European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805 S491
Ev445
A cognitive behavioral model for
panic attack treatment in comorbid
heart diseases (PATCHD): A pilot study
from the real-world
P. Tully
University of Adelaide, Medicine, Adelaide, Australia
Background Treating panic disorder comorbid with heart disease
is challenging due to:
– diagnostic overlap;
– the risk associated with ignoring chest pain and delaying seeking
medical attention;
– that cognitive-behavioral therapy based on “catastrophic misin-
terpretation of bodily symptoms” requires adaption to incorporate
the element of risk;
–that some interoceptive symptom inductions may be harmful.
Objective To describe a cognitive-behavioral therapy model of
panic attack treatment in comorbid heart diseases (PATCHD).
Methods We developed a modified CBT model that is based
on enhancing coping skills, performing safe interoceptive expo-
sures, supervised exercise, and countering avoidance. Eighteen
persons referred to PATCHDhad a dominant clinical picture of panic
attack/panic disorder after their heart failure (HF) diagnosis. We
quantified the total number of admissions and the length of hos-
pital stay (LOS) for CVD (ICD Codes I00-99) and psychiatric causes
(F00-99). Hospital data was collated blinded to original diagnosis.
Results Using paired t-tests bootsrapped 1000 times we found
evidence that there was a significant reduction in CVD admissions
and hospital LOS in the 6 months after participation in PATCHD.
There was however no significant change in psychiatric admissions
or psychiatric LOS. Pre- and post-treatment data from 14 HF par-
ticipants suggested a reduction in GAD-7 anxiety symptoms, total
PHQ-9 depression, cognitive-affective depression symptoms, but
not somatic depression symptoms.
Conclusions Pilot data suggested that PATCHD was associated
with a reduction in cardiovascular hospital admission and LOS, gen-
eral anxiety and depression, however the findings were based on
non-randomized and paired-sample data.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV446
psychological experiences reported in
regarding hepatitis C and use of
interferon: A clinical-qualitative study
in a Brazilian university outpatient
service considering its possible side
effects
I.D. Fahl , F.D. Costa , R.S.B. Stucchi , E.R. Turato ∗
University of Campinas, Laboratory of Clinical-Qualitative Research,
Campinas SP, Brazil
∗ Corresponding author.
Relevant emotional and behavioural reactions are associated with
diagnosis and treatment of hepatitis C that can impair adherence to
medical management. Hepatitis C accounts for significant number
of both – liver transplants and deaths. Treatment has asmajor com-
ponent the interferon alpha, and many of patients can experience
side effects that often lead to non-adherence to drug treatment and
dose modification.
Objective To discuss psychological meanings attributed to IFN
alpha treatment’s side effects and its symbolic relation with adher-
ence or not to treatment, on viewpoint of interviewed outpatients
at a Hepatitis Service.
Method Data collection was conducted using the Clinical-
Qualitative Method, utilizing semi-directed interviews with
open-ended questions in depth, fully transcribed. Qualitative Con-
tent Analysis employed for processing data, emerging meaning
cores, with categorization into discussion topics. Sample closed by
information saturation.
Results Nine interviews. The analysis revealed:
– coping attitude - handling the disease to have willpower; a moral
feeling regarding the need to overcome the disease and treatment
side effects to demonstrate “strength”, as well as to deny psycho-
logically the occurrence of side effects;
– disruptive attitude: reports of anxiety regarding to patients pre-
senting neuropsychiatric symptoms by medication;
– realistic attitude: speeches show perception of natural evolution
and treatment real function.
Conclusion Guilt feelings emerged regarding to difficulties of
being loyal to treatment, a strongly valorative speech on being ill
what must lead to “overcome the evils of life”. Health teams must
understand these meanings to talk openly about human feelings on
illness and treatment, promoting an adequate adherence.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV447
Stress factors and mental disorders in
systemic sclerosis
D. Veltishchev ∗, O.B. Kovalevskaya , O.F. Seravina ,
M.N. Starovoitova , T.A. Lisitsyna
1 Moscow Research Institute of Psychiatry, Stress Related Disorders,
Moscow, Russia
2 Nasonova Research Institute of Rheumatology, Systemic Rheumatic
Diseases, Moscow, Russia
∗ Corresponding author.
Introduction Systemic sclerosis (SSc) is a chronic, multisystem
disease of unknown etiology characterized by autoimmune inflam-
mation, abnormalities in small blood vessels, and progressive
fibrosis of the skin and visceral organs. Mental disorders (MD),
especially depression, occur quite often with SSc. The influence
of childhood experience, relations’ traumatic events with SSc and
MD, and MD’s clinical specific have not investigated carefully
still. The investigation has been realized in accordance with the
interdisciplinary program “stress factors and mental disorders in
auto-immune inflammatory rheumatic diseases”.
Methods Sixty SSc patients (4 male and 56 female mean age
49.9± 13.5) were included. ICD-10 criteria were used for MD semi-
structured interview. The stress factors were analyzed with the
specially elaborated scale. The cognitive disorders and their sever-
ity were diagnosed by neuropsychology tests.
Results Early traumatic childhood experiences (parental depri-
vation mainly) observed in 90% cases. The significant stress factors
were preceded SSc symptoms in 80% and MD in 70% cases. Most
patients self-reported connection between stressful life events
and exacerbation of SSc. MD preceded SSc in 76.6% cases. MD
were diagnosed in 48 (80%) SSc patients: depressive episode
(mild, moderate) − 26.6%, recurrent depressive disorder − 16.6%,
dysthymia – 23.3%, adjustment disorder −6.6% and schizotypal dis-
order – 40%. The mild or moderate cognitive impairments were
diagnosed in all MD cases.
Conclusion Individual history of stressful life events is important
factor for the predisposition and provocation of the rheumatic dis-
ease and MD in SSc patients. Depressive, schizotypal and cognitive
disorders are the common MD in SSc patients.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.