European Psychiatry - Volume 41 - April 2017

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S540 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S521–S582
tal Depression Survey (EPDS). Analysis procedures included cluster
analysis and hierarchical regression.
Results Individual symptoms were reported by 2.9–31.7% of the
sample. Separate clusters (CES-D = 4; EPDS = 2) were identified and,
of these, two clusters were primary predictors of maternal and
newborn outcomes. Results differed from that obtained with cut-
score analytics.
Conclusions Examination of depression symptom clusters as
related to health outcomes during childbearing has significance for
clinical practice and research, particularly for women who would
not score as depressed on established screening instruments.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0417
Health-related quality of life of
primary care patients with depressive
disorders
K. Riihimäki
Health Care and Social Services, MPY, Järvenpää, Finland
Background Depressive disorders are known to impair health-
related quality of life (HRQoL) both in the short and long
term. However, the determinants of long-term HRQoL out-
comes in primary care patients with depressive disorders remain
unclear.
Methods In a primary care cohort study of patients with depres-
sive disorders, 82% of 137 patients were prospectively followed up
for five years. Psychiatric disorders were diagnosed with SCID-I/P
and SCID-II interviews; clinical, psychosocial and socio-economic
factors were investigated by rating scales and questionnaires plus
medical and psychiatric records. HRQoL was measured with the
generic 15D instrument at baseline and five years, and compared
with an age-standardized general population sample (n = 3707) at
five years.
Results Depression affected the 15D total score and almost all
dimensions at both time points. At the end of follow-up, HRQoL of
patients in major depressive episode (MDE) was particularly low,
and the association between severity of depression (Beck Depres-
sion Inventory, BDI) and HRQoL was very strong (r= −0.804). The
most significant predictors for change in HRQoL were changes in
BDI and Beck Anxiety Inventory (BAI) scores. The mean 15D score
of depressive primary care patients at five years was much worse
than in the age-standardized general population, reaching normal
range only among patients who were in clinical remission and had
virtually no symptoms.
Conclusions Among depressive primary care patients, presence
of current depressive symptoms markedly reduces HRQoL, with
symptoms of concurrent anxiety also having a marked impact. For
HRQoL to normalize, current depressive and anxiety symptoms
must be virtually absent.
Disclosure of interest The author has not supplied his/her decla-
ration of competing interest.
EV0418
Antidepressant withdrawal mania:
Two case reports
D. Pereira ∗, I. Carreira Figueiredo , M. Marinho , R. Fernandes ,
V. Viveiros
Centro Hospitalar Psiquiátrico de Lisboa, Psychiatry, Lisboa, Portugal
∗ Corresponding author.
Introduction Although rarely reported, antidepressant discontin-
uation may induce hypomania or mania even in the absence of
bipolar disorder
Objectives We report two cases of antidepressant withdrawal
induced mania.
Methods Clinical process consultation and PubMed search were
performed in November 2016 using the search keywords antide-
pressant, mania and discontinuation.
Results Case report 1: a dysthymic 60 years old woman with
20 years of psychiatric following had been treated with venlafaxine
150mg/daily the past year. She abruptly stopped taking this drug,
developing heightened mood, irritability and racing thoughts five
days later. She was admitted at our hospital, initiating then val-
proate and antipsychotics. Two weeks later, the hypomania clinical
state remitted completely.
Case report 2: a 64 years old woman, with a 12-year-old diagnosis
of unipolar depression was brought to our emergency service with
complaints of disorganized behavior, paranoid delusional ideas,
excessive speech, irritablemood and reduced need for sleep, 1week
after abrupt trazodone 150mg/daily discontinuation. Valproic acid
1000mg/daily and olanzapine 20mg/daily were introduced, with
gradual improvement of symptoms. Two weeks later she was com-
pletely asymptomatic.
Conclusion Psychiatrists should be aware of the risk of antide-
pressant withdrawal induced mania. More studies should be
conducted about this subject, aiming for the clarification of risk fac-
tors and the establishment of clinical criteria for this phenomenon.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
References
[1] Andrade C. Antidepressant-withdrawal mania: a critical
review and synthesis of the literature. J Clin Psychiatry
2004;65:987–93.
[2] Berardis D. Emerging mania following escitalopramwithdrawal
in a patient with unipolar depression managed with its reintro-
duction. J Psychiatr Pract 2014;20(3).
EV0419
Vortioxetine versus citalopram in
treating major depressive disorder
(MDD)
A. Rossi ∗, E. Di Tullio , P. Prosperini , A. Feggi , C. Gramaglia ,
P. Zeppegno
1 Institute of Psychiatry,AOU Maggiore della Carità, Università del
Piemonte Orientale-A. Avogadro, Traslational Medicine, Novara, Italy
2 Institute of Psychiatry, AOU Maggiore della Carità, Traslational
Medicine, Novara, Italy
∗ Corresponding author.
Introduction Citalopram is a widely used antidepressant (AD),
indicated for the treatment of Major Depressive Disorder (MDD),
with a high and Selective Serotonin Reuptake Inhibitory action
(SSRI), good efficacy and safety profile. Vortioxetine is a novel
multimodal antidepressant compound, with a mixed action on
Serotonin (both 5-HT agonism and antagonism). Its clinical efficacy
has been established in several short and long term trials; further-
more it proved effective at mitigating cognitive dysfunction, which
is addressed to as one of the main causes of social impairment in
MMD patients.
Objectives To evaluate the relative efficacy and safety of Vortiox-
etine versus Citalopram, in patients suffering from MDD.
Aims To assess whether Vortioxetine effectiveness and tolerabil-
ity are comparable to those observed for previous antidepressants.
Methods The main outcomes were efficacy (variance from base-
line to 1 month) in the Montgomery-Åsberg Depression Rating
Scale (MADRS) and Hamilton Rating Scale for Depression (HAM-D)
and tolerability (adverse events). Changes in cognitive performance
were assessed using the following specifics tools: Digit symbol sub-
stitution test (DSST), Trail Making Test A (TMT-A) and Hopkins
Verbal Learning Test-Revised (HVLT-R).