European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S521–S582 S547
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0438
An expressive group approach to
borderline personality disorder in
patients with bulimia nervosa: A
clinical case
I. Ba˜nos Martín ∗, E. Guerra Gómez , K. Eaton Itúbide ,
B. Unzeta Conde , P. Vilari˜no Besteiro , C. Pérez Franco ,
P. García Jorge
1 Psychiatrist, Santa Cristina university hospital, Madrid, Spain
2 Psychologist, Santa Cristina university hospital, Madrid, Spain
3 Occupational therapist, Santa Cristina universitary hospital,
Madrid, Spain
∗ Corresponding author.
Introduction It is widely known comorbid Bulimia Nervosa (BN)
with Borderline personality disorders (BPD). This is associated
with worse prognosis and resistance to pharmacological and psy-
chotherapeutic treatments. In integrated treatment, both disorders
are addressed, not being frequent psychotherapy groups that
address only the personality traits. Some studies have proposed
the brain basis of psychodrama intervention in both pathologies.
Objectives To highlight the clinical effectiveness of adding a non-
verbal orientation (psychodrama) to the treatment of BN patients;
to specifically address personality traits, by presenting a clinical
case. We rely on studies.
Methods Clinical case: 42-year-old woman patient with BN
(DSM-5) severe degree, BITE: Symptoms scale = 28; S. Severity = 13;
and BPD (7 DSM-V); MCMI-III: BPD = 115 She is incorpo-
rated into a day hospital with integrated and multidisciplinary
approach: psychotropic drugs, individual, group and family psy-
chotherapy. This patient is added to an open psychodrama
group; where he works exclusively personality pathology, during
one year.
Results Improvement was observed in BN (she switched to
intermediate grade); BITE: Symptom scale = 23, S. Severity = 8;
also improves BPD criteria of DSM-V = 4 (minimum= 5) MCMI-III:
BPD = 104.
Conclusions (1) Psychodrama psychotherapy groups to treat
Bulimia and BPD could provide an added clinical improvement in
both pathologies.
(2) Insufficient RCTs compared to other models of psychotherapy
(mentalizing, interpersonal, dialectical behavior) do not allow to
speak even scientific evidence of psychodrama.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0439
A cognitive and behavioural group
therapy for binge eating disorder: An
original 12 sessions design
F. Boulet
Nîmes University Hospital, psychiatry, Nimes, France
The Binge Eating Disorder (BED) consists in binge eating with a
loss of control and guilty feeling. Weigh excessive preoccupation,
psychiatric comorbidities and psychosocial impairment are associ-
ated to BED. BED prevalence is 3 to 5%, which is the more frequent
eating disorder. The efficacy of CBT is well-known with several
publications.
Method We have proposed 12 sessions of 1.30 hours for a 6
to 8 patients group, managed by a psychiatrist trained to CBT.
Each session approaches a different topic (eating behavioural,
self-esteem, problem resolution, stigmatization, emotion coping,
cognitive therapy . . .).
Assessment Patients are evaluated before and after therapy with
Eating Disorder Inventory version 2 and Rathus Scale for self-
esteem. Thirty patients were included.
Results Patients improve eating behavioural and other topics like
self-esteem, social functioning, problem resolution and emotion
coping. It appears that 12 sessions group CBT could be effectivewith
patients who suffer of BED. Others studies are needed to evaluate
the long-term outcome.
Disclosure of interest The author has not supplied his/her decla-
ration of competing interest.
EV0440
Avoiding refeeding syndrome in
anorexia nervosa
D. Brigadeiro ∗, J. Nunes , T. Ventura Gil , P. Costa
Hospital Sousa Martins, ULS Guarda, Departamento de Psiquiatria e
Saúde Mental, Guarda, Portugal
∗ Corresponding author.
The termrefeeding syndrome has been used to describe the adverse
consequences that can occur in all malnourished patients in the
early stages of nutrition repletion whether the method of refeed-
ing is oral, enteral or parenteral. Those consequences include acute
thiamine deficiency resulting in Wernicke’s encephalopathy and
Korsakoff syndrome, with the potential for permanent cognitive
impairment; hypophosphatemia, hypokalemia, hypomagnesemia
and fluid overload resulting in cardiac failure. Adaptive changes
in metabolism occur during a period of starvation or fasting: lev-
els of glucose fall within 24 to 72 hours, as response, glucagon
levels rise and insulin concentrations decrease. Glucose levels are
maintained by glycogenolysis at first and gluconeogenesis latter.
The reintroduction of nutrition leads to a switch from fat to car-
bohydrate metabolism and an increase of insulin concentration.
Insulin stimulates the movement of potassium, phosphate, and
magnesium into the cell leading to its depletion in extracellular
compartment. Reactivation of carbohydrate metabolism increases
degradation of thiamine, a cofactor required for cellular enzymatic
reactions in Kreb’s cycle. Deficiency in all these nutrients can then
occur. Patients with anorexia nervosa are at risk of suffering from
refeeding syndrome. This psychiatric disorder causes potentially
life-threatening, physical complications and has the highest mor-
tality rate among psychiatric disorders. The purpose of this review
is to clarify recommendations for prevention and treatment of
refeeding syndrome in anorexia nervosa.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0441
Merycism – A case report about
rumination syndrome
M.C. Cochat Costa Rodrigues ∗ randão
1 Magalhães Lemos Hospital, Psychiatry, Porto, Portugal
2 Centro Hospitalar de São João, Clinic of Psychiatry and Mental
Health, Porto, Portugal
∗ Corresponding author.
Introduction Rumination is a common phenomenon among
ruminant animals but in humans, it is always regarded as a symp-
tom indicative of abnormal function of the upper gastrointestinal
track. It is characterized by recurrent regurgitation of recently
ingested food into the mouth. This syndrome was previously
described in children and adults with mental retardation, but this
entity is becoming increasingly recognized in children, adolescents
and adults with normal mental capacity.