European Psychiatry - Volume 33 - March 2016

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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 ∗, A. Mane Santacana ,
R.B. Sauras Quetcuti , E. Fernandez-Egea
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.
FC88
Trends of hospitalization for
schizophreniform disorder in USA:
A nationwide analysis
M. Rathod ∗, Z. Mansuri , S. Shambhu , K. Karnik , A. Sutaria ,
U. Mansuri
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, Chi2 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.
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 ∗ . Elosúa Lorente-Ome˜naca
L. Moreno-Izco eralta entura J. Cuesta
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