ABSTRACTS - World Psychiatric Association

and worse global functioning (as evaluated by the Global Assessment
of Functioning, GAF), both at the admission and in the course of the
last year. CGI improvement score was significantly higher in the
clozapine treated group. The most serious side effects were neutropenia
(6 cases), epileptic seizures (2), clonic jerks (4), pancreatitis (4),
ileus (1). All these side effects disappeared completely in a few days,
after withdrawal or dose reduction of clozapine. In conclusion, clozapine
is very effective in the treatment of psychotic disorders. Its current
underuse is not justified from a clinical point of view.
PO1.33.
EFFECTIVENESS OF COMPULSORY TREATMENT
WITH ANTIPSYCHOTICS
P.F.J. Schulte
Mental Health Services North-Holland North, Heiloo,
The Netherlands
In 2008 the Dutch Society for Psychiatry presented a guideline for
decision-making on compulsory hospitalization and treatment. As
part of the preparation a systematic review was carried out to assess
the effectiveness of compulsory treatment with antipsychotics, antidepressants
and electroconvulsive therapy. A systematic search strategy
in Medline revealed no randomized controlled trials and only one
controlled trial. Two controlled trials were included after additional
information by the authors. Hand search and inspection of the references
added five controlled and two uncontrolled trials. We present
here the controlled studies with antipsychotics.Three investigations
found no difference in treatment outcome between compulsorily and
voluntarily treated patients (the majority with psychosis and treated
with antipsychotics). The fourth investigation compared involuntarily
admitted patients (74.5% with schizophrenia or schizoaffective
disorder) who accepted medication with those who were compulsorily
treated with medication. The outcome was slightly better in the
group with compulsory medication. Hoge et al (1990) found longer
hospitalization and more seclusion and restraint in patients who
refused medication after admission in comparison to non-refusing
patients. In schizophrenic outpatients, a community treatment order
(CTO, which includes in nearly all patients obligatory medication)
leads to a decrease of number and duration of hospitalizations in the
twelve months after start of the CTO in comparison to the twelve
months before. A second investigation in psychotic outpatients with
CTO found less hospitalizations in the group with depot antipsychotics
in comparison to the group with oral antipsychotics. The
Dutch guideline commission concludes that compulsory treatment
with antipsychotics shows comparable effectiveness as voluntary
treatment.
PO1.34.
AN AUDIT OF ANTIPSYCHOTIC MEDICATION
PATHWAYS IN FIRST EPISODE PSYCHOSIS
Y. Dundar, J. Underwood, S. Jefferies, Y. Denham, D. Vecchio
Department of Psychiatry, North Devon District Hospital; North
Devon Specialist Team for Early Psychosis, Devon, UK
The National Institute for Health and Clinical Excellence (NICE)
guidelines published in 2002 recommend for first-episode psychosis
the prescription of atypical antipsychotics as first line at low dose as
monotherapy, and to initiate clozapine in treatment-resistant
patients. We aimed to compare current antipsychotic prescribing in
early psychosis in North Devon with practice recommendations by
NICE guidelines. We carried out a retrospective file audit on randomly
selected young people (n=36) presenting with first-episode psychosis
under the care of Specialist Team in Early Psychosis (STEP) in
North Devon. Diagnoses were: psychotic episode (48.3%), druginduced
psychosis (37.9%), schizophrenia (3.4%), schizoaffective
disorder (3.4%), mood disorder (3.4%) and psychotic depression
(3%). In 32 (89%) cases an antipsychotic medication was indicated.
Prescribing antipsychotic monotherapy was consistent with NICE
guidelines in all cases; however, clozapine was not initiated in any of
the four cases where there was no improvement for 6-8 weeks with
two different antipsychotics. Consistent with NICE guidelines: atypical
antipsychotic were used as first medication (93.8%), the prescription
of low-dose atypical antipsychotic as first medication (81.3%),
and antipsychotic dose range within the British National Formulary
standard range (83.6%). These findings suggest that there is some
inconsistency in prescribing practice. Introducing a standardized
form for recording initiation and changes in medication would be
useful to improve consistency and clarity of recording of medication.
In addition, well-staffed early intervention teams with dedicated consultant
input, specialised training, and procedures for involving and
educating users, cares and general practitioners are essential in
improving practice in an area where the diagnosis is often uncertain.
PO1.35.
ATTITUDES TOWARDS MEDICATION IN BIPOLAR
AND SCHIZOPHRENIC PATIENTS AT DISCHARGE
FROM PSYCHIATRIC ACUTE INPATIENT UNIT
J. Salva, M. Silvestre, J.L. Galan, J. Larumbe, A. Ugidos, I. Leon
Hospital Universitari Son Dureta, Palma de Mallorca; Hospital
Infanta Cristina, Badajoz; AstraZeneca Farmaceútica Spain;
Hospital Psiquiatrico de Alava; Hospital Virgen Blanca, León;
Mediclin-Quintiles, Madrid, Spain
The purpose of this study was to assess the attitudes towards medication
in bipolar and schizophrenic patients at discharge from a psychiatric
acute inpatient unit, and to explore factors associated with this
attitude. This was an observational, cross-sectional and multicenter
study. Patients were recruited consecutively in 5 inpatient acute units
in 5 states of Spain. Assessments were carried out in the 24-48 hours
prior to discharge. The average and median on the Drug Attitude
Inventory (DAI) was 16.0; 66.7% of the patients had a DAI>15. We
found a statistically significant relationship between DAI>15 and the
length of the assessed admission (p=0.01), the last admission
(p=0.007) and the last acute episode (p=0.04); the number of years
since the prior admission (p=0.04), the numer of years since the prior
acute episode (p=0.01), and the total score on the Scale to Assess
Unawareness of Mental Disorder (SUMD), used for assessment of
insight (p=0.001). There was no significant relationship between
DAI>15 and age, duration of illness, educational level, number of
acute episodes in the previous 5 years, psychoeducational therapy,
and CGI-S and CGI-C scores. We did not identify any variable with
influence on the DAI on the logistic regression analysis.
PO1.36.
DURATION OF DRUG THERAPY IN PATIENTS
WITH SCHIZOPHRENIA
J. McCombs, S. Zolfaghari, D. Stafkey-Mailey, V. Ganapathy
School of Pharmacy, University of Southern California, Los
Angeles, CA, USA
This study aimed to compare time to all-cause discontinuation
(TTAD) across drug therapies for patients with schizophrenia. Three
years of commercial health plan data were used to identify non-institutionalized
patients with schizophrenia initiating treatment using
162 World Psychiatry 8:S1 - February 2009