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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S238–S302



Rural primary care and psychiatry clinic in

Northern New England, USA.


People over age 18 diagnosed with a psychotic disorder

on medications.


Fifty consecutive clients during one month’s time

were invited to participate; 19 completed a one-month open-

label phase of the addition of a micronutrient to their medication

regimen; all 19 then withdrew rather than risk randomiza-

tion to a placebo. We then compared the response of those 19

over 24 months of micronutrients +medication to the 31 people

who declined participation enriched by an additional 28 con-

secutive patients recruited over the second month of the study

for a total of 59 who received medication without micronutri-


Outcome measures

All clients were evaluated with the Positive

and Negative Symptom Scale and the Clinical Global Impression

scale at study baseline and after 3, 6, 9, 12, 15, 18, and 24 months.

Psychosis was confirmed with clinical interview using DSM IV-TR

criteria. All participants had normal physical examinations and lab-

oratory studies.


Outcomes were similar for both groups until 15 months,

though the micronutrient group used significantly less antipsy-

chotic medication throughout that time (


< 0.001). At 15 months,

the micronutrients +medication group exhibited significantly

fewer symptoms than the medication only group, a difference that

was even stronger at 24 months.


Micronutrients may be a beneficial long-term,

adjunctive strategy for people with psychotic disorders, allowing

for smaller doses of antipsychotic medications.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.


Strategies for managing psychosis

with small amounts or no medication:

A proof of concept paper

L. Mehl-Madrona

1 ,

, B . M




Eastern Maine Medical Center, Family Medicine Residency, Bangor,



Coyote Institute, Education, Orono, USA

Corresponding author.


Some patients with the diagnosis of a psychotic dis-

order wish to minimize or avoid medications.


We report qualitative and quantitative data on a group

of patients as a proof of concept study–that management withmin-

imal or no medication is possible.


A series of 60 adult patients presented with psychosis

and engaged with us in dialogical psychotherapy, medication, and

lifestyle management over at least six months in an effort to mini-

mize or eliminatemedication. An additional 209 patients presented

for treatment but did not continue for six months. An anony-

mous, matched comparison group of 60 patients of the same age,

socio-economic status, diagnosis, and severity of illness was gen-

erated from the electronic health records at another large clinic

where one of us also worked (LMM). We quantifed symptom level

using the Brief Psychiatric Rating Scale, the Positive and Negative

Syndrome Scale, two depression rating scales, the Clinical Global

Inventory, and the Revised Behavior and Symptom Identification

Scale. Narrative interviews of all 269 patients generated qualitative



Thirty-nine patients managed well without medica-

tion; 16 managed well on low-dose medication. Four individuals

required progressively higher levels of medication and one decom-

pensated. The overall cost-benefit was favorable in creating fewer

hospitalization, crises, and diminished suicidality.


The results suggest the need for individualized

approaches that are client-centered and build upon the previous

successes of the person, enroll family and friends in a commu-

nity effort, and collaborate with those communities to apply those

approaches desired by the people themselves.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

e-Poster Walk: Schizophrenia and Other Psychotic

Disorders–Part 4


Relationships between smoking,

psychopathology and medication

outside effects in schizophrenia

L. Ghanmi

1 ,

, K. Zitoun


, L. Zouari


, M. Maalej



Regional hospital of Gabes, Psychiatry, Gabes, Tunisia


University Hospital Hedi Chaker, Psychiatry “C”, Sfax, Tunisia

Corresponding author.


To determine the relationship between smoking status and

clinical characteristics of schizophrenic patients.


It was a cross-sectional study. One hundred and

seventy-five schizophrenic outpatients were assessed by the Posi-

tive And Negative Syndrome Scale (PANSS), the Global Assessment

of Functioning Scale (GAF), the scale of measurement of abnormal

involuntary movements (AIMS) and by the rating scale akathisia

caused by a drug Thomas Barnes. Current smokers (


= 85) were

compared to non-smokers (


= 90) on clinical variables.


The mean number of cigarettes was 15 cig/day. In our

sample, current smokers account for half of the patients and were

exclusively men. Smokers were significantly more single patients

(76.5 vs. 58.9,


= 0.01). There were no significant differences

between smokers and non-smokers regarding clinical variables,

including age of onset of the disease, the duration of the disease, the

severity of positive and negative symptoms, and GAF scores. Smok-

ing was significantly associated with more frequent prescription of

conventional neuroleptics (98.8 vs. 92%,


= 0.03) and poorer adher-

ence to treatment (77 vs. 62.2%,


= 0.02). There were no significant

differences between the 2 groups regarding the average doses of

neuroleptics, the presence of extrapyramidal signs, scores on the

AIMS score and akathisia.


Smoking is common in patients suffering from

schizophrenia. Smoking status should be considered in the assess-

ment of neuroleptic treatment in schizophrenia.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.


Evaluation of sleeping profile in

schizophrenia patients treated with

paliperidone-extended release: Result

from an open labeled perspective

study in south East Asia (perfect study)

R. Kongsakon

Faculty of Medicine Ramathibodi hospital, Dep. of psychiatry,

Bangkok, Thailand


To evaluate the impact of treatment with paliperidone

extended release for 6 months on sleeping profile in schizophrenia