European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S710–S771 S749
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1060
Comparison of efficacy between
risperidone and aripiprazole in
combination with sodium valproate
in patients with acute manic or mixed
episodes
N. Amanat ∗, A. Nazeri Astane , B. Dieji , O. Rezaie ,
A. Biglarian
1 University of Social Welfare and Rehabilitation Sciences, Health in
Emergency and Disaster, Tehran, Iran
2 University of Social Welfare and Rehabilitation Sciences, Psychiatry
Department, Tehran, Iran
3 University of Social Welfare and Rehabilitation Sciences,
Biostatistics Department, Tehran, Iran
∗ Corresponding author.
Today, despite of the improvement in the psychological thera-
peutic approach, mania still remains as a challenging problem
for health system. The aim of this study is comparison efficacy
of risperidone and aripiprazole in combination with sodium val-
proate in bipolar patients with acute manic or mixed episodes
who hospitalized in Razi psychiatric hospital in Tehran. This study
was conducted as a double blind randomized clinical trial in two
groups of bipolar disorder patients with manic or mixed episodes
(18–65 age). Patients randomly set in two groups who received
valproate with aripiprazole or risperidone. Clinical response was
assessed with young mania rating scale (YMRS) and weight gain
at 3 and 6 weeks. Data was analyzed with Chi2 test, paired t-test
and analysis of covariance and repeated measurement. Evalua-
tion of treatment response after 3 and 6 weeks (50% reduction in
Young’s scale) in both groups did not show any significant differ-
ence between the two therapeutic combinations. The combination
of sodium valproate and risperidone showed higher weight gain
in comparison with the combination of valproate and aripipra-
zole at the end of week 6 (P < 0.001). The mentioned combination
in bipolar I disorder with manic or mixed episode has simi-
lar therapeutic effect, so that both of them are effective and
usable. There was no difference in their efficacy, and both treat-
ments can be used. Due to the less weight gain, the combination
of valproate and aripiprazole in patients who prone to weight
gain, this approach is recommended as more safe and effective
therapy.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1061
Bupropion induced hyponatremia:
A review of literature
M. Arts ∗ etrykiv ennema e Jonge
1 University of Groningen, University Medical Center Groningen,
Department of Old Age Psychiatry, Groningen, The Netherlands
2 University of Groningen, University Medical Center Groningen,
Department of Clinical Pharmacy and Pharmacology, Groningen, The
Netherlands
3 GGZ Friesland, Geriatric Psychiatry, Leeuwarden, The Netherlands
4 Leonardo Scientific Research Institute, Geriatric Psychiatry,
Groningen, The Netherlands
∗ Corresponding author.
Introduction For over 20 years, bupropion has been used as an
antidepressant by inhibiting the norepinephrine-dopamine reup-
take. Hyponatremia is a relatively rare condition that has been
associated with the use of antidepressants including selective
serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine
reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).
However, a few case studies have reported that bupropion was
associated with hyponatremia.
Objectives and aims To review available literature on bupropion-
induced hyponatremia and its possible underlying mechanisms.
Methods Case studies are presented and discussed followed by a
literature review.
Results Hyponatremia has been reported with the use of many
antidepressants, however, studies on bupropion induced hypona-
tremia has been limited. In literature only four case reports have
been presented. Typically, this condition is only seen in frail or
elderly patients. Possible mechanism is that bupropion may cause
hyponatremia by the noradrenergic stimulation of vasopressin
release.
Conclusion Clinicians should be aware of increased risk of
hyponatremia associated with antidepressants, including bupro-
pion. Especially in the elderly, clinical symptoms of hyponatremia
can be misinterpreted and may lead to a life-threatening condition.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1062
Off-label prescriptions of quetiapine
for sleep disturbances
M. Arts ∗, S. Petrykiv , J. Fennema , L. De Jonge
1 University of Groningen, University Medical Center Groningen,
Department of Old Age Psychiatry, Groningen, The Netherlands
2 University of Groningen, University Medical Center Groningen,
Department of Clinical Pharmacy and Pharmacology, Groningen, The
Netherlands
3 GGZ Friesland, Geriatric Psychiatry, Leeuwarden, The Netherlands
4 Leonardo Scientific Research Institute, Geriatric Psychiatry,
Groningen, The Netherlands
∗ Corresponding author.
Introduction Quetiapine, a short-acting atypical anti-psychotic
drug for the treatment of bipolar I disorder and schizophrenia, is
increasingly used off-label for the treatment of sleep disturbances
or insomnia. However, data supporting this off-label prescription
of quetiapine are limited.
Objectives and aims To report and discuss the effects of “off-label”
use of quetiapine for the treatment of sleep disturbances.
Methods An English-language literature search was con-
ducted using Pubmed, EMBASE and Cochrane library (December
1980–December 2015) using the search terms quetiapine,
insomnia, sleep disorders, sleep disturbances, and sleeplessness.
Results During the last decade, there is an enormous increase in
prescribing quetiapine. This anti-psychotic drug is among the best
selling drugs worldwide. For the approved indications, the usual
therapeutic dose range is 400–800mg/day. However, off-label use
of quetiapine was most evident for the 25mg/day to 100mg/day.
In some countries, off-label uses are promoted to non-psychiatrists
for the treatment of insomnia, dementia, agitation, and aggres-
sion. Inappropriate anti-psychotic use may lead to serious health
problems, including metabolic effects, increased sudden cardiac
death, and age-related side effects with increased risk for ortho-
static hypotension, fractures, pneumonia, cognitive impairment,
and stroke.
Conclusion There is growing concern regarding the poten-
tial harm from off-label prescription of anti-psychotics, par-
ticularly quetiapine. There is little evidence supporting the
enormous off-label uses of quetiapine. In addition, prescribing
quetiapine for indications that are not evidence based has eth-
ical, financial, and safety implications, especially in the older
population.