European Psychiatry - Volume 41 - April 2017

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S150 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S106–S169
emergency service in South Netherlands. A literature search was
performed using PubMed and CINAHL for the period 2000–2014.
Results From this research, we found a discrepancy between the
perception and the actual occurred aggression. Care workers often
do not discuss aggression related issues, however, case studies
show that aggression does occur frequently. In literature studies
we have found several risk assessment models, most of which are
used within the inpatient psychiatry.
Conclusion To avert aggression incidents and prevent recurrence,
it is important to maintain a solid risk analysis model. Introducing
a checklist risk crisis service (CRC) can promote a critical reflection
on the threat of aggression and bring awareness on the theme of
aggression. Implementation of a CRC in daily practice can be of great
value.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW0133
Incidence of Gamma-Hydroxybutyrate
(GHB) abuse and dependence in a
rural crisis resolution team in the
Netherlands
P. Michielsen ∗, L. Propadalo , M. Arts
1 Mental Health Western Northern Brabant, Out Patient Clinic
General Adult Psychiatry, Halsteren, The Netherlands
2 Mental Health Western Northern Brabant, Old Age Psychiatry,
Halsteren, The Netherlands
∗ Corresponding author.
Introduction GHB abuse and dependence are common in the
Western region of Northern Brabant, a rural region in the south
of the Netherlands.
Aim The main goal is to look at the incidence and management
of GHB abuse and dependence seen by the CRT in a rural area.
Method This is a retrospective data analysis based on patient files
of all assessments of theWesternNorthern Brabant crisis resolution
team (CRT) from 2013 till 2015. Inclusion criterion was current or
recent (<24 hours) use of GHB with or without alcohol and other
drugs. Several parameters were studied: frequency, duration and
dose of GHB use, reason for referral and treatment/policy, which is
used (admission, prescribed medication).
Results On a total of 4093 cases 50 persons were included. It
shows that the percentage over the years has remained about the
same (resp. 1.13%, 1.54% and 1.02%). Of all cases 41.5% used GHB
only, 39.6% also used other drugs, and 9.4% GHB with alcohol and
other drugs. During the assessment in the emergency department
37.7% was treated with a benzodiazepine, while 43.4% received no
psychotropic medication.
Conclusion GHB abuse anddependence are not commonly seen in
the CRT, but the withdrawal symptoms can be challenging and GHB
withdrawal is often accompanied by aggressive outbursts. There-
fore, it is very important to make a decision whether outpatient or
inpatient treatment is necessary and if psychotropic medication is
needed.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW0134
Clinical effects of the suicide attempt
with topiramate
G. Montero ∗, I. Alberdi , L. Niell , R.Á. Baena
Instituto de Psiquiatría y Salud Mental, Department of Psychiatry,
Hospital Clinico San Carlos, Madrid, Spain
∗ Corresponding author.
Objectives We report the case of a 45-year-old male diagnosed
with mixed personality disorder brought the hospital for strange
behavior. He is being treated with fluoxetine, lorazepam and topi-
ramate; and visited his psychiatrist 72 hours ago.
Results He has an adequate level of consciousness and describes
retrograde amnesia of the last 72 hours. We found blocks of thought
and abnormal behaviors such as dressing and undressing or sorting
his belongings repetitively. Urine was only positive for benzodi-
azepines. In arterial blood gas analysis it performed highlights
compensated metabolic acidosis. After ruling out neurological
diseases and administrating fluids i.v. the symptoms remitted,
persisting only the amnesia, establishing the diagnosis of suicide
attempt with topiramate.
Conclusions The use out-of-guidelines of topiramate in person-
ality and eating disorders is an increasingly common habit in
daily clinical practice, as well as suicide attempts with this drug.
In therapeutic doses, over 40% of patients taking topiramate,
have asymptomatic metabolic acidosis, which in stressful situ-
ations may have clinical relevance. In case of acute poisoning,
metabolic acidosis is more frequent and severe, manifesting itself
by hyperventilation, hypertension and varying degrees of impaired
consciousness and cognitive functions. There is also a paradoxi-
cal increase in the frequency of seizures. Treatment is supportive
and there is no antidote, being lethal cases exceptional. Gastric
lavage and administration of activated charcoal have limited use.
The determination of plasma concentrations of topiramate is not
available for most centers and is not useful in acute poisoning.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW0135
How involuntary admission might
have been avoided: An interview study
of referring general practitioners
K. Røtvold ynn ∗
1 University Hospital of North Norway, Division of Mental Health and
Addictions, Tromsø, Norway
2 UiT The Arctic University of Norway, Department of Clinical
Medicine, Tromsø, Norway
∗ Corresponding author.
Introduction The legal criteria for involuntary admission in Nor-
way are that the patient has a serious psychiatric disorder (i.e.
psychosis) and is in need of admission to secure needed treatment
or that there is a risk of danger. While there have been some studies
focusing on coercion in hospitals, less is known about the processes
leading up to involuntary admission and the reasoning of referring
doctors. In Norway, it is primarily general practitioners (GPs) that
refer patients.
Aims To study which factors that GPs who had recently referred
patients to involuntary admission thought might have made their
latest referral unnecessary.
Methods Seventy-four GPs were interviewed by phone. They had
all recently referred patients involuntarily to a major Norwegian
university psychiatric hospital. One central question concerned
how their latest involuntary referral might have been avoided.
Results These are the main factors that the GPs thought could
have been of importance in avoiding involuntary referral of their
patients:
– that the patient took the prescribed medication (28%);
– that they personally had the opportunity to closely follow up the
patient in the following days (22%);
– that other health care staff could follow up the patient closely in
the patient’s own home (i.e. home care nursing, etc.) (19%);
– that a family member of the patient could help the patient (8%).
Conclusions The GPs suggested that an increased availability of
resources andmore assistance fromother parts of the health service