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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.


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.


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


Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.


Incidence of Gamma-Hydroxybutyrate

(GHB) abuse and dependence in a

rural crisis resolution team in the


P. Michielsen

1 ,

, L. Propadalo


, M. Arts



Mental Health Western Northern Brabant, Out Patient Clinic

General Adult Psychiatry, Halsteren, The Netherlands


Mental Health Western Northern Brabant, Old Age Psychiatry,

Halsteren, The Netherlands

Corresponding author.


GHB abuse and dependence are common in the

Western region of Northern Brabant, a rural region in the south

of the Netherlands.


The main goal is to look at the incidence and management

of GHB abuse and dependence seen by the CRT in a rural area.


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).


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.


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


Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.


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.


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.


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.


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.


How involuntary admission might

have been avoided: An interview study

of referring general practitioners

K. Røtvold

1 , R. W


2 ,


University Hospital of North Norway, Division of Mental Health and

Addictions, Tromsø, Norway


UiT The Arctic University of Norway, Department of Clinical

Medicine, Tromsø, Norway

Corresponding author.


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.


To study which factors that GPs who had recently referred

patients to involuntary admission thought might have made their

latest referral unnecessary.


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.


These are the main factors that the GPs thought could

have been of importance in avoiding involuntary referral of their


– 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%).


The GPs suggested that an increased availability of

resources andmore assistance fromother parts of the health service