European Psychiatry - Volume 33 - March 2016

808 / 812

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.
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 ∗, A. Conseglieri Gámez ,
R. Candela Ramírez
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.
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.
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.
EV1435
Job satisfaction and resilience among
psychiatric nurses – A study in the
Institute of Mental Health, Singapore
Z. Zhimin ∗, P. Gangaram , H. Xie , S. Chua , S. Ong , S.E. Koh
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