European Psychiatry - Volume 33 - March 2016

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S50 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55
totally in agreement with that affirmation, we want to point out
that we often forget there is proven evidence of the preventative
utility of non-pharmacological interventions designed to increase
clinical follow-up and adherence to post-attempt outpatient treat-
ment. It is important to indicate that these interventions are not
aimed at specific disorders or population groups, but rather they
are of a more universal character and are thus more easily gener-
alised. During this presentation, some of these approaches will be
addressed and discussed.
Disclosure of interest The author has not supplied his declaration
of competing interest.
The effects of neuroleptics on the brain
S101
GROUP 6 year outcome data in
relation to antipsychotic medication
W. Cahn ∗, for GROUP Investigators
UMC Utrecht, Brain center, Utrecht, Netherlands
∗ Corresponding author.
Objective Genetic risk and outcome of psychoses (GROUP) is a
6 year longitudinal cohort study that focus on gene–environment
vulnerability and resilience in patients with psychotic disorders,
their unaffected familymembers and non-related controls. Itsmain
aim is to elucidate etiological and pathogenetic factors that influ-
ence the onset and course of psychotic disorders. In this substudy,
we will examine medication use over time, its relation with (the
change in) metabolic syndrome status and effects on the brain.
Methods A consortium of four university psychiatric centers
and their affiliated mental health care institutions, conducted
the GROUP study. At baseline, 1120 patients, 1057 siblings, 919
parents and 590 healthy controls were included. After inclu-
sion, participants, except parents, were evaluated again after
three and six years of follow-up. Extensive assessment of genetic
factors, environmental factors, medication use, metabolic param-
eters and outcome were performed. Moreover, brain imaging
was performed in a subset of participants, using a 1.5 Tesla MRI
scanner.
Results At baseline 65% of patients used atypical antipsychotics,
16% used conventional antipsychotics and 19% used clozapine. Sib-
lings and controls used no antipsychotics. Forty-three percent of
patients, 21.3% of siblings and 9.1% of controls used antidepres-
sants; 43.9% of patients, 2.1% of siblings and none of the controls
used a mood stabilizer. We are currently analyzing the medication
data over time in relation to (change in) metabolic syndrome status
and the effects on the brain.
Conclusion GROUP is a longitudinal cohort study in patients with
psychotic disorders, their healthy siblings and controls without
psychosis. This naturalistic substudy examines medication use, its
association with (change of) metabolic status and effects on the
brain in subjects with (high risk of) psychosis.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
S102
Discontinuation vs. continuation
treatment with neuroleptics for a
better long-term outcome
L. Wunderink ∗, R. Nieboer , F. Nienhuis , S. Sytema ,
D. Wiersma
1 Friesland Mental Health Services, University Medical Center
Groningen, Research & Education, Psychiatry, Leeuwarden,
Netherlands
2 Friesland Mental Health Services, Research and Education,
Leeuwarden, Netherlands
3 University Medical Center Groningen, Psychiatry, Groningen,
Netherlands
∗ Corresponding author.
Background Long-term functional outcome of dose-
reduction/discontinuation strategies in first-episode psychosis
(FEP) has not been studied before. The present study
compared 7-year outcome of an early antipsychotic dose-
reduction/discontinuation (DR) strategy with maintenance
treatment (MT). Primary outcome was (symptomatic and func-
tional) recovery; relapse rates, functional and symptomatic
remission were secondary outcomes.
Methods FEP patients (n = 128) symptomatically remitted for 6m
during their first treatment year who completed an 18 months trial
comparing MT and DR were followed-up at 7 years. Symptomatic
remission criteria were adopted from Andreasen et al., functional
remission criteria were based on a functioning scale. Recovery was
defined as meeting both criteria sets. MT or DR strategy, and base-
line parameters were entered in a logistic regression analysis with
symptom and functional remission and recovery at 7-years follow-
up as dependent variables.
Results One hundred and three patients consented to partici-
pate. DR-patients showed twice the recovery-rate of MT-patients
(40% against 18%), odds ratio 3.5 (P = .014). Symptomatic remission-
rates were equal (69% and 67%). Better DR recovery-rates were
attributable to higher functional remission-rates (46% vs. 20%) in
DR. Predictors of recovery were DR, baseline living together and
less severe negative symptoms. During the last 2 years of follow-
up the mean daily dose in haloperidol equivalents was 2.20mg in
DR vs. 3.60mg in MT (P = .031).
Relapse rates were initially higher in DR but leveled at 3 years;
61.5% relapsed in DR and 68.6% in MT in 7 years.
Conclusion DR of antipsychotics during early stages of remitted
FEP significantly improved 7-years outcome in terms of recov-
ery and functional remission compared to maintenance treatment.
Though initially relapse rates in GD were higher, these equalled
those inMT from3 years to the end of the study. While the necessity
of immediate antipsychotic treatment in FEP and positive symp-
toms relapse is robustly demonstrated in a great number of studies,
this study suggests thatwe are facedwith a dilemma concerning the
drawbacks of long-term maintenance antipsychotic treatment on
functional capacity. Though antipsychotic discontinuation appears
only feasible without relapse in a substantial minority of patients,
guided dose-reduction as far as positive symptoms remain sub-
sided and allow it, appears a feasible strategy in view of functional
recovery, doing justice to both sides of the dilemma.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.