European Psychiatry - Volume 33 - March 2016

773 / 812

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805 S769
EV1318
A systematic review on
pharmacological treatment in
delusional disorder
J.E. Mu˜noz Negro ∗, J. Cervilla-Ballesteros
Andalusian Health Service, Mental Health Unit, CIBERSAM.
University of Granada, Granada, Spain
∗ Corresponding author.
Introduction Pharmacological treatment is the gold standard in
DD. None SGA is authorized for the treatment of DD. To date, only
one systematic review-addressing treatment of DD has been per-
formed. However, it was only reported data about CBT therapy.
Methods A systematic review on pharmacological treatment of
DDwas conducted. We selected the best evidence available, mainly
searching in online databases. Then, we analyzed them critically,
assessing its biases and quality, finally performed a narrative and
quantitative synthesis.
Results The quality of the evidence was very low. There were not
randomized clinical trials and most of the studies were observa-
tional or case series reports. We could collected a good number of
cases, (n = 336) 137 FGA, 189 SGA and 10 antidepressants. Antipsy-
chotics achieved a good response in a 61.35% of the patients.
Moreover, SGA (65.08% good response) were more effective than
FGA (56.20% good response) although the difference did not
reach statistical significance. (Chi2 = 2.6384, P ≤ 0.10). Haloperidol
(88.14% good response), risperidone (69.60% good response) and
olanzapine (71.64% good response) were the most effective treat-
ments, although the difference in favour of haloperidol it might be
biases by the methodology used.
Conclusions Although the quality of the evidence was very low
to make strong recommendations, antipsychotics appear to be an
effective treatment for DD. We need to develop clinical trials in DD
and SGA might be the best candidates to do.
Keywords Paranoia; Delusional disorder; Treatment; First
generation antipsychotics; Second generation antipsychotics.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1319
Lamotrigine induced DRESS syndrome
in bipolar disorder: Multiple snares
behind a potentially life-threatening
adverse reaction
G. Oriolo ∗, A. Brugués , J.M. Goikolea , L. Pintor
1 Hospital Clínic de Barcelona, Psychiatry, Barcelona, Spain
2 Hospital Clínic de Barcelona, Dermatology, Barcelona, Spain
∗ Corresponding author.
Background Lamotrigine is widely used to prevent bipolar
depression. Drug Reaction with Eosinophilia and Systemic Symp-
toms (DRESS) is a rare, potentially life-threatening adverse effect.
The long latency between drug exposure and disease onset, added
to the high variability of its clinical presentation, can increase the
risk of misdiagnosis lamotrigine withdrawal delay.
Objective To highlight potential risk factors that can be related to
a worse clinical onset and evolution of lamotrigine-induced DRESS
syndrome.
Methods We report the case of a 25-year-old-man, with a type
I bipolar disorder, treated with lithium and lamotrigine 50mg per
day during the first 13 days of treatment, progressively increase up
to 200mg. Thirty-five days after the treatment initiation, a pruritic
rash appeared in his upper arms, and scabies infestation was diag-
nosed. After 72 hours, the patient required urgent hospitalization
due to hemodynamic instability.
Results On admission, facial edema and erythrodermia were
involving 70 to 80% of the body surface. DRESS diagnosis due to lam-
otriginewasmade following RegiSCAR criteria (Table 1). Psychiatric
medication was stopped and DRESS treatment established. Com-
plete recovery without recurrence was achieved after 2 months.
Conclusions The lamotrigine up titration faster than recom-
mended may have facilitated the DRESS syndrome reaction.
Moreover, the latency between lamotrigine introduction and the
rash onset could have increased the possibilities of misdiagnosis.
In light of this, physicians need to consider at least the last 3months
treatment history when assessing a rash, as the delay of DRESS
syndrome diagnosis can fastly lead to a fatal event.
Table not available.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1320
Long-acting injectable antipsychotics:
Diagnostics and patient profile
L. Pérez Gómez ∗, A. Gónzalez Fernández , D.F. Frías Ortíz ,
O.W. Muquebil Ali Al Shaban Rodríguez ,
C.M. Rodríguez Mercado , M. Jalón Urbina , L. García González
1 Centro de Salud Mental El Coto, Psiquiatría, Gijón, Spain
2 Hospital de San Agustín, Unidad de Hospitalización Psiquiátrica,
Avilés, Spain
3 Hospital Fundación de Jove, Unidad de Psiquiatría, Gijón, Spain
4 Centro de Salud Mental de Mieres, Psiquiatría, Mieres, Spain
5 Hospital Fundación de Jove, Psiquiatría, Gijón, Spain
6 Hospital Universitario Central de Asturias, Unidad de Psiquiatría,
Oviedo, Spain
∗ Corresponding author.
Introduction Long-acting injectable antipsychotics (LAIs) were
developed in the sixties with the purpose of improving schizophre-
nia maintenance treatment. The main advantages are: the ability
to ensure compliance, maintaining stable plasma concentrations
and allowing better clinical management of drug therapy. Long-
acting atypical injectable antipsychotics start to develop in the late
nineties. Currently, they are the most widely used depot treatment
for severe mental illness.
Objective Checking patient profile and diagnosis where we use
LAIs.
Methods Review of 217 patients treated with LAIs in CSM El
Coto–Gijón.
Results In our sample, the average age of the patients was 48.94
years old. Most of them were men (135 vs. 82). More than half
of treated patients were diagnosed with schizophrenia (112), the
paranoid subtype was the most repeated (93). Other severe mental
illnesses were also treated with LAIs: emotionally unstable per-
sonality disorder (31), delusional disorder (19), bipolar disorder
(15), schizoaffective disorder (12) and other less frequently. For
all groups, paliperidone palmitate was the most used injectable
antipsychotic. The new aripiprazole long-acting injectable starts
being used in psychotic patients with a significant affective com-
ponent.
Conclusions The schizophrenic patient remains being the prime
candidate for this therapy although other severe mental disor-
ders may also benefit of LAIs treatment. Most classical long-acting
injectable antipsychotics have been replaced by new atypical
injectable antipsychotics with a more tolerable side effects profile.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.