European Psychiatry - Volume 33 - March 2016

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S676 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
EV1022
Delay in initiating clozapine therapy
in a Sri Lankan setting
C. Kapugama ∗, W. Kotalawala
National Hospital of Sri Lanka, Department of Psychological Medicine
– Ward 59, Colombo, Sri Lanka
∗ Corresponding author.
Introduction Treatment resistance occurs in one third of patients
with schizophrenia. The only licensed drug for this is clozapine.
Guidelines recommend that clozapine be offered at the earliest
opportunity for patients with treatment resistance. Sometimes,
delays occur in initiating clozapine.
Objectives and aims To study the delay in offering clozapine to
patients with resistant schizophrenia.
Methods Descriptive study. Random sample of patients on cloza-
pine attending NHSL, ‘clozapine clinic’ were interviewed, and their
clinical records reviewed.
Results Sample 63 (25 males, 39.68%). Mean age: 34.95 years;
mean duration of illness: 13.42 years. Clinical diagnosis in all was
schizophrenia. Mean duration on treatment with clozapine was
6.80 years. In 28 (44.44%), two drug trials were tried prior to clozap-
ine; three drug trials in 26 (41.26%); four drug trials in 9 (14.28%). In
49 (77.77%) patients, two second-generation antipsychotics (SGAs)
tried prior to clozapine while in 14 (22.22%) three SGAs tried. Entire
sample was given both risperidone and olanzapine. Antipsychotic
polypharmacy was used in 18 (28.57%). Higher than recommended
doses of antipsychotics either alone or in combination, were used in
36 (57.14%). Olanzapine up to 30mg daily was tried in 25 (39.68%).
Conclusion There is a considerable delay in offering clozap-
ine to patients with resistant schizophrenia. Multiple drug trials,
antipsychotic polypharmacy and administration of higher than
recommended drug doses seem to precede clozapine in a large
percentage of patients.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1023
Aripiprazole is effective for the
improvement of psychotic symptoms
in patients with dementia with lewy
bodies
Y. Kikuchi∗, T. Kanbayashi , T. Shimizu
Akita University School of Medicine, Neuropsychiatry, Akita, Japan
∗ Corresponding author.
Objective Dementia with lewy bodies (DLB) is commonly consid-
ered the second most common form of dementia. The purpose of
this study is to investigate the treatment effects of aripiprazole in
patients with DLB.
Methods Eleven patients who had meet the criteria for DLB par-
ticipated in this study. The presence of psychotic symptoms was
confirmed by scores of either the delusions or hallucinations items
of the Neuropsychiatric Inventory (NPI) score. Patients who had 25
or more on the Mini-mental State Examination Scale (MMSE) at
the entry or having brain damage were excluded. Aripiprazole was
initiated at a low dose (3 or 6mg/day) and titrated to higher doses
at 2-weeks intervals or more rapidly based on investigator’s judg-
ment. Previous medications prior to aripiprazole administration
were not changed through this trial. Patient’s clinical status was
assessed at baseline, then 2 weeks during the study by using NPI,
Clinical Global Impression (CGI) and Brief Psychiatric Rating Scale
(BPRS) to measure psychotic behavioral symptoms, and Simpson-
Angus Scale (SAS) to measure parkinsonism symptoms. Clinical
Dementia Rating (CDR) and MMSE were carried out at screening
and end point to evaluate cognitive function.
Results The mean scores of the SAS and CDR were significantly
decreased at the study endpoint compared to baseline. The mean
scores of the NPI and BPRS improved up until 4 weeks after hav-
ing started aripiprazole. After 4 weeks, improvements slowed. The
mean score of the CGI-S was decreased up until 8 weeks.
Conclusion This study shows that aripiprazole may be effective
for the treatment of psychotic symptoms in patients with DLB.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1024
Tropicamide eye drops reduce
clozapine-induced hypersalivation: A
case report
O. Kilic ∗, H.M. Ozturk , E. Ata
1 Beykent University, Psychology, Istanbul, Turkey
2 Abant Izzet Baysal University Izzet Baysal Mental Health Research
and Training Hospital, Psychiatry, Bolu, Turkey
∗ Corresponding author.
Introduction Clozapine-induced sialorrhea (CIS) is a common,
treatment-limiting and stigmatizing side effect. All systemic agents
that are used for hypersalivationmay increase clozapine side effects
such as blood pressure changes, constipation, or arrythmias. Oral
application of topical anti-muscarinic agents may be a low side
effect option for treatment of CIS.
Objective The aim of this case report was to propose an off-label
treatment of tropicamide drops to CIS and to stimulate further
investigation.
Case report A 33-year-old male inpatient with schizophrenia has
been on clozapine 800mg and amisulpride 600mg/day. His drool-
ing was occasional and severe as drool drips off his chin during
the day and night. Wet area over the pillow, visual analog scale
(VAS), the short form of health survey (SF-36), UKU side effect rat-
ing scale, scale for the assessment of negative symptoms (SANS),
scale for the assessment of positive symptoms (SAPS) were applied
at baseline and in one-week intervals. Oral application of one drop
of tropicamide % 0.5 (5mg/mL) to left and one drop to right side
before going to bed in the first week and two drops to each side
were administered subsequently. Informed consent was given by
the patient.
Results No psychological, neurological, autonomic and other side
effects were observed associated with tropicamide. On VAS, the
patient rated hypersalivation 5/7 at baseline, 4/7 after one drop
each, 3/7 after two drops each.
Conclusions The reduction of CIS by oral use of tropicamide eye
drops is promising and should be explored with randomized con-
trolled trials.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1025
The therapeutic potential of natural
compounds against Alzheimer’s
disease: A preclinical pharmacological
study in both sexes
N. Kokras ∗ Dimitriadou otiropoulos
A.L. Skaltsounis , A. Tsarbopoulos , C. Dalla
1 Medical School, University of Athens, First Department of
Psychiatry, Athens, Greece
2 Medical School, University of Athens, Department of Pharmacology,
Athens, Greece
3 School of Health Sciences, University of Minho, Life and Health
Sciences Research Institute ICVS, Braga, Portugal