S578 P.3.f.
Psychotic disorders and treatment − Other (clinical)
duration of illness was 9.9±9.3years and the mean PANSS total
score was 72.4±18.7. All patients were treated by antipsychotics.
None of these variables was significantly associated with abnormal
CRP levels.
Overall, 63 patients (28.8%) were found to have abnormal CRP
levels defined by hs-CRP>3 mg/L. Forty-three patients (20.1%)
had a current major depressive disorder (MDD) according to the
Calgary scores (that specifically explore depression independently
of negative symptoms of schizophrenia).
In the whole sample, 51 (31.9%) were administered antide-
pressants (29 selective serotonin reuptake inhibitors, 12 serotonin
and norepinephrine reuptake inhibitors, 2 tricyclic agents, 4 other
antidepressants and 4 more than one antidepressant).
Abnormal CRP levels were found to be associated with an-
tidepressant consumption (35% in patients with abnormal CRP
vs 18.6% in controls, p = 0.01) but not with current MDD
(p > 0.05). Due to statistical lack of power, subgroup analyses
by antidepressant class were not carried out. Abnormal CRP
levels were also found to be significantly associated with BMI
(p < 0.0001), hypertriglyceridemia (p = 0.0015), high waist cir-
cumference (p < 0.0001), metabolic syndrome (p = 0.0011) and
abdominal obesity (p < 0.0001), but not with positive, negative
or general symptomatology (according to PANSS and Calgary
scores), current tobacco status, hypertension or high fasting glu-
cose (all p > 0.05).
In order to explore the association between abnormal CRP
level and antidepressant treatment, we performed multivariate
logistic regression analyses. Schizophrenic patients with abnormal
CRP levels had 2.8 times higher risk of taking antidepressant
medication (95% CI: 1.2−6.6, p = 0.016) compared to controls
after adjustment of age, gender, current psychotic and depressive
symptomatology, tobacco consumption and metabolic syndrome.
Additional adjustment on the number of lifetime depressive and
psychotic episodes did not change our results.
Conclusion: Abnormal CRP levels in schizophrenia were found
to be associated with antidepressant consumption, but not with
depression. Antidepressant consumption should be systematically
recorded in future studies exploring inflammation in schizo-
phrenia. Future clinical trials of interventions directed at lowering
the level of CRP and other inflammatory markers are discussed.
P.3.f.003 The Nursing Assessment of Medication
Acceptance: the reliability and validity of a
schizophrenia medication adherence scale
H. Hori1 ° , K. Atake1 , R. Igata1 , Y. Konishi1 , R. Yoshimura2
1 University of Occupational and Environmental Health,
Psychiatry, Kitakyushu, Japan; 2 University of Ocuupational
and Environmental Health, Psychiatry, Kitakyushu, Japan
Background: Schizophrenia is a chronic disease that requires
long-term pharmacotherapy. Adherence to a prescribed antipsy-
chotic therapy is crucial for a successful treatment outcome.
Indeed, antipsychotic medication adherence plays a key role in
patients with schizophrenia, and regular treatment has been proven
to ameliorate symptoms and reduce relapse rates. However many
patients with schizophrenia have low medication adherence. There
is, however, no objective assessment scale that can be used by
nurses or caregiver specialists. The Nursing Assessment of Med-
ication Acceptance (NAMA) was developed to assess patients’
medication adherence. This tool is composed of the following
four categories: (1) attitude; (2) compliance; (3) ingestion; and
(4) nursing effort. Each category is rated on a 5-point scale
(ranging from strongly agree = 1 to strongly disagree = 5), and
lower scores indicate higher degrees of adherence.
The aim of this study was to examine the validity and reliability
of the NAMA in patients with schizophrenia.
Methods: A total of 121 Japanese patients with schizo-
phrenia were enrolled. All subjects underwent evaluation using the
NAMA, the Drug Attitude Inventory (DAI-10) and the Brief Psy-
chiatric Rating Scale (BPRS). Reliability was investigated using
a test-retest method and a parallel-test method. To determine the
test-retest reliability of the NAMA, we tested 101 schizophrenia
patients twice, with the second assessment 2 to 4 weeks after the
date of the first assessment. For validity verification, standard-
related validity and the degree of concordance with the DAI-10
scores were measured. From May 2015 to July 2015, 121 pa-
tients were enrolled. Researchers collected demographic data and
performed semi-structured interviews to obtain clinical histories.
All subjects were administered the NAMA, DAI-10 and BPRS
in a quiet room. To prevent fatigue and withdrawal symptoms,
subjects were allowed a short break of approximately 5 minutes
or a cigarette. All participants completed each test in its entirety.
One month later, 101 patients underwent re-evaluation using
the NAMA and BPRS. This study was approved by the Ethics
Committee of the University of Occupational and Environmental
Health.
Results: A total of 121 chronic schizophrenia patients were
recruited (63 males; mean age ± SD: 55.3±13.4; mean duration
of illness: 28.2±13.4 years). Of the 121 patients, 101 completed
all the tests. The average total NAMA score was 7.2±2.9 points.
The time taken to complete the NAMA and the DAI-10 was
1.3±0.5 minutes and 2.9±2.3 minutes, respectively (p < 0.01).
The Cronbach’s alpha value of the NAMA in schizophrenia was
0.88. The test-retest correlation coefficients of the attitude, com-
pliance, ingestion and nursing effort subscores were all between
0.53 and 0.74 (p < 0.05). The total scores and all subscores for the
NAMA were significantly correlated (p < 0.05), and the NAMA
total scores were significantly correlated with the DAI-10 total
scores (p < 0.05). All NAMA subscores and the total score were
significantly correlated with the BPRS total scores.
Conclusions: The NAMA shows good reliability and validity in
measuring medication adherence in schizophrenia. The limitations
of this study include the involvement of many chronic-phase
patients and the sample size.
Disclosure statement: This research was supported in part by a grant from
Eli Lilly Japan KK.
P.3.f.004 Dealing with current tobacco smoking in
real world schizophrenia. Results from the
Face-Schizophrenia dataset
J. Mallet1 ° , G. Fond2 , Y. Le Strat3 , P. Llorca4 , C. Dubertret1
1 CHU Louis Mourier and Fondation FondaMental and Université
Paris Diderot, Psychiatry, Colombes, France; 2 GHU Créteil
Mondor and Fondation FondaMental, Psychiatry, Créteil,
France; 3 CHU Louis Mourier and Université Paris Diderot,
Psychiatry, Colombes, France; 4 CHU Clermont-Ferrand and
Université d’Auvergne and Fondation FondaMental, Psychiatry,
Clermont-Ferrand, France
Background: Tobacco smoking is more common in patients with
schizophrenia (SZ) than in general population. It is one of the main
 P.3.f. Psychotic disorders and treatment − Other (clinical)
causes of premature mortality in this disorder. Little is known
about the role of tobacco on SZ onset and maintenance. Incon-
sistent results were found on the influence of First Generation
Antipsychotic (FGA) vs. Second generation (SGA) on tobacco
consumption in patients with SZ. A recent work showed a better
efficacy of both FGA and clozapine on tobacco abstinence main-
tenance compared to other SGA in a 8-week follow-up study [1].
Tobacco smoking in schizophrenia is associated with younger age,
earlier onset of the disease, higher number of hospitalizations
or higher treatment doses. Little is known about the association
between tobacco smoking and respectively positive symptoms,
aggressiveness and history of childhood trauma (HCT).
Objective: The primary objective of this study was (i) to de-
termine if SGA administration was associated with lower tobacco
use disorder compared to FGA. The secondary objective was to
determine (ii) the prevalence of tobacco smoking, (iii) the clinical
and demographical characteristics of SZ smokers compared to
non-smokers and (iv) the association between tobacco smoking,
psychotic symptomatology and HCT in a non-selected stabilized
community-dwelling sample of patients with SZ.
Methods: The network of FondaMental Expert Center for
schizophrenia (FACE-SZ) assessed 474 SZ subjects (mean age =
32.2 years old; 75.7% male) with the Structural Clinical Inter-
view for DSM-IV Axis 1 Disorders (SCID), validated scales
for psychotic symptomatology and Childhood Trauma Question-
naire (CTQ). Aggressiveness was measured with the Buss-Perry
Aggression auto-Questionnaire (BPAQ). Global functioning was
evaluated with Global Assessment Functioning (GAF). Obser-
vance was evaluated with Brief Adherence Rating Scale (BARS).
Current tobacco smoking, alcohol consumption and ongoing an-
tipsychotic treatment were systematically recorded. Multivariate
logistic regression analyses were conducted with simultaneous
entry of sociodemographic covariates.
Results: Overall, 474 SZ subjects (non smokers, n = 215,
45.4%; smokers, n = 259, 54.6%) were consecutively included
in this study. Mean age at tobacco onset was 17.2 years old
(SD = 3.9), the mean lifetime tobacco consumption was 7.22 pack-
year (SD = 11.1). Non-smokers were significantly more likely
to benefit from a treatment with SGA than smokers (93% vs
85.4%; p = 0.018). In multivariate analysis, tobacco smoking was
associated with FGA use (Odds Ratio (OR) = 2.27 95% confidence
interval (CI):1.03–5.00; adjusted p = 0.04) and with higher self-
reported physical aggressiveness (OR = 1.04; 95% CI: 1.00–1.08;
adjusted p = 0, 03). Tobacco smoking was also strongly associated
with current alcohol disorder (OR = 10.56; 95% CI: 2.38–46.96;
adjusted p < 0.01). No significant association between tobacco
smoking and gender, age of illness onset, HCT, global function-
ing, observance or psychotic symptomatology was observed (all
p > 0.05).
Conclusions: Our results suggest a higher efficacy of SGA
in the treatment of comorbid tobacco use in schizophrenia in
community-dwelling SZ patients. Tobacco consumption is also
been associated with higher physical aggressiveness in patients
with SZ. Due to the cross-sectional design of the study, no direct
causal relationship can be definitely inferred from our work.
Further longitudinal studies are needed to confirm the potential
efficacy of SGA on tobacco use in schizophrenia.
References
[1] Wu, B.J., Lan, T.H., 2015. Predictors of smoking reduction outcomes
in a sample of 287 patients with schizophrenia spectrum disorders. Eur
Arch Psychiatry Clin Neurosci. 2015 Aug 27. [Epub ahead of print].
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P.3.f.005 Lipid profile in schizophrenia: study about
78 patients and 68 controls
A. Mhalla1 ° , W. Hadj Salah1 , B. Amamou1 , R. Mensi1 ,
F. Zaafrane1 , W. Douki1 , L. Gaha1 1 Research Laboratory
“Vulnerability to Psychotic disorders”- University of Monastir,
Research Laboratory “Vulnerability to Psychotic disorders”-
University of Monastir, Monastir, Tunisian Republic
Introduction: Cardiovascular diseases are common comorbidities
of schizophrenia and constitute the main factors of high mortality
in this pathology [1]. Cardiovascular damages are favored by
some risk factors, of which one of the most important is dyslipi-
demia [2]. In this context, a study of lipid profile in schizophrenia
is interesting.
The aims of this study were to estimate the prevalence of
dyslipidemia among patients with schizophrenia, compare it with
healthy controls and study its correlations with sociodemographic,
clinical, and therapeutic characteristics.
Methods: It was a cross-sectional, comparative and analytical
study conducted between April 2013 and March 2014 on 78
patients with schizophrenia and 68 healthy subjects who benefited
from the dosage of four serum lipid parameters: total cholesterol
(TC), High Density Lipoprotein Cholesterol (HDL-c), Low Den-
sity Lipoprotein Cholesterol (LDL-c) and triglycerides (TG). For
associations with the sociodemographic and clinical settings, we
used an information sheet and the following psychometric scales:
PANSS (Positive And Negative Syndrome Scale), CGI (Clinical
Global Impression), GAF (Global Assessment of Functioning) and
Calgary scale for depression.
Results: Patients showed significantly higher levels of TC
and LDL-c than controls with respectively (t = 2.83, p = 0.008)
and (t = 9.35, p < 0.001). They also had a significantly higher
cardiovascular index (CRI=TC / HDL-c); (t = 2.23, p = 0.033).
The rate of patients with hypercholesterolemia (TC 5 mmol/l)
was significantly higher than that of healthy controls (Relative
Risk = 2.96; p = 0.002); likewise, the rate of patients with a hyper
LDL-c (LDL-C 3 mmol/L) was significantly higher than that of
healthy controls (Relative Risk = 18.79; p < 0.001).
For the patients, LDL-c levels were significantly higher for
patients aged 35 or over, the CRI was on average higher than
4 for men indicating a high cardiovascular risk and lower than 4
for women.
Patients with alcohol use showed significantly higher TC levels
(t = 1.6; p = 0.038) and higher CRI (t = 1.94; p = 0.015), they had
significantly lower LDL-c levels (t = −2.91; p = 0.002) and HDL-c
levels (t = −2.45; p = 0.044). Patients with cannabis use showed
lower TG levels (t = −2.02; p = 0.049).
Concerning clinical associations, The comparison of different
patient groups according to the type of schizophrenia found
that the paranoid type was associated with values of the CRI
significantly lower compared to other patients (t = 1.98; p = 0.05).
There was a positive correlation between the scores of Calgary
scale of depression and of TG plasma concentrations (r = 0.39;
p < 0.001).
Concerning therapeutic associations, there was a negative corre-
lation between TG plasma concentrations and antipsychotic doses
in chlorpromazine equivalent (r = 0.3; p = 0.008).
Conclusions: The vast majority of the literature confirms our
results and showed that lipid disturbances were more frequent in
patients with schizophrenia and that these disturbances concern all
lipid parameters [3]. Lipid disturbances in schizophrenia appear