European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S710–S771 S755
Introduction Tardive syndromes (TS) resulting from prolonged
exposure to dopamine receptor blocking agents are frequent. Cloza-
pine is considered to have a low risk of causing new onset TS and
accounts therefore as an interesting option in patients with invali-
dating TS.
Objectives Our study aims to describe clozapine indications in
patients experiencing TS.
Methods Presentation of the clinical cases of five patients, who
experienced different kinds of TS secondary to 1st and 2nd gener-
ation anti-psychotic treatment.
Results We present the cases of AB aged 41, MJ aged 40, HM aged
31 and AS aged 30, diagnosed with schizophrenia; and FB aged
24,diagnosed with schizoaffective disorder. Adverse side effects
to conventional anti-psychotics such as limb and trunk tremors
were described for AB, choreic limb movements, axial and segmen-
tal dystonia for MJ, AS, FB and oculogyration for FB. All patients
were switched to atypical anti-psychotics without improvement
of the TS. The switch to clozapine, associated with abotulinum
injection for MJ, led to regression of the TS and improvement of
clinical signs. In fact, according to several studies, clozapine seems
to be an interesting option when invalidating TS occurs. The low
prevalence of TS under clozapine can be explained by its low affin-
ity for striatal-D2 receptors, its anti-serotonin and anti-cholinergic
effects.
Conclusions Clozapine should be considered in symptomatic
patients who develop TSwhile receiving other anti-psychotics. Fur-
ther research on mechanism of TS and clozapine effect on TS is
needed.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1080
Isolated rhabdomyolysis caused by
olanzapine: About a clinical case
Y. Laajili ∗ llini Rebhi Haloui Cheour
1 Razi Hospital Mannouba Razi, Psychiatrie Department E, Nabeul,
Tunisia
2 Razi Hospital Mannouba Razi, Psychiatrie Department E, Tunis,
Tunisia
∗ Corresponding author.
Introduction Atypical anti-psychotics are increasingly pre-
scribed, given their tolerance. Among these anti-psychotic
olanzapine, known for its adverse metabolic effects. By against
an adverse event type rhabdomyolysis with olanzapine appears
uncommon (<1%) and few clinical cases have been reported in the
literature.
Aim The aim of our study is to illustrate with a clinical case the
occurrence of an isolated rhabdomyolysis with olanzapine.
Materiel and method Starting from the study of the case of a
patientwith rhabdomyolysiswith olanzapinewe studied the litera-
ture data. Clinical vignette: it is about a patient aged 25 followed for
bipolar disorder type I. He responded to the association olanzapine
and valproic acid then to valproic acid only. His last hospitaliza-
tion for manic relapse dating to September 9, 2015 occurred in a
context of treatment discontinuation. Upon admission the patient
underwent an oral treatment based olanzapine and valproic acid.
A dosage of creatine phosphokinase (CPK) done systematically, on
September 11 showed high levels of (CPK) to 973 (U/L) without
clinical signs of neuroleptic malignant syndrome. The electrocar-
diogram and biological tests results were normal. Other etiologies
can lead to elevated (CPK) were eliminated. The persistent eleva-
tion of CPK motivated the arrest of olanzapine. The evolution was
marked by a return to normal CPK rates after 15 days. The olanzap-
ine was replaced by haloperidol and vaproic acid maintained. The
pharmacovigilance investigation conclude to the accountability of
olanzapine in this rhabdomyolysis.
Conclusion Second generation, anti-psychotics are known for
their better tolerance compared to conventional antipsychotics.
However, they are not devoid of side effects.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1081
Rechallenge clozapine after
agranulocytosis in refractory
schizophrenia. A case report
R. Landera Rodríguez ∗ Juncal Ruiz Martín Gutiérrez
M. Gómez Revuelta , I. Madrazo del Río Hortega ,
L. Sánchez Blanco , G. Pardo de Santayana Jenaro ,
D. Abejas Díez
1 Hospital Universitario Marqués de Valdecilla, Psychiatry,
Santander, Spain
2 Hospital Universitario Álava-Sede Santiago, Psychiatry,
Vitoria-Gasteiz, Spain
∗ Corresponding author.
Introduction Clozapine, is widely prescribed for treatment of
refractory schizophrenia, but its use may be limited by poten-
tially serious adverse effects. Themost feared complication remains
agranulocytosis [absolute neutrophil count (ANC) < 500/mm3],
which occurs in 1% of patients. Guidelines recommend immediate
cessationuntil the granulocyte count normalizes, but little is known
about the subsequent treatment and the possibility of restoring
clozapine.
Objectives To know procedures that allow clozapine rechallenge
after induced agranulocytosis in refractory schizophrenia.
Methods We present a clinical case of agranulocytosis and evo-
lution after simple reinstitution of clozapine.
Results A 38-year-old woman diagnosed refractory schizophre-
nia. After 10 years with clozapine (300mg/day), we find neu-
tropenia (ANC 1420/mm3) in a monthly control blood count with
progression to agranulocytosis (ANC 460/mm3) in the following
month. We suspend clozapine and started olanzapine (20mg/day)
with restoration of haematological values in a period of one month.
The patient had psychotic decompensation at two months after
the change with lack of response to different psychopharmaco-
logical strategies for five months. According to the hematology
department we decided to re-introduce clozapine (200mg/day)
in combination with olanzapine with complete clinical remission.
Between the 3rd and 9th week after rechallenge we observe a
progressive decline in ANC, while remaining within the range of
normal. From the 9th week and in the last 6months neutrophil
counts remained stable.
Conclusions Although, more research is needed to establish the
safety to rechallenge of clozapine after agranulocytosis, it must be
an alternative to consider when other treatment strategies fail.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1082
Combination of aripiprazole and
olanzapine in first episode psychosis
patient with metabolic syndrome: A
case report
I. Licanin ∗, H. Senad
University of Sarajevo Clinical Center, Psychiatry, Sarajevo, Bosnia
and Herzegovina
∗ Corresponding author.
There are numerous factors that predispose patients with
schizophrenia to develop metabolic syndrome and become