ABSTRACTS - World Psychiatric Association

useful in clinical practice as an adjuvant treatment for hospitalized
patients with severe, drug-resistant major depression.
PO1.166.
VAGUS NERVE STIMULATION AND RESISTANT
DEPRESSION: A SYSTEMATIC REVIEW
C. Daban, A. Martinez-Aran, N. Cruz, M. Bonin, E. Vieta
Clinical Institute of Neurosciences, Hospital Clinic, University
of Barcelona, Spain
Since 2005, vagus nerve stimulation (VNS) is considered as an
adjunctive for treatment-resistant depression (TRD) (unipolar or
bipolar). Our objective is to give a clear overview of the safety and
efficacy of the VNS by means of a systematic review. The review was
made using the major databases beginning in January 2000 until April
2008. A total of 108 references were found, but only 20 add-on studies
meeting the required criteria were selected for this review. Since
only one double-blind randomized study was published, a metaanalysis
was not feasible. Regarding the efficacy, VNS is associated to
a reduction of depressive symptoms in a majority of the open studies.
Unfortunately, in the only double-blind study the results are rather
disappointing and inconclusive. Regarding safety, despite its invasive
nature, VNS can be considered as safe and feasible. VNS therapy is
an interesting new approach for the treatment of TRD. Although the
results are rather promising, we must be cautious in our conclusions
since the evidence is only based on open studies. Further clinical trials
are needed in bipolar patients, regarding the predictors of
response, the cost-efficacy and the mechanism of action to better
understand and develop VNS therapy for affective disorder.
PO1.167.
FUNCTIONAL OUTCOME AFTER 12 MONTHS
OF DEEP BRAIN STIMULATION FOR TREATMENT
RESISTANT MAJOR DEPRESSIVE DISORDER
S.H. Kennedy, S. Rizvi, H. McNeely, P. Giacobbe, H.S. Mayberg,
A.M. Lozano
University of Toronto, Ontario, Canada; St. Joseph’s Hamilton
Healthcare, Hamilton, Canada; McMaster University, Hamilton,
Canada; Emory University, Atlanta, GA, USA
Although improvements in function are fundamental to recovery
from a depressive episode, reductions of individual symptoms often
precede objective increases in a patient’s functional capacity. In order
to assess the full utility of an antidepressant therapy, it is not only necessary
to explore the rate of symptom decline, but also the trajectory
for improvement across various domains of function. In 20 patients
with treatment resistant major depressive disorder, measures of mental,
physical, and sexual function, and neuropsychology tests that
assess executive function, memory and emotional responsivity, were
administered before and at various times up to 12 months after deep
brain stimulation to the subcallosal ingulated gyrus. The rate and
degree of functional improvement across measures was analyzed for
all patients. The influence of executive function, memory and emotional
responsivity and personality dimensions was also examined in
relation to functional outcome. The results extend the emerging evidence
base on deep brain stimulation as an alternative to existing
options for treatment resistant depression.
PO1.168.
APPLYING TWO TRANSCRANIAL MAGNETIC
STIMULATION SESSIONS PER DAY COULD HELP
IN THE FASTER REDUCTION OF DEPRESSIVE
SYMPTOMS
P. Sakkas, C. Theleritis, C. Psarros, V. Masdrakis,
T. Paparrigopoulos, G.N. Papadimitriou
First Psychiatry Department, Athens University Medical School,
Eginition Hospital, Athens, Greece
During the last seven years, we completed various pilot studies using
repetitive transcranial magnetic stimulation (rTMS), trying to evaluate
its efficiency. In this context we selected some patients suffering
from drug resistant major depression, who wanted to be treated with
rTMS, and gave them an intensive treatment. We raised the magnetic
intensity to 110-120% of the motor threshold. We gave them about 40
trains of 20-25 Hz per session, using two electromagnetic coils. Also,
we extended the overall duration of treatment to three weeks.
Patients were evaluated with the Hamilton Depression Rating Scale
(HDRS) at baseline as well as at the end of every week thereafter. In
addition, we extended our period of clinical assessment to two more
weeks, because we had an indication from some of our patients that
rTMS sometimes produces a late effect. Ten patients were treated with
two daily sessions (one in the morning, and another in the afternoon)
for five days every week and for three consecutive weeks. Preliminary
results indicate that patients who were treated with two daily sessions
of rTMS had a faster reduction of depressive symptoms on the HDRS,
and some of them also a faster remission of depressive symptoms, in
comparison to patients treated with one rTMS session per day. Further
investigations in larger patient populations should verify this preliminary
result.
PO1.169.
NON-ECT TREATMENT OF CATATONIA
M. El-Shazly, M. Chandran
Department of Neurosciences, University of Birmingham; Hallam
Street Hospital, Birmingham, UK
Catatonia is considered a rare and potentially lethal condition. It is a
syndrome that encompasses multiple motor signs. It can be the only
presenting feature in a patient with underlying multiple neuropsychiatric
syndrome. It is, however, more usually associated with schizophrenia
and to a lesser extent with mixed manic episodes in bipolars.
Electroconvulsive therapy (ECT) is generally considered the treatment
of choice for various forms of catatonia, e.g., organic, lethal and
schizophrenic. The use of benzodiazepines in catatonia remains unlicensed.
There are reports of the use of intravenous (i.v.) low-dose
lorazepam in treating excited catatonia, while higher doses are reported
to have worsened the condition. We present the treatment of four
different types of catatonia (one of organic/antipsychotic induced,
one of iatrogenic, one of schizophrenic and one of depressive catatonia)
without the resort to ECT or i.v. medication. In all cases benzodiazepines
were used, mostly during the stuporous phase. The use was
judicious and time limited. Other treatment strategies were used such
as withdrawing certain drugs or the introduction of others. All cases
responded satisfactorily. In no case ECT was needed. We discuss these
cases in detail and present a review of the literature on the use of benzodiazepines
in catatonia. We present an argument for including catatonia
as one of the indications for benzodiazepine use.
197