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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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1254

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1255

EV271

Implementation of British tool for the

evaluation of outpatient

child-adolescent mental health

services (CAMHS) in Attica-Greece

A. Katideniou

1 ,

, K. Kavalidou

2

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1256

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