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S108

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S72–S115

FC87

An observational study of

clozapine-induced sedation and its

pharmacological management

S. Ramos Perdigues

1 ,

, A. Mane Santacana

2

,

R.B. Sauras Quetcuti

3

, E. Fernandez-Egea

4

1

Nuestra Se˜nora de Jesus, Spain

2

Hospital Del Mar, Psychiatry, Barcelona, Spain

3

CSMA Horta, Psychiatry, Barcelona, Spain

4

Behavioural and Clinical Neurosciencie Institute, Psychiatry,

Cambridge, United Kingdom

Corresponding author.

Introduction

Clozapine is the only drug approved for resistant

schizophrenia, but remains underused because of its side effects.

Sedation is common, but its management is unclear.

Objectives

To analyze factors associated with clozapine-induced

sedation and the efficacy of common treatment strategies.

Aims

To determine clozapine-induced sedation factors and pos-

sible therapeutic strategies.

Methods

Using two years’ electronic records of a community

cohort of resistant schizophrenia spectrumdisorder cases on cloza-

pine, we performed three analyses: a cross-sectional analysis of

which factors were associated with number of hours slept (objec-

tive proxy of sedation), and two prospective analyses: which factors

were associated with changes in hours slept, and the efficacy of the

main pharmacological strategies for improving sedation.

Results

One hundred and thirty-three patients were included;

64.7% slept at least 9 hours/daily. Among monotherapy patients

(

n

= 30), only norclozapine levels (

r

= .367,

P

= .033) correlated with

sleeping hours. Multiple regression analyses confirmed the find-

ings (

r

= .865,

P

< .00001). Using the cohort prospectively assessed

(

n

= 107), 42 patients decreased the number of hours slept between

two consecutive appointments. Decreasing clozapine (40%) or aug-

menting with aripiprazole (36%) were the most common factors. In

the efficacy analysis, these two strategies were recommended to 22

(20.6%) and 23 (21.5%) subjects, respectively. The majority (81.8%

and 73.9%) did not report differences in the hours slept.

Conclusions

Sedationis common and involves pharmacological

and non-pharmacological factors. The only correlation was a weak

correlation between norclozapine plasma levels and total sleeping

hours. Reducing clozapine and aripiprazole augmentationwere the

most successful strategies to ameliorate sedation, although both

strategies were effective only in a limited numbers of subjects.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.091

FC88

Trends of hospitalization for

schizophreniform disorder in USA:

A nationwide analysis

M. Rathod

1 ,

, Z. Mansuri

1

, S. Shambhu

1

, K. Karnik

2

, A. Sutaria

1

,

U. Mansuri

3

1

Drexel University, School of Public Health, Philadelphia, USA

2

Children’s Hospital of San Antonio - Texas, Department of

Pediatrics, San Antonio, USA

3

Icahn School of Medicine at Mt. Sinai, School of Public Health, New

York, USA

Corresponding author.

Objectives

Schizophreniform disorder (SD) is an important cause

of morbidity and mortality in hospitalized patients. While SD has

been extensively studied in the past, the contemporary data for

impact of SD on cost of hospitalization are largely lacking.

Methods

We queried the Healthcare Cost and Utilization

Project’s Nationwide Inpatient Sample (HCUP-NIS) dataset

between 1998–2011 using the ICD-9 codes. Severity of comorbid

conditions was defined by Deyo modification of Charlson comor-

bidity index. Primary outcome was in-hospital mortality and

secondary outcome was total charges for hospitalization. Using

SAS 9.2, Chi

2

test,

t

-test and Cochran-Armitage test were used to

test significance.

Results

A total of 8645 patients were analyzed; 36.21% were

female and 63.79% were male (

P

< 0.0001); 49.04% were white,

39.06% black and 19.9% of other race (

P

< 0.0001). Rate of hospi-

talization decreased from 599.22/million to 394.47/million from

1998–2011. Overall mortality was 0.23% andmean cost of hospital-

izationwas 17930.23. The in-hospital mortality reduced from0.21%

to 0.15% (

P

< 0.0001) and mean cost of hospitalization increased

from 9662.88$ to 27,749.68$ from 1998–2011. Total spending on

SD related admissions have increased from $47.59 million/year to

$853.83 million/year.

Conclusions

While mortality has slightly decreased from 1998 to

2011, the cost has significantly increased from $47.59 million/year

to $853.83 million/year, which leads to an estimated $806.24 mil-

lion/year additional burden to US health care system from 1998

to 2011. In the era of cost conscious care, preventing SD related

hospitalization could save billions of dollars every year. Focused

efforts are needed to establish preventive measures for SD related

hospitalization.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.092

FC89

Assessment of cognitive impairment

with the cognitive assessment

interview (CAI) was useful for

identifying poor psychosocial

functioning outcome in patients with

psychosis

A. Sánchez-Torres

1 , 2 , 3 ,

, M .R

. Elosúa

2 , R.

Lorente-Ome˜naca

1 , 3 ,

L. Moreno-Izco

1 , 3 , V . P

eralta

1 , 3 , J. V

entura

4 , M.

J. Cuesta

1 , 3

1

Complejo Hospitalario de Navarra, Department of Psychiatry,

Pamplona, Spain

2

Universidad Nacional de Educación a Distancia, Department of

Basic Psychology I, Madrid, Spain

3

IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

4

UCLA, Department of Psychiatry, Semel Institute for Neuroscience

and Human Behavior, Los Angeles, USA

Corresponding author.

Introduction

Cognitive impairments clearly impact the daily

functioning of patients with psychosis.

Objectives

To assess cross-sectionally whether there are dif-

ferences in the cognitive domains assessed with the CAI, for

considering the real-world functioning of a sample of patients with

psychosis.

Methods

The sample consisted of 76 patients with a DSM-IV

psychotic disorder. Patients were assessed with the cognitive

assessment interview (CAI), which is an interview-based measure

of cognitive functioning that is intermediate between cognitive

functioning and daily functioning, and three subscales of the spe-

cific levels of functioning (SLOF), an informant-rated measure of

functioning. The CAI was used to assess the patient and an infor-

mant, and these scoreswere integrated into a rater composite score.

We divided the sample by a median-split procedure for each of the

three functional domains, and then applied ANOVAs to compare the

two groups (impaired/not impaired) in the six cognitive domains

of the CAI: working memory, attention, verbal memory, problem

solving, processing speed, and social cognition.

Results

We found significant differences between the impaired

vs. non-impaired groups in most of the cognitive domains assessed

with the CAI

( Fig. 1 ).