SYMPOSIA

Poster Presentations
pharmacological treatments such as methadone, buprenorphine, buprenorfine-naloxone as well as psychosocial therapy. Buprenorphine-
Naloxone therapy is being used effectively as an alternative treatment to entering patients into a methadone outpatient clinics (1). The
clinical relevant effect of buprenorphine depends on m-opioid receptor agonism (2).
Case: 16-years-old male patient with opioid dependence diagnosed according to DSM-IV criteria entered CEMATEM ( Child and
Adolescent Alchol and Substance Treatment Centre ) clinic for out-patients in Bakirkoy Research and Training Hospital for Psychiatry and
Neurology and a week later the patient has been hospitalized. Liver enzyme levels were normal and opiat value was found as positive in
sub-threshold in routine controls and after 6- 8 hours Buprenorfin-Naloksan combination (Suboxone) treatment was received the patient
experienced withdrawal symptoms.In patient’s routine blood tests, hepatitis C virus (HCV) was determined and the patient developed
significiantly elevated liver enzyme levels during buprenorphine-naloxone treatment.
Conclusions: Although Buprenorphine has been used clinically in the early 1970s, it’s metobolism has not been fully unterstood already
(3). Buprenorphine was mainly metobolized by N-dealkylation and glucuronidation of buprenorphine and norbuprenorphine by CYTP450
isoforms in liver ( 4). For non-hepatitis subjects, buprenorphine treatment showed no evidence of altered liver enzyme levels.
In contrast, AST and ALT levels increased significantly with buprenorphine treatment among patients with a history of hepatitis (5).
Liver enzym values significiantly elevated in this case with hepatitis C received Buprenorphine-Naloxone combination treatment.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S201-2
[PP-129] Ref. No: 105
The use of z hypnotics in the management of insomnia in forensic psychiatric
units in Oxford, England
Hasanen Ali Altaiar
Oxford Health NHS Trust, Littlemore Hospital, Oxford, ox4 4xn, UK
E-mail: hasanen.al-taiar@oxfordhealth.nhs.uk
Objectives: Insomnia has an estimated prevalence of 30% in general population and its prevalence is higher among psychiatric patients. In 1987 a
survey showed around half of psychiatric patients received a hypnotic medication. Also people with mental health problems have an increased risk of
developing dependence on hypnotics. “Z-drugs” are benzodiazepine like medications and are used as primary pharmacological treatment for insomnia.
They include zolpidem, zaleplon, and zopiclone. Zopiclone is not available in the US, although its active stereoisomer, eszopiclone is available. NICE
guidelines recommend trying non-pharmacological interventions such as sleep hygiene prior to considering “z drugs.” The symptoms, findings of
evaluation, and the reasoning behind prescribing “z drugs” should be documented in medical and nursing notes. The maximum duration should not be
longer than 2 weeks when “z drugs” were used.
The aims of this study included: To review if ‘z-drugs’ were prescribed according to the NICE guidelines, whether “insomnia” was documented in patient
charts or not, if other measures were tried before prescribing a “z drug,” and if the reason for switch was documented, in case of switching from one “z
drug” to another.
Methods: We reviewed all the progress notes and medication charts for a 6-month duration between January 1-June 30, 2010 for all of the inpatients (n=
74) in the 6 forensic wards at the Littlemore Hospital. We identified the patients, who were prescribed “z drugs” for insomnia, and reviewed their records.
Results: We found out that only 3 patients were prescribed “z drugs,” which was zopiclone 7.5mg/day for all of three cases. All orders were for as needed
basis use. Insomnia was recorded in medication charts, but not in the notes section. Non-pharmacological measures were tried in only one of the patients
and documentation was found in one case, too. The maximum duration was not documented and there was no revision in original orders.
Conclusions: Based on our data the “z drugs” are rarely used in forensic units of Littlemore Hospital. The only prescribed one was zopiclone and it was
used only for a couple of days. The documentation regarding use of those medications was rare and no case of switch to another “z drug” was found.
Checking for the response to the treatment and conducting the study in general wards beside forensic units would have improved this study and
provided more patients, who were prescribed those medications.
The majority of forensic patients are on high doses of antipsychotics or rapid tranquilizers, which might help to cope with insomnia. We found that
other than documentation the standards were followed by the Trust. As forensic patients were supervised at all times on-call doctors should be able to
prescribe Z hypnotics, when needed. The use of sleep hygiene in treatment of insomnia should be encouraged for all patients.
Key words: Z hypnotics, forensic, psychiatric, z drugs, Oxford
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S202
S202 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org