European Psychiatry - Volume 41 - April 2017

241 / 916

25th European Congress of Psychiatry / European Psychiatry 41S (2017) S170–S237 S237
EW0385
Efavirenz and neuropsychiatric
effects–When the treatment
complicates matter further
M. Marinho ∗, C. Novais , J. Marques , M. Braganc¸ a
1 São João Hospital Centre, Clinic of Psychiatry and Mental Health,
Porto, Portugal
2 Local Healthcare Unit of Matosinhos, Clinic of Psychiatry,
Matosinhos, Portugal
∗ Corresponding author.
Introduction Efavirenz, a non-nucleoside analogue inhibitor of
the reverse transcriptase, has become commonly used in the
treatment of HIV infection. Although highly effective, efavirenz is
associated with causing neuropsychiatric side effects in approxi-
mately 50% of patients.
Objectives To provide an overview of efavirenz-induced neu-
ropsychiatric effects.
Methods Literature review based on PubMed/Medline.
Results The neuropsychiatric side effects of efavirenz usually
begin quickly, commonly peak in the first two weeks after the
start of therapy, and can include depression, anxiety, sleep dis-
turbances, impaired concentration, aggressive behavior, paranoia,
psychosis. Generally, these events are mild to moderate in sever-
ity and time limited, however, in a small number of cases, are late,
persistent or intolerable. They are often associated with a negative
impact on treatment adhesion. Some factors are known to increase
the risk of neuropsychiatric effects in HIV-positive patients. The
behavioral effects of efavirenz appear to be dose-dependent and
mediated predominately by the 5-HT2A receptor, a primary site
of action of lysergic acid diethylamine (LSD). Importantly, the
efavirenz-induced neuropsychiatric effects may be difficult to dis-
tinguish fromHIV-related neuropsychiatric symptoms, preexisting
mental disorder or substance use. The neuropsychiatric effects
should be treatedwith non-pharmacologic or pharmacologic inter-
ventions, according to severity. The psychiatric status of patients
should be closely monitored for at least the first 6 to 12 months of
treatment.
Conclusion Taking into account the high rates of neuropsychiatric
side effects, it is crucial that the physicians are familiar with this
important subject, and the decision to initiate efavirenz in psychi-
atric patients is individualized.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW0386
HIV/AIDS “worried well”–When the
“virus” leads to a significant illness,
even in its absence
M. Marinho ∗, V. Covelo , J. Marques , M. Braganc¸ a
1 São João Hospital Centre, Clinic of Psychiatry and Mental Health,
Porto, Portugal
2 Local Healthcare Unit of Matosinhos, Clinic of Psychiatry,
Matosinhos, Portugal
∗ Corresponding author.
Introduction Management of HIV/AIDS “worried well” people is
among the most complex and challenging psychiatric problems in
HIV care.
Objectives To provide an overview of HIV/AIDS “worried well”.
Methods Literature review based on PubMed/Medline, using the
keywords “HIV” and “worried well”.
Results The HIV/AIDS “worried well” are those individuals who
are intensely worried about being infected with HIV, despite over-
whelming evidence to the contrary. Indeed, they will rapidly
return with the renewed conviction that the physician has “got
it wrong” or “missed something”. So, they tend to over-utilize
health care services. Seven HIV/AIDS “worried well” sub-groups
have been identified: those with past sex or drug use history;
those with relationship problems; the partners/spouse of those at
risk; couples in individual or family life transitions; past history
of psychological problems; misunderstanding of health education
material; and pseudo and factitious AIDS. These patients have sev-
eral striking consistencies in their presenting phenomenology and
background features and usually have psychiatric problems asso-
ciated. The authors will analyze all these aspects. Currently there
are no guidelines to deal with this clinical condition, however
cognitive-behavioral therapy along with selective serotonin reup-
take inhibitors has been an effective approach. It is also important
to ensure follow-up discussion to these patients, especially where
unresolved life issues may cause future vulnerability in absence of
intervention.
Conclusions Patientsmay express their concerns about HIV infec-
tion by several ways, directly or indirectly, and psychiatrists need
to be aware of this reality, which causes much suffering as well as
severe monetary loss.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW0387
Brain-derived neurotrophic factor
(BDNF) levels and delirium
D. Adamis ∗, J. Williams , K. Finn , V. Melvin , D. Meagher ,
G. McCarthy
1 Sligo Mental Health Services, Psychiatry, Sligo, Ireland
2 Sligo University Hospital, Pathology Department, Sligo, Ireland
3 School of Biological Science, Cork institute of Technology, Cork,
Ireland
4 Graduate-Entry Medical School University of Limerick, Psychiatry,
Limerick, Ireland
∗ Corresponding author.
Introduction Studies of the association between blood BDNF lev-
els and delirium are very few and have yielded mixed results.
Objectives To investigate the blood BDNF levels in the occurrence
and recovery of delirium.
Methods Prospective, longitudinal study. Participants were
assessed twice weekly with MoCA, DRS-R98, APACHE-II. BDNF lev-
els of the same were estimated with ELISA method. Delirium has
been define as per DRS-98R (cut-off > 16) and recovery of delirium
as at least two consequently assessments without delirium prior to
discharge.
Results No differences in the levels of BDNF between those
with delirium and those who never developed it. Excluding
those who never developed delirium (n = 140), we analysed the
effects of BDNF and the other variables on delirium resolution
and recovery. Of the 58 remained with delirium in the sub-
sequently observations (max = 8) some of them continue to be
delirious until discharge or death (n = 39) while others recov-
ered (n = 19). BDNF levels and MoCA scores were significantly
associated with both delirium cases who became non-delirious
(resolution) during the assessments and with overall recovery.
BDNF (Wald 2 = 11.652, df: 1 P= .001), for resolution. For recov-
ery Wald 2 = 7.155; df: 1, P = .007. No significant association was
found for the other variables (APACHE-II, history of dementia, age or
gender)
Conclusions BDNF do not have a direct effect in the occurrence of
delirium but for those delirious of whom the levels are increased
during the hospitalisation they are more likely to recover from
delirium.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.