J. Gama Marques

EPA-0909 – A review of olfactory reference syndrome about a series of clinical cases

Introduction The Olfactory Reference Syndrome (ORS) is a clinical condition in which patients are convinced that they exude an unpleasant odor that is noticed by others. It was described for the first time in 1891, but became relevant in the nosology with Phillips in 1971. Since then discussion remains about diagnostic framework of this clinical entity. Objectives About a clinical case series, the authors intend to review clinical features, nosological framework and response to treatment of the ORS. Methods Review of literature collected from online medical databases. Report of a case series of five patients with ORS. Results The literature on the ORS consists mainly of case reports, and there are few controlled studies and systematic reviews. It was found that in most cases the complaints relate to a typical body odor, more often fecal, genital or halitosis. These beliefs range from overvalued ideas to delusions with strong conviction and they are usually accompanied by ideas of self-reference. Patients do not always smell the odor that they believe to emanate. The disturbance has high social, family and work impact. The response to treatment is variable and it was observed at different rates when antipsychotics, antidepressants and psychotherapy are used. Discussion/Conclusion Although it was proposed for integration in DSM-5 as an independent entity, the ORS was not so defined, remaining as a disorder whose characteristics overlap other diagnoses, including delusional disorder, in which is usually included, but also disorders from the obsessive-compulsive spectrum and social anxiety, given the variability of morbid consciousness. We also discuss the possible relationship of the ORS with symptoms of olfactory expression in other psychiatric disorders. The ORS deserves the attention of psychiatrists since it brings great suffering for the patient, as well as high demand for non-psychiatric care and the consequent delay in diagnosis and treatment.

721 – European psychiatric trainees and their interactions with the pharmaceutical industry: results from the efpt-prirs study

The influence of pharmaceutical industry (PI) on clinical practice and research in psychiatry has been considered a serious problem. Strict rules and guidelines were developed to regulate the interactions between doctors and PI. However, there is an ongoing debate whether these were thoroughly implemented in practice and internalized by physicians. The objective of our study was to assess the attitudes and behaviors of trainees in psychiatry and child & adolescent psychiatry toward PI across Europe. Methodologically, a validated questionnaire with additional items was administered to1444 trainees in 20 European countries. The minimum response rate was set at 60%. We found a high variation across countries in number of interactions between trainees and PI representatives; Portugal and Turkey had the highest number of interactions. The majority (59.76%) agreed that interactions with PI representatives have an impact on physicians’ prescribing behavior; whereas only 29.26% and 19.79% agreed interactions with PI representatives and gifts from PI have impact on their own prescribing behavior, respectively. Most of the gifts were considered appropriate by the majority, except tickets to vacation spot and social dinner at a restaurant. Of the sample, 70.76% think they have not been given sufficient training regarding how to interact with PI representatives. Only less than 20% indicated they have guidelines at institutional or national level. In conclusion, there is substantial interaction between trainees and PI across countries. The majority feel inadequately trained regarding professional interaction with PI, and believes they are immune to the influence of PI.

P-852 - Access to information in psychiatric training (ATIIPT) among the delegates to the european federation of psychiatric trainees (EFPT) 2011 forum

Introduction In the last decades, psychiatric training has undergone a major transformation due to the contribution of recent scientific developments in psychiatry. Nowadays, the information acquired during the Psychiatric training seems considerably variable in content and quality between different countries. However, data concerning access to information and also about the educational resources available to the trainees in Europe is very limited. Objectives and aims The ATIIPT survey aimed to evaluate Psychiatric trainees’ access to published, online, seniors or industrys information in Europe. Methods A short paper questionnaire constituted of 7 questions (Appendix 1) was created by the members of the EFPT Research Working Group and passed to each delegate of the 32 countries represented at the 19th EFPT Forum in Prague, Czech Republic, on the 2nd of July 2011. Results According to the ATIIPT results, access to information among Psychiatric trainees in Europe is heterogeneous. The most available resources are books and websites, and the most preferable resource is journals. Most of the trainees find their resources sufficient, with the main obstacles being related to low availability of journals and books, lack of time and help from seniors. Conclusions Better access to information and more evidence in practice is warranted, since the introduction of novel approaches to access to information may create better psychiatrists in the future, encourage medical students to consider psychiatry as a potential career, and help reduce negative attitudes towards mental illness.

P02-184 - The European federation of psychiatric trainees’ psychiatric resident - industry relationship survey (EFPT-PRIRS)

There is no doubt that, in the modern era, psychiatry and the pharmaceutical industry have a relationship, though the nature of this is not universally well defined. Given that psychotropic medication is widely prescribed (ranking 3rd and 4th in US sales in 2007), and the role of the pharmaceutical industry in medical education has come under scrutiny, it is worth noting that the relationship between the industry and psychiatry trainees has not been studied in great depth. Our Pan-European research group, composed exclusively of psychiatry trainees from at least 18 different countries, as part of the European Federation of Psychiatric Trainees (EFPT) has sought to study this in a systematic fashion. I will present preliminary findings of our survey, PRIRS (Psychiatric Residents-Industry Relationship Survey) which is currently taking place. It is also hoped that this will facilitate a discussion amongst those attending the session, on the role of the pharmaceutical industry in psychiatric training, education and in general.

P03-343 - Treatment choice in psychiatry? How would European trainees treat psychosis for their patients and themselves, and what influences decision-making?

Objectives Recent evidence has questioned modern psychiatric clinical practice, specifically the prescribing of “atypical” antipsychotics. Our Pan-European Research Group wished to ascertain clinical practice amongst European trainees, which treatments trainees would desire for themselves, and factors influencing this. Methods A semi-structured survey was constructed from prior literature, piloted, and a homogenous sample size of at least 50 was agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, with questions on preference of antipsychotic for patients in given scenarios, and factors influencing choice. Physicians were asked for their preference should they develop psychosis. Results i) Treatment choice of antipsychotic for patients 93% (n=600) of respondents chose to prescribe “atypical” antipsychotics (excluding Clozapine), 6% (n=42) choosing “typical” antipsychotics, 1% (n=6) choosing Clozapine as first-line therapy. ii) Treatment choice if trainees developed psychosis 89% (n=530) of responders chose to prescribe “atypical” antipsychotics (excluding Clozapine), 7% (n=40) choosing “typical” antipsychotics, 4% (n=23) choosing Clozapine as first-line therapy. iii) Factors influencing choice These mapped onto three domains: cost, efficacy and side-effect profile (less than 5% other reasons). 79% (n=458) of those who responded felt efficacy most important, 46% (n=270) felt side-effect profile most important and 3% (n=16) considered cost of paramount importance. 38% (n=272) of those who responded to the survey stated that the CATIE trial had influenced their decision-making. Conclusions Psychiatry trainees’ choice of antipsychotic medication for both patients and themselves is based on perceived benefits, as opposed to evidence base and recent literature.

PW01-264 - How would European trainees treat bipolar disorder for their patients and themselves, and what influences decision-making?

Objectives Guidelines produced for management of Bipolar Disorder illustrate change in evidence-base for treatment of acute and maintenance phases of illness. Our Pan-European Research Group assessed clinical practice and desired treatments amongst amongst Psychiatry trainees. Methods A semi-structured survey was piloted, and homogenous sample size (at least 50) agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, questioning preference of mood stabiliser for patients, trainees themselves and factors influencing choice. Results Tables 1 summarise choices. Number (n) Percentage Drug(s) 263/224 40.8/34.8 Lithium 121/101 18.8/15.7 Semisodium Valproate 133/85 20.7/13.2 Sodium Valproate 21/50 3.3/7.8 Lamotrigine 27/18 4.2/2.8 Lithium and Sodium Valproate 10/15 1.6/2.3 Carbamezapine 24/12 3.7/1.9 2nd Generation Atypical antipsychotics 8/4 1.2/0.7 Various combinations 34/134 5.3/21 Left blank [Choice of mood stabiliser for patient/themselves] Factors influencing decision-making mapped onto cost, efficacy and side-effect profile (less than 4% other reasons). 66% (n=538) of respondents felt efficacy most important, 25% (n=202) felt side-effect profile most important and 3% (n=24) considered cost of most importance. Conclusions No clear difference exists in choice of mood stabiliser for European trainees and their patients, and decisions based on perceived efficacy are generally in keeping with established guidelines.