P. Prosperini

P02-144 - Subjective well-being under neuroleptics (SWN): a predictor of clinical and psychosocial outcome in acute patients. preliminary data

Objectives To evaluate the subjective well-being of a group of patients who were hospitalized at the Institute of Psychiatry (Novara), compared to the severity of illness. Methods Patients are evaluated at admission and discharge through self-administration of the SWN (Subjective Well-being under Neuroleptics) scale, which contains five subscales (emotional regulation; self-control; mental functioning; social integration and physical functioning) assessing patients’ psychophysical and emotional well-being, calculating a value for each subscale and a total score. The clinician fills in the CGI (Clinical Global Impression) for each patient, which provides a global judgement in three areas: severity of illness, global improvement and therapeutic effectiveness. Results From June 2009, 51 patients were evaluated at admission and discharge: 26 diagnosed with psychosis and 25 diagnosed with personality disorders. Preliminary data suggest a meaningful improvement of the physical functioning in the psychotic group, a tendency to improvement of the social integration area in the personality disorders group. Among the psychotic group, the schizophrenic patients (n°=14) have shown an improvement in the self-control subscale. Conclusions Literature suggests that a high SWN score is associated with a better compliance and an early improvement of subjective well-being is a major predictor of the chance of remission. This study will allow to compare the subjective well-being evaluated by SWN with the clinical judgment of the CGI and above all if this can represent a predictor index for the compliance and the chance of remission.

A Case Report of a Woman Affected with Rapid Cycling Bipolar Disorder I and Methabolic Syndrome Improved with Aripiprazole Monotherapy.

Introduction We present the case of a 51-years-old Caucasian woman with Bipolar Disorder I (BDI), treated for a long time with typical antipsychotics and mood stabilizers. She referred to our outpatient service because she wished to revise her precriptions, which had caused several side-effects, including metabolic syndrome, gain of body weight, sedation, cognitive impairments, and extrapiramidal symptoms. Moreover, treatment was poorly effective, the patients compliance was lacking and she experienced frequent relapses. Aims We started treating the patient with aripiprazole at a daily dose of 15 mg. Our aim is to describe the substantial clinical and metabolic improvements of a patient who poorly responded to previous prescriptions. Methods Psychometric measures for the assessment of mood and social functioning were administered at baseline and at the follow-up interviews. Body Mass Index was monitored and blood tests were performed to evaluate the lipid profile (LDL, HDL, total cholesterol, triglycerides), blood glucose, and glycated haemoglobin. Results In the last two years the patient has regularly taken her therapies and attended to follow-up visits. Her social functioning and tolerance to stressful situations have improved, as well as her metabolic profile. Noteworthy, she had not needed further hospitalizations. Conclusions Our clinical observations support the efficacy of aripiprazole in the treatment of BDI. Switching to aripiprazole should be considered in cases similar to the one we have described, characterized by poor compliance, obesity or metabolic syndrome, sensitivity to manifest extrapiramidal syndrome (especially tardive dyskinesia) and other side effects such as sedation and cognitive impairments.

Empathy and Social Cognition: a Comparison of Schizophrenic Patients and Healthy Controls

Introduction Patients affected by schizophrenia have deficits in social cognition, functioning and in properly interpreting facial expression. These disabilities contribute to global impairment in social and relational skills. Data started being collected in the context of the Italian-Network-of-Research-on-Psychosis, headed by Mario Maj and Silvana Galderisi, in our centre;collection went on also after the conclusion of the national project. Aims To compare social inference and facial emotion identification in schizophrenic patients and healthy controls. Material and Methods We recruited 50 patients with Schizophrenia and 50 healthy controls (HCs) matched for sex, age and level of education. Socio-demographic characteristics were gathered;assessment of both patients and HCs included The Awareness of Social Inference Test (TASIT) and the Facial Emotion Identification Test (FEIT);furthermore patients were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). Results Some differences in socio-demographic variables emerged (patients are more often unemployed and single). Moreover, the preliminary analyses highlight several differences between schizophrenic patients and HCs at TASIT and FEIT:patients performed significantly worse than HCs in both tests, with longer reaction times. Discussion As expected schizophrenic patients showed social skills deficits and difficulties in identifying facial emotions. Our preliminary results point out disabilities in understanding social messages and interpreting human behaviour;these features underlie poor and limited social relationships proper to schizophrenia. 1 Galderisi S et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia;WorldPsychiatry2014,13(3):275-287 2 Mucci A et al. The Specific Level of Functioning Scale: Construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community Schizophr Res.2014Oct;159(1):144-50

EPA-0777 – Alexithymia, facial emotion identification and social inference in ed patients: a case-control study

Introduction Alexythimia, reduced cognitive empathy and emotion awareness and understanding are present among individuals with Eating Disorders (EDs). Facial expression is a reliable marker of emotion and an important source of social information. Thus, the ability to judge facial expression is essential for successful interpersonal interactions. Objectives To evaluate alexythimia, facial emotion identification and social inference abilities in a sample of ED patients, compared to a sample of patients with another psychiatric diagnosis and a group of healthy controls, matched by gender and age. Aims To describe a specific pattern of emotional dysregulation in ED patients. Methods ED patients and the Psychiatric Control Group are recruited at the Institute of Psychiatry in Novara, while healthy controls are recruited on a community basis. All patients and controls are females, aged 18–65. All patients are undergoing the Structured Clinical Interview for DSM-IV -Patient version (SCID-I-P), healthy controls are administered the Structured Clinical Interview for DSM-IV – Non Patient version (SCID-I-NP). All subjects are undergoing the following: SCID-II, Eating Disorder Inventory − 3 (EDI-3), Binge Eating Scale (BES), Beck Depression Inventory (BDI), Symptom Checklist − 90 (SCL-90), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT), Temperament and Character Inventory (TCI), Rosenberg Self-Esteem Scale (RSES), Interpersonal Reactivity Index (IRI), Toronto Alexithymia Scale (TAS-20). Results The recruitment and analysis of the samples are ongoing. The ED sample is expected to show greater alexythimia and a poorer performance at FEIT and TASIT, compared to the control samples. Conclusions Clinical implications will be discussed.

P03-129 - Atypical neuroleptics and glucose metabolism: A study project

Introduction Metabolic syndrome and cardiovascular diseases are important causes of morbidity and mortality among patients with mental illness. Atypical antipsychotics are more associated with obesity, metabolic syndrome, abnormal glucose and lipid metabolism than first generation antipsychotics. Objectives To identify risk factors related to glucose metabolism in short, medium and long time treatment and find out which are related to neuroleptic therapy and which depends on genetic background and lifestyle. To follow up clinical and self-rated variations of the psychiatric symptoms. Methods We included psychotic or bipolar patients in treatment with only one typical (haloperidol) or atypical (clozapine, olanzapine, risperidon, aripiprazole, paliperidon) neuroleptic, drug-naive or after a wash-out from previous therapy. Patients will be evaluated five times (at baseline and after 1, 3, 6, 12 months) with a blood sample (haemocrome, glucose, insulin, Hb A1C, thyroid hormones, liver and pancreatic function), BMI, Basal Metabolic Rate (BMR), OGTT, HOMA index, familiar and pharmacological history, SIDE and CGI. Results From blood exams and OGTT we will obtain data regarding variations of glucose metabolism and the possible relationship with neuroleptic medications. From SIDE questionnaire we will assess the impact of side-effects by the patients perspective and with CGI the variations of symptom severity. Conclusions Our study will allow us to identify risk factors concerning glucose metabolism alterations related to antipsychotic medications.

P03-365 - Venlafaxine and CYP2D6 in clinical practice: work in progress

Objective Venlafaxine (V) is a SNRI metabolized primarily by the highly polymorphic cytochrome P4502D6 enzyme (CYP2D6) in O-desmethylvenlafaxine (ODV), the main active metabolite. Four CYP2D6 metabolizer phenotypes have been identified: poor (PM), intermediate (IM), extensive (EM) and ultrarapid (UM). Approximately 5-10% Caucasians are PMs; in these individuals metabolism of substrate is decreased and adverse clinical effects may be expected. The effectiveness of pharmacogenetic tests is controversial because the association between plasma levels of V/ODV and side effects is not attested. We discuss the association between CYP2D6-genotype and Venlafaxine clinical effects. Methods We will recruit Caucasian patients aged 18 to 65, eligible for Venlafaxine treatment, satisfying DSM-IV criteria for major depressive episode, dysthymia or depressive adjustment disorder. Exclusion criteria will be: pregnancy, acute suicidality, alcohol/substance abuse, concomitant/prior antidepressive treatment in the previous 3 months. We will assess patients’ age, gender, DSM-IV diagnosis, Venlafaxine dose, concomitant pharmacological treatment, BMI, BP, tobacco use, liver and kidney functionality. Clinical response and side effects will be monitored using CGI, HAM-D and SIDE at T0 (onset), T1 (1 week later) and T2 (6 weeks later). The patients will be analyzed for the presence of 16 CYP2D6-genotype variants by INFINITITTM CYP2D6 assay which utilizes AutoGenomics proprietary film-based microarray technology. Results We expect to find out a correlation between CYP2D6-genotype, Venlafaxine dose and clinical response to treatment. Conclusions We will investigate whether a pharmacogenetic test prior to treatment can be useful in clinical practice to detect a proper Venlafaxine dosage or to switch to a different drug.