Oslo Study Research Articles

Network Analysis of Brain and Bone Tissue Transcripts Reveals Shared Molecular Mechanisms Underlying Alzheimer's Disease and Related Dementias and Osteoporosis.

Alzheimer's disease and related dementias (ADRD) and osteoporosis (OP) are 2 prevalent diseases of aging with demonstrated epidemiological association, but the underlying molecular mechanisms contributing to this association are unknown. We used network analysis of bone and brain transcriptomes to discover common molecular mechanisms underlying these 2 diseases. Our study included RNA-sequencing data from the dorsolateral prefrontal cortex tissue of autopsied brains in 629 participants from ROSMAP (Religious Orders Study and the Rush Memory and Aging Project), with a subgroup of 298 meeting criteria for inclusion in 5 ADRD categories, and RNA array data from transiliac bone biopsies in 84 participants from the Oslo study of postmenopausal women. After developing each network within each tissue, we analyzed associations between modules (groups of coexpressed genes) with multiple bone and neurological traits, examined overlap in modules between networks, and performed pathway enrichment analysis to discover conserved mechanisms. We discovered 3 modules in ROSMAP that showed significant associations with ADRD and bone-related traits and 4 modules in Oslo that showed significant associations with multiple bone outcomes. We found significant module overlap between the 2 networks in modules linked to signaling, tissue homeostasis, and development, and Wingless-related integration site (Wnt) signaling was found to be highly enriched in OP and ADRD modules of interest. These results provide translational opportunities in the development of treatments and biomarkers for ADRD and OP.

Oral anaerobe bacteria-a common risk for cardiovascular disease and mortality and some forms of cancer?

This review explores the results of research on oral health concerning cardiovascular diseases and some forms of cancer and is based on results from published systematic reviews and some studies. The research results will have a strong focus on exploring the relationship between different aspects of oral infections. The relationship between oral health parameters, cardiovascular diseases (CVD), and certain cancers was examined from different angles, including prospective analyses, in a population-based health study in Oslo from the year 2000 (Oslo II study). A major finding was that low levels of antibodies to the oral anaerobe Tannerella forsythia predict both CVD mortality in men with a history of myocardial infarction and incidence of bladder cancer in a random sample of men in the study. Low levels of antibodies to Treponea denticola predict the incidence of bladder and colon cancer in a random sample of men in the study. Both anaerobe bacteria are part of the so-called red complex of bacteria in chronic periodontitis together with Pophyromonas gingivalis. These three bacteria have different properties and are causal in chronic periodontitis. They migrate into the local tissues by adhering to the oral epithelium, break down soft and hard tissues, and spread via the circulation to organs distant from the mouth. This paper will give an overview of which oral health measures have been explored and associated with different CVD and cancer diagnoses and what scientific literature supports or contravenes our hypothesis. The oral microbiome is described with the most relevant bacteria related to microbiology, serum, autopsies, and associated causes such as alcohol. There will be a mention of the possibilities and limitations of different study designs. There seems to be a causal relationship between oral anaerobe bacteria and systemic diseases regulated by the immune system. This is seen alongside other well-known risk factors, especially for CVD. The prospective finding of a relation to the incidence of certain cancers and CVD is particularly intriguing. However, further research is needed to determine the biological mechanisms underpinning these associations.

Natural history of periodontal disease: The original Sri Lanka and Oslo studies.

Susceptibility to periodontal disease depends on individual factors within the host response to the bacterial challenge. The study of these factors requires longitudinal studies of an undisturbed development of the disease process. On the basis of the original longitudinal studies on the natural histology of periodontal disease staged in Sri Lanka and Oslo/Norway, several analyses of periodontal parameters and tooth status have been performed. The main findings were that in the first 20 years of complete absence of oral hygiene practices or preventive services attachment was lost at various rates. Three groups of subjects could be identified: rapidly progressing (RP) (8%), moderately progressing (MP) (81%), and subjects with no disease progression (NP) (11%). In the second two decades, the RP subjects have lost most of their teeth and no NP patients were identified anymore. The progression rate in these two decades was much slower, and the tooth mortality decreased. It could be predicted that subjects who had lost more than 2 mm at age 30 would not maintain a functional dentition at age 60. The corresponding control population in Oslo was used to study the influence of gingival inflammation on the initiation and progression of periodontal disease. The pattern and rates of attachment loss were identified in a population that was exposed to optimal and regular preventive services from age 3 onward. In the observation period of 26 years, it could be demonstrated that gingival inflammation varied little throughout adult life and always bleeding sites occurred consistently in 10% to 20%. The role of ongoing gingivitis in the pathogenesis of attachment loss was identified and also reflected stability whenever it was absent. Tooth mortality was only found in subjects with ongoing gingivitis. After 50 years of tooth age, 63% of the teeth were still maintained, while 99.8% were maintained after 50 years when gingival inflammation had been absent. Consequently, continuous gingivitis represented a risk factor for tooth loss.

Do sociodemographic factors play a role in the relation between COVID-19 infection and obesity? Findings from a cross-sectional study in eastern Oslo

Abstract Aim This study aims to assess the odds of having COVID-19 according to an individual’s weight status and to identify the sociodemographic factors associated with having COVID-19 in a sample of individuals residing in the eastern districts of Oslo. Subject and methods This is a cross-sectional study that uses primary survey data collected in six districts of Oslo in June 2021. Chi-square tests are used to test associations between sociodemographic variables and individuals with healthy weight vs overweight/obesity and those who reported having COVID-19 or not. Logistic regression models were computed to identify the sociodemographic factors associated with having COVID-19 (sex, age, educational level, income, employment status, district of residence and having been born in Norway) using body mass index and dichotomic and continuous variable. Results The percentage of COVID-19 cases was higher in individuals with overweight/obesity (5.9%) than in individuals with healthy weight (5.0%). Being a woman, with overweight/obesity, from a younger age group, unemployed and not having been born in Norway, increases the odds of having COVID-19. Conclusion More research on the relevance of sociodemographic factors in the association between weight status and COVID-19, together with biological aspects, is needed, to allow the identification and protection of groups at greater risk of infection.

Coupling of iron and dissolved organic matter in lakes–selective retention of different size fractions

Increasing concentration of iron (Fe) is observed in many boreal lakes, such as for the present study in Oslo Østmark, SE-Norway (1983–2018). As Fe-regulating processes are complex and dynamic, the link between mobilizing and retention processes is still not well understood. A seasonal study (2017–2018) from two headwaters, with medium and high dissolved organic matter (DOM) concentrations, showed that the loading of Fe to the lakes was highly dependent on flow conditions. Significantly higher values of Fe were related to autumn and winter periods with high runoff of highly colored and aromatic DOM compared to a severe drought period with minimum Fe values in the lakes. Compared to DOM, a significantly larger part of Fe was in a colloidal form, and a size-selective process (dependent on flow and water retention time) seemed to preferentially settle Fe compared to DOM. In contrast to Fe, the variability in DOM concentrations was moderate through the whole year. However, there were significant changes in the spectroscopic properties of DOM, with decreased fluorescence intensity and increased spectral slope during the warm dry season, indicating increased importance of DOM turnover in the lake. As Fe was transported from the catchment during high flow condition, at the same time as the oxic form of sulfur (SO42−), there was no sign of retention of Fe as FeS. We conclude that the mobilization and retention of compounds that are mainly in a colloidal form, such as Fe, are especially vulnerable to changes in flow conditions, suggesting increased variation in Fe levels in a future climate with increased frequency of flooding and drought episodes.

Augmented reality as a participation tool for youth in urban planning processes: Case study in Oslo, Norway

Augmented reality (AR) allows objects to be digitally simulated in the real world through smartphones, tablets, and headsets. While there are interesting AR technology case studies in participatory urban planning, this type of research has yet to be conducted within a real-life municipal planning scenario. Following the UN Habitat recommendation that further studies in AR as a participatory tool seek to integrate planning with real citizens, we studied the use of AR for the Oslo Trees plan in Norway. The case study consists of field work with AR between 2020 and 2021 over five weeks, with five different groups of youth participants from eight different districts of Oslo, who were tasked with planning a portion of Oslo’s 100,000 new trees. We document how these youths used AR in films, images, drawings, interviews, screen recordings, and recorded presentations. We find that AR is a highly intuitive tool for these youth user groups in design and planning and how the AR schemes impacted the final design of the plan. The use of AR aided users’ ability to generate their own planning proposals on site at scale; nearly all participants increased their understanding of participation, urban planning, architecture, and design in the workshops. In addition, the youths experienced an increased sense of confidence in displaying their design intentions and appreciated being given control of the planning process. However, we also found that location tracking and positioning in AR is imprecise and often “buggy” in the current state of the technology, causing irritation among users. Furthermore, despite the high degree of control afforded to users through AR, experts were still needed to verify which tree proposals were viable, offering important insights into how AR could be designed in the future. We conclude with a discussion on opportunities and barriers for the implementation of AR in participatory urban planning, pointing to the need for a more coordinated and holistic approach to both AR technology development and planning policy if the technology is to be developed further for participatory urban planning.

Low level of antibodies to the oral bacterium Tannerella forsythia predicts bladder cancers and Treponema denticola predicts colon and bladder cancers: A prospective cohort study.

This study explores the risk for cancer by level of antibodies to the anaerobe oral bacteria of periodontitis Tannerella forsythia (TF), Porphyromonas gingivalis (PG), and Treponema denticola (TD) all three collectively termed the red complex, and the facultative anaerobe bacterium Aggregatibacter actinomycetemcomitans (AA). The prospective cohort, the Oslo II-study from 2000, the second screening of the Oslo study of 1972/73, has been followed for 17 ½ years with regard to cancer incidence and mortality. A random sample of 697 elderly men comprised the study cohort. The antibody results measured by enzyme linked immunosorbent assay (ELISA) were used in the Cox proportional hazards analyses, and quartile risk on cancer incidence in a 17 ½ years follow-up. Among the 621 participants with no prior cancer diagnoses, 221 men developed cancer. The incidence trend was inverse, and the results are shown as 1st quartile of highest value and 4th as lowest of antibody levels. The results of the Cox proportional regression analyses showed that TF inversely predicts bladder cancer (n = 22) by Hazard Ratio (HR) = 1.71 (95% CI: 1.12, 2.61). TD inversely predicts colon cancer (n = 26) by HR = 1.52 (95% CI: 1.06, 2.19) and bladder cancer (n = 22) by HR = 1.60 (95% CI: 1.05, 2.43). Antibodies to two oral bacteria, TF and TD, showed an inverse risk relationship with incidence of specific cancers: TF bladder cancer, TD bladder and colon cancer. Lowered immunological response to the oral infection, periodontitis, is shown to be a risk factor in terms of cancer aetiology.

Sexual Victimization in the Digital Age: A Population-Based Study of Physical and Image-Based Sexual Abuse Among Adolescents

Adolescents increasingly use social media platforms, and these practices open up new forms of sexual victimization, in particular image-based sexual abuse (IBSA). Few studies have examined prevalence rates and correlates of both physical sexual victimization (PSV) and these new forms of victimization in representative samples. We used data from 5,245 adolescent girls (53%) and 4,580 adolescent boys (47%) from the population-based Young in Oslo Study (mean age 17.1 years, SD = 0.9). Of all respondents, 2.9% had experienced IBSA, 4.3% PSV, and 1.7% both IBSA and PSV in the course of the previous 12 months. Multivariate analyses revealed that PSV victims, after control for other variables, had many characteristics described in previous studies of sexual victimization. Girls had higher prevalence rates than boys, many had been victims of other types of violence, and were part of peer groups with much use of alcohol and drugs. PSV victims also reported early intercourse onset and a higher proportion had been commercially sexually exploited. Lesbian, gay, and bisexual adolescents had higher victimization rates. Victims of both PSV and IBSA had a similar but even more pronounced profile. The IBSA victims were different: They lacked many of the traditional risk factors for sexual victimization, there were no significant gender differences in this group, and IBSA victims more often came from high socioeconomic backgrounds. In conclusion, we observe a reconfigured landscape of sexual victimization patterns among Norway adolescents due to their increasing participation on social media and digital platforms.

The Influence of Mental Health Literacy, Migration, and Education on the Duration of Untreated Psychosis.

Background: Duration of untreated psychosis (DUP) is associated with outcome in psychotic disorders and influenced by contextual factors such as immigration. Here we aimed to investigate the effect of mental health literacy (MHL) on duration of untreated psychosis considering the influence of migration and education.Methods: A total of 269 participants who received their first adequate medical treatment for a psychotic disorder within the current or past year were included to the Thematically Organized Psychosis study in Oslo, Norway. Sociodemographic and clinical information was collected through systematic interviews. MHL was measured as “recognition of psychotic symptoms” and assessed by “The Attitudes and Beliefs about Mental Health Problems” schizophrenia version. Influence of education, migration and MHL on DUP was analyzed with hierarchical block-wise multiple regression analysis.Results: Recognition of psychotic symptoms explained a small but unique variance (2.3%) in DUP after the effects of other important predictors were controlled for. Longer DUP was also associated with less education, lower premorbid social, and academic functioning, a diagnosis within schizophrenia spectrum disorder, and earlier age of onset. The model explained 26% of variance in DUP. Migration after the age of six and length of education were associated with MHL but did not have a significant interaction with MHL in predicting DUP.Conclusions: MHL, measured as recognition of psychotic symptoms, has a small but significant independent effect on DUP. The effect of MHL was larger than years of education and migration history, and did not interact with either, in predicting DUP. This suggests that MHL is an independent factor in prevention strategies for early psychosis.

Autoantibodies Against Methylglyoxal-Modified Apolipoprotein B100 and ApoB100 Peptide Are Associated With Less Coronary Artery Atherosclerosis and Retinopathy in Long-Term Type 1 Diabetes

OBJECTIVEMethylglyoxal (MGO), a reactive aldehyde forming advanced glycation end products (AGEs), is increased in diabetes and recognized by the immune system, resulting in anti-AGE–specific autoantibodies. The association of these immune responses with macro- and microvascular complications in type 1 diabetes remains unclarified. We investigated associations between MGO-modified apolipoprotein B100 (apoB100) and apoB100 peptide 5 (MGO-p5) autoantibodies and coronary atherosclerosis and retinopathy in type 1 diabetes.RESEARCH DESIGN AND METHODSIgM and IgG against MGO-apoB100 and MGO-p5 were measured by ELISA in plasma from 103 subjects with type 1 diabetes and 63 control subjects (Dialong study) and in a replication cohort of 27 subjects with type 1 diabetes (Oslo study). Coronary atherosclerosis was assessed by computed tomography coronary angiography or intravascular ultrasound. Retinopathy was classified by retinal photos.RESULTSMGO-apoB100 IgM and MGO-p5 IgM levels were higher in subjects with diabetes with no coronary artery stenosis compared with subjects with significant stenosis (median [interquartile range]: 96.2 arbitrary units [AU] [71–126.8] vs. 54 AU [36.1–85.4], P = 0.003 for MGO-apoB100; and 77.4 AU [58–106] vs. 36.9 AU [28.9–57.4], P = 0.005 for MGO-p5). MGO-apoB100 IgM and MGO-p5 IgM were associated with less severe coronary stenosis after adjusting for confounders (odds ratio 0.2 [95% CI 0.05–0.6], P = 0.01; and 0.22 [0.06–0.75], P = 0.02). The inverse association of MGO-p5 IgM and coronary stenosis was confirmed in the replication cohort. Subjects with proliferative retinopathy had significantly lower MGO-apoB100 IgM and MGO-p5 IgM than those with background retinopathy.CONCLUSIONSAutoantibodies against AGE-modified apoB100 are inversely associated with coronary atherosclerosis and proliferative retinopathy, suggesting vascular protective effects of these autoantibodies in type 1 diabetes.

The randomised Oslo study of renal denervation vs. Antihypertensive drug adjustments: efficacy and safety through 7 years of follow-up

Purpose The blood pressure (BP) lowering effect of renal sympathetic denervation (RDN) in treatment-resistant hypertension shows variation amongst the existing randomised studies. The long-term efficacy and safety of RDN require further investigation. For the first time, we report BP changes and safety up to 7 years after RDN, compared to drug adjustment in the randomised Oslo RDN study. Materials and methods Patients with treatment-resistant hypertension, defined as daytime systolic ambulatory BP ≥135 mmHg after witnessed intake of ≥3 antihypertensive drugs including a diuretic, were randomised to either RDN (n = 9) or drug adjustment (n = 10). The initial primary endpoint was the change in office BP after 6 months. The RDN group had their drugs adjusted after 1 year using the same principles as the Drug Adjustment group. Both groups returned for long-term follow-up after 3 and 7 years. Results The decrease in office BP and ambulatory BP (ABPM) after 6 months did not persist, but gradually increased in both groups. From 6 months to 7 years follow-up, mean daytime systolic ABPM increased from 142 ± 10 to 145 ± 15 mmHg in the RDN group, and from 133 ± 11 to 137 ± 13 mmHg in the Drug Adjustment group, with the difference between them decreasing. In a mixed factor model, a significantly different variance was found between the groups in daytime systolic ABPM (p = .04) and diastolic ABPM (p = .01) as well as office diastolic BP (p<.01), but not in office systolic BP (p = .18). At long-term follow-up we unveiled no anatomical- or functional renal impairment in either group. Conclusions BP changes up to 7 years show a tendency towards a smaller difference in BPs between the RDN and drug adjustment patients. Our data support RDN as a safe procedure, but it remains non-superior to intensive drug adjustment 7 years after the intervention.

Usage of SIMWE model to model urban overland flood: a case study in Oslo

Abstract There has been a surge of interest in the field of urban flooding in recent years. However, current stormwater management models are often too complex to apply on a large scale. To fill this gap, we use a physically based and spatially distributed overland flow model, SIMulated Water Erosion (SIMWE). The SIMWE model requires only rainfall intensity, terrain, infiltration, and surface roughness as input. The SIMWE model has great potential for application in real-time flood forecasting. In this study, we use the SIMWE model at two resolutions (20 m and 500 m) for Oslo, and at a high resolution (1 m) at the Grefsen area, which is approximately 1.5 km2 in Oslo. The results show that the SIMWE model can generate water depth maps at both coarse and high resolutions. The spatial resolution has strong impacts on the absolute values of water depth and subsequently on the classification of flood risks. The SIMWE model at a higher spatial resolution produces more overland flow and higher estimation of flood risk with low rainfall input, but larger areas of risk with high rainfall input. The Grefsen case study shows that roads act as floodways, where overland flow accumulates and moves fast.

Direct visual targeting versus preset coordinates for ANT-DBS in epilepsy.

Deep brain stimulation (DBS) of the anterior thalamic nucleus (ANT) may be used against refractory focal epilepsy, but only two randomized double-blinded trials have been performed. The Oslo study was discontinued prematurely since reduction in seizure frequency was less than expected. The aim of the present study was to review the targeting used in the Oslo study and to identify the actual positions of the contacts used for stimulation. BrainLab MRI data were available from 12 Oslo study patients. Based on MRI the coordinates of the center of the ANT were identified. The coordinates were considered as the visually identified preferred target and were compared with the target originally used for ANT electrode implantation and with the actual electrode positions estimated from post-operative CT scans. We found considerable differences between the visually identified preferred target, the originally planned target, and the actual electrode position. The total distance between the active electrode position and the visually identified preferred target was on average 3.3mm on the right and 2.9mm on the left side. Indirect targeting based on preset coordinates may contribute to explain the modest effect of ANT-DBS on seizure frequency seen in the Oslo study. Observed differences between the center of the ANT and the actual electrode position may at least in part be explained by variations in position and size of the ANT. Direct identification of the target using better MRI imaging protocols is recommended for future ANT-DBS surgery.

The Oslo Study: How will MaaS Defeat Traffic?

The Oslo Study: How will MaaS Defeat Traffic?

Does new bicycle infrastructure result in new or rerouted bicyclists? A longitudinal GPS study in Oslo

Well-connected bicycle infrastructure networks are widely accepted to be an important factor for increasing the level of bicycling in urban environments where motorised and active transport modes must co-exist. However, little is known about the extent to which new bicycle infrastructure results in changes of route amongst existing bicyclists as opposed to changes in the mode of transport. This article addresses the route-mode research gap through a panel study in which participant travel behaviour (n = 113) is recorded with a smartphone Global Positioning System (GPS) application. The study observes short-term changes to route and mode choice of participants before and after the establishment of a contraflow bicycle lane in Oslo, Norway. Video and radar-based traffic counting are used as supplementary methods to affirm bicycle volume changes in the broader population.The bicycle lane intervention resulted in a shift in the preferred route in the neighbourhood. The intervention street saw increased numbers of bicycle trips taken whilst the two nearest parallel routes in the same neighbourhood witnessed a decrease. For bicycle trips taken on the intervention street, the mean deviation from the shortest path increased (from 171 to 221 m, p < .05). Bicycle counts based on video observations also support the route shift finding. Bicycle modal share did not significantly increase when comparing the panel sub-group exposed to the intervention (n = 39) with a quasi-control group (n = 47) who were not exposed but had made at least one trip in the near vicinity of the intervention in both time periods.This natural experiment study provides evidence to suggest that route substitution from nearby streets and paths can explain more of the change in bicycling levels than modal shifts to bicycling in the short term following the opening of the bike lane.

The Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID: a randomised placebo-controlled trial.

The aim of this double-blinded randomised placebo-controlled trial was to investigate the efficacy of clonidine for delirium in medical inpatients greater than 65years. Acutely admitted medical patients greater than 65years with delirium or subsyndromal delirium were eligible for inclusion. Included patients were given a loading dose of either placebo or clonidine; 75μg every third hour up to a maximum of four doses to reach steady state and further 75μg twice daily until delirium free for 2days, discharge or a maximum of 7days of treatment. The primary endpoint was the trajectory of the Memorial Delirium Assessment Scale (MDAS) for the 7days of treatment. Presence of delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and severity measured by MDAS were assessed daily until discharge or a maximum of 7days after end of treatment. Because of slower enrolment than anticipated, the study was halted early. Ten patients in each group were studied. The low recruitment rate was mainly due to the presence of multiple patient exclusion criteria for patient safety. There was no significant difference between the treatment group in the primary endpoint comparing the trajectory of MDAS for the 7days of treatment using mixed linear models with log transformation, (P=.60). The treatment group did not have increased adverse effects. No effect of clonidine for delirium was found, although the study was under powered. Further studies in less frail populations are now required.

The use of clonidine in elderly patients with delirium; pharmacokinetics and hemodynamic responses

BackgroundThe Oslo Study of Clonidine in Elderly Patients with Delirium (LUCID) is an RCT investigating the effect of clonidine in medical patients > 65 years with delirium. To assess the dosage regimen and safety measures of this study protocol, we measured the plasma concentrations and hemodynamic effects of clonidine in the first 20 patients.MethodsPatients were randomised to clonidine (n = 10) or placebo (n = 10). The treatment group was given a loading dose (75μg every 3rd hour up to a maximum of 4 doses) to reach steady state, and further 75μg twice daily until delirium free for 2 days, discharge or a maximum of 7 days. Blood pressure (BP) and heart rate (HR) were measured just before every dose. If the systolic BP was < 100 mmHg or HR < 50 beats per minute the next dose was omitted. Plasma concentrations of clonidine were measured 3 h after each drug intake on day 1, just before intake (day 2 and at steady state day 4–6) and 3 h after intake at steady state (Cmax). Our estimated pre-specified plasma concentration target range was 0.3–0.7μg/L.Results3 h after the first dose of 75μg clonidine, plasma concentration levels rose to median 0.35 (range 0.24–0.40)μg/L. Median trough concentration (C0) at day 2 was 0.70 (0.47–0.96)μg/L. At steady state, median C0 was 0.47 (0.36–0.76)μg/L, rising to Cmax 0.74 (0.56–0.95)μg/L 3 h post dose. A significant haemodynamic change from baseline was only found at a few time-points during the loading doses within the clonidine group. There was however extensive individual BP and HR variation in both the clonidine and placebo groups, and when comparing the change scores (delta values) between the clonidine and the placebo groups, there were no significant differences.ConclusionsThe plasma concentration of clonidine was at the higher end of the estimated therapeutic range. Hemodynamic changes during clonidine treatment were as expected, with trends towards lower blood pressure and heart rate in patients treated with clonidine, but with dose adjustments based on SBP this protocol appears safe.Trial registrationClinicalTrials.gov NCT01956604, 09.25.2013. EudraCT Number: 2013–000815-26, 03.18.2013. Enrolment of first participant: 04.24.2014.

S114. ASSOCIATION BETWEEN APATHY AND DEPRESSION: SECONDARY OR REFLECTING UNDERLYING COMMON FEATURES?

BackgroundNegative symptoms and depression have in many studies been found to be moderately associated, and when present, it reflects negative symptoms of a secondary nature. Primary negative symptoms are thought to be intrinsic to schizophrenia, while secondary to be caused by depression, positive symptoms and medication side effects. Instability in above associations over time is also considered to reflect a secondary origin. Despite the clinical importance of secondary negative symptoms little research has focused on what is their underlying nature. Especially apathy and depression have common clinical features and are often found to correlate. Apathy and depression are self-perceived states and self-reports could add to our understanding. Studying the underlying themes of associations between apathy and depression as well as stability over time could therefore add to the current understanding of the primary or secondary nature of negative symptoms.MethodsEighty-four first episode psychosis patients from TOP/NORMENT study in Oslo, Norway were assessed at baseline and 1-year follow-up with the Calgary Depression Scale (CDSS), Apathy Evaluation Scale (AES), both self-report (AES-S) and clinician (AES-C), and the Positive and Negative Symptoms Scale (PANSS). Correlation with total scale, individual scale items and linear regression was used to study associations and explained variance over time. Results were repeated controlling for positive symptoms and excluding those with high level of depression.ResultsCDSS and AES correlated at the 0.4 to 0.5 levels at both baseline and follow up, regardless of AES-S or AES-C. Hopelessness and feeling of depression were the CDSS items with stable and concurrent correlation strength to AES-S and AES-C. For CDSS, we found correlation of equal strength and stability to the AES-S- and AES-C items of getting things done during the day, spending time on interests, getting excited and taking initiative. Same significant correlations to CDSS were found for PANSS amotivation factor, but not for PANSS expressive factor. Controlling for PANSS positive symptoms did not change results, and excluding those with high levels of depression only mildly changed results.DiscussionThis study shows a significant correlation between apathy and depression that is stable over time for the full scale and also at the item level, regardless of self-reporting or clinician assessed apathy. Underlying themes of the concurrent correlation reflect lack of initiative and hopelessness and are in line with the defeatist beliefs found to correlate with negative symptoms, mediate between motivation and reduced effort and have recently been a target for cognitive remediation therapy. This study does not give an answer to a primary or secondary origin of apathy, but the stability points more to an underlying common nature than one being the cause of the other.

T3. METACOGNITIVE BELIEFS IN SEVERE MENTAL DISORDERS

BackgroundAffective dysregulation and psychotic experiences or symptoms often co-occur in the general population as well as in bipolar and psychotic disorders, suggesting a complex interplay. Early trauma is hypothesised to be important for the aetiology of both, and individuals with early traumatic experiences often develop disorders characterised by an admixture of affective and psychotic symptoms. Early emotional abuse seems to be particularly relevant for both disorders. Studies of common factors associated with affective dysregulation and psychosis in bipolar and psychotic disorders could help further theoretical understanding and tailor therapeutic interventions. Metacognitive beliefs – beliefs that outline the importance or consequence of thoughts – have been proposed as one possible common factor. Compared to healthy controls, patients with affective or psychotic disorders hold higher levels of metacognitive beliefs that could be maladaptive. Metacognitive beliefs have been linked to affective and/or psychotic diagnoses and symptoms in these disorders, and to early trauma in general. However, little is known about the specific relationships between symptoms of bipolar/psychotic disorders, early emotional abuse, and metacognitive beliefs.This project had three objectives: (1) to examine the prevalence of metacognitive beliefs in bipolar and psychotic disorders, compared to controls; (2) explore whether illness-related factors were linked to metacognitive beliefs; (3) examine if symptomatic responses (depression or positive symptoms) to early emotional abuse were mediated by metacognitive beliefs.MethodsPatients with a bipolar or psychotic disorder, and healthy controls, were included through the on-going Thematically Organised Psychosis (TOP) Study in Oslo, Norway. Analyses included t-tests for group comparisons, regression analyses, and regression based mediation pathway analyses where the indirect effects were tested with bootstrapped confidence intervals.ResultsPatients with bipolar or psychotic disorders reported higher levels of metacognitive beliefs compared to controls. Metacognitive beliefs were significantly related to depression for all patients. Higher levels of metacognitive beliefs were also related to illness-factors related to a poorer long-term outcome, specifically an earlier age at onset of affective disorder in bipolar disorders, and poorer premorbid social adjustment in psychotic disorders. Metacognitive beliefs significantly mediated the relationship between early emotional abuse and depression. The combination of metacognitive beliefs and depression significantly mediated the relationship between early emotional abuse and positive symptoms. The mediation models explained a moderate amount of the variance in symptoms (R2 = .21 and .29) compared to direct models of early emotional abuse impacting on symptomatic responses directly (R2 = .04 and .03)DiscussionOur results show that patients with bipolar or psychotic report higher levels of metacognitive beliefs compared to controls, and that such beliefs relate to current symptoms of depression in both patient groups. Our results also suggest that metacognitive beliefs relate to factors present before or at the onset of illness, which are often linked to a poorer long-term outcome in the disorders. Further, our findings suggest that in regards to early emotional abuse, metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could thus be relevant treatment targets in regards to depression and positive symptoms in bipolar and psychotic disorders.

Neighborhood or School? Influences on Alcohol Consumption and Heavy Episodic Drinking Among Urban Adolescents.

Little is known about the relative influences of neighborhood and school on the alcohol socialization process. Survey data from the Young in Oslo Study (N = 10,038, mean age 17.1 years, 52% girls) were used to investigate the details of such influences, using cross-classified multilevel models. School and neighborhood contexts were equally important for ordinary alcohol use; however, neighborhood influences were mainly explained by individual and family factors, whereas peer-based sociocultural processes played a key role in explaining school effects. Neither context had much impact on heavy episodic drinking. The study suggests that "privileged" youth may be at risk of high alcohol consumption. Parental influences and peer-based sociocultural aspects of the school milieu should be considered in prevention efforts.