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Long-acting injectable antipsychotics: second-generation compared to first-generation drugs. Clinical outcomes and reflections
P.3.d. Psychotic disorders and treatment − Treatment (clinical)
S535
Table 1 (abstract P.3.d.009). Authors
Study Design
Participants
Treatment Duration
Celecoxib doses
Antipsychotics
Major Findings
Muller et al. 2002
Double-blind, randomized, placebo-controlled, add-on Double-blind, randomized, placebo-controlled, add-on Double-blind, randomized, placebo-controlled, add-on
N = 50 Schizophrenics. Duration of illness not specified (mean 5.9 years) N = 270 Schizophrenics. Duration of illness 10 years N = 38 Schizophrenics. Continuously ill (mean 20 years)
5 weeks
400 mg/day
11 weeks
400 mg/day
8 weeks
400 mg/day
Significant advantage of the COX-2 inhibitor No advantage on the COX-2 inhibitor No advantage on the COX-2 inhibitor
Double-blind, randomized, placebo-controlled, add-on Double-blind, randomized, placebo-controlled, add-on
N = 40 first manifestation schizophrenia
12 weeks
400 mg/day
N = 60 active phase of chronic schizophrenia
8 weeks
400 mg/day
Risperidone (flexible dose) Risperidone (flexible dose) Risperidone or olanzapine (constant dose) Risperidone (flexible dose) Risperidone (flexible dose)
Rappart and Muller 2004 Rapaport et al. 2005
Zhang et al. 2006 Akhondzadeh et al. 2007
[5] Akhondzadeh, S., Tabatabaee, M., Amini, H., Ahmadi Abhari, S.A., Abbasi, S.H., Behnam, B., 2007. Celecoxib as adjunctive therapy in schizophrenia: a double-blind, randomized and placebo-controlled trial. Schizophr Res 90, 179–185.
P.3.d.010 Long-acting injectable antipsychotics: second-generation compared to firstgeneration drugs. Clinical outcomes and reflections V. Fricchione Parise1 ° , L. Addeo2 , R. Laezza1 , G. Balletta1 , G. Manna3 1 Mental Health Centre “Australia” & “San Giacomo”, A.S.L. Avellino, Avellino, Italy; 2 Local Mental Unit, ASL Avellino, Lauro AV, Italy; 3 Local Mental Unit, ASL Avellino, Cervinara AV, Italy Introduction: Schizophrenia/Delusional Disorders affect approximately 0.5−1% of population, with associated social burden and economic costs; antipsychotic-drugs are their mainstay treatment. Failure to adhere medication regimens with subsequent relapse and hospitalization is key-problem. Patients non-compliance rate varies 20% to 60% [1], in reason of lack disease awareness, weak conviction drug-therapies utility, treatment complexity, sideeffects seriousness. Haloperidol, Fluphenazine, Zuclopentixol are first-generation cheap drugs, available as decanoate depot, worldwide used; Risperidone, Paliperidone, Olanzapine are most used second-generation antipsychotics in prolonged-release, expensive form. Not available at study-time Aripiprazole-LAI. Objectives: Acquisition cost second-generation antipsychotics long-acting injection (SGA-LAI) is very high than first-generation long-acting drugs (FGA-LAI); informations need in terms costeffectiveness and improved outcomes. SGA-LAIs claim more effectiveness and tolerability without producing disabling sideeffects compared to older FGA-LAIs [2]. This pragmatic study directly compares their relative effectiveness employing them under ordinary circumstances in psychotic outpatients [3]. Methods: This pragmatic, open-label, observational, parallelgroup study is based on 90 intent-to-treat (ITT) outpatients with ICD-10 diagnosis of Schizophrenia or like Delusional Disorder. Consecutive patients were randomly assigned to treatment with FGA-LAI or SGA-LAI. Was used an optimal not excessively high dose of FGA-LAI contrariely to older studies. Exclusion criteria: disorders or conditions controindicating investigational drug. Other concomitant medications, psychiatric or non, was permitted but none oral antipsychotic supplementation after early two weeks. Patients were assessed at baseline and after 4, 8, 12 months of follow-up, with BPRS 24-items, GAF, Lunsers, haematic samples estimation, body-mass-index. Primary outcomes: treatment dis-
Significant advantage of the COX-2 inhibitor Significant advantage of the COX-2 inhibitor
continuation/hospitalization; secondary outcomes: improved psychotic symptoms, tolerability/side-effects [4]. Outcomes were performed by a trained assessor masked to allocate treatment. Results: ITT: 90 outpatients (60% Male, 40% Female) whose 45 randomly allocated to FGA-LAI (17 Haloperidol, 16 Zuclopentixol, 12 Fluphenazine) and 45 to SGA-LAI (18 Risperidone, 12 Paliperidone, 15 Olanzapine). Drop-out: 22 (24.44%) subdivided in SGA-LAI group: 12 (26.66%), 7 for inefficacy, 4 for sideeffect, 1 for non-compliance, and FGA-LAI group: 10 (22.22%) 4 for inefficacy, 4 for side-effect, 2 for non-compliance. On remainder 68 (33 SGA-LAI, 35 FGA-LAI) at follow-up analisys of primary outcome revealed no substantial differences, also obtained improved change BPRS total scores and GAF were similar, while mild/medium EPS symptoms incidence was reported in FGA-LAI group, weight-gain prevalence (more Olanzapine LAI) and hyperprolactinemia (much more Risperidone and Paliperidone LAI) emerged for SGA-LAI group. Also for concomitant medications use there was none significant difference among various LAI [5]. Conclusions: Patients taking FGA-LAI experienced EPS/ Akathisia mild increase than those taking SGA-LAI (9% compared to 4%); partecipants taking SGA-LAI gained weight overtime (more for Olanzapine LAI) while those on FGA-LAI lost weight; SGA-LAI Risperidone and Paliperidone increased serum prolactine significantly more than Olanzapine-LAI and FGALAI. Primary outcome: there was no statistically or clinically remarkable differences between SGA- and FGA-LAI (only mild percentage insignificant discard favorable to FGA-LAI). Comprehensively, in terms of treatment discontinuation, hospitalization, improved psychotic symptoms, tolerability, the SGALAI group provided none additional benefits in comparison with FGA-LAI group. Mild marginal benefit of SGA-LAI have to be balanced with their cost and formality o f administration. Older FGA-LAI remain a suitable, valid therapeutic chance with possible cost-benefit advantages. References [1] Kroken, R.A., Kjelby, E., Wentzel-Larsen, T., Mellesdal, L.S., Jorgensen, H.A., Johnsen, E. 2014 Time to discontinuation of antipsychotic drugs in a schizophrenia cohort: influence of current treatment strategies. Ther Adv Psychopharmacol 4(6), 228–239. [2] Nielsen, J., Jensen, S.O., Friis, R.B., Valentin, J.B., Correl, C.U. 2015 Comparative effectiveness of risperidone long-acting injectable vs firstgeneration antipsychotics long-acting injectables in schizophrenia: results from a nationwide, retrospective inception cohort study. Schizophr Bull 41(3), 627−36. doi: 10.1093/schbul/sbu128. [3] Freudenreich, O. 2014 Paliperidone depot is not different from haloperidol in relapse prevention of schizophrenia, but different side effects should be considered. Evid Based Ment Health 17(4), 110. [4] Taylor, D. 2009 Psychopharmacology and adverse effects of antipsychotic long-acting injection: a review. Br J Psychiatry 195, 13−19.
S536
P.3.d. Psychotic disorders and treatment − Treatment (clinical)
[5] Castillo, E.G., Stroup, T.S. 2015 Effectiveness of long-acting injectable antipsychotics: a clinical perspective. Evid Based Ment Health 18, 36−39. doi:10.1136/eb-2015–102086.
P.3.d.011 Combination of clozapine with paliperidone in treatment-resistant schizophrenia G. Oriolo1 ° , I. Dominguez1 , A. Fortea1 , M. Bioque1 , M. Bernardo1 , E. Parellada1 1 Hospital clinic, Institute of Neuroscience, Barcelona, Spain Introduction: Clozapine (CLZ) has been considered the best choice to treatment-resistant schizophrenia (TRS), thought is not effective in 40 to 70% of those patients [1]. Combination strategy (CS) with a second antipsychotic drug is the most frequently employed pharmacological strategy for the management of CLZresistant schizophrenia [2]. Limited literature is available on paliperidone as a CS, being extended-release (pali-ER) or the long-acting injectable palmitate paliperidone (PP-LAI) [3]. Due to its documented fast onset of action, delayed time-to-recurrence and well tolerability, when used with CLZ it could represent a novelty and effective CS. Aim: To describe the clinical outcomes of TRS patients treated with pali-ER or PP-LAI in combination with CLZ. Methods: We conducted a naturalistic observational retrospective non-interventional study of patients with diagnosis of schizophrenia and related disorders (DSM-IV criteria). Patients that accomplished TRS criteria [4] and who were treated with CLZ combined with paliperidone as CS, either oral or 1-month injectable, were selected. The study was based on the analysis of registries of computerised medical records from the database of 18 years old patients included in the CLZ pharmacovigilance protocol for haematological monitoring. Socio-demographic and clinical variables were obtained from 23 patients. CLZ daily dose and the basal version of the clinical global impression scale for schizophrenia (b-CGI-SCH) [5] were calculated before and after treatment combination. Results: The mean age was 42.2 years old (±11.9 DS) and 18 of 23 patients were males. More than the 50% of patients lived with the origin family, had permanent laboral inability and did not have a partner. Pali-ER or PP was added to CLZ in 20 patients, whereas in 3 patients CLZ was added to previous treatment with paliperidone. The CS was preferentially conducted in outpatients’ setting (61%). The CLZ dose combined with paliperidone was lower [mean = 280 mg per day (SD = +/−145)] than the CLZ dose when used alone [mean = 317.1 mg per day (SD = ±165.7)], but no statistical significance was achieved (t = 1.325, p = 0.201). Concerning side effects, sedation and weight gain were the most frequent (28% and 16% respectively), whereas 7 patients did not refer any new side effect after combination. One case of agranulocytosis was reported, and CLZ was immediately interrupted. Concerning the b-CGI-SCH scale, we found statistical significant differences in the average punctuation calculated before and after treatment combination for each dimension (Positive symptoms mean score = 2.78, 95% CI = 2.35–3.21 t = 13.37, p < 0.01. Negative symptoms mean score = 1.04, 95% CI = 0.69–1.40, t = 6.07, p < 0.01. Depressive symptoms mean score = 1.56, 95% CI = 1.28–1.85, t = 11.33, p < 0.01. Cognitive symptoms mean score = 0.74, 95% CI = 0.41–1.06, t = 4.71, p < 0.01. Global symptoms mean score = 2.56 95% CI = 2.22–2.91, t = 15.62, p < 0.01). Conclusions: A significant clinical improvement was observed in our cohort of TRS patients by the mean of the b-CGI-SCH scale, when CLZ and paliperidone were used as CS. The lower
antipsychotic doses during the CS, thought no significant, can reduce the risk and incidence of side effects, increasing at the same time treatment adherence. Well-designed studies with bigger sample size are needed in order to confirm our results. References [1] Minamoto, S., Jarskog, L.F., Fleischaker, W.W., 2014. New therapeutic approaches for treatment-resistant schizophrenia: a look to the future. J Psychiatr Res 58, 1−6. [2] Dold, M., Leucht, S., 2014. Pharmacotherapy of treatment-resistant schizophrenia: a clinical perspective. Evid Based Mental Health 17(2), 33−37. [3] Maia de Olivera, J.P., Nunes, E.A., Ushirohira, J.M., Machado-deSousa, J.P., Bressan, R.A., Hallak, J.E., 2015. Paliperidone palmitate for refractory and clozapine-resistant schizophrenia. J Neuropsychiatry Clin Neurisci 27(1), e14-e16. [4] Suzuki, T., Remington, G., Mulsant, B.H., Uchida, H., Raji, T., GraffGuerrero, A., 2012. Defining treatment-resistant schizophrenia and response to antipsychotics: A review and recommendation. Psychiatry Res 197, 1−6. [5] Haro, J.M., Kamath, S.A., Ochoa, S., Novick, D., Rele, K., Fargas, A., et al., 2003. The clinical global impression-schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta psychiatr Scand 107(S416), 16−23. Disclosure statement: I received grants and honoraria from Janssen, grants from Otsuka-Lundbeck and Pfizer. This abstract is not financially supported by any companies.
P.3.d.012 Clinicians’ attitudes to cardiac function monitoring guidelines during antipsychotic treatment: a retrospective report on 434 patients with severe mental illness M. Manchia1 ° , G. Firinu1 , B. Carpiniello1 , F. Pinna1 1 University of Cagliari, Public Health- Clinical and Molecular Medicine, Cagliari, Italy Severe mental illness (SMI) has considerable excess morbidity and mortality, a proportion of which is explained by the presence of cardiovascular conditions, caused in part by caused in part by antipsychotic (AP) induced QT-related arrhythmias and sudden death by Torsades de pointes (TdP). The implementation of evidence-based recommendations for cardiac function monitoring might reduce the incidence of these AP-related adverse events. Our primary aim was to investigate the clinicians’ adherence to evidence-based recommendations for cardiac function monitoring, including electrocardiogram (ECG), biochemical testing (electrolytes) and assessment of individual cardiologic risk factor before and after starting AP treatment in real life clinical setting, as well as for the prescription of psychotropic drugs at low risk for QT prolongation when indicated. To this end we performed a retrospective assessment of 434 AP-treated SMI patients longitudinally followed-up at an academic community mental health center. The secondary aims of this study were to assess whether the presence of risk factors for QT-related arrhythmias and TdP, such as cardiac or vascular comorbidities, in AP-treated patients impacted on (1) the choice of AP, or other psychotropic treatment such as antidepressants or mood stabilizers, with low risk for QT prolongation, and (2) on the choice of a specific AP pharmacological class (i.e. first generation versus second generation AP). We conducted a retrospective assessment of 434 SMI patients followed up longitudinally at the Section of Psychiatry of the Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy. We collected detailed clinical data for the reference period starting on 1 January 2010 and ending on 30 April 2015. Patients were included in the study if: (1) they had a diagnosis of psychotic disorder, mood disorder, or
S535
Table 1 (abstract P.3.d.009). Authors
Study Design
Participants
Treatment Duration
Celecoxib doses
Antipsychotics
Major Findings
Muller et al. 2002
Double-blind, randomized, placebo-controlled, add-on Double-blind, randomized, placebo-controlled, add-on Double-blind, randomized, placebo-controlled, add-on
N = 50 Schizophrenics. Duration of illness not specified (mean 5.9 years) N = 270 Schizophrenics. Duration of illness 10 years N = 38 Schizophrenics. Continuously ill (mean 20 years)
5 weeks
400 mg/day
11 weeks
400 mg/day
8 weeks
400 mg/day
Significant advantage of the COX-2 inhibitor No advantage on the COX-2 inhibitor No advantage on the COX-2 inhibitor
Double-blind, randomized, placebo-controlled, add-on Double-blind, randomized, placebo-controlled, add-on
N = 40 first manifestation schizophrenia
12 weeks
400 mg/day
N = 60 active phase of chronic schizophrenia
8 weeks
400 mg/day
Risperidone (flexible dose) Risperidone (flexible dose) Risperidone or olanzapine (constant dose) Risperidone (flexible dose) Risperidone (flexible dose)
Rappart and Muller 2004 Rapaport et al. 2005
Zhang et al. 2006 Akhondzadeh et al. 2007
[5] Akhondzadeh, S., Tabatabaee, M., Amini, H., Ahmadi Abhari, S.A., Abbasi, S.H., Behnam, B., 2007. Celecoxib as adjunctive therapy in schizophrenia: a double-blind, randomized and placebo-controlled trial. Schizophr Res 90, 179–185.
P.3.d.010 Long-acting injectable antipsychotics: second-generation compared to firstgeneration drugs. Clinical outcomes and reflections V. Fricchione Parise1 ° , L. Addeo2 , R. Laezza1 , G. Balletta1 , G. Manna3 1 Mental Health Centre “Australia” & “San Giacomo”, A.S.L. Avellino, Avellino, Italy; 2 Local Mental Unit, ASL Avellino, Lauro AV, Italy; 3 Local Mental Unit, ASL Avellino, Cervinara AV, Italy Introduction: Schizophrenia/Delusional Disorders affect approximately 0.5−1% of population, with associated social burden and economic costs; antipsychotic-drugs are their mainstay treatment. Failure to adhere medication regimens with subsequent relapse and hospitalization is key-problem. Patients non-compliance rate varies 20% to 60% [1], in reason of lack disease awareness, weak conviction drug-therapies utility, treatment complexity, sideeffects seriousness. Haloperidol, Fluphenazine, Zuclopentixol are first-generation cheap drugs, available as decanoate depot, worldwide used; Risperidone, Paliperidone, Olanzapine are most used second-generation antipsychotics in prolonged-release, expensive form. Not available at study-time Aripiprazole-LAI. Objectives: Acquisition cost second-generation antipsychotics long-acting injection (SGA-LAI) is very high than first-generation long-acting drugs (FGA-LAI); informations need in terms costeffectiveness and improved outcomes. SGA-LAIs claim more effectiveness and tolerability without producing disabling sideeffects compared to older FGA-LAIs [2]. This pragmatic study directly compares their relative effectiveness employing them under ordinary circumstances in psychotic outpatients [3]. Methods: This pragmatic, open-label, observational, parallelgroup study is based on 90 intent-to-treat (ITT) outpatients with ICD-10 diagnosis of Schizophrenia or like Delusional Disorder. Consecutive patients were randomly assigned to treatment with FGA-LAI or SGA-LAI. Was used an optimal not excessively high dose of FGA-LAI contrariely to older studies. Exclusion criteria: disorders or conditions controindicating investigational drug. Other concomitant medications, psychiatric or non, was permitted but none oral antipsychotic supplementation after early two weeks. Patients were assessed at baseline and after 4, 8, 12 months of follow-up, with BPRS 24-items, GAF, Lunsers, haematic samples estimation, body-mass-index. Primary outcomes: treatment dis-
Significant advantage of the COX-2 inhibitor Significant advantage of the COX-2 inhibitor
continuation/hospitalization; secondary outcomes: improved psychotic symptoms, tolerability/side-effects [4]. Outcomes were performed by a trained assessor masked to allocate treatment. Results: ITT: 90 outpatients (60% Male, 40% Female) whose 45 randomly allocated to FGA-LAI (17 Haloperidol, 16 Zuclopentixol, 12 Fluphenazine) and 45 to SGA-LAI (18 Risperidone, 12 Paliperidone, 15 Olanzapine). Drop-out: 22 (24.44%) subdivided in SGA-LAI group: 12 (26.66%), 7 for inefficacy, 4 for sideeffect, 1 for non-compliance, and FGA-LAI group: 10 (22.22%) 4 for inefficacy, 4 for side-effect, 2 for non-compliance. On remainder 68 (33 SGA-LAI, 35 FGA-LAI) at follow-up analisys of primary outcome revealed no substantial differences, also obtained improved change BPRS total scores and GAF were similar, while mild/medium EPS symptoms incidence was reported in FGA-LAI group, weight-gain prevalence (more Olanzapine LAI) and hyperprolactinemia (much more Risperidone and Paliperidone LAI) emerged for SGA-LAI group. Also for concomitant medications use there was none significant difference among various LAI [5]. Conclusions: Patients taking FGA-LAI experienced EPS/ Akathisia mild increase than those taking SGA-LAI (9% compared to 4%); partecipants taking SGA-LAI gained weight overtime (more for Olanzapine LAI) while those on FGA-LAI lost weight; SGA-LAI Risperidone and Paliperidone increased serum prolactine significantly more than Olanzapine-LAI and FGALAI. Primary outcome: there was no statistically or clinically remarkable differences between SGA- and FGA-LAI (only mild percentage insignificant discard favorable to FGA-LAI). Comprehensively, in terms of treatment discontinuation, hospitalization, improved psychotic symptoms, tolerability, the SGALAI group provided none additional benefits in comparison with FGA-LAI group. Mild marginal benefit of SGA-LAI have to be balanced with their cost and formality o f administration. Older FGA-LAI remain a suitable, valid therapeutic chance with possible cost-benefit advantages. References [1] Kroken, R.A., Kjelby, E., Wentzel-Larsen, T., Mellesdal, L.S., Jorgensen, H.A., Johnsen, E. 2014 Time to discontinuation of antipsychotic drugs in a schizophrenia cohort: influence of current treatment strategies. Ther Adv Psychopharmacol 4(6), 228–239. [2] Nielsen, J., Jensen, S.O., Friis, R.B., Valentin, J.B., Correl, C.U. 2015 Comparative effectiveness of risperidone long-acting injectable vs firstgeneration antipsychotics long-acting injectables in schizophrenia: results from a nationwide, retrospective inception cohort study. Schizophr Bull 41(3), 627−36. doi: 10.1093/schbul/sbu128. [3] Freudenreich, O. 2014 Paliperidone depot is not different from haloperidol in relapse prevention of schizophrenia, but different side effects should be considered. Evid Based Ment Health 17(4), 110. [4] Taylor, D. 2009 Psychopharmacology and adverse effects of antipsychotic long-acting injection: a review. Br J Psychiatry 195, 13−19.
S536
P.3.d. Psychotic disorders and treatment − Treatment (clinical)
[5] Castillo, E.G., Stroup, T.S. 2015 Effectiveness of long-acting injectable antipsychotics: a clinical perspective. Evid Based Ment Health 18, 36−39. doi:10.1136/eb-2015–102086.
P.3.d.011 Combination of clozapine with paliperidone in treatment-resistant schizophrenia G. Oriolo1 ° , I. Dominguez1 , A. Fortea1 , M. Bioque1 , M. Bernardo1 , E. Parellada1 1 Hospital clinic, Institute of Neuroscience, Barcelona, Spain Introduction: Clozapine (CLZ) has been considered the best choice to treatment-resistant schizophrenia (TRS), thought is not effective in 40 to 70% of those patients [1]. Combination strategy (CS) with a second antipsychotic drug is the most frequently employed pharmacological strategy for the management of CLZresistant schizophrenia [2]. Limited literature is available on paliperidone as a CS, being extended-release (pali-ER) or the long-acting injectable palmitate paliperidone (PP-LAI) [3]. Due to its documented fast onset of action, delayed time-to-recurrence and well tolerability, when used with CLZ it could represent a novelty and effective CS. Aim: To describe the clinical outcomes of TRS patients treated with pali-ER or PP-LAI in combination with CLZ. Methods: We conducted a naturalistic observational retrospective non-interventional study of patients with diagnosis of schizophrenia and related disorders (DSM-IV criteria). Patients that accomplished TRS criteria [4] and who were treated with CLZ combined with paliperidone as CS, either oral or 1-month injectable, were selected. The study was based on the analysis of registries of computerised medical records from the database of 18 years old patients included in the CLZ pharmacovigilance protocol for haematological monitoring. Socio-demographic and clinical variables were obtained from 23 patients. CLZ daily dose and the basal version of the clinical global impression scale for schizophrenia (b-CGI-SCH) [5] were calculated before and after treatment combination. Results: The mean age was 42.2 years old (±11.9 DS) and 18 of 23 patients were males. More than the 50% of patients lived with the origin family, had permanent laboral inability and did not have a partner. Pali-ER or PP was added to CLZ in 20 patients, whereas in 3 patients CLZ was added to previous treatment with paliperidone. The CS was preferentially conducted in outpatients’ setting (61%). The CLZ dose combined with paliperidone was lower [mean = 280 mg per day (SD = +/−145)] than the CLZ dose when used alone [mean = 317.1 mg per day (SD = ±165.7)], but no statistical significance was achieved (t = 1.325, p = 0.201). Concerning side effects, sedation and weight gain were the most frequent (28% and 16% respectively), whereas 7 patients did not refer any new side effect after combination. One case of agranulocytosis was reported, and CLZ was immediately interrupted. Concerning the b-CGI-SCH scale, we found statistical significant differences in the average punctuation calculated before and after treatment combination for each dimension (Positive symptoms mean score = 2.78, 95% CI = 2.35–3.21 t = 13.37, p < 0.01. Negative symptoms mean score = 1.04, 95% CI = 0.69–1.40, t = 6.07, p < 0.01. Depressive symptoms mean score = 1.56, 95% CI = 1.28–1.85, t = 11.33, p < 0.01. Cognitive symptoms mean score = 0.74, 95% CI = 0.41–1.06, t = 4.71, p < 0.01. Global symptoms mean score = 2.56 95% CI = 2.22–2.91, t = 15.62, p < 0.01). Conclusions: A significant clinical improvement was observed in our cohort of TRS patients by the mean of the b-CGI-SCH scale, when CLZ and paliperidone were used as CS. The lower
antipsychotic doses during the CS, thought no significant, can reduce the risk and incidence of side effects, increasing at the same time treatment adherence. Well-designed studies with bigger sample size are needed in order to confirm our results. References [1] Minamoto, S., Jarskog, L.F., Fleischaker, W.W., 2014. New therapeutic approaches for treatment-resistant schizophrenia: a look to the future. J Psychiatr Res 58, 1−6. [2] Dold, M., Leucht, S., 2014. Pharmacotherapy of treatment-resistant schizophrenia: a clinical perspective. Evid Based Mental Health 17(2), 33−37. [3] Maia de Olivera, J.P., Nunes, E.A., Ushirohira, J.M., Machado-deSousa, J.P., Bressan, R.A., Hallak, J.E., 2015. Paliperidone palmitate for refractory and clozapine-resistant schizophrenia. J Neuropsychiatry Clin Neurisci 27(1), e14-e16. [4] Suzuki, T., Remington, G., Mulsant, B.H., Uchida, H., Raji, T., GraffGuerrero, A., 2012. Defining treatment-resistant schizophrenia and response to antipsychotics: A review and recommendation. Psychiatry Res 197, 1−6. [5] Haro, J.M., Kamath, S.A., Ochoa, S., Novick, D., Rele, K., Fargas, A., et al., 2003. The clinical global impression-schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta psychiatr Scand 107(S416), 16−23. Disclosure statement: I received grants and honoraria from Janssen, grants from Otsuka-Lundbeck and Pfizer. This abstract is not financially supported by any companies.
P.3.d.012 Clinicians’ attitudes to cardiac function monitoring guidelines during antipsychotic treatment: a retrospective report on 434 patients with severe mental illness M. Manchia1 ° , G. Firinu1 , B. Carpiniello1 , F. Pinna1 1 University of Cagliari, Public Health- Clinical and Molecular Medicine, Cagliari, Italy Severe mental illness (SMI) has considerable excess morbidity and mortality, a proportion of which is explained by the presence of cardiovascular conditions, caused in part by caused in part by antipsychotic (AP) induced QT-related arrhythmias and sudden death by Torsades de pointes (TdP). The implementation of evidence-based recommendations for cardiac function monitoring might reduce the incidence of these AP-related adverse events. Our primary aim was to investigate the clinicians’ adherence to evidence-based recommendations for cardiac function monitoring, including electrocardiogram (ECG), biochemical testing (electrolytes) and assessment of individual cardiologic risk factor before and after starting AP treatment in real life clinical setting, as well as for the prescription of psychotropic drugs at low risk for QT prolongation when indicated. To this end we performed a retrospective assessment of 434 AP-treated SMI patients longitudinally followed-up at an academic community mental health center. The secondary aims of this study were to assess whether the presence of risk factors for QT-related arrhythmias and TdP, such as cardiac or vascular comorbidities, in AP-treated patients impacted on (1) the choice of AP, or other psychotropic treatment such as antidepressants or mood stabilizers, with low risk for QT prolongation, and (2) on the choice of a specific AP pharmacological class (i.e. first generation versus second generation AP). We conducted a retrospective assessment of 434 SMI patients followed up longitudinally at the Section of Psychiatry of the Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy. We collected detailed clinical data for the reference period starting on 1 January 2010 and ending on 30 April 2015. Patients were included in the study if: (1) they had a diagnosis of psychotic disorder, mood disorder, or