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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S116–S348

S271

EW447

Which antidepressants are associated

with increased risk of developing

mania? A retrospective electronic case

register cohort study

R. Patel

1 ,

, P. Reiss

1

, H. Shetty

2

, M. Broadbent

2

, R. Stewart

3

,

P. McGuire

1

, M. Taylor

1

1

Institute of Psychiatry, Psychology and Neuroscience, Department of

Psychosis Studies, London, United Kingdom

2

South London and Maudsley NHS Foundation Trust, Biomedical

Research Centre Nucleus, London, United Kingdom

3

Institute of Psychiatry, Psychology and Neuroscience, Department of

Psychological Medicine, London, United Kingdom

Corresponding author.

Introduction

The symptoms of bipolar disorder are sometimes

misrecognised for unipolar depression and inappropriately treated

with antidepressants. This may be associated with increased risk of

developing mania. However, the extent to which this depends on

what type of antidepressant is prescribed remains unclear.

Aims

To investigate the association between different classes of

antidepressants and subsequent onset of mania/bipolar disorder in

a real-world clinical setting.

Methods

Data on prior antidepressant therapy were extracted

from 21,012 adults with unipolar depression receiving care from

the South London and Maudsley NHS Foundation Trust (SLaM).

multivariable Cox regression analysis (with age and gender as

covariates) was used to investigate the association of antidepres-

sant therapy with risk of developing mania/bipolar disorder.

Results

In total, 91,110 person-years of follow-up data were

analysed (mean follow-up: 4.3 years). The overall incidence rate

of mania/bipolar disorder was 10.9 per 1000 person-years. The

peak incidence of mania/bipolar disorder was seen in patients

aged between 26 and 35 years (12.3 per 1000 person-years). The

most frequently prescribed antidepressants were SSRIs (35.5%),

mirtazapine (9.4%), venlafaxine (5.6%) and TCAs (4.7%). Prior

antidepressant treatment was associated with an increased inci-

dence of mania/bipolar disorder ranging from 13.1 to 19.1 per

1000 person-years. Multivariable analysis indicated a significant

association with SSRIs (hazard ratio 1.34, 95% CI 1.18–1.52) and

venlafaxine (1.35, 1.07–1.70).

Conclusions

In people with unipolar depression, antidepressant

treatment is associated with an increased risk of subsequent

mania/bipolar disorder. These findings highlight the importance

of considering risk factors for mania when treating people with

depression.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.565

EW448

Characterization of

agomelatine-induced liver injury,

incidence and risk factors: A pooled

analysis of 7605 treated patients

G. Perlemuter

1 ,

, P. Cacoub

2

, D. Valla

3

, D. Guyader

4

, B. Saba

5

,

C. Batailler

5

, K. Moore

6

1

Antoine-Béclère Hospital, Assistance publique–Hôpitaux de Paris,

Hepato-gastroenterology, Clamart, France

2

Groupe hospitalier Pitié-Salpétrière, Internal medicine and clinical

immunology, Paris, France

3

Hôpital Beaujon, Hepatology, Clichy, France

4

CHU de Rennes, Liver disease unit and National reference center for

rare iron overload diseases of genetic origin, Rennes, France

5

Institut de Recherches Internationales Servier, Neuropsychiatrie,

Suresnes, France

6

Royal Free Campus, University College London, UCL Institute of

Liver and Digestive Health, London, United Kingdom

Corresponding author.

Introduction/objective

The hepatic safety of agomelatine was

assessed in 49 phase II and III studies. The aim was to analyze the

characteristics of patients who developed an increase in transami-

nases whilst taking agomelatine.

Method

A retrospective pooled analysis of changes in serum

transaminase in 7605 patients treated with agomelatine (25mg or

50mg/day) from 49 completed studies was undertaken. A signif-

icant increase in serum transaminase was defined as > 3-fold the

upper limit of normal (> 3ULN). Final causality was determined in

a case-by-case review by five academic experts.

Results

Transaminase increased to > 3ULN in 1.3% and 2.5% of

patients treatedwith 25mg and 50mg of agomelatine respectively,

compared to 0.5% for placebo. The onset of increased transami-

nases occurred at < 12 weeks in 64% of patients. The median time to

recovery (to

2ULN) was 14 days following treatment withdrawal.

Liver function tests recovered in 36.1% patients despite the contin-

uation of agomelatine, suggesting the presence of a liver adaptive

mechanism. Patients with elevated transaminases at baseline, sec-

ondary to obesity and fatty liver disease (NAFLD), had an equally

increased risk of developing further elevations of transaminases

with agomelatine and placebo. This reflects the widespread fluctu-

ations of serum transaminases in patients with NAFLD.

Conclusions

The overall incidence of abnormal transaminases

was low and dose dependent. No specific population was identi-

fied regarding potential risk factors. Withdrawal of agomelatine

led to rapid recovery, and some patients exhibited an adaptive phe-

nomenon. The liver profile of agomelatine seems safe when serum

transaminases are monitored.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.566

EW449

Hospital admissions and direct costs:

A comparative study between

paliperidone palmitate and oral

antipsychotics

A. Soler Iborte

1 ,

, S. Galiano Rus

2

, J.A. Ruíz Sánchez

3

1

Servicio Andaluz de Salud, UGC Jaén Norte, Unidad de Salud Mental

Comunitaria de Linares, Linares, Jaén, Spain

2

Servicio Andaluz de Salud, UGC Jaén Norte, Hospital San Juan de la

Cruz, Úbeda, Jaén, Spain

3

Servicio Andaluz de Salud, UGC Jaén Norte, Unidad de Salud Mental

Comunitaria Úbeda, Úbeda, Jaén, Spain

Corresponding author.

Introduction

The total costs of schizophrenia increased to 2576

million Euros in 2013 in Spain, or 2.7% of the annual cost of

health services. The hospitalizations, alongwith other intermediate

resources, such as Day Hospital, etc., significantly contribute to the

increase of economic burden. In Spain, the average hospital stay of

schizophrenic patients is 18.24 days, totalling to an average cost of

6,753 Euros/patient (370.23 Euros/patient/day).

Material and methods

The sample selected included patients

fromboth sexes, aged between 18 and 65 years old, with diagnostic

criteria of schizophrenia (according to DSM-IV and ICD-10), admit-

ted in the Mental Health Hospital Unit (MHHU), Úbeda between

2012 and 2013, with registered visits of at least 2 outpatient visits

or 1 hospitalization related to the schizophrenia diagnosis (

n

= 48).

Results

After the start of treatment with the injectable antipsy-

chotic drug of prolonged duration, the number of patients that

required hospitalization for any psychiatric motive went from 24

patients (49.7%) to 11 patients (22.4%;

P

< 0.001). The patients who

started treatment with PAP during hospitalization had an average