European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805 S435
EV269
An audit of melatonin prescribing in a
community-based child and
adolescent mental health service
(CAMHS)
A. Javed∗, M.F. Moosa , T. Sandhu
Birmingham Children’s Hospital NHS foundation Trust, Community
Child and Adolescent Psychiatry, Birmingham, United Kingdom
∗ Corresponding author.
Introduction Melatonin in widely prescribed in the United King-
dom for the treatment of sleep difficulties and disorders in children.
Licensed and unlicensed products are available. A prolonged-
release form, licensed for use in older adults, is used ‘off-label’ in
children.
Aims and objectives To ensure evidence-based, cost effective pre-
scribing of melatonin.
Methods Retrospective data was collected over a 3-month
period. Prescriptions for all forms of melatonin issued to patients
under 16 years of age with sleep disorders were included. A case
note audit was conducted. Standards were measured based on
evidence-based ‘advice’ and generic prescribing guidelines. Main
outcome measures were, forms of Melatonin used, timing of its use
(before or after sleep behaviour therapy), documentation, and cost
to the service.
Results The licensed prolonged-release product was prescribed
in 92% of cases (n = 59), and for the great majority (93%) it was
below or within the recommended dose range (4–6mg). Melatonin
was used more often as first line (69%) therapy as compared to the
recommended sleep behaviour therapy. There was lack of docu-
mentation, relating to its ‘off-label’ use and shared decision-making
with patients. Overall cost of prescribed Melatonin was £1800 per
month.
Conclusions A licensed product of melatonin was used, cost-
effectively. However, a question remains about the timing if its use
and relevant discussion with patients. A local guideline is needed
to guide clinicians on appropriate use of melatonin and to improve
documentation.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV270
Olfactory reference syndrome – a
case report
C. Kapugama
National Hospital of Sri Lanka, Department of Psychological
Medicine–Ward 59–, Colombo, Sri Lanka
Introduction Olfactory reference syndrome (ORS) is a condition
characterised by persistent preoccupation about body odour with
feelings of embarrassment, shame, distress, avoidance and isola-
tion. There is often referential thinking.
Case description A 16-year-old male was referred to Child and
Adolescent Mental Health Services. He believed that ‘everyone
thought I smelt bad’ for the past 3 years. He avoided going out
with friends, sitting at restaurants, going to the cinema, and playing
games. He sprayed himself with deodorant between every lesson.
He insisted his laundry to be done by hand using special products.
He asked his mother how he smelled before going to school. He
spent his time in isolation in his room. When asked, he accepted
that his concerns were excessive. He was commenced on cognitive
behaviour therapy (CBT) with his mother as a co-therapist.
Discussion There has been much debate over whether ORS war-
rants a separate entity in the current classificatory systems. At
present it is placed between delusional disorders, social phobia,
body dysmorphic disorder and obsessive compulsive disorders.
Our patient did not experience hallucinations. His conviction was
derived from referential thinking and did not reach the level of a
delusion. Literature on management of ORS is scarce. Our patient
was offered CBT and he showed improvement from first session
onwards. By the end of therapy he ratedhis improvement as 80%. He
stopped avoidance behaviours and reassurance seeking and used
techniques to combat automatic thoughts.
CBT seems a promising option in the management of ORS.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV271
Implementation of British tool for the
evaluation of outpatient
child-adolescent mental health
services (CAMHS) in Attica-Greece
A. Katideniou ∗, K. Kavalidou
1 Athens University of Economics and Business, Counselling Service,
Athens, Greece
2 University of Glasgow, Suicidal Behaviour Research Laboratory,
Glasgow, United Kingdom
∗ Corresponding author.
Introduction The development of child-adolescent mental health
services (CAMHS) is a necessity for each country. Based on
evidence-based findings the provision of specific quality standards
in regard to mental health services, maximizes the patients’ health
care outcomes and satisfaction.
Objectives A British tool adapted in the Greek context accesses
the services against the British standards. For the current study, we
used the part of the tool referred to the areas of:
– referral and access;
– assessment & care planning;
– care & intervention.
Aims Promotion of evaluation and quality assurance of Greek
CAMHS.
Methods Due to the fact that Greek services are based on the
British model, we chose the British self-review questionnaire of
Quality Network for Community CAMHS (QNCC). The tool was
translated, adapted and posted to services. Twelve out of twenty
outpatient CAMHS of Attica (includes Athens) responded. Data col-
lected was computed in SPSS taking a highest and a lowest score of
meeting the standards.
Results Based on a scale of “not meeting the standards”, “mod-
erately meeting the standards”, and “meeting the standards”, ten
out of twelve services moderately met the British Standards on all
three areas examined. It should be noted that the “assessment and
care” section was found to have a higher quality of replies among
services reaching the 75%–100% of “meeting the standards” for two
services.
Conclusions Greek CAMHS show a satisfactory function in Attica
prefecture, taking into consideration the extremely difficult polit-
ical/financial circumstances. Strengths and weaknesses between
different domains were also identified.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV272
Symbolic development in TD, DS and
ASD
M. Kékes Szabó
University of Szeged, Department of Applied Pedagogy and
Psychology, Szeged, Hungary
This study is about symbolic processes in atypical populations,
which is presumed to lead to a deeper understanding of the