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