puberty. Psychiatry Investig 9, 25−28.

[2] Achenbach, T.M., 1991. Manual for the Child Behavior Checklist/4−18and 1991 Profile. Burlington, V.T., University of Vermont, Departmentof Psychiatry.

[3] Bae, S.C., Ruperto, N., Lee, J.H., Uhm W.S., Park, Y.W., Kim, S.Y.,for the Paediatric Rheumatology International Trials Organisation(PRINTO)., 2001. The Korean version of the Childhood Health As-sessment Questionnaire (CHAQ) and the Child Health Questionnaire(CHQ). Clin Exp Rheumatol 19 (Suppl. 23), S96-S100.

P.7.b.007 Prevalence and treatment patterns of adults

with newly diagnosed attention-deficit/

hyperactivity disorder in Sweden

Y. Ginsberg1 °, E. Medin2, E. Ahnemark3, P. Carlqvist21Karolinska Institutet, Department of Medical Epidemiologyand Biostatistics, Stockholm, Sweden; 2HERON EvidenceDevelopment AB, Nordic Operations, Stockholm, Sweden; 3Shire,Global Medical Affairs, Danderyd, Sweden

Purpose: Attention-deficit/hyperactivity disorder (ADHD) is aheterogeneous neurodevelopmental disorder in children, adoles-cents and adults, characterized by symptoms of impulsivity, hy-peractivity and inattention. Few studies have been conducted witha focus on estimating the prevalence of ADHD in Sweden. Basedon a review of Swedish and international studies, the NationalBoard of Health and Welfare (NBHW) estimated that 3−5% ofschool-age children in Sweden have ADHD [1]. While ADHD iscommonly considered a childhood disorder, it has been reportedthat approximately 65% of patients diagnosed in childhood con-tinue to experience symptoms into adulthood [2]. In Sweden, adultADHD has been reported to account for 2.7% of all psychiatricdiagnoses [3]; however, to our knowledge, there are no studiesassessing the current treatment patterns for this population. Theobjective of this study was to use comprehensive national registrydata sets to investigate the prevalence of a registered diagnosisof ADHD in adults during a 5-year period, and to describe thepharmaceutical treatment patterns for this population in Sweden.

Methods: Data from the National Patient Register (NPR) andthe Prescribed Drug Register (PDR), both held by the NBHW,were used for this analysis. The number of patients diagnosedwith ADHD between 2007 and 2011 were identified in the NPRusing the following ICD-10 codes for hyperkinetic disorders:F90.0, Disturbance of activity and attention; F90.0A, DAMP;F90.0B, ADHD; F90.0C, ADD; F90.0X, Activity and attentiondisturbance, unspecified; F90.1, Hyperkinetic conduct disorder;F90.8, Other hyperkinetic disorders; F90.9, Attention-deficit hy-peractivity disorder, unspecified type; F98.8, Other specified be-havioural and emotional disorders with onset usually occurringin childhood and adolescence. To estimate treatment pattern,

the eligibility criteria excluded patients who received ADHDmedication (stimulants or atomoxetine [ATX]) within 1 year priorto their first appearance in the NPR with the defined diagnosis.

Results: The number of newly diagnosed adults with ADHDper year increased from 2809 patients (male: 60.3%; mean [SD]age: 31.4 [10.7] years) in 2007 to 6816 patients (male: 53.1%,mean [SD] age: 32.4 [11.9] years) in 2011, with a relative largerincrease in diagnosed females (+187%) than males (+114%).Approximately 70% of newly diagnosed adults with at least 1 yearof follow-up in the PDR (diagnosed 2007–2010) had �1 prescrip-tion of ADHD medication. First-line drug treatment options fornewly diagnosed adults for all years were: osmotic release oralsystem methylphenidate (OROS-MPH; 66.0% in 2011), followedby other modified-release MPH formulations (MPH-MR; 16.5%in 2011) and ATX (12.6% in 2011). The most common second-line treatment option over the 5-year study period was MPH-MR (39%), followed by OROS-MPH (21%) and ATX (15%).Hypnotics and anxiolytics were the most prevalent concomitantpsychiatric medications.

Conclusions: The number of newly diagnosed adults withADHDmore than doubled during the 5 years studied. The majorityof newly diagnosed patients received at least one prescription forpharmacological treatment. The most prevalent first-line treatmentoption was OROS-MPH followed by MPH-MR and ATX duringthe period from 2007 to 2011, with MPH accounting for themajority of all first-line prescriptions for ADHD medication.

References

[1] National Board of Health and Welfare, 2002. ADHD hos barnoch vuxna. Kunskapsoversikt. ISBN 91–7201–656−6. Available at:http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/10942/2002–110−16_200211017.pdf.

[2] Faraone, S.V., Biederman, J., Mick, E., 2006. The age-dependentdecline of attention deficit hyperactivity disorder: a meta-analysis offollow-up studies. Psychol Med 36, 159–165.

[3] Nylander, L., Holmqvist, M., Gustafson, L., Gillberg, C., 2013.Attention-deficit/hyperactivity disorder (ADHD) and autism spectrumdisorder (ASD) in adult psychiatry. A 20-year register study. Nord JPsychiatry 67, 344–350.

Disclosure statement: This research was funded by the Sponsor, ShireSweden. Y Ginsberg has received speaker fees and/or served as a consultantfor Janssen-Cilag, Novartis, HB Pharma and Eli Lilly, and has been involvedin clinical trials conducted by Janssen-Cilag and Novartis. She has served asa scientific advisory board member for Novartis. P Carlqvist and E Medinare employed by HERON Evidence Development AB, which has receivedfinancial support from Shire. E Ahnemark is employed by, and holdsstock/stock options in, Shire. Shire develops and manufactures treatmentsfor psychiatric disorders including ADHD.

P.7.b.008 Auditory verbal hallucinations in youth:

a longitudinal observational study

K. Maijer1 °, S.J.M.C. Palmen1, I.E.C. Sommer1 1Brain CenterRudolf Magnus, Psychiatry, Utrecht, The Netherlands

Background: Auditory Verbal Hallucinations (AVH) are commonin youth. For example, a Dutch general population study among3870 children aged 6−7 years old showed a 9% prevalence rateof AVH [1]. Although AVH are transient in the majority ofchildren, a subgroup experiences substantial suffering and problembehavior [1]. Also, persistence of AVH is associated with lowersecondary school level [2]. Furthermore, the presence of AVHis associated with severe psychopathology (such as disruptivebehaviour, attention deficit disorders, emotional disorders, per-sonality traits and substance use disorders) and the development

S710 P.7.b. Child and adolescent disorders and treatment − Disorders (clinical)

of psychotic disorders later in life [3]. For this subgroup, earlydetection and intervention is warranted, while for the majorityof children with AVH medical involvement seems unnecessary.Unfortunately, at this time, we cannot accurately differentiatebetween those at risk and those with transient symptoms. TheBrain Center Rudolf Magnus opened an outpatient Voices Clinicfor youth. The Voices Clinic offers thorough diagnostic assessmentand if indicated, treatment. Also, a longitudinal observationalstudy started to reveal biological, psychological and social factorsthat predict outcome of youth with AVH.

Purpose of the study: The aim of this project is to definein youth which biological, psychological and social factors canpredict development and persistence of AVH and co-morbiddistress and dysfunction and, thereby, an increased risk for thedevelopment of more severe psychopathology. The results of thisstudy will enable to predict in which subgroup of youngstersAVH are relatively harmless and will disappear over time andwhich subgroup is at high risk for persistence of AVH andthe development of severe psychopathology and should receivetreatment.

Methods: The study population consists of 180 children andadolescents with AVH aged 8−18 years and 180 siblings with-out AVH, aged 8−18 years. Assessments include questionnaires(concerning personality traits, coping style, self-esteem, childhoodtrauma and life events), structured clinical interviewing (AVHcharacteristics and screening for DSM disorders by means ofMINI-KID), physical examination and neuropsychological tests.Also, parents will be assessed concerning personality traits andparenting style. All participants will receive re-assessments witha follow up duration of 5 years.

Results: We clinically assessed 40 children and adolescents(aged 6−18 years) of whom 29 (72%) were girls and 11 (28%)were boys. All children experienced distress at familial, socialand/or school level related to their voices. AVH were associatedwith attention deficit disorder, autism spectrum disorder, anxietydisorders and depressive disorder as well as borderline personalitytraits and mild mental retardation. Moreover, 16 (40%) childrenmet criteria for more than one DSM diagnosis. A formal psychoticdisorder was diagnosed in 4 cases. Only 4 cases did not meet fullcriteria for a DSM classification.

Conclusion: AVH in a clinical setting occur in a broad spec-trum of psychiatric disorders, ranging from developmental dis-orders to psychotic disorder. Moreover, AVH occur even in theabsence of a formal DSM classification. Nevertheless, AVH wereassociated with significant distress in all individuals, indicatingthe need for diagnosis and treatment of AVH across diagnosticboundaries.

References

[1] Bartels-Velthuis AA, Jenner JA, van de Willige G, van Os J, Wiersma D.Prevalence and correlates of auditory vocal hallucinations in middlechildhood. Br J Psychiatry. 2010; 196: 41−46.

[2] Bartels-Velthuis AA, van de Willige G, Jenner JA, van Os J, Wiersma D.Course of auditory vocal hallucinations in childhood: 5-year follow-upstudy. Br J Psychiatry. 2011; 199: 296–302.

[3] Kelleher I, Keeley H, Corcoran P, et al. Clinicopathological significanceof psychotic experiences in non-psychotic young people: evidence fromfour population-based studies. Br J Psychiatry. 2012; 201: 26−32.

P.7.b.009 Predictors of weight gain after six months

of treatment with second-generation

antipsychotics in pediatric and adult patients

C.M. Dıaz-Caneja1 °, L. Pina-Camacho1, D. Fraguas1,A. Gonzalez-Pinto2, R. Rodrıguez-Jimenez3, A. Garcıa4,J. Sanjuan5, P. Saiz6, B. Arias7, I. Corripio8, C. Arango11Hospital General Universitario Gregorio Maranon, Departmentof Child and Adolescent Psychiatry CIBERSAM IiSGM Schoolof Medicine Universidad Complutense de Madrid, Madrid,Spain; 2Hospital Santiago Apostol, Department of PsychiatryCIBERSAM, Vitoria, Spain; 3Hospital 12 de Octubre, Departmentof Psychiatry CIBERSAM, Madrid, Spain; 4Hospital Ramon yCajal, Department of Psychiatry CIBERSAM, Madrid, Spain;5University of Valencia, Department of Psychiatry CIBERSAM,Valencia, Spain; 6University of Oviedo, Department of PsychiatryCIBERSAM, Oviedo, Spain; 7Universidad de Barcelona, Facultatde Biologıa CIBERSAM, Barcelona, Spain; 8Hospital de laSanta Creu i Sant Pau, Department of Psychiatry CIBERSAM,Barcelona, Spain

Background: Second-generation antipsychotics (SGA) have beenconsistently associated with weight gain and other metabolic dis-turbances, such as dyslipidemia and dysglycemia both in pediatricand adult populations [1,2]. The identification of early predictorsof weight gain during treatment with SGAs could help cliniciansidentify patients at higher risk of experiencing accelerated weightgain, in whom more intensive interventions would be warranted.To date, no studies have compared predictors of weight gain indifferent age groups.

Purpose: To identify predictors of weight gain after six monthsof treatment with SGAs in pediatric and adult patients.

Methods: This naturalistic, prospective study assesses anthro-pometric and metabolic changes after one, three and six monthsof treatment with SGAs in antipsychotic naıve (defined as havinga total lifetime exposure to SGAs �10 days) pediatric and adultpatients. Linear regression models were used to identify predictorsfor changes in body mass index (BMI) age- and gender-adjustedZ-scores after six months of treatment with SGAs in the pediatricand adult group. Age, sex, baseline BMI Z-scores, early changesin leptin and adiponectin (at month 1), antipsychotic, and 6-monthcumulative antipsychotic dose in chlorpromazine equivalents wereincluded in the models. All the statistical analyses were performedwith SPSS 18.

Results: One hundred and sixty adult (age 45.04±18.46 years,50% male) and 58 pediatric patients (age 15.69±1.66 years,72.4% male) comprised the study sample. 50.6% of the adultpatients and 70.7% of the pediatric patients had a diagnosis ofpsychosis. In the adult group, 32.5% of the participants wereon risperidone, 36.3% on quetiapine and 28.1% on olanzapine.Within the pediatric sample, 58.6% were on risperidone, 31% wereon quetiapine and only 5% received olanzapine. After six monthsof antipsychotic treatment, BMI Z-scores increased significantlyboth in the adult (0.39±0.58, p< 0.001) and pediatric sample(0.65±0.69, p< 0.001). Within this period, increase in BMIZ-scores was significantly higher in pediatric patients (p = 0.03);and more pediatric than adult patients presented with a clinicallysignificant increase (defined as �0.5) in BMI Z-scores (83% vs.55%, p< 0.001, RR= 1.51). Controlling for cumulative antipsy-chotic dose, treatment with olanzapine, baseline BMI and earlychanges in leptin significantly predicted changes in BMI Z-scoresat month 6 in adults (F = 18.35, p< 0.001; r2 = 0.320), whereas