European Psychiatry - Volume 33 - March 2016

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S684 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
2 Klinikum rechts der Isar, Technischen Universität München,
Munchen, Germany
3 Feinstein Institute for Medical Research, Department of Psychiatry,
Manhasset, NY, USA
∗ Corresponding author.
Antipsychotics are the cornerstone of treatment for schizophre-
nia, but they have limited effectiveness, as most patients require
subsequent strategies at some point of their treatment. Despite
being widely used, the efficacy of pharmacologic augmentation
of antipsychotics is controversial and no combination treatment
has been approved for schizophrenia. We conducted a systematic
review in PubMed and PsycInfo on June 1st 2015 and a random
effects meta-analysis of meta-analyses of short-term, placebo-
controlled studies of pharmacological augmentation strategies of
antipsychotics in schizophrenia. Methodological quality of meta-
analyses was measured using the AMSTAR, plus 6 additional items
developed to rate the content quality of the meta-analyzed tri-
als. Out of 3062 publications, we identified 36 eligible augmenting
strategies. For total symptom reduction, 25 strategies augmenting
antipsychotics and 5 strategies augmenting clozapine were eligi-
ble and examined. Eleven strategies were more efficacious than
placebo, none of them augmenting clozapine. Significant effect
sizes ranged between SMD −1.03 and −0.23. Efficacy was not
correlated with the quality of the meta-analyses. Only the meta-
analysis for NSAIDs augmentation had a score greater than half of
the possible points for content quality. Only antipsychotics, aza-
pirones, antidepressants and lithium were less discontinued than
placebo. Serotonin-3-receptor antagonists, lamotrigine, mirtazap-
ine/mianserine, minocycline and estrogens had large effect sizes
augmenting antipsychotics. However the quality of the content
of most meta-analyses was low. The NSAIDs augmentation meta-
analysis had the best content quality, yet with a low effect size for
efficacy. The evidence for short-term augmentation strategies of
antipsychotics in schizophrenia is inconclusive, due to the limited
quality of the available trials.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1048
California rocket fuel: And what about
being a first line treatment?
J. Silva ∗, J. Mota , P. Azevedo
1 Magalhães Lemos Hospital, Inpatient C Unit, Porto, Portugal
2 Magalhães Lemos Hospital, Inpatient C Unit, Electroconvulsive
therapy Unit, Porto, Portugal
∗ Corresponding author.
Introduction The association venlafaxine-mirtazapine is cur-
rently known as California Rocket Fuel (CRF). Studies show
advantage in terms of efficacy and rapid control of depressive
symptoms compared to other associations. Venlafaxine is a selec-
tive serotonin-noradrenalin reuptake inhibitor and mirtazapine is
a noradrenergic-specific serotonergic antidepressant: the result is
a potent noradrenergic and serotonergic effect. Studies say that CRF
should be performed only for drug-resistant depression; however,
there are case reports of its use as a first line treatment, in selected
patients.
Objectives To summarize the latest literature about this field and
to present a case report.
Aim To explore and critically review the controversies of
venlafaxine-mirtazapine association as a first line antidepressants
strategy.
Methods A brief review of the latest literature was performed,
using PubMed and the keywords “venlafaxine-mirtazapine associ-
ation”. A case report about a depressed woman is presented.
Results Despite most studies are referent to its utility in drug-
resistant depression, there are recent pilot studies that recommend
CRF as a first line option.
M., a 64-year-oldwoman, had her first psychiatric consultation. She
had been depressed for 2 years, she lost 10 kg, had total insomnia
and suicidal thoughts. CRF was started up to 150/15mg, daily. An
improvement was noticed after two weeks of treatment and the
stabilization of depressive symptoms were achieved by the fourth
month.
Conclusions CRF seems to be effective and useful. Patients with
insomnia andweight lossmay benefit fromCRF as a first line option.
However, more studies are needed.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1049
The impact of tobacco smoking in
patients taking long-action injection
drugs – A retrospective comparative
study between haloperidol and
risperidone
J. Silva ∗, H. Prata-Ribeiro
1 Magalhães Lemos Hospital, Inpatient C Unit, Porto, Portugal
2 Júlio de Matos Hospital, General and Transcultural Psychiatry Unit,
Lisbon, Portugal
∗ Corresponding author.
Introduction Smoking rate seems to be higher among patients
with schizophrenia, comparing to other psychiatric entities, mainly
in those who are on typical antipsychotics. Tobacco is known to
have enzyme inducer properties, due to cytochrome P450 com-
plex activity: CYP1A1, CYP1A2, CYP2E1 and CYP2D6. CYP2D6 and
CYP1A2 play an important role in antipsychotics metabolism,
mainly in the first generation ones, like haloperidol, despite its
importance in risperidone metabolism.
Aim To analyze the importance of tobacco smoking in patients
taking long-action injections.
Objectives To investigate how sexual dysfunction varies with
tobacco smoking, in patients taking long-action injections.
Methods Individuals from both sexes, from 18 to 55 years old,
taking antipsychotic long-action injections, answered the Arizona
Sexual Experience Scale (ASEX).
Results In the studiedpopulation (n = 44), therewere 20 individu-
als on haloperidol and 24 individuals on risperidone. In a total of 18
(40.9%) positive results for sexual dysfunction, 6 were on haloperi-
dol (30%), 12 (50%) were on risperidone. Seventeen individuals of
the 20 who were on haloperidol were smokers, but only 4 were
considered to have sexual dysfunction, 35.3%; 12 of the 24 indi-
viduals who were on risperidone were smokers, but only 5 were
considered to have sexual dysfunction, 41.7%.
Conclusions Patients treated with haloperidol smoke more, com-
paring to risperidone. Sexual dysfunction is more frequent in
patients taking risperidone than in patients taking haloperidol. This
data supports that CYP2D6-CYP1A2 induction by tobacco, mainly
interacts with haloperidol, which may be helpful for patients to try
less side effects.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.