European Psychiatry - Volume 41 - April 2017

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S870 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S847–S910
examinations are often complete, invasive, even going to an explo-
rative laparotomy for one patient.
Conclusion The CHS remains not well known. A better under-
standing of this syndrome will enable better patient care while
avoiding costly spending unnecessary investigations.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1416
Drug safety related to agents used for
opioid maintenance therapy
M. Gahr ∗, J. Eller , C. Hiemke , R.W. Freudenmann ,
B.J. Connemann , D. Lang , C. Schönfeldt-Lecuona
1 University Hospital of Ulm, Psychiatry and Psychotherapy III, Ulm,
Germany
2 University of Mainz, Psychiatry and Psychotherapy, Mainz,
Germany
3 University Hospital of Ulm, Psychosomatic Medicine and
Psychotherapy, Ulm, Germany
∗ Corresponding author.
Introduction There is only little data regarding drug safety related
to agents used for opioid maintenance therapy (OMT).
Objectives/aims To study drug safety and the reporting behaviour
of adverse drug reactions (ADR) related to OMT.
Methods A cross-sectional questionnaire-based telephone sur-
vey among physicians providing outpatient OMT in a federal state
of Germany (n = 176; response rate = 55.7%) was conducted.
Results Most of the respondents (n = 97/55.1%) reported that
they observe ADR related to buprenorphine, [dihydro]codein and
[levo]methdone rarely (n = 38/21.6%), very rarely (n = 39/22.2%)
or never (n = 20/11.4%). Methadone was reported to be most fre-
quently associated with the occurrence of ADR (n = 82/46.6%),
followed by levomethadone ( n = 33/18.8%), buprenorphine
(n = 6/3.4%), and dihydrocodeine ( n = 3/1.7%). Frequently observed
ADR related to these agents were gastrointestinal, nervous system
and psychiatric disorders, and hyperhidrosis. Methadone and lev-
omethadone (not buprenorphine) were reported to be frequently
associated with fatigue, weight gain, and sexual dysfunction. Only
buprenorphine was reported to be frequently associated with
withdrawal and rebound effects, and drug intolerance. Hundred
twenty-nine participants (73.3%) stated that they never report
ADR related to OMT, whereas n = 19 (10.8%) did so when referring
to ADR related to their complete medical practice (Chi2 = 141.070;
df = 1; P < 0.001).
Conclusions Our data revealed similar patterns of ADR related to
outpatient OMT as those reported in the product information or
in pain therapy. Motivation to report ADR related to agents used
for OMT may be reduced compared to ADR related to the general
medical practice.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1417
Absent substance use disorder and
survival of extraordinarily high blood
alcohol concentration
M. Gahr ∗, H. Graf , K. Malejko
University Hospital of Ulm, Psychiatry and Psychotherapy III, Ulm,
Germany
∗ Corresponding author.
Introduction Intoxications with alcohol are very frequent in clin-
ical psychiatry and may lead to death depending on (maximum)
blood alcohol concentration (BAC) and accompanying factors as
liver function, tolerance, comedication, etc. Death may occur due
to ethanol-induced respiratory depression and/or aspiration of gas-
tric content (due to an impaired gag reflex); thus, securing of the
airway and ventilation are occasionally necessary.
Objectives/aims To illustrate the broad range of clinical outcomes
of alcohol intoxications and their adequate therapy.
Methods We present the case of a 58-year female patient with
depression who demonstrated a very high BAC of 8.68 g/L (repre-
senting the highest survived BAC in literature) due to ingestion of
large amounts of alcohol with suicidal intent.
Results Intubation and ventilation were lifesaving and the
patient did not develop any physical or mental consequential dam-
age. As the patient had not regularly used alcohol or any other
psychotropic agent tolerance could be ruled out.
Conclusions This case emphasizes the necessity of rapid securing
of the airway in patients with alcohol intoxication and respiratory
depression and, furthermore, illustrates the large inter-individual
differences regarding ethanol susceptibility.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1418
The neural basis of cognitive control
in gambling disorder: A systematic
review of fMRI studies
L. Moccia ∗, M. Pettorruso , L. De Risio , F. De Crescenzo ,
L. Di Nuzzo , E. Conte , B. Leone , V.R. Ferri , G. Martinotti ,
M. Di Nicola , L. Janiri
1 University Hospital “A. Gemelli”, Catholic University of the Sacred
Heart, Psychiatry and Psychology, Rome, Italy
2 “G. D’Annunzio” University, Department of Neuroscience and
Imaging, Institute of Psychiatry, Chieti, Italy
∗ Corresponding author.
Introduction Decreased cognitive control over the urge to be
involved in gambling activities is a core feature of gambling
disorder (GD). Cognitive control can be conceptualized as the
sum of high-order cognitive faculties interacting in the achieve-
ment of goal-oriented behaviors. As such, cognitive control can
be differentiated into several cognitive sub-processes, such as
response inhibition, conflict monitoring, decision-making and cog-
nitive flexibility, all of which prove to be pivotal in GD clinical
phenomenology.
Objectives Over the past few years, several studies and reviews
have indicated a lack of cognitive control in GD through self-report
questionnaires and neurocognitive tasks. Conversely, there are only
a limited number of neuroimaging studies, which investigate the
neural mechanisms underlying diminished cognitive control in GD.
Aims This research aims to systematically review functional
magnetic resonance imaging (fMRI) studies that target cognitive
control in GD.
Methods A literature search was conducted in order to find
appropriate published articles on fMRI studies in GD.
Results Fourteen fMRI studies were included. Depending on
which neurocognitive task was employed, the studies were divided
into five different sections: conflict monitoring, response inhibi-
tion, delay discounting, cognitive flexibility and decision-making.
Conclusions Impaired activity in prefrontal cortex may account
for decreased cognitive control in GD, contributing to the progres-
sive loss of control over gambling behaviors. However, the way in
which cognitive control interacts with affective and motivational
processes in GD is still matter of investigation. Among prefrontal
areas, orbitofrontal cortex has been indicated as a possible nexus for
sensory integration, value-based decision-making and emotional
processing, thus contributing to both motivational and affective
aspects of cognitive control.