A.L. Montejo

The need for routine physical health care in schizophrenia.

When managing their patients with schizophrenia, psychiatrists are increasingly concerned about physical disorders, including weight gain, obesity, metabolic abnormalities (in particular, diabetes and the metabolic syndrome), prolactin increase, sexual dysfunction and cardiovascular disease. Other common health-related problems in these patients include recreational drug use, sedation/physical inactivity, adverse drug effects and poor self-care. Each of these can have an impact on patient well-being, adherence to therapy and life expectancy. Collectively they can pose substantial barriers to optimal outcomes. However, the widespread acknowledgement of the importance of the physical health of patients with schizophrenia does not always result in consistent monitoring and management of physical health risks in the clinic. Urgent action is needed to ensure that psychiatrists prioritise physical healthcare alongside mental healthcare as a way to improve the longterm outcomes of treatment in all patients with schizophrenia.

Estimation of a multiattribute utility function for the Spanish version of the TooL questionnaire.

OBJECTIVES To estimate and assess the psychometric properties of a multiattribute utility function (MAUF) for the Spanish version of the Tolerability and Quality of Life (TooL questionnaire). METHODS Balanced data on 243 patients diagnosed with schizophrenia or bipolar disorder were gathered. In addition to the demographic and clinical variables and the usual generic health-related quality of life (HRQoL) questionnaires (EuroQol-5D [EQ-5D] and Short Form-6D [SF-6D]), instruments considered included the Spanish versions of the Positive and Negative Symptoms of Schizophrenia Scale (PANSS), Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Udvalg for Kliniske Undersogelser (UKU), and Clinical Global Impression Severity (CGIS) scale. MAUF parameters estimation involved a number of visual analogue scale (VAS) and time trade-off (TTO) ratings that proved difficult to be performed by the patients. After checking for inconsistencies in patient responses, the original sample was reduced to a still balanced subsample of 70 individuals. A multiplicative-form MAUF was estimated following the standard methodology. RESULTS Good convergent validity was demonstrated because utility estimates from the MAUF presented strong correlations with utilities from the generic HRQoL instruments included: SF-6D (0.66, P < 0.01), EQ-5D (0.69, P < 0.01), and moderate correlations with the rest of instruments considered: PANSS (-0.27, P = 0.10), YMRS (-0.30, P = 0.08), MADRS (-0.48, P < 0.01), UKU (-0.35, P < 0.01). Criterion validity was also met because differences in mean utilities by clinical severity were found (P < 0.01). Utilities from the MAUF covered a wider range of health states [0.04,1.00] than those from the SF-6D [0.53,1.00] and EQ-5D [0.23,0.96]. CONCLUSIONS Utilities from the MAUF showed good psychometric properties, serving as a complement to generic health utilities. If misapplied, however, utilities from this instrument might favor the positive evaluation of drugs showing fewer associated side effects.

EPA-1694 – Antipsychotics and prolactin. Study of prevalence and associated sexual disfunction

Introduction Hyperprolactinaemia is a common side effect of some APS, associated to important clinical manifestations (sexual dysfunction, breast disturbances and even increase of certain types of cancer risk). Objective To evaluate the levels of prolactinemia associated to different APS, including the newest ones, and its association with sexual dysfunction (SD). Methods Observational cross-sectional study. Adult patients treated with one APS for at least 4 weeks and with no other PRL-rising treatment were included. Hyperprolactinaemia was defined as 20 microgr/L in women, 18 microgr/L in men. SD was evaluated with the specific SD questionnaire PR-Sex-DQ-SALSEX (Montejo et al, 2001). Results 288 patients were evaluated, with the following APS treatment distribution: aripiprazol (22.2%), risperidone (17.01%), olanzapine (16.67%), quetiapine (7.99%), long-acting paliperidone (6.25%), long-acting risperidone (4.51%), oral paloperidone (4.17%), oral risperidone (4.17%) and others (21.18%; APS with N Conclusions In our sample paliperidone and risperidone were associated to higher mean PRL levels and sexual disfunction, while quetiapine, olanzapine and aripiprazol were the less PRL-raising APS. This might be taken in consideration when electing a long-term antipsychotic treatment for patients, given the important clinical consequences associated to sustained hyperprolactinaemia.

PMH43 THE SPANISH VERSION OF THE TOOL QUESTIONNAIRE: A USEFUL MEASURE FOR EVALUATING THE HRQOL AND UTILITIES FROM SCHIZOPHRENIC AND BIPOLAR PATIENTS

PMH42 HEALTH-RELATED QUALITY OF LIFE OF MARRIED,WORKING WOMENWITH CHILDREN (SUPERWOMAN SYNDROME) IN KOREA Kim S, Park S, Park H Kyung Hee University, Seoul, South Korea, Kyung Hee University, Yongin, Gyeonggi-Do, South Korea, Pochon CHA University, Sungnam, Gyeonggi-Do, South Korea OBJECTIVES: To assess health-related quality of life (QoL) of married, working women with children (working-moms) faced with psychosocial stress (known as superwoman syndrome). METHODS: A total of 200 working-moms (aged 40.2 5.3) were recruited randomly by telephone, and a questionnaire was administered to classify types of superwomen syndrome: selfreliance type (ST), conflict type (CT), and additive type (AT). To compare, a community samples of aged group (n = 80, aged 70.0 5.9) were recruited at a local community center. We measured QoL using SF-36v2 for both groups. RESULTS: As expected younger working-moms reported significantly higher physical function (PF: 79.7 18.7 vs. 71.9 21.9; p = .0031) and mental health (MH: 49.2 15.3 vs. 41.0 14.8; p < .0001). On the contrary role-physical (RP: 78.9 23.6 vs. 80.5 22.5) and role-emotional (RE: 77.2 25.0 vs. 83.2 24.0) scores were lower than aged. Additionally, social functioning (SF) was significantly lower in working-moms (p < .0003). Further by types, most physical-related scales of ST group (n = 10) were significantly higher (all p’s < 0.0025), whereas vitality (VT) and MH were lower than aged.Majority of working-momswere classified as CT group (n = 169). They reported the same QoL patterns as total samples. Notably, AT group (n = 21) reported only MH (62.9 13.8 vs. 41.0 14.8; p < 0.0001) was significantly higher than aged, and rest were either similar (PF, VT), or significantly lower than aged (RP: 62.8 24.6 vs. 80.5 22.5, RE: 55.1 26.6 vs. 83.2 24.0; all p’s < 0.002). CONCLUSIONS: Most workingmoms reported higher functioning and well-being, but in fact they were limited in playing roles due to physical andmental problems. It is suspected that they are denying and suppressing their various health problems. Particularly, additive group report they are in well-being, but the study showed they are definitely not. They even may develop mentally and physically-related diseases in the near future. Therefore, a cohort study is urgent for working, married women with children in Korea.

EPA-0380 – Effects of agomelatine and escitalopram on emotional detachment, emotional processing and motivation during a 9-week treatment in healthy volunteers

Dysfunctions of the emotion processing circuitry are associated with Major Depressive Disorder (MDD) and can be modulated by antidepressants like selective serotonin reuptake inhibitors (SSRIs). Moreover, motivation, pleasure or interest are important neuropsychological states of emotional life, and are known to be impaired in MDD patients. Under SSRIs, some patients report decreases in motivation and/or in emotional responsiveness commonly described as emotional detachment (Corruble E et al , 2013) and having significant impact on drug compliance and quality of life. The antidepressant agomelatine displays a unique neurochemical profile, different from SSRIs, being a MT1/MT2 receptors agonist and a 5HT2C receptors antagonist (De Bodinat C et al , 2010). Data from healthy volunteers and patients suggest that agomelatine is associated with less emotional detachment as compared to SSRIs notably with a more specific action in the facial expression recognition task (Harmer CJ et al , 2011), lower scores on scales for blunting (Corruble E et al , 2013), and absence of sexual dysfunction (Montejo AL et al , 2010). Here, the effects of two antidepressants, agomelatine (25 and 50mg) and escitalopram (10–20mg) on emotional detachment, emotional processing, motivation and sexual function were assessed during a 9-week randomised, double-blind, placebo-controlled, parallel-designed study in healthy male and female volunteers aged between 18-45 years. A battery of neuropsychological and motivation tasks/questionnaires available in the literature were used. Investigating antidepressant effects on key psychological processes in healthy volunteers allows elucidation of the direct actions of antidepressants unconfounded by changes in mood symptoms. The study is on progress.

P03-95 - Managing strategies for antidepressant-related sexual dysfunction. results from a multicentric, pragmatic study with 2000 patients in spain: the SALSEX-I study

Introduction Antidepressant-related sexual dysfunction (ADr-SD) is the most frequent and long-lasting adverse event, often underestimated and rarely spontaneously communicated. Strategies to manage it haven’t been explored to date. Study aim To explore ADr-SD clinical management in regular practice. Objectives 1. To stablish the prevalence of SD in patients following antidepressant treatment. 2. To describe the therapeutic interventions used when SD is detected. Methods Cross-sectional, multicentric and naturalistic study. Patients taking antidepressant for at least two months without previous SD were included. SD was evaluated with the specific questionnaire PR-Sex-DQ (SALSEX, Montejo et al 2001). Results 1988 out of 2000 patients recruited resulted eligible for the analysis. According to PRSexDQ scores SD was present in 87.5% ot the sample. Only 44.2% communicated it spontaneusly. 66.2% reported regular to poor tolerance of SD and 19.6% had thought about discontinuing treatment due to it. Regarding the therapeutic interventions used for managing ADr-SD, waiting for its spontaneus remission was the most frequent strategy reported (36.8%), followed by changing the antidepressant (32.5%) and reducing the dosage (18.5%); 5% chosed “weekend holidays”, 4% discontinued the antidepressant, 2.5% associated another antidepressant and 1.3% added a 5-phosphodiesterase inhibitor. Bupropion and mirtazapine were the antidepressants most frequently selected for the switching and association strategies. Conclusions These results study highlight the high rates of SD related to antidepressants and its potential association with non-adherence to treatment. Despite this unfortunatelly clinicians do prefer to wait rather than performing any active strategy to manage this adverse event.

EPA-1591 - Sexual and relational dysfunctions in people wit schizophrenia

Sexual and emotional/relational dysfunctions are commonly associated to some treatment of severe mental illness (bipolar disorder and schizophrenia) mainly antipsychotic-related hyperprolactinaemia. Unfortunately these dysfunctions are present during the long term after the antipsychotic onset to provide continued symptom control and enable recovery. Many patients with schizophrenia, mainly young males, consider impairment of sexual function as one of the most important adverse effects together with extrapyramidal symptoms, weight gain, and sedation. Unfortunately many patients may consider this drug-induced impairment of sexual function unacceptable influencing strongly the compliance. Hyperprolactinemic antipsychotics like haloperidol, risperidone, paliperidone and amisulpride are more likely associated with this adverse event. Nevertheless ariprazole, quetiapine, ziprasidone, clozapine and olanzapine are not related to sexual dysfunction and should be first election in these patients. Recent studies (Montejo 2010) shows that sexual, emotional and personal relationships are highly relevant in at least 65% of patients suffering Schizophrenia as much as the control group of normal population. Many patients have few information about sexual education and theres a lack of appropriate interviews with their psychiatrist in this topic. Love and emotional stable relationships could definitively contribute to normalize their lives. Given that patients taking some antipsychotics may experience poorly tolerated side effects, it is therefore important to tailor treatment to the individual with respect to efficacy and tolerability, and to manage any treatment-emergent side effects adequately in order to facilitate compliance and achieve the best possible outcomes.