European Psychiatry - Volume 33 - March 2016

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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 ∗, P. Reiss , H. Shetty , M. Broadbent , R. Stewart ,
P. McGuire , M. Taylor
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.
EW448
Characterization of
agomelatine-induced liver injury,
incidence and risk factors: A pooled
analysis of 7605 treated patients
G. Perlemuter ∗, P. Cacoub , D. Valla , D. Guyader , B. Saba ,
C. Batailler , K. Moore
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.
EW449
Hospital admissions and direct costs:
A comparative study between
paliperidone palmitate and oral
antipsychotics
A. Soler Iborte ∗, S. Galiano Rus , J.A. Ruíz Sánchez
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