G. Konstantakopoulos

Pregabalin in the discontinuation of long-term benzodiazepines' use†

Tolerance, dependence, and adverse effects on cognitive functions are well‐known consequences of long‐term use of benzodiazepines (BDZ), especially at high doses, raising thorny therapeutic problems in their discontinuation. One promising pharmacological agent in BDZ discontinuation might be the newer anti‐epileptic pregabalin, already successfully tested in the treatment of anxiety disorders.

Pregabalin in the Treatment of Alcohol and Benzodiazepines Dependence

We review all available studies on the use of the newer anticonvulsant drug pregabalin (PGB) in the treatment of both alcohol dependence (AD) and benzodiazepine dependence (BD). In AD, the available evidence includes one open‐label and one double‐blind randomized studies, whereas in BD, only a few case reports and one open‐label study are as yet available. In both conditions, PGB was found efficacious with significant improvement in withdrawal symptoms at the dosage ranges of 150–450 mg/day (AD) and 225–900 mg/day (BD). Moreover, its side effects were mild and transient. Despite the limited quality of the studies design, their findings suggest that PGB might constitute a novel efficacious and safe option in the treatment of both AD and BD.

Tiagabine augmentation to fluvoxamine-risperidone combination in the treatment of obsessive-compulsive disorder.

Despite the recent progress in the pharmacological treatment of obsessive-compulsive disorder (OCD) – especially with high doses of serotonin reuptake inhibitors, alone or in combination with low doses of antipsychotics – a non-negligible proportion of patients remains refractory to it. For these patients augmentation tactics with drugs from other chemical classes, including antiepileptic drugs, seems advisable. We report on the case of a female inpatient with OCD, whereby the adjunction of tiagabine, a selective GABA reuptake inhibitor at 15 mg/day, to a fluvoxamine (400 mg/day)–risperidone (1 mg/day) combination led to the patients marked improvement as reflected in the reduction by almost 47% of her score on the Yale-Brown Obsessive Compulsive Scale. With respect to tiagabines specifically anti-OCD mechanism of action, we note that enhanced inhibitory GABAergic neurotransmission slows down excitatory glutamatergic transmission in the cortico-striato-thalamic system, which presumably constitutes the core pathophysiological mechanism of OCD symptoms.

EPA-1030 – The greek version of the camberwell assessment of need: psychometric properties and associations with quality of life and social disability in schizophrenia

Introduction Needs assessment has been highlighted as a crucial factor in the development, organisation and evaluation of mental health services. Moreover, meeting self-reported needs is of prime importance for ensuring quality of life and reducing social disability for people with severe mental disorders. Objectives Service evaluation based on patients’ need assessments has never taken place in Greece. Furthermore there are no standardized needs assessment instruments. Given the underfunding of psychiatric services due to the current economic crisis, systematic need assessment is expected to contribute to the efficient use of their limited resources. Aims To examine the concurrent validity, inter-rater and test-retest reliability of the Greek research version of the Camberwell Assessment of Need (CAN-R). Method Fifty-three schizophrenia patient–staff pairs were interviewed twice to test the inter-rater and test-retest reliability of the CAN-R (Greek version). The WHOQOL-BREF and WHODAS 2.0 were administered to the patients to examine concurrent validity. Results The inter-rater and test-retest reliability of patient and staff interviews for the 22 individual items and the eight summary scores of the instruments four sections were good to excellent. Significant correlations emerged between CAN scores and the WHOQOL-BREF and WHODAS 2.0 domains for patient and staff ratings, indicating good concurrent validity. Conclusion Our results suggest that the Greek version of the CAN-R is a reliable instrument for assessing mental health patients’ needs. This is the first CAN-R validity study with satisfactory results using WHOQOL-BREF and WHODAS 2.0 as criterion variables.

EPA-0988 – Cognitive and affective theory of mind in schizophrenia and euthymic bipolar disorder

Introduction There is substantial evidence that patients with schizophrenia present with impaired Theory of Mind (ToM). ToM impairment has been also reported in euthymic bipolar disorder (BD). However, data from direct comparisons of patients with schizophrenia and BD on ToM abilities are limited. Objectives It has been suggested that different aspects of mentalizing processing, such as epistemic and emotional mental representations, i.e. cognitive and affective ToM, must be separately examined. Aims The aim of the study was to compare ToM ability and both its cognitive and affective components between schizophrenic and euthymic BD patients. Methods Fifty three BD type I euthymic patients, 54 patients with schizophrenia and 53 healthy controls (HC) completed a multi-facet battery of ToM tasks, including False belief task, Hinting task and Faux Pas Recognition Test (FP). Besides the overall ability to recognize Faux Pas, two specific components of ToM – cognitive and affective – were assessed with FP. The three groups were matched for gender, age and education. Results BD and schizophrenia patients showed no impairment in the False belief task. Schizophrenia patients performed significantly lower than HC and BD patients in Hinting task, FP recognition and affective ToM. Both patient groups were impaired in cognitive ToM. However, only BD patients with a history of psychosis performed significantly lower than HC in affective ToM. Conclusions In contrast to schizophrenia patients, euthymic BD patients show a specific deficit only in cognitive but not in affective ToM. Further research on the impact of these deficits on social and occupational functioning is warranted.

P02-201 - Safety of the electroconvulsive therapy-paliperidone combination

Objectives Patients with psychotic or mood disorders often undergo electroconvulsive therapy (ECT) while receiving antipsychotic and/or other pharmacological agents. Paliperidone (PLP) -a benzisoxazole derivative and the principal active metabolite of risperidone- is a second-generation antipsychotic which has been developed in an osmotic controlled-release oral-delivery system. Thus the peak-through fluctuations of its concentration in plasma are minimized, with consequently decreased incidence of side-effects. To the best of our knowledge, there are, as yet, no reports on the safety of ECT-PLP co-administration. Methods Nine female inpatients suffering from affective disorders (N=7) or schizophrenia (N=2) underwent ECT while receiving PLP (3-12 mg/d). Patients’ regimen included other psychotropic medications as well (mainly antidepressants and/or antipsychotics). All patients were monitored closely for recovery time, post-ictal delirium, cardiological and EEG status for at least one hour after each ECT session. In addition to their clinical evaluation, patients’ cognitive -especially memory- functioning was regularly assessed by the Mini Mental State Examination. Overall, patients underwent 83 sessions of bilateral ECT. Results ECT-PLP combination was well tolerated and even in cases where cognitive side-effects were of moderate severity (three cases; all were also receiving venlafaxine), they were transient. Conclusions Although anecdotal and thus in need of replication in well-designed large studies, our preliminary findings suggest that ECT and PLP can be safely combined whenever both indicated.

P02-213 - QTc interval changes during ECT-ziprasidone-quetiapine-tricyclics co-administration: safety issues

Objectives Both tricyclic antidepressants and some atypical antipsychotics, such as ziprasidone and quetiapine, used as augmentation agents in severe major depression, are known to increase QTc interval to a moderate extent (10-20 msec). Moreover, electroconvulsive therapy (ECT) also increases patients’ propensity to arrhythmias. Finally, females are more prone than males to both drug-induced QTc prolongation and torsades-de-pointes. Thus, the combination of all the above treatments raises serious safety concerns. We investigated the safety of the co-administration of ECT with a tricyclic-ziprasidone-quetiapine combination with respect to QTc interval in six female patients with severe major depression resistant to pharmacotherapy. Methods Each patient underwent a series of 10-11 sessions of bilateral ECT. QTc intervals were calculated at baseline and several times up to 10 min after seizures cessation in a total of 63 patients/ECT sessions. Results A small initial decrease of QTc after the administration of pre-ECT medications was followed by its steady statistically non-significant increase during the first 20 sec after seizure cessation. Thereafter, a steady larger and statistically significant decrease of QTc emerged during the ensuing 21-50 sec interval. Finally, this decrease was gradually reversed within the following 2 min approximately with return of QTc interval to stable baseline levels. Conclusions Overall, QTc interval changes remained within normal limits (fixed at 470 msec in women), without the occurrence of any cardiac adverse events, especially severe arrhythmias such as torsades-de-pointes. Our findings suggest that the co-administration of these treatments might be safe, at least with respect to QTc interval changes.

Primary and secondary affective disorders in a sample of alcohol dependent inpatients: sociodemographic differences

Background Several studies indicate that patients with comorbid alcohol dependence and affective syndromes can be differentiated on the basis of the time of onset of mood symptoms relative to alcohol abuse. However, there are limited data on the underlying pathogenetic mechanisms and risk factors that differentiate between primary and secondary affective disorders (AD) in the context of alcohol dependence. In the present study we investigated the sociodemographic characteristics, family history and the course of illness in cases of comorbid alcohol dependence and AD.