

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
S711
2
Laboratorios Farmacéuticos Rovi-S.A., R&D, Madrid, Spain
3
SGS Exprimo NV, Exprimo, Mechelen, Belgium
∗
Corresponding author.
Introduction
Risperidone-ISMis a new long-acting intramuscular
formulation intended to achieve sustained plasma concentrations
over 4weeks without oral supplementation. The clinical efficacy
to risperidone has been associated with 65–80% occupancy of
dopamine D2 receptor (D2RO) and a mean C
max
between 7.5 ng/mL
and 80 ng/mL.
Aim
Use a population PK/PD model to predict the PK and the
D2RO for Risperidone-ISM in schizophrenic patients and to charac-
terize the relationship among doses, in order to guide dose selection
for a future Phase-III trial.
Methods
A population PK/PD analysis for Risperidone-ISM using
Monolix software was conducted based on 6641 plasma samples
from two Phase-I studies (17 healthy subjects and 31 schizophrenic
subjects, respectively) and 1 Phase-II study (60 schizophrenic sub-
jects). Simulations were subsequently undertaken predicting the
steady state PK and D2RO after multiple Risperidone-ISM doses
administered every 28 days for 12weeks.
Results
Doses of 75 and 100mg, administered either in gluteal or
deltoid muscle, were predicted to result in median C
max
and C
trough
that stayed between 7.5 ng/mL and 80 ng/mL. At steady state 75mg
and 100mg dose (gluteal) achieved a D2RO average [min–max]
of 70.8% [61.4–80.4] and 74.3% [66.2–82.1], respectively; a 75-mg
and 100-mg dose (deltoid) achieved a D2RO average [min–max] of
69.3% [56.5–80.3] and 73.0% [61.8–82.1], respectively. The model
estimated that the 65% D2RO occurs within first 8 h after treatment.
Conclusions
Simulations were carried out supporting doses of
75mg and 100mg Risperidone-ISM to show the greatest efficacy
and safety potential to be assessed in the future Phase-III trial.
Disclosure of interest
The authors have not supplied their decla-
ration of competing interest.
http://dx.doi.org/10.1016/j.eurpsy.2016.01.2118EV1134
Electroconvulsive treatment in
Parkinson’s disease and psychosis:
A case report
T. Aparicio Reinoso
∗
, S. Gonzalez Parra
Hospital Dr. R Lafora, Psychiatry, Madrid, Spain
∗
Corresponding author.
Background
Drug induced parkinsonism is a common side effect.
Objective
The present report describes the case of a
schizophrenic patient who developed a parkinsonism after receiv-
ing antipsychotic drugs and who had improved his schizophrenia
and parkinsonism after electrovulsive therapy.
Case summary
We report the case of a man, who is 35 years
old and was admitted to a psychiatric ward, due to decompen-
sated schizophreniawith psychotic features. The patient developed
pronounced parkinsonian features, which did not improve with
discontinuation of the drug or with carbidopa/levodopa. After sev-
eral unsuccessful treatments, the patient was treated with ECT and
showed improvement in both diseases.
Results
The patient’s response to this treatment justifies the use
of ECT in patients with both syndromes: a psychosis productive
and Parkinson’s disease. Even the maintenance therapy can estab-
lish the initial response achieved and keep it through time. We
should keep in mind that the management of these patients, can be
extremely difficult because the medications used to both disorders
are antagonistic.
Conclusion
ECT can be considered in patients with a psychiatric
illness associated with parkinsonism.
Disclosure of interest
The authors have not supplied their decla-
ration of competing interest.
Further readings
Popeo D, Kellner CH. ECT for Parkinson’s disease. Med Hypotheses
2009;73:468–9.
Haryan P, Adams CE. Terapia electroconvulsiva para la
esquizofrenia (Cochrane Review). La Biblioteca Cochrane
Plus,
número 3,
2008.
Oxford,
Update Software Ltd.
http://www.updatesoftware.com[Translated by The Cochrane
Library, Issue. Chichester, UK: John Wiley & Sons, Ltd].
American Psychiatric Association. Andersen K, Balldin J, Gottfries
CG, et al. A double-blind ealuation of electroconvulsive therapy in
Parkinson’s disease with “on-off” phenomena. Acta Neurol Scand
1987;76:191–9.
Fink M. ECT for Parkinson’disease? (Editorial) Convul Ther
1988;4:189–91.
http://dx.doi.org/10.1016/j.eurpsy.2016.01.2119EV1135
Intramuscular maintenance
treatment with ultra-high-dose
long-acting injectable aripiprazole in
an elderly patient suffering from
chronic refractory schizophrenia:
A case report
L. Bartova
∗
, M. Dold , N. Praschak-Rieder , A. Naderi-Heiden ,
S. Kasper
Medical University of Vienna, Department of Psychiatry and
Psychotherapy, Vienna, Austria
∗
Corresponding author.
Long-acting injectable (LAI) aripiprazole is increasingly appreci-
ated in the course of a maintenance treatment of schizophrenia
due to efficacy in delaying – and decreasing relapse, and low rates
of feared side effects. In line with the prescribing information, the
maximal starting – as well as maintenance dose was restricted to
400mg following a 26-day interval between the single doses.
We present a 72-year-old female inpatient (66 kg) with an
acute exacerbation of chronic refractory schizophrenia, exhibit-
ing primarily positive symptoms including excessive persecutory
delusions, self-care deficit, poor insight and insufficient adherence
to continuous intake of oral medication. Since she developed a
post-injection syndrome after an accidental intravascular adminis-
tration of olanzapine LAI 405mg, the antipsychotic treatment was
switched to aripiprazole LAI 300mg once monthly. Due to insuffi-
cient clinical response, aripiprazole LAI was gradually increased up
to 1200mg per month under continuous plasma level monitoring.
Here, 2 single injections of aripiprazole LAI 300mg were delivered
into both gluteal muscles concurrently, every 14 days.
Consequently, we observed a clinicallymeaningful improvement (a
total-score reduction from 111 to 75 on the Positive and Negative
Syndrome Scale), as well as no objectifiable side effects, assessed
by “The Dosage Record Treatment Emergent Symptom Scale” and
“The Barnes Akathisia Rating Scale”, despite multi-morbidity and
rather advanced age of the patient.
Our safe experience with applying the almost threefold higher
monthly dose over 12weeks may encourage researchers to further
investigate the efficacy, tolerability as well as handling of highly
dosed aripiprazole LAI in refractory schizophrenia.
Disclosure of interest
The authors have not supplied their decla-
ration of competing interest.
http://dx.doi.org/10.1016/j.eurpsy.2016.01.2120