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S804

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2416

EV1432

Application of psychiatric laws in

Santa Isabel mental hospital (Leganés)

during the Civil War and first decades

of the Spanish post-war (1936–1952)

P. Vázquez de la Torre Escalera

1 ,

, A. Conseglieri Gámez

2

,

R. Candela Ramírez

1

1

Fuenlabrada Hospital, Psychiatry, Madrid, Spain

2

Parla Hospital, Psychiatry, Madrid, Spain

Corresponding author.

Introduction

The Republican psychiatric reform, particularly the

promulgation of the Decree of 3rd July 1931, marked the first seri-

ous attempt by the Government to transformpsychiatric assistance

in Spain. However, the literature examining the implementation

of these legislative changes in the clinical practice of the mental

institutions is still very scarce.

Objectives and aims

We intend to analyse the actual extent of the

Republican reforms in the assistance of mental patients admitted

to the Leganés Asylum during this turbulent period of the history

of Spain, mainly focusing on the implementation of the Decree of

3rd July 1931.

Methods

The method followed includes a review of the medical

records, statistic registers and other documents kept at the institu-

tion’s historical archive.

Result

During the study period, all the statistical forms on men-

tal patients required by law were completed. However, during the

years of the war (1936–1939) other documents required under

the Decree of 1931 were quite irregularly compiled in the clini-

cal records. Furthermore, the semester medical bulletins that had

to be submitted to Court, whenever a patient’s clinical condition

required a hospital sojourn beyond six months, were systemati-

cally suppressed. These administrative procedures were restored

after the war. Similarly, during the war, assumptions of admissions

not covered by previous legislationwere added, such as admissions

by military order, which were abolished once the war ended.

Conclusions

The exceptional situation lived during the Civil War

prevented the regular implementation of psychiatric legislation at

the Leganés Mental Hospital. Once the war ended, its enforcement

was restored.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2417

EV1433

The use of repetitive transcranial

magnetic stimulation in Malta – A

clinical perspective

M. Xuereb

University of Malta, Psychiatry, Msida, Malta

Repetitive Transcranial Magnetic Stimulation (rTMS) has been

approved by the FDA for treatment resistant, severe, non-psychotic

unipolar affective disorder. The aim of this presentation is to share

our experience setting up the rTMS clinic – a first on our small

island. We will also be showing data of patients over the treatment

period through individual comments made by patients as well as

through established depression scales. Finally, a modus operandi of

managing side effects, community monitoring and follow-up will

be suggested.

Disclosure of interest

The author has not supplied his/her decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2418

EV1434

Atypical neuroleptic malignant

syndrome in adolescence

H. Yilmaz

, S. Köse , B. Özbaran

Ege University Bornova, 35040 Izmir, Turkey

Corresponding author.

Objective

To report re-challenges of antipsychotic drugs after

neuroleptic malignant syndrome (NMS) in a case of Cotard syn-

drome and considering electroconvulsive treatment as an option

in these cases.

Case report

A 17-year-old adolescent, treated for acute psychotic

attack with multi-antipsychotic (olanzapine, risperidone) for 15

days, developed NMS within 48 hours of the addition of low doses

of clozapine to his regimen. Symptoms included fever, agitation,

dysautonomia, pulmonary edema, ventricular failure and labora-

tory findings, which included elevation of CK levels, leukocytes,

transaminase, resolved after discontinuation of psychotropics, sup-

portive management and 6 days of treatment with bromocriptine

and amantadine. At first, patient was treatedwith lowdoses of que-

tiapine. Then, we decided to imply ECT because of two reasons. The

first reason is low dosage of quetiapine was not believed to control

symptoms which included Cotard syndrome based on assertions

such as “I amdead”, “I cannot breathe”, “My teeth andmy bones are

melted”, suicidal thoughts, incoherence speech. The second reason

is increasing quetiapine dose rapidly could have caused relapsing of

NMS. Finally, we transferred our patient to another child psychiatry

clinic where ECT can be applied.

Discussion

Starting atypical antipsychotic drugs in re-emergence

of post NMS psychosis and catatonia is a challenge. Because of the

risk of relapsing NMS, anti-psychotic drugs must be started lower

dosage, titrated up slowly then patient should be monitored at

least two weeks until resumption of therapy. Process of monitoring

depends on existing of clinical residua. Moreover, it is unclear when

clinical residua exist, thus it is difficult to interpret the existing

guidelines on safe reintroduction of antipsychotics. At that point,

ECT can be considered as an option in order to control psychotic

symptoms.

Conclusions

Clinicians should closely monitor patients when

restarting anti-psychotic drugs after NMS owing to risk of relapsing

NMS and ECT should be considered as an option in order to control

symptoms.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2419

EV1435

Job satisfaction and resilience among

psychiatric nurses – A study in the

Institute of Mental Health, Singapore

Z. Zhimin

1 ,

, P. Gangaram

1

, H. Xie

2

, S. Chua

1

, S. Ong

3

, S.E. Koh

3

1

Institute of Mental Health, Community Psychiatry, Singapore,

Singapore

2

Institute of Mental Health, Nursing, Singapore, Singapore

3

Institute of Mental Health, Nursing Administration, Singapore,

Singapore

Corresponding author.

Introduction

The widespread nursing shortage and nurses’ high

turnover rate has become a global issue. Job satisfaction ranks

highly as one of the main factors influencing turnover rates among

nurses. Mental health nursing has been reported to be a particularly

stressful specialty, yet little is known about the level of job satisfac-

tion among psychiatric nurses in Singapore. Resilience is defined as

a means of adapting to stress at the workplace, and may serve as a

factor influencing job satisfaction.

Objectives/Aims

This study aimed to explore the current level of

job satisfaction in psychiatric nurses working in the only tertiary