S4-148 P.5 Anxiety disorders and anxiolytics actionsinvolve presynaptic receptors, since at these autoreceptors partial agonists have full efficacy . In however, bus,Piron: appeared ineffective, a finding that needs replieatton and elaboration WIth a study using ipsapirone. Moreover, buspironewasmoreproneto inducereduced locomotion. than werethe full agonists f1esinoxan and 8-0H-DPAT. Reference Molewijk, H.E., van der Poel, A.M.• Mos. J. van derHeyden, J.A.M., and Olivier. B. (1995) Conditioned ultrasonic distress vocalizations in adult male rats as a behavioural paradigm for screening anti-panic drugs. Psychopharmacology 117, 32-40. I P.5.025I Characteristics of patients with a prescription of benzodiazeplne C. Barnas I, S. Frohlich2, S. Whithworth 3, C. Miller 3. W.W. Fleischhacker3. I Department of Clinical Psychiatry, University of Vienna, Wiihringer CurteII8-Z0, A-WOO Vienna, Austria; 2 Institute of Psychology, 3 Department of Psychiatry, University of lnnsbruck; Austria Various epidemiological studies have shown that benzodiazepine con- sumers are mostly elderly female patients. Somatic illness, especially chronic progredient disease, seems to be a factor that may lead to long-term benzodiazepine use. The aim of the present study was to detect possible differences in somatically ill patients who use a benzodiazepine and such patients who do come along withouta tranquilizer, In a general hospital fourty consecutively admitted patients who re- ceived a benzodiazepine prescription were examinedand comparedwith fourty age and sex matchedcontrols who were admitted during the same time and who did not receive a tranquilizer. The investigation consisted of a semi-structured interview which recorded the soziodemographic variables of the patients and data about their somatic illness. Patients were also interviewed about previous ben- zodiazepine intakeand, if applicable, about the patternsof the tranquilizer intake. In a second step the anxiety level of the patients was assessed using the Hamilton Anxiety Scale (HAMA) and the Stait Trait Anxiety Inventory (STAl). This was followed by the 16 Personality Factors Test (16-PF) and a test to describecopying strategies with somatic illness (KGG). During the investigation period 13.2% of the admitted patients receiveda benzodiazepine prescription. 63% of these patientswere fe- males. whereasonly 52% of the totally admitted patientswere females (p < 0.01). Patients who received a benzodiazepine were significantly older (61.5 ± 10.5years) than patients withouttranquilizers (57.2 ± 8.5 years; p < 0.05). Daily benzodiazepine doses ranged between 3 and 20 mg diazepamequivalents (mean = 7.05 rng). A comparison between the 40 benzodiazepine receiving patients and 40 sex and age matchedcontrols showed that the benzodiazepine group subjectively rated their illness more severe on a visual analogscale than controls (p < 0.05), whereas there was no differencein similar ratingsof their treating doctors. Duration of illness was longer in the tranquilizer group (88.7 ± 110.3 months) than in the control group (33.7 ± 30.3 months; p < 0.01). Anxiety levels as measured with the HAMA as well as with the STAI were significantly higher in the benzodiazepine group. In the 16PFtest benzodiazepine consumers described themselves significantly more sensitive to stress, more concerned. emotionally less stable and with a higher levelof tension. The results of this study raise the question whetherbetter psychologi- cal/psychotherapeutic care for patients in generalhospitalscould lead to a reduction in benzodiazepine prescriptions. I P.5.02S! Combination of two SSRI's in long-term treatment of patients with OCD-four case reports Eva Palova, Department of Psychiatry; Un iversity of P.l. Safarik. Tr. SNP I, 04066 Kolice; SlovakRepublic -' Compounds having an effect on serotonergic neurotransmission have demonstrated a reproducible therapeutic effect on OeD. Most recent attention has been focused on the specific serotoninre-uptake inhibitor (SSRI) class of compounds. The evidence that SSRI's are effective in short- and long-term treatments of OCD is now equivocal. Despite success with potent inhibitors of 5-HT re-uptake as many as 40-60% of OCD patients remaineclinically unchanged or minimally improved after an adequate trial withthese agents. One approachto these treatment-refractory patients may be the combi- nation of two SSRI·s. Four (4) case reports of long-term treatment (6-42 months)of patients with treatment-refractory OCD with combination of two SSRI's (f1uoxetine + f1uvoxamine) are presented and discussedin this presentation. All patients met DSM-ill-R criteria for OCD and had a baseline score of 7 or more on the National Institute of Mental Health (NIMH) Global Obsessive-Compulsive Scale. Efficacy measuresincludedthe Yale-Brown Obsessive Compulsive Scale (Y-BOCS),the NIMH Global OC Scale and the CGI Scale. These scales were completedat baseline and at the end of months3. 6, 12, 18,24. 3D, 36 and 42. Routine hematology, biochemistry profile, urinary tests, ECG and a physicalexamination were performed at the baseline and regularly during the treatment. All patients were treatment responders (Y-BOCS score decreased more than 30% from baseline).The maximumdaily dose for ftuoxetine was 40 mg/dayand for f1uvoxamine 100mg/day. No serious side effects were recorded during the treatment. We have decided to present our case reports of treatment OCD patients with the combination of two SSRI's because the combinationof two SSRI's as an alternative treatment for the patients with OCD is being mentioned in psychiatric literature very seldom. Our results suggestthat combination of two SSRI's can be an alter- native and safe way for treatment for some of patients with treatment refractory OCD. References [I] McDougle, CJ.• Goodman. W.K.. Price, L.H. (1993) Thepharmacotherapy of obsessive-compulsive disorder. Pharmacopsychiatry 26. Supplement I, 24-29. [2] Jenike, M.A. (1992) Pharmacologic treatment of obsessive-compulsive dis- orders. In: Jenike, M.A. (Ed.) Obsessional disorders . Psychiatri c Clinics of North America. Vol. 15. No.4. W.B. Saunders Company. Philadelphia, PA. pp. 895-919. I P.5.027I Efficacy of different serotonergic drugs In obsesslve-compulsive disorder C. Pfanner, S. Presta, A. Gemignani, A. Milanfranchi, P.Lensi, S. Ravagli, I. Maremman i, D. Marazziti. Institute of Psychiat ry, University of Pisa; via Roma 67. 56100Pisa,Italy Obsessive-compulsive disorder (OCD) has been considered for a long time resistant to both psychopharmacological and psychotherapeutic treatments, In the last decades, the antiobsessional properties of the non specific serotonin (5-HT) reuptake inhibitor clomipramine has clearly emerged in different studies. Fluvoxamine is one of the selective 5HT reuptakeinhibitors (SSRIs), besides fluoxetine, sertralineand paroxetine, whichdemonstrates an improvedsafety profile as compared with classi- cal tricyclics. Some authors suggest that ftuvoxamine is more effective than placebo (Greist et al., 1995). Fluvoxarnine appeared also superior to behavioral therapy (Cottraux et al., 1990), similar to clomipramine (Freeman et al, 1994). and superior to desipramine (Goodman et al., 1989).A double-blind trial was performedto assess theeffectiveness and tolerability of high dosages (300 mg/day) of f1uvoxamine in comparison with clomipramine for treatmentof OCD. A total of 26 subjects with OCD, strictly defined with no comorbid disorder. were included in the study. 13 subjects were randomizedto fluvoxamine and 13to clomipramine. The OC symptoms severity was rated by the Yale Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI). Doses began from 50 mg/day and were treated up to 300 mg/daywithin 15 days. For cathegorical variables. test of statistical significance were based on usual X 2 value. For continuous variables summarystatisticswere made using t test, and, whenever appropriate. analysis of variance. For safety data, descriptive statisticswere adopted. Of the 26 patients. only one dropped out for the occurrence of a serious medical event, independent from treatment study. The Y-BOCS total score showedan equal improvement in the f1uvoxamine group and in the clomipraminegroup (38% vs 40%). comparedto baseline values.