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S58 Abstracts of the 3rd Biennial Schizophrenia International Research Conference/ Schizophrenia Research 136, Supplement 1 (2012) S1S375

efficacy over time despite the continued use of medication; c) finally, with

the use of animal MRI and post-mortem histology we have examined the

effects of continuous medication on cortical structures in preclinical models

and we find that typical and atypical antispychotics leads to a decrease

in cortical volume with a suggestion of striatal hypertrophy. Cumulatively

these findings suggest that exposure to antipsychotics has longer-lasting

and compensatory effects on the brain - while the animal findings are not

veridical models of the human condition, they do identify the neurobiolog-

ical considerations that should inform human investigations.

META-ANALYSIS ON RELAPSE PREVENTION WITH ANTIPSYCHOTIC

DRUGS COMPARED TO PLACEBO IN SCHIZOPHRENIA

Stefan Leucht

Technische Universitaet Muenchen, Munich, Germany

The benefits of relapse prevention with antipsychotic drugs compared to

placebo in schizophrenia have not been sufficiently addressed by system-

atic reviews, leaving many open questions and controversial issues on

which guidelines disagree. We, therefore, conducted a meta-analsis on

65 RCTs with 6493 participants, and addressed more than 15 outcomes

and various subgroups. The aim was a comprehensive assessment of all

relevant research questions in this area. Antipsychotic drugs significantly

reduced relapse overall and important subgroups such as first-episode

patients. There were also positive effects on a number of other efficacy

related outcomes including hospitalisation and quality of life. In contrast,

the side-effects of antipsychotic drugs were well documented. We did not

find significant effects of various potential moderator variables. There was

no evidence for supersensitivity psychosis. These findings have major im-

plications for patients and clinicians, and should be considered by guideline

developers.

RELAPSE PREVENTION IN SCHIZOPHRENIA: A SYSTEMATIC REVIEW AND

META-ANALYSIS OF SECOND-GENERATION ANTIPSYCHOTICS VERSUS

FIRST-GENERATION ANTIPSYCHOTICS

Christoph Correll

The Zucker Hillside Hospital, New York, NY, USA

The potential advantages of second-generation antipsychotics (SGAs) over

first-generation antipsychotics (FGAs) are debated for the acute treatment

of schizophrenia, but are even less clear regarding relapse prevention, a

primary goal in schizophrenia treatment.

Methods: Systematic review/meta-analysis of randomized, controlled trials,

lasting 6 months comparing individual SGAs with FGAs in schizophrenia.

Primary outcome was study-defined relapse, preferring survival analysis-

based rates over raw rates. Secondary outcomes included relapse at 3, 6

and 12 months, treatment failure, hospitalization, and dropout due to any

cause, non-adherence and intolerability. Pooled relative risk (RR) [+/-95%

CIs] was calculated using random-effects model, with numbers-needed-

to-treat (NNT) calculations where appropriate. Additional analyses were

performed to identify moderators, mediators or potential biases for the

primary outcome.

Findings: Twenty-three studies (n=4,521, mean duration = 61.922.4

weeks) were included. Except for isolated, single trial-based superior-

ity, none of the individual SGAs outperformed FGAs regarding relapse

rates. Grouped together, however, SGAs were significantly superior to FGAs

in preventing relapse (29.0% vs. 37.5%, RR=0.80, CI: 0.70-0.91, p=0.0007,

I2=37%; NNT=17, CI: 10-50, p=0.003). SGAs were also superior regarding

relapse at 3, 6 and 12 months (p=0.04, p

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overtly distinguishable prior to randomisation. Other studies suggest that

those who wish to receive psychological therapy and have better coping

and working memory are more responsive to CBTp [3,4], and should be the

initial focus for psychotherapeutic effort.

References:[1] Garetyet al.(2008).A RCTof CBTandFI forthepreventionof relapse andreduction

of symptoms in psychosis. BJP 192, 412-423.

[2] Dunn et al. (2011). Effective elements of CBTp; results of a novel type of subgroup

analysis based on principle stratification.In press Psychol Med.

[3] Prekumar et al. (2009). Structural magnetic resonance imaging predictors of re-

sponsiveness to CBTp. Schiz Res, 115, 146-155.

[4] Prekumar et al. (2011). Coping styles predict responsiveness to CBTp. Psychiatry

Res, online doi:101016/j.psychres.2010.12.029

Workshop

CARDIOVASCULAR RISK IN SCHIZOPHRENIA THE PROBLEM AND

SOME SOLUTIONS

Chairpersons: Fiona P. Gaughran and Shubulade Smith

Discussant: Robin M. Murray

Tuesday, 17 April 2012 6:30 pm 8:30 pm

Overall Abstract: IMPACT Metabolic syndrome in people with psychosis in

South London and a novel health promotion intervention to address it Prof

Marc De Hert - systematic evaluationof guidelines for monitoring cardio-

metabolic risk in schizophrenia Prof David Taylor; The role of medication

in increasing and managing cardiovascular risk in psychosis Prof Richard

Holt - discussant Schizophrenia is a life-shortening disease (Harris and

Barraclough 1998). People with severe mental illness (SMI) in South London

have a reduced life expectancy of 8-17 years and a standardised mortality

ratio of 2.15 [Chang et al 2011]. The average life expectancy for those with

SMI is 64.5 years for men and 69.9 years in women (compared with 77 years

and 82 years in the general population). This mortality gap has widened in

recent decades, highlighting the failure of health improvements in the gen-

eral population to translate to people with SMI [Hyang et al 2011]. People

with SMI have an increased incidence of physical disorders such as car-

diovascular disease, metabolic syndrome and diabetes. Reversible lifestyle

factors such as diet, obesity, smoking and lack of exercise are prominent,

as are the effects of medication on cardiovascular risk, but there may also

be shared pre-morbid risk factors between SMI and cardiovascular risk,relating to social inequalities, ethnicity or genetic risk. The UK Department

of Health recently published No Health Without Mental Heath which

prioritises the physical healthcare of those with severe mental illness. This

is now becoming a priority internationally. Key in the reduction of mortality

is early identification and active management of cardiovascular risk. This

symposium will present up to date research on the extent of the problem of

cardiovascular risk and morbidity in people with severe mental illness and

detail recent interventions designed to combat this co-morbidity. Prof Urban

Osby will test the theory of shared risk factors by presenting results from

a genetic study of cardiovascular morbidity is a Swedish population with

psychosis. Drs Fiona Gaughran and Shubulade Smith will jointly present

data on the prevalence of cardiovascular risk factors in a diverse popu-

lation with psychosis in South London and describe a novel psychosocial

intervention to improve lifestyle choices in this group. Prof Marc De Hert

will describe his evaluation of the content and quality of existing screening

guidelines for cardiovascular risk in schizophrenia and his recommenda-

tions for future guidelines. Prof David Taylor will present new findings on

cardiovascular risk from anti-psychotic combinations and suggest proto-

cols for the pharmacological management of common cardiovascular risk

factors in psychosis. The aims and objectives of the symposium will be to

update the audience on the latest work on cardiovascular risk in psychosis

and to inform them of pharmacological, psychosocial and health service

recommendations for the identification and management of that risk.

IMPaCT MOTIVATING A CHANGE IN HEALTH BEHAVIOUR

Shubulade Smith, Fiona Gaughran

Institute of Psychiatry, London, United Kingdom

Unfortunately people with severe mental illness (SMI) have more physical

problems and use more illicit substances, especially cannabis, than the

general population. These additional problems lead to worsening of mental

and physical health and a poorer quality of life in the sufferer, as well as

causing more distress and burden to their families. They also increase the

costs of care. IMPACT aims to target the poor physical health and excessive

substance use seen in SMI. A randomly selected UK population of people

with psychosis who receive their ongoing mental health care through a

community mental health team was assessed in terms of health. Health was

defined holistically as mental health, cardiovascular risk factors and lifestyle

choices, e.g. diet, exercise, and use of tobacco, alcohol, cannabis and othersubstances. The findings from this will be presented. There is evidence

that behavioural interventions may be associated with an improvement

in physical health and substance use in this population. We have devel-

oped, validated and manualised a health promotion intervention (IMPaCT

therapy), which uses a modular approach to working with people with

severe mental illness to empower them to improve their physical health

and substance use habits. It consists of a therapy package to support clients

to become healthier. The therapy is provided by care coordinators (mental

health practitioners) over a 6-9 month period and combines Cognitive

Behavioural Therapy (CBT) with Motivational Interviewing (MI) principles.

The aim is to work with clients to help them identify their own problem

health behaviours, e.g. smoking, diet, exercise, drug and alcohol use. A

RCT is in progress assessing the effectiveness and cost-effectiveness of this

intervention in the above population. This represents independent research

commissioned by the National Institute for Health Research (NIHR) under

its Programme Grants for Applied Research scheme (RP-PG-0606-1049).

The views expressed in this presentation are those of the author(s) and not

necessarily those of the NHS, the NIHR or the Department of Health.

SYSTEMATIC EVALUATION OF GUIDELINES FOR MONITORING

CARDIO-METABOLIC RISK IN SCHIZOPHRENIA

Marc De Hert

UPC K.U. Leuven, Leuven, Belgium

Metabolic and cardiovascular health problems have become a major fo-

cus for clinical care and research in schizophrenia. Aims To evaluate

the content and quality of screening guidelines for cardiovascular risk in

schizophrenia. Method Systematic review and quality assessment of guide-

lines/recommendations for cardiovascular risk in people with schizophreniapublished between 2000 and 2010, using the Appraisal of Guidelines for

Research and Evaluation (AGREE). Results The AGREE domain scores varied

between the 18 identified guidelines. Most guidelines scored best on the

domains scope and purpose and clarity of presentation. The domain

rigour of development was problematic in most guidelines, and the

domains stakeholder involvement and editorial independence scored

the lowest. The following measurements were recommended (in order of

frequency): fasting glucose, body mass index, fasting triglycerides, fasting

cholesterol, waist, high-density lipoprotein/low-density lipoprotein, blood

pressure and symptoms of diabetes. In terms of interventions, most guide-

lines recommended advice on physical activity, diet, psychoeducation of the

patient, treatment of lipid abnormalities, treatment of diabetes, referral for

advice and treatment, psychoeducation of the family and smoking cessation

advice. Compared across all domains and content, four European guidelines

could be recommended.

Conclusions: Four of the evaluated guidelines are of good quality and should

guide clinicians screening and monitoring practices. Future guideline de-

velopment could be improved by increasing its rigour and assuring user and

patient involvement. Some suggestions for the ideal content of guidelines

and the practical challenges in their implementation will be discussed.

SHARED GENETIC RISKS FOR SCHIZOPHRENIA AND CARDIOVASCULAR

DISEASE

Urban Osby

Karolinska Institutet, Stockholm, Sweden

Patients with schizophrenia have an increased risk for morbidity and mor-

tality from metabolic disorders, such as obesity, coronary heart disease

(CHD), impairment of glucose tolerance including diabetes, hypertension,

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