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P.3.a.019 Clinical experience of use of risperidone long acting injection in forensic patients in a high secure hospital
S396
P.3.a Psychotic disorders and antipsychotics – Psychotic disorders (clinical)
Results and Conclusions: In our study there was a significant reduction of errors number in antisaccadic test (p < 0.05) and improvement in 29º/s gain (p < 0.05) on the end of study. Other changes of monitored oculometric parameters (38 and 49º/s gain, mean eye movement velocity, time of saccade duration, latency of saccade) were not at statistical significance level. We observed also significant improvement in negative symptoms (PANSS-Negative symptom subscale; −16.1%; p < 0.001) after use of glycine. Our data suggests that augmentation of antipsychotic treatment (typical or/and atypical agents) with glycine can improve negative symptoms in schizophrenic patients, what is similar to data from several studies in that subject, moreover results of eye movements analysis indicates betterment in antisaccadic test – probably very important tool in primary negative symptoms assessment. Further analysis of data demonstrated no significant correlation between improvement in antisaccadic test and negative symptomtomatology of psychosis (p = 0.2) in our study patients. Combined medication was safe and predominantly well tolerated, a few patients complaint was subjective gastric discomfort or nausea. Further larger, randomized and controlled trials are needed to explore action of glycine (or similar agents) treatment on negative symptoms in schizophrenia, its impact on normalization of eye movements and eventual using to evaluate primary deficit. In our psychiatric department we plan to organize randomized double-blind study to augment antipsychotic treatment with sarcosine – inhibitor of glycine transporter. References [1] Holzman PS. Eye movements and the search for the essence of schizophrenia. Brain Res Brain Res Re. 2000;31(2−3):350−6. [2] Hutton SB, Crawford TJ, Gibbins H, Cuthbert I, Barnes TR, Kennard C, Joyce EM. Short and long term effects of antipsychotic medication on smooth pursuit eye tracking in schizophrenia. Psychopharmacology (Berl). 2001;157(3):284−91. [3] Hutton SB. Improved antisaccade performance in schizophrenia with risperidone. J Neurol Neurosurg Psychiatry 2002;72(4):429.
Anonymised data for the patients were obtained from the database and the case notes. Measures of successful outcomes from treatment with RLAI included reduction in incidents of aggression, progression to lower dependency settings within the hospital, assessment of clinical improvement by the treating psychiatrist and discharge to conditions of lower security. Summary of results: All patients had a history of serious offending. In total 80 patients suffering from schizophrenia or schizoaffective disorder were prescribed RLAI (61 males and 19 females). Data on 4 patients treated for 6 weeks or under were excluded from the study, thus resulting in 76 patients being included in the final analysis. The mean duration of treatment was 80.5 weeks (range 7–280 weeks) and majority of the patients were treated with the 50 mg RLAI every 2 weekly. At the point of analysis 33 patients (43%) continued receiving RLAI, of which 31 were reported to have a favourable outcome, and 14 were discharged to conditions of medium security. Of those patients in whom RLAI was discontinued (43), 12 patients were subsequently treated with clozapine, and the major cause of discontinuation was lack of satisfactory clinical response. In the patient group that continued on treatment, RLAI was well tolerated. Conclusions: RLAI was found to be an effective treatment for schizophrenia or schizoaffective disorder in this highly specialised and complex group of forensic patients presenting with the highest level of risk. The results have particular significance given that patients in high secure forensic settings have a long history of psychosis with poor previous treatment response. More than a third of patients who showed a favourable response to RLAI were able to be discharged to conditions of medium security. RLAI being an atypical antipsychotic drug associated with fewer neurological side-effects than the older conventional drugs [2] may be more acceptable in this subgroup of patients where drug compliance is a major long term treatment issue. Implications of the findings are discussed. References
P.3.a.019 Clinical experience of use of risperidone long acting injection in forensic patients in a high secure hospital M. Das1 ° , T. Maden1 , T. McKinnon1 , K. Das2 , J. Wakelam3 . 1 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, United Kingdom; 2 Old Age Psychiatry, West London Mental Health Trust, London, United Kingdom; 3 Pharmacy Department, West London Mental Health Trust, Crowthorne, United Kingdom Purpose: Long acting injectable risperidone (RLAI) has been found to be effective in treatment of patients with schizophrenia and schizoaffective disorder [1]. Forensic patients suffering from schizophrenia or schizoaffective disorder presents with different management issues related to risk of violence and recidivism. A major cause of relapse amongst the general schizophrenia population is non-compliance with medication and this is also applicable in the forensic setting, and non compliance is associated with increased risk of recidivism in forensic patients. There is scant data on the effectiveness of RLAI in forensic setting. This naturalistic study examined the use of RLAI in 80 patients in an English High Secure Hospital. Patients admitted to a high secure hospital present with the highest degree of risk within the forensic setting. Methods: The hospital pharmacy database was used to identify all patients prescribed RLAI for a period of 6 years (2002–2008).
[1] Kane, J.M., Eerdekens, M., Lindenmayer, J.P., et al, 2003 Long-acting injectable risperidone: efficacy and safety of the first long-acting atypical antipsychotic. American Journal of Psychiatry 160, 1125–1132. [2] Geddes, J., Freemantle, J., Harrison, P., et al 2000 Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. British Medical Journal 321, 1371–1376.
P.3.a.020 Serum trace elements and glucose 6 phosphate dehydrogenase activity level in schizophrenia B. Kaya1 , N. Akdao2 , E. Fadyllyoolu3 , S. Unal4 , A. Sayal5 , 1 Gazi University, Faculty of H. Erdooan6 ° , M.H. Emre3 . medicine Psychiatry department, Ankara, Turkey; 2 Haceteppe University, Faculty of medicine Physiology department, Ankara, Turkey; 3 Inonu University, Faculty of medicine Physiology department, Malatya, Turkey; 4 Inonu University, Faculty of medicine Psychiatry department, Malatya, Turkey; 5 Gulhane Military Medical Academy, Ankara, Turkey; 6 Gaziosman Papa University, Faculty of medicine Physiology department, Tokat, Turkey Glucose 6 phosphate dehydrogenase is the rate limiting enzyme of the hexose monophosphate cascade which is the cascade for the synthesis of nucleotide, reducted glutation, fatty acid and cholesterol precursor. At the same time, it is an important enzyme for neuronal development during and after fetal life and for
P.3.a Psychotic disorders and antipsychotics – Psychotic disorders (clinical)
Results and Conclusions: In our study there was a significant reduction of errors number in antisaccadic test (p < 0.05) and improvement in 29º/s gain (p < 0.05) on the end of study. Other changes of monitored oculometric parameters (38 and 49º/s gain, mean eye movement velocity, time of saccade duration, latency of saccade) were not at statistical significance level. We observed also significant improvement in negative symptoms (PANSS-Negative symptom subscale; −16.1%; p < 0.001) after use of glycine. Our data suggests that augmentation of antipsychotic treatment (typical or/and atypical agents) with glycine can improve negative symptoms in schizophrenic patients, what is similar to data from several studies in that subject, moreover results of eye movements analysis indicates betterment in antisaccadic test – probably very important tool in primary negative symptoms assessment. Further analysis of data demonstrated no significant correlation between improvement in antisaccadic test and negative symptomtomatology of psychosis (p = 0.2) in our study patients. Combined medication was safe and predominantly well tolerated, a few patients complaint was subjective gastric discomfort or nausea. Further larger, randomized and controlled trials are needed to explore action of glycine (or similar agents) treatment on negative symptoms in schizophrenia, its impact on normalization of eye movements and eventual using to evaluate primary deficit. In our psychiatric department we plan to organize randomized double-blind study to augment antipsychotic treatment with sarcosine – inhibitor of glycine transporter. References [1] Holzman PS. Eye movements and the search for the essence of schizophrenia. Brain Res Brain Res Re. 2000;31(2−3):350−6. [2] Hutton SB, Crawford TJ, Gibbins H, Cuthbert I, Barnes TR, Kennard C, Joyce EM. Short and long term effects of antipsychotic medication on smooth pursuit eye tracking in schizophrenia. Psychopharmacology (Berl). 2001;157(3):284−91. [3] Hutton SB. Improved antisaccade performance in schizophrenia with risperidone. J Neurol Neurosurg Psychiatry 2002;72(4):429.
Anonymised data for the patients were obtained from the database and the case notes. Measures of successful outcomes from treatment with RLAI included reduction in incidents of aggression, progression to lower dependency settings within the hospital, assessment of clinical improvement by the treating psychiatrist and discharge to conditions of lower security. Summary of results: All patients had a history of serious offending. In total 80 patients suffering from schizophrenia or schizoaffective disorder were prescribed RLAI (61 males and 19 females). Data on 4 patients treated for 6 weeks or under were excluded from the study, thus resulting in 76 patients being included in the final analysis. The mean duration of treatment was 80.5 weeks (range 7–280 weeks) and majority of the patients were treated with the 50 mg RLAI every 2 weekly. At the point of analysis 33 patients (43%) continued receiving RLAI, of which 31 were reported to have a favourable outcome, and 14 were discharged to conditions of medium security. Of those patients in whom RLAI was discontinued (43), 12 patients were subsequently treated with clozapine, and the major cause of discontinuation was lack of satisfactory clinical response. In the patient group that continued on treatment, RLAI was well tolerated. Conclusions: RLAI was found to be an effective treatment for schizophrenia or schizoaffective disorder in this highly specialised and complex group of forensic patients presenting with the highest level of risk. The results have particular significance given that patients in high secure forensic settings have a long history of psychosis with poor previous treatment response. More than a third of patients who showed a favourable response to RLAI were able to be discharged to conditions of medium security. RLAI being an atypical antipsychotic drug associated with fewer neurological side-effects than the older conventional drugs [2] may be more acceptable in this subgroup of patients where drug compliance is a major long term treatment issue. Implications of the findings are discussed. References
P.3.a.019 Clinical experience of use of risperidone long acting injection in forensic patients in a high secure hospital M. Das1 ° , T. Maden1 , T. McKinnon1 , K. Das2 , J. Wakelam3 . 1 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, United Kingdom; 2 Old Age Psychiatry, West London Mental Health Trust, London, United Kingdom; 3 Pharmacy Department, West London Mental Health Trust, Crowthorne, United Kingdom Purpose: Long acting injectable risperidone (RLAI) has been found to be effective in treatment of patients with schizophrenia and schizoaffective disorder [1]. Forensic patients suffering from schizophrenia or schizoaffective disorder presents with different management issues related to risk of violence and recidivism. A major cause of relapse amongst the general schizophrenia population is non-compliance with medication and this is also applicable in the forensic setting, and non compliance is associated with increased risk of recidivism in forensic patients. There is scant data on the effectiveness of RLAI in forensic setting. This naturalistic study examined the use of RLAI in 80 patients in an English High Secure Hospital. Patients admitted to a high secure hospital present with the highest degree of risk within the forensic setting. Methods: The hospital pharmacy database was used to identify all patients prescribed RLAI for a period of 6 years (2002–2008).
[1] Kane, J.M., Eerdekens, M., Lindenmayer, J.P., et al, 2003 Long-acting injectable risperidone: efficacy and safety of the first long-acting atypical antipsychotic. American Journal of Psychiatry 160, 1125–1132. [2] Geddes, J., Freemantle, J., Harrison, P., et al 2000 Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. British Medical Journal 321, 1371–1376.
P.3.a.020 Serum trace elements and glucose 6 phosphate dehydrogenase activity level in schizophrenia B. Kaya1 , N. Akdao2 , E. Fadyllyoolu3 , S. Unal4 , A. Sayal5 , 1 Gazi University, Faculty of H. Erdooan6 ° , M.H. Emre3 . medicine Psychiatry department, Ankara, Turkey; 2 Haceteppe University, Faculty of medicine Physiology department, Ankara, Turkey; 3 Inonu University, Faculty of medicine Physiology department, Malatya, Turkey; 4 Inonu University, Faculty of medicine Psychiatry department, Malatya, Turkey; 5 Gulhane Military Medical Academy, Ankara, Turkey; 6 Gaziosman Papa University, Faculty of medicine Physiology department, Tokat, Turkey Glucose 6 phosphate dehydrogenase is the rate limiting enzyme of the hexose monophosphate cascade which is the cascade for the synthesis of nucleotide, reducted glutation, fatty acid and cholesterol precursor. At the same time, it is an important enzyme for neuronal development during and after fetal life and for