European Psychiatry - Volume 33 - March 2016

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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 ∗, M. Petrosino , M. Fabrazzo
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.
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.
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.
EV1047
Mega-review of meta-analyses
investigating the short-term efficacy
of pharmacologic augmentation
strategies of antipsychotics in patients
with schizophrenia
J.M. Rubio ∗, G. Inczedy-Farkas , S. Leucht , J.M. Kane ,
C. Correll
1 Zucker Hillside Hospital, Department of Psychiatry, Glen Oaks, NY,
USA