- Email: [email protected]
P.3.f.018 Evolution of anhedonia and depressive symptoms in Romanian outpatients diagnosed with major depressive episode and treated with agomelatine
P.3.f. Psychotic disorders and treatment − Other (clinical) 13.3% (mean: 245 pg/mL; SD: 18.65). None of the patients had positive results for the infectious diseases tested (HIV, syphilis and hepatitis B and C). Total cholesterol abnormalities were found in 20.0% of the patients (mean: 208.17 mg/dL; SD: 10.44) and triglycerides in 10.0% (mean: 179 mg/dL; SD: 21.93). Twenty percent patients had positive results for cannabis screening and 3.3% for cocaine screening. In neuroimaging 30.0% of the patients revealed abnormalities in CT: 3.3% ventricular asymmetry; 3.3% plagiocephaly; 6.7% frontal sulci accentuation; 6.7% parietal sulci accentuation; 3.3% calcification of cerebral sickle; 3.3% probable arachnoid granulation and 3.3% enlargement of perivascular interstitial just-atrial space. None of the MRI made reveal significant abnormalities. Conclusions: Initial medical work-up in patients with firstepisode psychosis has two main aims: 1)Exclude medical treatable disorders that could be responsible for psychotic symptoms; 2)Establishing the presence of relevant medical comorbidities (particularly important in patients who are in the beginning of psychopharmacological treatment). Protocols regarding tests in the work-up of first-episode psychosis could help to standardize the evaluation of these patients. In our sample of first-episode psychosis patients no medical causes for psychosis were found, but abnormalities in laboratory findings affected the choice of psychopharmacological treatment. References [1] Freudenreich, O., Schulz, S.C., Goff, D.C., 2009. Initial medical workup of first-episode psychosis: a conceptual review. Early Interv Psychiatry 3(1), 10−8.
P.3.f.017 Depersonalization and schizophrenia M.J. Jaen Moreno1 ° , G. Chauca Chauca2 , P. Alonso Lobato3 , M. Guiote Malpartida4 1 Hospital Infanta Margarita, cordoba, Spain; 2 Hospital Infanta Margarita, Psiquiatr´ıa, cordoba, Spain; 3 USMC Pe˜ narroya, Psiquiatria, Cordoba, Spain; 4 Hospital Universitario Reina Sof´ıa, Unidad de Agudos, Cordoba, Spain Introduction: Depersonalization (DP) is an alteration in the perception or experience of himself, so that the individual feels strange and distant, like an external observer of his body or his own psychic processes [1,2]. The mains psychopathological characteristics of depersonalization are the sense of strangeness of the environment, feelings of automation, self-observation, emotional alterations, body image and in the experience of time [1]. Clinically depersonalization may occur as an independent category (depersonalization disorder) or as a symptom of other psychiatric and neurological disorders. Many authors have indicated the presence of depersonalization in schizophrenia, especially during the prodrome and acute phase of the disease [3], although it is possible that depersonalization is not so specific to schizophrenia but constitutes a general characteristic of the prespsychosis states, independently of etiology [2]. Material and Methods: A total of 48 subjects in the area of Mental Health of C´ordoba were evaluated from 2009 to 2012. The sample consisted of men and women between 18 and 50 years old, diagnosed with paranoid schizophrenia according to DSM-IV-TR. We excluded subjects with severe brain injury, mental retardation, neurological disease and/or severe sensory disturbances impeding evaluation. The total sample was distributed along two groups, one called “first psychotic episode” (n = 20) and the second
S545
called “multiple psychotic episodes” (n = 28). The first group was included once the diagnosis of schizophrenia was confirmed. The tools used to obtain the results presented in this study were the following questionnaires: – Cambridge Depersonalization Scale (CDS). The CDS consist of 29 items that assess the frequency, duration and intensity of the experience. – Dissociative Experiences Scale (DES). The DES is a visual analog scale with three dimensions: absorption, amnesia and depersonalization-derealisation. – Positive and Negative Syndrome Scale (PANSS). The PANSS scale consists of 30 items that assess schizophrenia from a categorical and dimensional perspective. – Beck Depression Inventory (BDI). The BDI consists of 21 items that mainly evaluated the clinical symptoms of melancholy and intrusive thoughts of depression. Results: The sample consisted of 33 men (68.8%) and 15 women (31.3%). 41.7% had completed primary school and 52% lived in urban areas compared to 48% who lived in a rural area. Score obtained in CDS for “intensity” was 40.58 (± 32.7), “frequency” 16.02 (± 13.7) and “duration” 24.14 (± 19.46). These scores were slightly higher for patients suffering first episodes than those with greater disease evolution. The score for the DES scale in its domain of depersonalization-derealisation was 14.64 (± 13.12) and the highest score was seen in the first episode again. Regarding the PANSS, no differences were found for positive symptoms subscale, but for the other subscales. Conclusions: Patients with first episodes have slightly higher scores for DP and dissociative experiences than those with greater disease progression. References [1] Berrios GE, Sierra M., 1997. Depersonalization: a conceptual history. History of psychiatry 8(30 Pt 2),213−29. [2] Sierra M., 2009. Depersonalization: A new look at a neglected syndrome: Cambridge University Press. [3] Mayer-Gross W., 1935. On Depersonalization. British Journal of Medical Psychology 15(2),103−26.
P.3.f.018 Evolution of anhedonia and depressive symptoms in Romanian outpatients diagnosed with major depressive episode and treated with agomelatine C. Tudose1 , P. Traian1 , M.V. Petre1 ° , V. Marinescu1 , G.I. Ciorica1 , C.E. Maliche2 1 Alexandru Obregia Psychiatric Hospital, Psychiatry, Bucuresti, Romania; 2 Constanta Psychiatric Hospital, Psychiatry, Constanta, Romania Depression is one of the most prevalent psychiatric disorder. It is estimated that by 2020 it will be ranked second in terms of disability-adjusted life year which is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death [1]. Agomelatine is an antidepressant with an unique pharmacological synergy between the antagonist action on serotoninergic 5HT2c receptors and the agonist actions on the melatonergic receptors [2]. The most recent meta-analysis of the published and unpublished studies of agomelatine showed that it is an effective antidepressant with similar efficacy to standard antidepressants [3]. Anhedonia is a core symptom of depression (together with depressed mood) and it is defined as the lack of ability to feel and experience pleasure and can be evaluated
S546
P.3.f. Psychotic disorders and treatment − Other (clinical)
with Snaith Hamilton Pleasure Scale [4]. Anhedonia affects the severity of the depression, predicts a poor outcome, a higher risk of suicide and it is a common residual symptom hard to treat. Agomelatine showed in a pilot study a positive effect in reduction of anhedonia [5]. Study purpose: To assess the major depressive episode adherence and symptoms, evaluated by clinicians and patients, in Romanian outpatients that received agomelatine, with focus on anhedonia in natural settings. Methods: HEDONIA study was a prospective, multicentre, observational study performed in Romania in 75 psychiatric sites. Recruitment took place in July-August 2014 and included adult outpatients with major depressive episode. All sites initiated and continued care and patients treatment according to their best current medical practice and in the study were evaluated only the patients taking agomelatine (1213 patients and 1155 completed all 3 study visits). The study consisted in 3 visits (screening visit (V1); follow-up at 2−3 weeks (V2); follow-up visit 6−8 weeks (V3)) that assessed the patients on: Montgomery Asberg Depression Rating Scale, Clinical Global Impression Rating Scale, Patient Global Impression Rating Scale and Snaith Hamilton Pleasure Scale. Results: The study included 850 females and 363 males diagnosed with major depressive disorder. Patient’s treatment adherence to pharmacological treatment was more than 95%. A statistically significant improvement was observed for both scales used to assess patient’s status: Montgomery Asberg Depression Rating Scale and Snaith Hamilton Pleasure Scale (p < 0.001). Clinicians’ and patients’ assessment of improvement and severity of disease were comparable, with slight differences in the fact that in the beginning of the treatment patients reported worse rates than clinicians and after 2 months of treatment patients reported a higher improvement than clinicians. Both assessments must be taken into consideration for further research. After 2 month treatment the scores for anhedonia ware significantly reduced and patients were able to resume normal activities. No adverse effects were recorded. Conclusion: Patient’s adherence to treatment was above 95% and optimal response was obtained in most of the patients. The highest rate of improvement was observed after 2 months of treatment. Patients’ overall status and scales scores improved after 2 months. Interestingly the patients scored higher than clinicians. No significantly weight gain or liver function changes were observed. References [1] Wittchen H U, Jacobi F, Rehm J, Gustavsson A, Svesson M, Jonsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, J. Van Os, Preising M, Salvador-Carulla L, Simon R, Steinhausen H C, 2011. The size and burden of mental disorders and other disorder of the brain in Europe 2010. European Neuropsychopharmacology 21, 655–657. [2] Stephen M. Stahl, 2014. Mechanism of action of agomelatine. CNS Spectrums 19, 207–2012 [3] David Taylor, Anna Sparshatt, Semma Olofinjana, 2014. Antidepressant efficacy of agomelatine: meta-analysis of published and unpublished studies. British Medical Journal. 348:g1888 doi 10.1136/bmj.g1888 [4] Snaith R P, Hammilton M, Morley S, Humayan A, Hargreaves D, Trigwell P, 1995. A scale for the assessment of hedonic tone. British Journal of Psychiatry 167, 99–103 [5] Giovanni Martinotti, Gianna Sepede, Francesco Gambi, Giuseppe Di Iorio, Domenico De Berardis, Marco di Nicola, Marco Onofrij, Luigi Janirini, Massimo Di Giannantonio, 2012. Agomelatine versus venlafaxine XR in the treatment of anhedonia in major depressive episode: a pilot study. Journal of Clinical Psychopharmacology 32(4), 487–491. Disclosure statement: I also work as a marketing specialist consultant for Servier Romania.
P.3.f.019 The effect of thought disorders on remission of symptoms in schizophrenia B. Yalın¸cetin1 , K. Alptekin2 ° , H. Ula¸s2 , T. Binbay2 , B.B. Akdede2 Eylul University, Department of Neuroscience, Izmir, Turkey; 2 Dokuz Eylul University, School of Medicine, Department of Psychiatry, Izmir, Turkey
1 Dokuz
Objective: Thought disorders in schizophrenia that deteriorate in acute episodes usually persist during the illness chronically in a vague form [1]. Antipsychotic treatment reduces thought pathology associated with acute episodes of schizophrenia, but residual thought pathology continues even after remission has been attained [2]. Negative formal thought disorder, identified with poverty of speech and poverty in the content of speech, was suggested to be associated with poor response to treatment in schizophrenia [3]. Schizophrenia patients having negative thought disorder are less likely to attain remission [4]. Positive formal thought disorder, determined by features like derailment, perseveration, circumstantiality, tangentiality, blocking and incoherence, usually disappears as the acute episode alleviates. The aim of this study is to investigate the effect of thought disorders on the course of symptomatic remission in schizophrenia. Methods: The study was carried out with the sample consisted of 117 patients (40 female, 77 male) diagnosed with schizophrenia according to DSM-IV. Study patients were selected from the Schizophrenia Outpatient Unit of Psychiatry Department in Dokuz Eylul University, School of Medicine. The patients were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Thought and Language Index (TLI). Using remission criteria developed by the Andreasen group, 45 patients were evaluated as “remitted” and 72 patients as “not-remitted”. Remitted patients scored 3 or less on the following items of the Positive and Negative Syndrome Scale: P1-Delusions, P2-Conceptual disorganization, P3-Hallucinatory behavior, N1-Blunted affect, N4-Passive/apathetic social withdrawal, N6-Lack of spontaneity and flow of conversation, G5-Mannerism/Posturing, G9-Unusual thought content. The Thought and Language Index comprises of impoverishment of thought and disorganization of thought subscales. Impoverishment of thought category includes poverty of speech, weakening of goal and perseveration. Disorganization of thought category includes looseness, peculiar word use, peculiar sentence construction, peculiar logic and distractibility. We used logistic regression to determine the effect of thought disorders on symptomatic remission while controlling for sociodemographic and other clinical characteristics. Results: Logistic regression analyses revealed that poverty of speech (odds ratio: 1.62, p = 0.001) and peculiar logic (odds ratio: 1.58, p = 0.04) contribute to the prediction of symptomatic remission in patients with schizophrenia. Regarding the two subscales of the Thought and Language Index, impoverishment of thought was found to be related to symptomatic remission (odds ratio: 1.48, p = 0.001). There was no association found between disorganization of thought and remission of symptoms. Conclusion: These findings suggest that course of symptomatic remission is influenced by thought disorders in patients with schizophrenia. Poverty of speech and peculiar logic might have specific associations with symptomatic remission in schizophrenia. Impoverishment of thought might be a predictive factor rather than disorganization of thought in remission of the symptoms. Disorganization of thought representing positive thought disorder seems to be unrelated to the course of remission. Since
P.3.f.017 Depersonalization and schizophrenia M.J. Jaen Moreno1 ° , G. Chauca Chauca2 , P. Alonso Lobato3 , M. Guiote Malpartida4 1 Hospital Infanta Margarita, cordoba, Spain; 2 Hospital Infanta Margarita, Psiquiatr´ıa, cordoba, Spain; 3 USMC Pe˜ narroya, Psiquiatria, Cordoba, Spain; 4 Hospital Universitario Reina Sof´ıa, Unidad de Agudos, Cordoba, Spain Introduction: Depersonalization (DP) is an alteration in the perception or experience of himself, so that the individual feels strange and distant, like an external observer of his body or his own psychic processes [1,2]. The mains psychopathological characteristics of depersonalization are the sense of strangeness of the environment, feelings of automation, self-observation, emotional alterations, body image and in the experience of time [1]. Clinically depersonalization may occur as an independent category (depersonalization disorder) or as a symptom of other psychiatric and neurological disorders. Many authors have indicated the presence of depersonalization in schizophrenia, especially during the prodrome and acute phase of the disease [3], although it is possible that depersonalization is not so specific to schizophrenia but constitutes a general characteristic of the prespsychosis states, independently of etiology [2]. Material and Methods: A total of 48 subjects in the area of Mental Health of C´ordoba were evaluated from 2009 to 2012. The sample consisted of men and women between 18 and 50 years old, diagnosed with paranoid schizophrenia according to DSM-IV-TR. We excluded subjects with severe brain injury, mental retardation, neurological disease and/or severe sensory disturbances impeding evaluation. The total sample was distributed along two groups, one called “first psychotic episode” (n = 20) and the second
S545
called “multiple psychotic episodes” (n = 28). The first group was included once the diagnosis of schizophrenia was confirmed. The tools used to obtain the results presented in this study were the following questionnaires: – Cambridge Depersonalization Scale (CDS). The CDS consist of 29 items that assess the frequency, duration and intensity of the experience. – Dissociative Experiences Scale (DES). The DES is a visual analog scale with three dimensions: absorption, amnesia and depersonalization-derealisation. – Positive and Negative Syndrome Scale (PANSS). The PANSS scale consists of 30 items that assess schizophrenia from a categorical and dimensional perspective. – Beck Depression Inventory (BDI). The BDI consists of 21 items that mainly evaluated the clinical symptoms of melancholy and intrusive thoughts of depression. Results: The sample consisted of 33 men (68.8%) and 15 women (31.3%). 41.7% had completed primary school and 52% lived in urban areas compared to 48% who lived in a rural area. Score obtained in CDS for “intensity” was 40.58 (± 32.7), “frequency” 16.02 (± 13.7) and “duration” 24.14 (± 19.46). These scores were slightly higher for patients suffering first episodes than those with greater disease evolution. The score for the DES scale in its domain of depersonalization-derealisation was 14.64 (± 13.12) and the highest score was seen in the first episode again. Regarding the PANSS, no differences were found for positive symptoms subscale, but for the other subscales. Conclusions: Patients with first episodes have slightly higher scores for DP and dissociative experiences than those with greater disease progression. References [1] Berrios GE, Sierra M., 1997. Depersonalization: a conceptual history. History of psychiatry 8(30 Pt 2),213−29. [2] Sierra M., 2009. Depersonalization: A new look at a neglected syndrome: Cambridge University Press. [3] Mayer-Gross W., 1935. On Depersonalization. British Journal of Medical Psychology 15(2),103−26.
P.3.f.018 Evolution of anhedonia and depressive symptoms in Romanian outpatients diagnosed with major depressive episode and treated with agomelatine C. Tudose1 , P. Traian1 , M.V. Petre1 ° , V. Marinescu1 , G.I. Ciorica1 , C.E. Maliche2 1 Alexandru Obregia Psychiatric Hospital, Psychiatry, Bucuresti, Romania; 2 Constanta Psychiatric Hospital, Psychiatry, Constanta, Romania Depression is one of the most prevalent psychiatric disorder. It is estimated that by 2020 it will be ranked second in terms of disability-adjusted life year which is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death [1]. Agomelatine is an antidepressant with an unique pharmacological synergy between the antagonist action on serotoninergic 5HT2c receptors and the agonist actions on the melatonergic receptors [2]. The most recent meta-analysis of the published and unpublished studies of agomelatine showed that it is an effective antidepressant with similar efficacy to standard antidepressants [3]. Anhedonia is a core symptom of depression (together with depressed mood) and it is defined as the lack of ability to feel and experience pleasure and can be evaluated
S546
P.3.f. Psychotic disorders and treatment − Other (clinical)
with Snaith Hamilton Pleasure Scale [4]. Anhedonia affects the severity of the depression, predicts a poor outcome, a higher risk of suicide and it is a common residual symptom hard to treat. Agomelatine showed in a pilot study a positive effect in reduction of anhedonia [5]. Study purpose: To assess the major depressive episode adherence and symptoms, evaluated by clinicians and patients, in Romanian outpatients that received agomelatine, with focus on anhedonia in natural settings. Methods: HEDONIA study was a prospective, multicentre, observational study performed in Romania in 75 psychiatric sites. Recruitment took place in July-August 2014 and included adult outpatients with major depressive episode. All sites initiated and continued care and patients treatment according to their best current medical practice and in the study were evaluated only the patients taking agomelatine (1213 patients and 1155 completed all 3 study visits). The study consisted in 3 visits (screening visit (V1); follow-up at 2−3 weeks (V2); follow-up visit 6−8 weeks (V3)) that assessed the patients on: Montgomery Asberg Depression Rating Scale, Clinical Global Impression Rating Scale, Patient Global Impression Rating Scale and Snaith Hamilton Pleasure Scale. Results: The study included 850 females and 363 males diagnosed with major depressive disorder. Patient’s treatment adherence to pharmacological treatment was more than 95%. A statistically significant improvement was observed for both scales used to assess patient’s status: Montgomery Asberg Depression Rating Scale and Snaith Hamilton Pleasure Scale (p < 0.001). Clinicians’ and patients’ assessment of improvement and severity of disease were comparable, with slight differences in the fact that in the beginning of the treatment patients reported worse rates than clinicians and after 2 months of treatment patients reported a higher improvement than clinicians. Both assessments must be taken into consideration for further research. After 2 month treatment the scores for anhedonia ware significantly reduced and patients were able to resume normal activities. No adverse effects were recorded. Conclusion: Patient’s adherence to treatment was above 95% and optimal response was obtained in most of the patients. The highest rate of improvement was observed after 2 months of treatment. Patients’ overall status and scales scores improved after 2 months. Interestingly the patients scored higher than clinicians. No significantly weight gain or liver function changes were observed. References [1] Wittchen H U, Jacobi F, Rehm J, Gustavsson A, Svesson M, Jonsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, J. Van Os, Preising M, Salvador-Carulla L, Simon R, Steinhausen H C, 2011. The size and burden of mental disorders and other disorder of the brain in Europe 2010. European Neuropsychopharmacology 21, 655–657. [2] Stephen M. Stahl, 2014. Mechanism of action of agomelatine. CNS Spectrums 19, 207–2012 [3] David Taylor, Anna Sparshatt, Semma Olofinjana, 2014. Antidepressant efficacy of agomelatine: meta-analysis of published and unpublished studies. British Medical Journal. 348:g1888 doi 10.1136/bmj.g1888 [4] Snaith R P, Hammilton M, Morley S, Humayan A, Hargreaves D, Trigwell P, 1995. A scale for the assessment of hedonic tone. British Journal of Psychiatry 167, 99–103 [5] Giovanni Martinotti, Gianna Sepede, Francesco Gambi, Giuseppe Di Iorio, Domenico De Berardis, Marco di Nicola, Marco Onofrij, Luigi Janirini, Massimo Di Giannantonio, 2012. Agomelatine versus venlafaxine XR in the treatment of anhedonia in major depressive episode: a pilot study. Journal of Clinical Psychopharmacology 32(4), 487–491. Disclosure statement: I also work as a marketing specialist consultant for Servier Romania.
P.3.f.019 The effect of thought disorders on remission of symptoms in schizophrenia B. Yalın¸cetin1 , K. Alptekin2 ° , H. Ula¸s2 , T. Binbay2 , B.B. Akdede2 Eylul University, Department of Neuroscience, Izmir, Turkey; 2 Dokuz Eylul University, School of Medicine, Department of Psychiatry, Izmir, Turkey
1 Dokuz
Objective: Thought disorders in schizophrenia that deteriorate in acute episodes usually persist during the illness chronically in a vague form [1]. Antipsychotic treatment reduces thought pathology associated with acute episodes of schizophrenia, but residual thought pathology continues even after remission has been attained [2]. Negative formal thought disorder, identified with poverty of speech and poverty in the content of speech, was suggested to be associated with poor response to treatment in schizophrenia [3]. Schizophrenia patients having negative thought disorder are less likely to attain remission [4]. Positive formal thought disorder, determined by features like derailment, perseveration, circumstantiality, tangentiality, blocking and incoherence, usually disappears as the acute episode alleviates. The aim of this study is to investigate the effect of thought disorders on the course of symptomatic remission in schizophrenia. Methods: The study was carried out with the sample consisted of 117 patients (40 female, 77 male) diagnosed with schizophrenia according to DSM-IV. Study patients were selected from the Schizophrenia Outpatient Unit of Psychiatry Department in Dokuz Eylul University, School of Medicine. The patients were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Thought and Language Index (TLI). Using remission criteria developed by the Andreasen group, 45 patients were evaluated as “remitted” and 72 patients as “not-remitted”. Remitted patients scored 3 or less on the following items of the Positive and Negative Syndrome Scale: P1-Delusions, P2-Conceptual disorganization, P3-Hallucinatory behavior, N1-Blunted affect, N4-Passive/apathetic social withdrawal, N6-Lack of spontaneity and flow of conversation, G5-Mannerism/Posturing, G9-Unusual thought content. The Thought and Language Index comprises of impoverishment of thought and disorganization of thought subscales. Impoverishment of thought category includes poverty of speech, weakening of goal and perseveration. Disorganization of thought category includes looseness, peculiar word use, peculiar sentence construction, peculiar logic and distractibility. We used logistic regression to determine the effect of thought disorders on symptomatic remission while controlling for sociodemographic and other clinical characteristics. Results: Logistic regression analyses revealed that poverty of speech (odds ratio: 1.62, p = 0.001) and peculiar logic (odds ratio: 1.58, p = 0.04) contribute to the prediction of symptomatic remission in patients with schizophrenia. Regarding the two subscales of the Thought and Language Index, impoverishment of thought was found to be related to symptomatic remission (odds ratio: 1.48, p = 0.001). There was no association found between disorganization of thought and remission of symptoms. Conclusion: These findings suggest that course of symptomatic remission is influenced by thought disorders in patients with schizophrenia. Poverty of speech and peculiar logic might have specific associations with symptomatic remission in schizophrenia. Impoverishment of thought might be a predictive factor rather than disorganization of thought in remission of the symptoms. Disorganization of thought representing positive thought disorder seems to be unrelated to the course of remission. Since