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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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2032

EV1048

California rocket fuel: And what about

being a first line treatment?

J. Silva

1 ,

, J. Mota

2

, P. Azevedo

1

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2033

EV1049

The impact of tobacco smoking in

patients taking long-action injection

drugs – A retrospective comparative

study between haloperidol and

risperidone

J. Silva

1 ,

, H. Prata-Ribeiro

2

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2034