European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S772–S846 S823
EV1276
Brain-based psychotherapy for
psychosis
L. Mehl-Madrona ∗, B. Mainguy
1 Eastern Maine Medical Center, Family Medicine, Orono, USA
2 Coyote Institute, Education, Orono, USA
∗ Corresponding author.
Introduction Psychotherapy methods are evolving for patients
with psychosis.
Methods We present a psychotherapy of psychosis that is brain-
based, along with results of working with patients using these
methods. Patients with psychosis are known to have decreased
connectivity of the elements of the default mode network, also
known as the story-making brain. These patients are known
to tell narratives that lack coherence, of both excessive ele-
ments and inadequate elements. These stories are rigid and
either cacophonous or rigidly monologic. The key brain area
of the precuneus shows diminished connectivity to other brain
areas. We present a narrative approach in which patients are
assisted through rehearsal and modeling to tell more coherent
stories about their life experiences. We work toward achiev-
ing a future orientation in which a sequence of actions leads
toward an achievement of a future goal. The protagonist encounters
obstacles and learns how to overcome them. Through itera-
tive rehearsals, the story achieves more vivid mental imagery
and emotional connectivity. Delusions and voices are accepted
and incorporated into those stories in ways that provide the
patient with improved capacity to cope with their delusions and
voices.
Results We present the results of 59 patients who worked with
these techniques and compare themto amatched cohort of patients
treated conventionally. The treated patients show statistically sig-
nificant improvement in positive and negative symptoms and in
quality of life.
Discussion Brain-based narrative psychotherapy approaches can
improve the quality of life and reduce symptoms.
Conclusion These techniques are worthy of further exploration.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1277
First-episode psychosis
intervention – description of our early
intervention model
B. Melo ∗, C. Alves Pereira , R. Cajão , J. Ribeiro Silva , S. Pereira ,
E. Monteiro
Centro Hospitalar Tondela Viseu, Department of Psychiatry, Viseu,
Portugal
∗ Corresponding author.
Introduction The research about the benefits of early diagnosis
and treatment of first-episode psychosis had significantly increased
in last decades. There have been several early intervention pro-
grams in psychotic disease, implemented worldwide, in order to
improve the prognosis of these psychotic patients.
Objectives To present a brief description of the first-
episode psychosis intervention team of Tondela-Viseu Hospital
Centre–Portugal and its model. We aim to further characterize our
population and describe its evolution since 2008.
Aims We aim to clarify the benefits of an early intervention in
psychosis.
Methods We conducted a retrospective cohort study of patients
being followed by our team from November 2008 to September
2016. Demographic and medical data were collected (such as diag-
nosis, duration of untreated psychosis, treatments and its clinical
effectiveness, relapse rate and hospital admissions) in patient’s
clinical records. The intervention model protocol of this team was
also described and analyzed.
Results This multidisciplinary team consists of three psychia-
trists, one child Psychiatrist, one psychologist and five reference
therapists (areas of nursing, social service and occupational ther-
apy). It includes patients diagnosed with first-episode psychosis,
aged 16 to 42 years old, followed for five years. The team followed,
since its foundation, 123 patients, mostly male. The most prevalent
diagnosis are schizophrenia and schizophreniform psychosis. The
team is currently following 51 patients.
Conclusions This team’s intervention have progressively
assumed a more relevant importance in the prognosis of patients
with first-episode psychosis, by reducing the duration of untreated
psychosis, the relapse rate and by promoting social reintegration.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1278
Rechallenge of clozapine in a low
secure setting following pericardial
effusion
A. Mohandas ∗, J. McCarthy , A. Hartley , E. Fatima ,
L. Shearman
1 Devon Partnership NHS Trust, Langdon Hospital, Dawlish, United
Kingdom
2 Devon Partnership NHS Trust, Core Trainee CT3, Exeter, United
Kingdom
3 Devon Partnership NHS Trust, Specialty trainee ST5, Exeter, United
Kingdom
∗ Corresponding author.
Introduction Clozapine is licensed for treatment-resistant
schizophrenia and when clozapine is not able to be used, less
evidence based practices may be required. Full remission may
require combinations or high doses of psychotropic medications
having greater potential for interactions and side effects. If this
is not successful, symptoms may persist and long-term disability
may occur.
Aims To explore safety and efficacy of a rechallenge of clozap-
ine in a patient with treatment resistant schizoaffective disorder,
who previously developed pericardial effusion. Collateral history
reported best improvement with clozapine compared to other
medications.
Objectives To improve level of functioning and reduce need for
less evidence based choices of medication.
Methods Initial consultation with clozapine monitoring service
over prospects of rechallenge. Full medication history and review.
Consultationwith a cardiologist regarding validity of local monitor-
ing strategy. Obtain consent from the patient and his family. Titrate
clozapine slowly. Once clozapine initiated, measure temperature,
blood pressure, pulse rate and monitoring of symptoms of peri-
carditis including chest pain, cough and dyspnoea daily. ECG and
echocardiography at baseline and 2 and 4 weeks after initiation of
the rechallenge. ECGs monthly thereafter, with a further echocar-
diogram at 3 months. Weekly troponin and CRP for three months
to monitor developing myocarditis and pericarditis.
Results Successful rechallenge of clozapine with significant
reduction in psychopathology, improvement in functioning and no
adverse events reported. Reduction of risk enabled transfer to open
ward conditions.
Conclusions There is increasing evidence of successful rechal-
lenges of clozapine however, further research is necessary to aid
such clinical decisions.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.