European Psychiatry - Volume 33 - March 2016

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S572 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
EV694
Explorations of cooperation and
recalcitrance in secure mental health
hospitals
M. McKeown ∗, M. Chandley , F. Jones , K. Wright ,
J. Duxbury , P. Foy
1 University of Central Lancashire, School of Nursing, Preston, United
Kingdom
2 Mersey Care NHS Trust, Ashworth Hospital, Liverpool, United
Kingdom
∗ Corresponding author.
This paper reports on the findings of three qualitative research
studies undertaken within, respectively, medium and low secure
units in one UK region, and a high secure mental health hospital in
England (UK). The first study investigated alliance based involve-
ment practices. The second explored service user and staff views
and sense making of the notion of recovery. The third study is
ongoing into service user and staff experiences of extreme coer-
civemeasures, such as forms of restraint and long-termseclusion or
segregation. All studies utilised either semi-structured interviews
or focus groups. All data was subject to thematic analysis.
Selected and emergent themes include:
– the importance of relationships and communication; security
first; involvement as pacification;
– different understandings of recovery; the importance of
meaningful occupation; staff-service user relationships; recovery
journeys and dialogue with the past; and recovery as personal
responsibility;
– good and bad coercion; cooperation, resistance and recalcitrance;
and alternatives to coercion.
Findings suggest that cooperation is largely framed by services in
terms of compliance with a bio-medical model. The impact of the
secure environment, whilst ever-present, is not an absolute con-
straint on the realisation of recovery or involvement objectives.
The availability of extreme coercive measures raises some seem-
ingly paradoxical understandings from both service user and staff
perspectives. Critical social theory is drawn on to illuminate the
tensions between cooperation and recalcitrance and suggest fur-
ther exploration of their respective legitimacy.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV695
Effectiveness of paliperidone depot in
seriously violent men with comorbid
schizophrenia and dissocial
personality disorder in a UK
high-security hospital
A.M. Mortlock ∗, F. Larkin , C. Ross , S. Sengupta , M. Das
West London Mental Health NHS Trust, Broadmoor Hospital,
Berkshire, United Kingdom
∗ Corresponding author.
Introduction High-security hospital patients are often complex
in presentation characterised by treatment resistance, medication
non-concordance and history of violence. Paliperidone is licensed
as both an oral and depot antipsychotic for the treatment of
schizophrenia. Whilst there is data for the effectiveness of paliperi-
done palmitate (PP), there are no studies involving patients in
forensic settings or those with comorbid personality disorder.
Objective To determine the effects of PP on violence, aggression
and personality pathology.
Aim To evaluate the clinical effectiveness of PP.
Methods This was a retrospective service evaluation involving 11
patients. Medical records and interviews with the treating psychia-
trist were used to formulate clinical global impression (CGI) and to
identify incidents of violence. The effect on personality symptom
domains; cognitive-perceptual, impulsive-behavioural dyscontrol
and affective dysregulationwas ascertained, as well as engagement
with occupational and psychological therapies.
Results Six patients were being prescribed PP. All 6 showed
improvement in the CGI score with benefits in the symptom
domains. Two patients demonstrated a reduction in violence
risk and 2 remained incident-free. There was improvement in
engagement with therapies. Benefits were also seen in aspects of
personality for those who had discontinued PP.
Conclusions This pragmatic study of a small but complex patient
group demonstrated that PP was effective in reducing symptoms of
schizophrenia. Additionally and for the first time, it was shown that
PP was also effective in reducing violence as well as improving per-
sonality pathology dimensions in a comorbid patient. This could
have significant implications for management of high-security
patients.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV696
The characteristics of alcohol
pharmacokinetics of Korean female
B. Nam ∗, Y.J. Kwon , K.H. Lee , D.I. Jon , I. Shon , J.S. Seo
1 Konkuk University, psychiatry, Chungju, Republic of Korea
2 Soonchunhyang University, Psychiatry, Cheonan, Republic of Korea
3 Dongguk University, Psychiatry, Gyeongju, Republic of Korea
4 Hallym University, Psychiatry, Anyang, Republic of Korea
5 Keyo Hospital, Psychiatry, Uiwang, Republic of Korea
∗ Corresponding author.
Introduction The systematized and proper sized research of alco-
hol pharmacokinetics in Korean has not reported ever.
Objectives and aim Aim of this study is to measure the value
and alcohol pharmacokinetic factors in Korean adult female and
the relationship between the value and some variables includ-
ing age, smoking, total body water, drinking capacity, BMI, blood
cholesterol, body fat and body fat ratio.
Methods Ninety-one subjects were randomly divided into two
groups. One group was provided as much as 0.35mg/mL/kg of
alcohol and the other as much as 0.70mg/mL/kg, and blood alco-
hol concentration was measured 15, 30, 45, 60, 90, 120, 180, and
240min after the women finished drinking.
Results The subjects’ mean alcohol elimination rate ( ) was
−0.002379mg/100mL·h, and there was no statistically signifi-
cant difference in elimination rate between the two groups. The
mean time to reach maximum blood alcohol concentration was
45minutes, alcohol absorption rate was 0.1123 ± 0.1799 g/L/min,
and the area under the concentration curve was 109.15 ±62.95.
Among the factors that correlatedwith alcohol metabolism, alcohol
absorption rate and follicle-stimulating hormone were statistically
significant, but age, body mass index, and body fat percentage were
not significantly correlated with alcohol metabolism.
Conclusions These results suggest that the values for healthy
Korean females can differ from the cut-offs that are currently used
in Korea, which suggests that the legal limit for driving under intox-
ication should be adjusted.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.