European Psychiatry - Volume 41 - April 2017

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S502 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S465–S520
Methods Clinical and literature reviews.
Results (Case report) This poster presents the case of 92-year-old
woman who lives alone with no family support who was brought
to the emergency room due to a fall. Consequently, she was diag-
nosedwith small cell lung carcinoma. Instead of the proposed short
term rehab to receive radiotherapy, the patient insisted that she be
discharged to her home. The psychosomatic team was consulted
to evaluate the patient’s capacity to make a decision regarding this
form of treatment. The psychiatrist who evaluated the patient felt
that she lacks capacity. However, palliative care felt strongly that
patient’s capacity should not be challenged, arguing that she has
been living independently, doingwell, and is agreeing to treatment.
Conclusion We will review the most updated guidelines on how
to performa capacity evaluation, how these guidelines are incorpo-
rated in residency curriculums, andwhether residents fromvarious
specialties are being trained on evaluating decisional capacity. We
will also explore optimal ways to educate primary care physicians
on how to evaluate decisional capacity and when to seek psychia-
trists’ expertise for these evaluations.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0302
Polydipsia and intermittent
hyponatremia
S. Ramos-Perdigues ∗, M.J. Gordillo , C. Caballero , S. Latorre ,
S.V. Boned , G. Miriam , P. Torres , M. De Almuedo , M.T. Sanchez ,
E. Contreras , E. Gomez , E. Sanchez , M. Segura , C. Torres ,
G. Gemma , M. Tur , A. Fernandez , C. Merino
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
∗ Corresponding author.
Introduction Hyponatraemia occurs in 4% of schizophrenic
patients. Dilutional hyponatraemia, due to inappropriate retention
of water and excretion of sodium, occurs with different psy-
chotropic medications and could lead to hippocampal dysfunction.
This complication is usually asymptomatic but can cause severe
problems, as lethargy and confusion, difficult to diagnose in men-
tally ill patients.
Objectives To describe a case of a patient with psychotropic
poli-therapy, admitted three times due to hyponatremia and the
pharmacological changes that improved his condition.
Aims To broadcast the intermittent hyponatraemia and polydip-
sia (PIP), a not rare condition, suffered by treated schizophrenic
patients and discuss its physiopathology and treatment thorough
a case report.
Methods A 56-year schizophrenic male was admitted for pre-
senting disorganized behavior, agitation, auditory hallucinations,
disorientation, ataxia, vomits and urinary retention. He was on
clomipramine, haloperidol and clotiapine (recently added), que-
tiapine, fluphenazine and clonazepam. After water restriction his
symptoms improved and he was discharged. Twenty-five days
later, he was readmitted for presenting the same symptoms and
after water restriction, he was discharged. Five days later, he was
again admitted and transferred to the psychiatric ward.
Results Haloperidol, fluphenazine and clomipramine were
replaced by clozapine. These changes lead him to normalize the
hypoosmolality and reduce hiswater-voracity. Endocrinology team
did not label this episode of SIADH due to its borderline blood and
urine parameters.
Conclusions Hyponatremia is frequent in schizophrenic patients
and may have severe consequences. Therefore, a prompt recogni-
tion and treatment is warranted.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0303
Clozapine induced diarrhea
S. Ramos-Perdigues ∗, M.J. Gordillo , C. Caballero ,
S. Latorre , S.V. Boned , M.T. Sanchez , P. Torres ,
M. Guisado , E. Contreras , M. De Almuedo , E. Esmeralda ,
E. Sanchez , M. Segura , A. Fernandez , C. Torres , G. Herrero ,
M. Tur , C. Merino
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
∗ Corresponding author.
Introduction Clozapine (CZP) is the only antipsychotic approved
for resistant schizophrenia 1. Due to its side effects, CZP is not the
first therapeutic option in a psychotic episode. Its anticholinergic
effects often cause constipation, however, diarrhea have also been
described in literature.
Objectives We describe a patient with two episodes of severe
diarrhea after clozapine initiation, which lead to CZP discontinu-
ation.
Aims Discuss about the differential diagnosis of diarrhea in CZP
patients and the needing of a further studies for clarify the more
appropriate management in CZP induced diarrhea.
Methods We present a case report of a 46 years man diagnosed
with schizoaffective disorderwho presented two episodes of severe
diarrhea with fever, which forced his transfer to internal medicine
and UCI after CZP initiation.
Results At the first episode analytical, radiological and histo-
logical findings led to Crohn’s disease diagnosis, which required
budesonide and mesalazine treatment. In the second episode, the
digestive team concluded that the episode was due to clozapine
toxicity despite the controversial findings (clostridium toxin and
Crohn’s compatible biopsies)
Conclusions Diarrhea caused by CZP has been controversial in the
literature. However due to the severity of digestive episodes and
the paucity of alternative treatments further studies for a better
understanding of its physiopathology are warranted.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0304
The unnoticed interictal disphoric
disorder
S. Ramos-Perdigues ∗, E. Bailés , A. Mané , L. Pintor
1 Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
2 Univeristy Pompeu Fabra, Psychology, Barcelona, Spain
3 Institute of Neuropsychiatry and Addictions, Psychiatry, Barcelona,
Spain
4 Epilepsy Unit, Hospital Clinic of Barcelona, Psychiatry, Barcelona,
Spain
∗ Corresponding author.
Introduction Psychiatric morbidity in refractory epilepsy is
frequent and has a negative influence on quality of life. Treatment-
refractory epileptic patients are at higher risk of developing
psychiatric disturbances. The interictal dysphoric disorder (IDD)
has been described as a pleomorphic pattern of symptoms claimed
to be typical of patients with epilepsy. It is characterized by 3/8
symptoms: depressivemood, anergia, pain, insomnia, fear, anxiety,
irritability, and euphoric mood.
Objectives To provide evidence that psychiatric morbidity is high
in refractory epilepsy and to describe associations to IDD.
Aims The present study aims to show that there are typical psy-
chiatric conditions in epilepsy that can be unnoticed.
Methods We cross-sectional analyzed the psychopathologic out-
comes of patients with refractory epilepsy. The assessments
methods included SCID for DSM-IV and clinical interview for
epileptic specific psychiatric conditions.
Results The sample consists of 153 patients, with a mean age
of 37. A total of 42.5% were males. One or more Axis I diagnoses