Table of Contents Table of Contents
Previous Page  687 / 812 Next Page
Information
Show Menu
Previous Page 687 / 812 Next Page
Page Background

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805

S683

EV1044

Pro-BNP as a biomarker of

asymptomatic clozapine-related heart

dysfunction: Possible usefulness for

clozapine management

V. Prisco

1 ,

, M. Petrosino

2

, M. Fabrazzo

1

1

University of Naples SUN, Department of Psychiatry, Naples, Italy

2

ASL Salerno- Department of Mercato San Severino, Department of

Psychiatry, Mercato San Severino, Italy

Corresponding author.

Cardiovascular clozapine-related side effects such as tachycar-

dia and orthostatic hypotension are well recognized, but are

rarely clinically important. However, the increasing number of life-

threatening drug-related complications are giving rise to concerns

about cardiac adverse reactions (myocarditis, cardiomyopathy,

pericarditis and heart failure). The diagnosis is usually made con-

sidering patient’s symptoms, such as tachycardia, slightly increased

body temperature, subjective chest pain, dyspnea. However, this

symptomatology is not always present in a clozapine-related peri-

carditis. Some authors suggest measuring BNP levels to detect

early and asymptomatic cardiac dysfunction. We here report the

clinical cases of two women, respectively 22 and 28 years old.

They both suffered from an early onset resistant schizophrenia.

Clozapine was gradually introduced, at a dose of 200mg/day, in

both patients. After about one month in both cases, while the

first patient was nearly asymptomatic, apart from the intermittent

fever (only PCR and pro-BNP values were elevated, 16.88mg/dL and

1004 pg/mL, respectively), the second one showed a classic symp-

tomatology suggestive of pericarditis. Clozapine was discontinued

in both patients, resulting in progressive resolution of pericarditis.

Interestingly, in the patient in which pro-BNP was elevated, after

clozapine cessation, the pro-BNP fell down dramatically. Pro-BNP

plasma levels appears to be an interesting test in identifying sub-

jects with asymptomatic cardiac impairment. It would be useful to

evaluate if early treatment with beta-blockers and ACE-inhibitors

may allow the prosecution of clozapine treatment after develop-

ing of mild signs of cardiac toxicity in drug resistant schizophrenic

patients responsive to clozapine.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2029

EV1045

Pseudoakathisia in a patient with

clotiapine abuse: Report of a case

P. Quandt

, M.D.R. Cejas Méndez

Hospital Universitario de Canarias, Psiquiatría, La Laguna, Spain

Corresponding author.

Introduction

Objective symptoms of akathisia in the absence of

subjective symptoms is known as pseudoakathisia, more often

diagnosed in older patients with long-term antipsychotic treat-

ment.

Objective

To describe a case of pseudoakathisia in a patient with

clotiapine abuse.

Aims

Pseudoakathisia management.

Methods

X is a 47-year-old male with chronic insomnia treated

with clotiapine 40mg/day for four years. He admits abusive neu-

roleptic consumption in the past eight months (160mg/day),

without any psychiatric control for years. In recent months he has

experienced different organic complications, requiring multiple

hospitalizations. During psychiatric examinations due to confu-

sional states, repeated lower limbs movements were objectified. X

reported he presented these movements for at least six months,

without complaints of inner restlessness feeling. Neurological

examination showed normal DAT-SCAN result. Clinical progression

was evaluated using BARS scale (Barnes Akathisia Rating Scale).

Results

Following the results of tests and statements of drug his-

tory, X was diagnosed with clotiapine-induced pseudoakathisia.

Neuroleptic treatment was suspended, and clonazepam 6mg/day

and propranolol in ascending doses up to 80mg/day were initi-

ated. In subsequent evaluations, progressive decrease inmovement

intensity was observed. However, complete remission after four

months from clotiapine suspension was not achieved.

Conclusions

Pseudoakathisia is a concept not well defined at this

moment and different hypotheses about its nature are consid-

ered. It has been suggested that it is a form of delayed dyskinesia,

or a clinical progression from akathisia, with acquired subjective

discomfort tolerance. The most widely used treatment includes

benzodiazepines, beta-blockers and anticholinergics, although

their effectiveness is limited.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2030

EV1046

Reduction in medication expenditure:

Review of strategies at a children’s

psychiatric facility

B. Reddy

, M.W. Azeem , J. Smiles , L. Carrabetta

Albert J. Solnit Children’s Center, Child and Adolescent Psychiatry,

Middletown, CT, USA

Corresponding author.

Prescription drug costs rise about 15% annually. Solnit Center has

been exploring ways to reduce overall expenditure on medica-

tions while promoting best practice of care. Lack of facility-based

pharmacy has posed specific challenges in ordering medications,

optimal usage and minimizing wastage of drugs. Each of these

areas were examined and reviewed at Pharmacy and Therapeu-

tics Committee of the facility. This information was shared with

the ordering physicians and standard prescribing practices were

established. This project was aimed at tracking medication costs

over a 11-year period while monitoring supplies and destruction

of unused medications.

Aims

1. Reduce overall medication expenditure while main-

taining standard of care. 2. Develop a program to return unused

medications for refund.

Methods

1. Monthly review of pharmacy cost by facility, patient

and medication. 2. Development and legislative approval of a pro-

gram to return drugs. 3. Collaborate with contracted pharmacy

to explore ways to cut costs. 4. Train nurses and physicians to

understand optimal ordering practice. 5. Demonstrate medications

wasted with associated financial impact to the facility.

Results

The expenditure to the facility over 11 years has grad-

ually decreased despite increase in medication costs. In 2004, the

facility spent $ 712,904 and in 2014, the expenditurewas $ 584,022.

Conclusions

Awareness about costs and optimal ordering prac-

tices led to significant savings to the facility.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2031

EV1047

Mega-review of meta-analyses

investigating the short-term efficacy

of pharmacologic augmentation

strategies of antipsychotics in patients

with schizophrenia

J.M. Rubio

1 ,

, G. Inczedy-Farkas

1

, S. Leucht

2

, J.M. Kane

1 , 3

,

C. Correll

1 , 3

1

Zucker Hillside Hospital, Department of Psychiatry, Glen Oaks, NY,

USA