B. Ibach

Polypharmazie in der Gerontopsychiatrie

Polypharmazie ist der gleichzeitigen Gebrauch von mehreren Medikamenten und ergibt sich bei alteren Menschen mit psychiatrischen Erkrankungen aus verschiedenen Umstanden. Die mit zunehmendem Alter ansteigenden somatischen und psychiatrischen Morbidifatsinzidenzen und-pravalenzen fuhren haufig zur gleichzeitigen Verordnung von mehreren Medikamenten.

P03-46 - Long-term safety, tolerability and efficacy of risperidone long-acting injectable and oral atypical antipsychotics in schizophrenic patients: two year naturalistic study

Objectives This non-interventional study (RIS-SCH-4023) examined tolerability and effectiveness of risperidone long-acting injectable (RLAI) versus oral second generation antipsychotics (oSGA: amisulpride, aripiprazole, olanzapine, quetiapine, risperidone or ziprasidone) in schizophrenia under daily routine. Methods Outpatients receiving RLAI (n=177) or oSGA (n=257) were followed-up for 2 years (m/f 42%/58%; mean age 34.6 years; duration of disease 2.6 years). Outcome measures included PANSS, CGI, relapse rates, treatment adherence and tolerability. Post-hoc analyses focused on baseline between-group differences. Results Multivariable analysis using recursive partitioning showed that upon study entry RLAI patients were 3.7 times (CI=2.48-5.59) more likely than oSGA patients to have switched to study medication due to non-compliance and/or to be substance abusers (RLAI= 59.9%, n=106/177 vs. oSGA=28.6%, n=73/255). Despite these differences, both groups demonstrated significant improvements in efficacy measures with no between-group differences. There were no significant differences in discontinuation of study medication over the two years (RLAI 41.2% vs. oSGA 36.6%) or in yearly relapse rate before change of the initial therapy (RLAI 0.48±1.48 vs. oSGA 0.71±2.63). In patients with high adherence (≥75%) to previous treatment (physicians’ estimates, 4-point Likert scale) RLAI vs. oSGA patients had significantly better retention rates (RLAI 57.4% vs. oSGA 35.1%) and times (527.0±32.6 vs. 424.1±22.3 days). Most frequently reported treatment-related adverse events were weight increase (13.0% vs. 9.7%), EPS (7.9% vs. 5.5%), hyperkinesia (6.2% vs. 3.5%), fatigue (5.7% vs. 9.7%). Conclusions Results suggest that factors associated with poor outcomes such as poor compliance and substance abuse may be attenuated by treatment with RLAI.

PW01-178 - Effectiveness, tolerability and compliance of schizophrenic patients under treatment with oral atypical antipsychotics or long-acting injectable risperidone in daily routine

Introduction This study assessed treatment compliance, effectiveness, tolerability and safety of oral second generation antipsychotics (oSGA) versus long-acting injectable risperidone (RLAI). Methods Non-interventional, 24-month study (RIS-SCH-4057) in schizophrenic patients (ICD-10 F20.x; CGI≤5) with monotherapy of oSGA (amisulpride, aripiprazole, olanzapine, quetiapine, ziprasidone, or risperidone) or RLAI. Results Interim analysis after 12 months including 300 RLAI and 159 oSGA patients (ITT; m/f 48%/52%; age 42.1±11.5 years; mean disease duration 8.8±8.1 years). PANSS, CGI-C and SWN-K significantly improved in both groups (p 70% of both groups. In RLAI vs. oSGA patients retention rates were higher (54.0% vs. 43.3%; p=0.0542), retention time was 277±11 vs. 254±13 days (p=0.0995), relapse rate/patient/year was 0.15 vs. 0.21 and time to first relapse was 309±7 vs. 290±10 days (p=0.0485). Adverse events (AEs) were reported in 69.0% RLAI vs. 76.1% oSGA patients, serious AEs in 19.7% vs. 19.5%. One RLAI patient died with no causal relationship to study medication. Most common AEs at least possibly related to the study medication in RLAI vs. oSGA patients were fatigue (12.7% vs. 16.4%), disturbance in attention (12.7% vs. 13.8%), dry mouth (13.0% vs. 13.2%), weight increase (11.0% vs. 10.1%), and EPS (3.0% vs. 2.5%). 6.0% RLAI and 6.9% oSGA patients had serious AEs at least possibly related to the study medication. Conclusions The trend of these data towards lower relapse rates and longer retention with RLAI vs. oSGA indicates that RLAI therapy may help patients effectively to achieve better long-term outcomes.

P03-44 - Effectiveness of long-acting injectable risperidone in the post-acute treatment of schizophrenic patients in ambulatory care

Introduction Major goals in the treatment of schizophrenic out-patients are the reduction and stabilization of psychopathological symptoms, the reduction of relapses and a lasting improvement of the quality of life. Methods Non-interventional, 52-week study (RIS-SCH-4091) in schizophrenic patients after treatment of exacerbation or first episode of schizophrenia (ICD-10 F20.x) with monotherapy of long-acting injectable risperidone (RLAI). Results Interim-analysis after 12 months of 75 patients (ITT, m 64%; 32.7±9.1 years; N=88 safety set). Duration of observation was 278.8±119.3 days. Median start and end dose of RLAI was 37.5 mg/2 weeks. More than 80% of RLAI patients showed 75-100% compliance; 63% improved compliance compared to previous treatment. Improvement from baseline to endpoint was significant (p Conclusions The results indicate that RLAI has good tolerability and good clinical effectiveness in the therapy of schizophrenic out-patients. High compliance, low hospitalization and low relapse rates under RLAI may help patients achieve stable remission and to master daily life.

P03-45 - Psychosocial functioning of schizophrenic patients in post-acute treatment with long-acting injectable risperidone in ambulatory care

Introduction Improvement of social and occupational functioning is a major goal in the treatment of schizophrenic patients and therefore may improve reintegration of patients and their ability to lead an independent life. Methods Non-interventional, 52-week study (RIS-SCH-4091) in schizophrenic patients after treatment of exacerbation or first manifestation of schizophrenia (ICD-10 F20.x; duration of disease ≤10 years) with long-acting injectable risperidone (RLAI) in monotherapy. Presented here is the assessment of the treatment based on the Clinical Global Impression (CGI), the Global Assessment of Functioning (GAF), and skills assessing the ability of patients for reintegration as quantified by the short version of the International Classification of Functioning, Disability and Health for Mental Disorders (Mini ICF-APP). Results Interim-analysis after 12 months of 75 patients (ITT, m 64%; 32.7±9.1 years; N=88 safety set). Duration of observation was 278.8±119.3 days. GAF total scores improved significantly (24.4±23.7); 76.0% of the patients improved in CGI-C. Mini-ICF-APP total scores improved significantly from 1.96±0.68 to 1.18±0.94 at final observation. All Mini-ICF-APP sub-items improved significantly, particularly within: participation in public roles, non-occupational activities, self maintenance, competency, flexibility, family relations. 119 adverse events (AEs; 28 serious AEs) were reported in 47 patients. Most common AEs at least possibly related to RLAI were lack of effectiveness 8.0%, weight increase 8.0%, psychotic disorder 5.7%, anxiety 3.4%, EPS 3.4%. Conclusions Results indicate that treatment with RLAI may improve global functioning of patients by reducing typical disorder of functioning, capacity and participation. Treatment with RLAI may help patients to reintegrate into social and occupational environments.

P2-436: The neuropsychiatric practitioner's experience with Alzheimer's disease and treatment thereof: A survey on general impressions in everyday routine

[89.3/65.3], men 71,1 [81.6/62.6]).Co-existing dementia prior to ECT was diagnosed in 10 (23.8%) patients, mild cognitive imparment (MCI) in 7 (16.7%). Advanced vascular or neurodegenerative disease was found in 50% of patients. The affective symtoms were rated with Hamilton Depressions Scale 24 (HAMD 24) before, during and after finishing ECT. All patients achieved complete or partial remission of affective symptoms in HAMD 24. During ECT-treatment, patients with dementia or MCI showed more distinctive cognitive deficits than geriatric participiants without preexisting cognitive deficits in rating MMSE. In patients with cerebrovascular lesions, neurodegeneration or both in cranial MRI transient cognitive impairments were induced faster than in patients without cerebral changes. About 75% of these patients had not achieved baseline levels in cognitive functioning 8 weeks after finishing treatment. In 1/3 MCI or dementia were diagnosed in follow-up. Geriatric patients without cognitive impairment before treatment and no or only mild neuroimaging findings achieved full cognitive functioning during follow-up. Conclusions: Our results show that ECT is effective in refractory geriatric depression. Severe cognitive side-effects occur mainly in patients with pre-diagnosed cognitive impairment or MRI signs of neurodegenerative or vascular disease.