Compared with workers in other sectors, hospital workers are victims of high rates of non-fatal workplace assault injuries worldwide. Unfortunately, a large amount of these injuries is a result from violent acts committed by patients. International research has focused on perceived reasons for patient violence among physicians and patients.

To determine the prevalence and factors of patient-to worker violence in two hospitals in the central-eastern region of Tunisia.

A cross-sectional bi-centric study was conducted in two teaching hospitals. This study included all healthcare workers of these hospitals. Data collection was performed by a structured self-administered questionnaire related to demographic and professional characteristics of participants. Participants were asked about violence where the perpetrators were patients using a questionnaire developed and validated by a Jordanian team to evaluate Violence. Beck’s Depression Inventory II and Rosenberg self-esteem scale were chosen to explore self-esteem issues and mood disorders. The Fagerstrom test for nicotine dependence was used to assess cigarette dependence. The Internet addiction test was used to evaluate internet addiction.

The response rate was of 19%. The mean age of the sample was 34.5 ±9.6 years. In work sit, 46.9% (n=239) reported being exposed to at least one incident of patient-to-worker violence. Exposure to verbal violence was reported by 92.1% of workers. Among the sample, 18.9% of participants reported feelings of low self-esteem. Asked about depressive symptoms, appetite problems were reported in 77.1% of cases. A significant association was found between patient-to-worker violence, nationality (p= 0.01) and occupation (p= 0.01) of respondents. Results showed also that patient-to-worker violence was significantly associated with smoking (p=0.043), the degree of cigarette addiction (≤10-3) and alcohol consumption (p=0.008). Mood disorders were associated to exposure to patient-to-worker violence. An increased risk to be exposure to incidents of physical violence was found among workers with depressive symptoms. Also, reporting physical violence was associated with self-esteem issues and feelings of worthlessness.

Violence has become an alarming hazard in hospitals. This study showed the association between different factors and the exposure to patient-to-worker violence incidents in two hospitals. Being exposed to patient-to-worker violence has negative impacts. Some of type II violence’s consequences are to impact quality of life of workers, depression, psychological squeals, effectiveness of work and the decrease of quality of care. In order to reduce patient-to-worker violence, urgent prevention programs should be incorporated in hospitals.

None Declared

The Profile of Mood States is one of the most widely used instruments to assess mood states. It is a rapid and economic method of assessing transient affective states (McNair et al. 2003) and it has been translated and validated to several languages including Portuguese. In our country we have several versions, with different factorial structures and number of items. The scale presents a list of feelings and emotions (adjectives) that people commonly experience.

With university students, we have used a version composed of 36 items that evaluates three factors, with good validity and reliability: Depression, Anxiety/Hostility and Positive Affect (Amaral et al. 2013).

However, to be included in digital apps that in addition to ecological momentary assessment parameters require a weekly or even daily assessment of mood states, this version has little usability.

To develop a shorter version of the POMS-36 based on Exploratory Factor Analysis and to analyse its construct validity using Confirmatory Factor Analysis in a sample of Portuguese college students.

765 students (69.2% females; mean age=22.09±2.433; range: 17-26) fill in the POMS-36 and the Perceived Stress Scale (Amaral et al. 2014). The total sample was randomly divided in two sub-samples. Sample A (N=380) was used to EFA and sample B (N=385) was used to CFA.

Through EFA (with varimax rotation and extracting three factors), the four items with the highest loadings in their respective factor were selected. Then, the CFA, carried out with the AMOS, revealed that this three-factor model, with two pairs of correlated errors, indicated a good fit (X2/df= 4.6010; CFI =.9561; GFI =.9406; TLI=.9559; RMSEA=.0687, p[rmsea=0.04]. The internal consistency analysis resulted in α (Cronbach alphas) <.75 for the three factors. Pearson correlations of the three factors - Depression, Anxiety/Hostility, Amability/Vigour – with Perceived stress were all significantly (p<.01) and moderate, respectively: .533, .614 and -.461.

Although much shorter, the new POMS-12 has good validity (construct and divergent-convergent) and reliability, being more suitable in studies that require frequent and rapid self-monitoring of affective states, such as ISABELA (“IoT Student Advisor and Best Lifestyle Analyser”), an app targeting student mental health and well-being in which we have been working.

None Declared

Recent studies proved that academic procrastination is a very common pervasive problem that has a negative impact on general well-being, causing distress, anxiety, remorse and unhappiness. It could also result in poor academic performance and negatively affect students’ satisfaction with themselves and their academic life.

The aim of this study was to explore the influence of self-esteem and self-efficacy on academic procrastination among Tunisian medical students.

We conducted a cross-sectional, descriptive and analytical study among medical students from Tunisia. Data were collected through an anonymous online questionnaire, exploring sociodemographic characteristics, the “Tuckman Procrastination Scale” (TPS), the “Rosenberg’s self-esteem scale” (RSES) and the “General Self-Efficacy Short Scale” (GSESS).

A total of 133 participants completed the questionnaire. Their mean age was 26 ± 3,8 years, with a sex-ratio (F/M) of 4,5. Among them 87.2% were engaged in academic procrastination, 57,1% showed low self-esteem and 55,6% perceived themselves as non-effective.

GSESS score were higher among males (p=0.019)

TPS score was negatively correlated with RSES score (p<0.001; r=-0.372). RSES score was positively correlated with GSESS score (p<0.001; r=0.44).

No relationship was proved between TPS and GSESS.

Even though procrastination is most of the time considered as a maladaptive and detrimental behavior with a psychological cost, some authors consider it acting in a beneficial way, as it reflects self-reliance, autonomy and self-confidence knowing that they are able to finish their task in time. As a result, procrastination is linked to feelings of superiority and it should be recoined as “purposeful delay”.

None Declared

Medical students have to do multiple tasks as part of their extensive curriculum in order to achieve the proficiencies expected of them. Being overwhelmed creates a time management problem, substance use and a tendency to procrastinate. Therefore, accumulated tasks may generate distress that could result in poor academic performance.

The aim of this study was to investigate prevalence and factors related to academic procrastination in Tunisian medical students.

It was a cross-sectional, descriptive and analytical study conducted among Tunisian medical students. Data were collected through an anonymous online questionnaire, assessing sociodemographic characteristics, the “Tuckman Procrastination Scale” (TPS) and the “Time Management Subscale of the Learning and Study Strategies Inventory” (LASSI-TM).

A total of 133 participants completed the questionnaire. Their mean age was 26 ± 3,8 years, with a sex-ratio (F/M) of 4,5.

The mean LASSI-TM score was 16.69±4.6. Among students, 65.4 % showed deficit in time management.

The mean TPS score was 42.48±7.11. According to this scale, 87.2% of participants were engaged in academic procrastination. TPS score was significantly higher among psychoactive substances users (p=0.004), in those with psychiatric history (p=0.026) and in students with a rank over than 100 (p=0.029). It was negatively correlated with LASSI-TM score (p<0.001; r=-0.706).

Considering the heavy load of work that the students undergo, it would be prudent to arrange for group trainings and workshops that will cultivate students with strategies and skills for effective time management, so that the tendency to procrastinate will be managed and their academic performance would improve.

None Declared

The metaverse is a digital world created using different technologies like virtual reality (VR), augmented reality (AR), cryptocurrency and the internet.

Interest in the metaverse has grown in recent months in different fields and it could have potential application in the treatment of mental health disorders.

To gain a better understanding of metaverse and to explore its possible applications on mental health.

Review of recent literature about the implications of the metaverse users in mental health.

Metaverse is a virtual universe where people can interact with other users, objects, and environments personifying an avatar. VR, AR and mixed reality (MR) have been used in the treatment and diagnosis of various mental health disorders for last years.

Attention deficit hyperactivity disorder, eating disorders, anxiety, phobias and post-traumatic stress disorder have been already benefited from VR. Also, there are results to treat persecutory delusions in psychosis. On the other hand, we know that to spend a significant amount of time playing 3D immersive games and using social media, could lead to insecurity, anxiety, depression and behavioural addiction.

The lack of evidence and these risks could be limitations to implement Metaverse for the therapeutic management of mental health.

Many companies have already started to develop virtual mental health clinics with mental health professionals serving patients in real time, some spaces have already offer group therapy sessions. Other immersive spaces have also been created for practising mindfulness, meditation, or yoga.

The new technologys have changed the way that we socialise, work, and interact, even the way that we receive medical treatment. The metaverse could prove useful in the management of the mental health disorders that have already benefited from VR, but at the same time we could potentially lead to the worsening of others.

None Declared

Antipsychotics are medications with an array of FDA approved indications in the field of psychiatry including Schizophrenia, Bipolar Mania, Bipolar Depression, Maintenance treatment for Bipolar Disorder, Schizoaffective Disorder, as well as an Adjunct treatment in Unipolar Depression and Tic disorders, among other indications for non-adult patients. Antipsychotics are widely used in psychiatric inpatient units throughout the United States, and globally. We observed trends of antipsychotic use in 3 different adult inpatient units with the same patient demographics located within one inner city hospital in the Bronx over a period of 4 months. We correlated the choice of antipsychotic to the prescribing physician’s period of training/date of graduation from psychiatry residency and reported the results.

Identify the choice of antipsychotics used by different psychiatrists.

Correlate the dates of each psychiatrists residency training to the antipsychotics they chose.

Identify whether the psychiatry residency training accuried in different decades has influenced psychiatrics to pick certain antipsychotics.

We obtained the dates of psychiatric residency training for each of 3 psychiatrists (Physicians 1, 2 and 3) assigned to one of 3 different inpatient psychiatric units which share the same patient demographics in an inner-city hospital in the Bronx. We obtained a record of total psychiatric inpatient hospitalizations from February 10th 2022 to June 10th 2022 in all 3 psychiatric inpatient units. The principal diagnoses for the total hospitalizations (300 patients) were reviewed and patients with diagnoses that do not have FDA approval for antipsychotic use were excluded. Among the remaining patients (267) we compared antipsychotic prescription trends and grouped patients according to antipsychotic of choice. We then correlated the antipsychotic of choice groups to one of three units/prescribing physician and the years of psychiatry residency training. The trends for antipsychotic of choice were compared to training dates and presented in a table.

Physician 1 who trained from 1980 to 1984 prescribed: 87% HALDOL and 13 % Chlorpromazine. Physician 2 who trained from 1992 to 1996 prescribed: 91 % PALIPERIDONE and 9% Risperidone. Physician 3 who trained from 2003 to 2007 prescribed: 60 % ABILIFY and 40% Olanzapine.

The physician with the earliest graduation date used mainly HALDOL, a first-generation antipsychotic, to treat disorders with FDA approval for antipsychotic use. The physician with the most recent graduation date, used mainly ARIPIPRAZOLE, a third-generation antipsychotic, to treat disorder with FDA approval for their use. The physician with a graduation date between them, used mainly (PALIPERIDONE), a second-generation antipsychotic to treat the disorders.

None Declared

Currently, in addition to their frequent use in community medicine, the use of antidepressants is a fundamental pillar of pharmacological treatments used in psychiatry. Due to this frequent use, we must be aware of the possible side effects, in particular the SIADH produced in this clinical case by SSRIs. There are already described cases of this association including other antidepressants and many different types of drugs.

To review the current literature on the management of this pathology when it is secondary to the use of frequently used drugs such as SSRIs.

We report the case of a 64-year-old woman hospitalised in the psychiatric department for malnutrition secondary to unspecified eating disorder (ED). During admission, treatment with sertraline was started with ascending doses up to 100mg, subsequently producing slight edema with the following analytical results: plasma Na: 123 mEq/L (135-145), plasma osmolarity: 250 mOsm/kg (275-300), urinary Na: 174 mEq/L (>40), fulfilling diagnostic criteria for SIADH.

Afterwards, we reduced sertraline until discontinuation and started treatment with water restriction and urea (30 grams/24 hours) during admission and after discharge. During admission, we observed disappearance of the edema and partial improvement of the analytical values (Na:131 mEq/L), which were normalised with home treatment of daily urea.

The precise prevalence of SIADH from the use of SSRIs is unknown, it is known that patients older than 65 are at higher risk of developing severe hyponatraemia in the first 5 weeks after initiation. Similarly, treatment with water and urea restriction, together with discontinuation of SSRIs, appears to be sufficient.

SSRIs can cause SIADH a reversible but potentially life-threatening pathology, and we need to be aware of this possibility especially in the older population and being able to handle it

None Declared

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a serious condition associated with persistently high ADH with water retention despite sufficient vascular volume. Sodium valproate (VPA), an antiepileptic indicated to treat bipolar disorder, blocks sodium (Na) and calcium ions. Few studies have examined the association between VPA and SIADH.

This abstract has two interrelated objectives: (1) to describe a VPA-associated SIADH case study we encountered in our clinical setting; and (2) to review literature for other VPA-associated SIADH cases to illuminate associations and possible risk factors.

After recording a case from clinical experiences, we completed a literature review of other cases of hyponatremia associated with VPA.

We reviewed resulting artticles from searches in PubMed and in the aggregate Dartmouth Biomedical Library indices with no date or language parameters. We then searched those articles’ bibliographies.

Ms. A is a 63-year-old woman with schizoaffective disorder, bipolar type, hospitalized for the resurgence of visual hallucinations (VH) of “monsters” asking her to hurt herself and others. She had been adherent to VPA (500mg twice daily) and non-adherent to prescribed Olanzapine (25mg). On Day 1 (D1), her labs were concerning for serum Na 119mEq/L (n=135-145), serum osmolality (SOsm) 264mEq/L (n=275-295), and inappropriately high urine osmolality 111mOsm/kg (n <100 mosmol/kg in hyponatremia) and urine Na 34mEq/L (n <20 mosmol/kg in hypovolemic hyponatremia). Her VPA level was 73.6 mcg/mL.

She was restarted on her home psychiatric medications for VH, and her hyponatremia responded to water restriction, with serum osmolality at 292mEq/L by D4 (see Figure). She was admitted to the inpatient psychiatric unit for concerns of persistent VH. On D13, her SOsm worsened to 267mEq/L and VPA was discontinued at that time. On D19, SOsm improved to 283mEq/L. Her VH responded well to discontinuing VPA and adding Risperidone (titrated to 6mg) and on D22 she was discharged home. Given the chronological sequence of her newly developed VH, the patient’s hallucinations were likely multifactorial, with contribution from hyponatremic encephalopathy-related psychosis.

Our literature review found ten articles reporting thirteen other cases of VPA-associated SIADH (see Table). Our patient shared demographics with most previously reported cases: being older in age and having polytherapy and a low baseline Na. None of the previous case reports showed specific drug interactions to be particularly likely causes of hyponatremia.

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Although VPA-associated SIADH is a rare phenomenon, caution is warranted when evaluating patients with VPA use presenting acutely with psychosis and hyponatremia. These symptoms could be the manifestation of hyponatremic encephalopathy-related psychosis.

None Declared

During the last decade there has been a resurgence of interest on the use of psychedelics as novel treatments for mental disorders, including treatment-resistant depression (TRD). Psilocybin, the chemical component of “magic mushrooms”, has been administered with psychotherapy in randomized clinical trials (RCTs) showing large and sustained antidepressant effects. As the use of psilocybin expands, it is becoming more important to understand whether psilocybin’s psychedelic effects are required for psilocybin’s antidepressant effects. Psilocybin’s psychedelic effects are known to be dependent on serotonin 2A receptor (5-HT2AR) activation. Given the safety concerns associated with psilocybin’s psychedelic effects, all studies have used it in conjunction with at least 12 hours of intensive psychotherapy. This makes psilocybin-assisted psychotherapy (PAP) highly resource intensive and impedes scalability given limited resources and access to trained therapists in most jurisdictions. Studies in healthy volunteers have shown that psilocybin’s psychedelic effects are blocked by 5-HT2AR antagonists like risperidone and ketanserin. In a pre-clinical study using a mouse model of depression, administration of ketanserin followed by psilocybin had the same antidepressant effect as psilocybin alone. We propose to conduct the first study to test in humans whether the antidepressant effects of psilocybin are attenuated by 5-HT2AR blockade from risperidone.

Aim 1: To evaluate the feasibility and tolerability of administering psilocybin with risperidone in adults with TRD by evaluating recruitment, retention, tolerability, and safety.

Aim 2: To evaluate psychedelic effects (measured with the 5-Dimensional Altered States of Consciousness Rating Scale) in the three groups.

Aim 3: To evaluate antidepressant effects (measured with the Montgomery Asberg Depression Rating Scale; MADRS) in the three groups. .

A three-arm, 4-week, double blind, proof-of-concept RCT for patients with a DSM-5 major depressive episode that has failed to respond to at least two adequate trials of antidepressants. Participants will be randomized to: 1) psilocybin 25 mg plus risperidone 1 mg; 2) psilocybin 25 mg plus placebo; 3) placebo plus risperidone 1 mg. All participants will receive 12 hours of manualized psychotherapy.

Ethics approval for the proposed study has been obtained. We will present preliminary feasibility data at the meeting in March.

If the study demonstrates that psilocybin’s psychedelic effects are not necessary for psilocybin’s antidepressant effects, the combination of psilocybin and a 5-HT2AR antagonist, such as risperidone, could increase acceptability and access to the use of psilocybin to treat MDD and related conditions.

None Declared

Paralytic ileus is the slowing or complete cessation of the passage of intestinal contents without a barrier to prevent passage in the gastrointestinal tract. Many factors such as heavy metal poisoning, infections, metabolic instabilities, spinal cord injuries, drugs and post-operative reasons can cause paralytic ileus. Quetiapine is a second generation antipsychotic drug acting on multiple receptors. Due to its muscarinic receptor antagonism, adverse effects on the gastrointestinal tract may occur.

In this case report, acute paralytic ileus developing in a patient with bipolar disorder who was being treated with sodium valproate and quetiapine is discussed.

Methods: Case: The case is a 60-year-old male patient diagnosed with bipolar disorder. Apart from the medical diagnoses of hypertension and coronary artery disease, he had no other additional illness or history of surgery. He was brought to the emergency department in March 2022 with complaints of nausea, vomiting, abdominal distension, and decreased oral intake.

There are few case reports of paralytic ileus associated with quetiapine in the literature. In a study published in 2018, it was reported that paralytic ileus developed on the 15th day following the initiation of quetiapine therapy (Chiang & Lan, Clin Psychopharmacol Neurosci 2018; 16(2) 228–231). In another case report published in 2016, it was shown that ischemic colitis developed in a patient using quetiapine and tropatepine drugs (Cuny et al., L’encephale 2016; 43(1) 81–84). In the case we reported, the patient had been using quetiapine for about 5 years. Long illness duration and old age were risk factors for the emergence of paralytic ileus in our case.

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In conclusion, the wide use of quetiapine in psychiatry requires us to be careful about such serious adverse effects. Especially in elderly patients and those with comorbid conditions, adverse effects should be closely monitored and the patient should be informed in advance of possible situations.

None Declared

Three generations of antipsychotics, all of which are based on the dopaminergic hypothesis of schizophrenia, are available for clinical use. Still, more than 66% of the patients diagnosed with schizophrenia spectrum disorders (SSD) could not achieve remission. Also, the glutamatergic hypothesis of schizophrenia is supported by translational models of this disease, even if the antipsychotics derived from this conceptual framework are not yet available on the market. However, the need for new pathogenesis models for schizophrenia and new generations of antipsychotics is acute, therefore, an exploration of the antipsychotics in the pipeline could be helpful in understanding the current stage of research in schizophrenia.

To assess the evidence supporting the potential benefits of new antipsychotics in the pipeline.

A literature review was performed through the main electronic databases PubMed, Cochrane, Clarivate/Web Of Science, and EMBASE) and clinical trials repositories (US National Library of Medicine and World Health Organization Clinical Trials Registry Platform) using the search paradigm “antipsychotics” AND “schizophrenia” AND “non-dopaminergic” AND “non-glutamatergic”. All papers published between January 2010 and September 2022 were included.

Xanomeline/trospium (xanomeline is a muscarinic M1/M4 receptor agonist at the central nervous system, while trospium limits its peripheral effects) was efficient for schizophrenia in one phase III clinical trial. Pimavanserin (a selective 5HT2A inverse agonist and antagonist) was efficient in improving negative symptoms of schizophrenia in a phase II trial. Roluperidone (a 5HT2A and σ2 receptor antagonist) has been associated with favorable results in phase III clinical trials, mainly on negative symptoms of schizophrenia. SEP-363856 is a TAAR-1 agonist and 5HT1A agonist, currently explored in phase III clinical trials for schizophrenia. MK-8189 is a phosphodiesterase 10A inhibitor, investigated in phase III clinical trials for schizophrenia.

Based on the retrieved data in the literature, multiple mechanisms, other than glutamatergic and dopaminergic pathways, are currently being investigated, and many of the antipsychotics based on these mechanisms are in the advanced stage of research. This is important not only for the clinical need to find more efficient and tolerable drugs for patients with schizophrenia but also because they may shed new light on the pathogenesis of this disease.

None Declared

According to the Consensus Guideline, the “therapeutic reference range” (TRR) defines ranges of drug blood concentrations that specify a lower limit below which a drug-induced therapeutic response is unlikely to occur and an upper limit above which tolerability decreases or the therapeutic improvement ceases. The TRR can be obtained from concentration measurements (trough (pre-dose) plasma concentration under steady-state conditions) in studies at therapeutically effective doses.

The aim is to examine the TRR for cariprazine (CAR: 1.5 mg/day to 6 mg/day) in schizophrenia studies.

The population based TRR for CAR is derived by PK/PD evaluation from phase 2/3 schizophrenia efficacy studies with sparse PK sampling. The population PK simulated TRR is compared to the actually measured values obtained from two PK studies. As the two active metabolites of cariprazine also contribute to the drug effect, plasma exposure is given for Total cariprazine (CAR + DCAR + DDCAR) and the parent drug (CAR).

PK/PD analyses demonstrated an increase in efficacy with increasing exposure. These efficacy results are related to Total cariprazine trough concentrations of ca. 30 nM and 100 nM that determine the lower and upper TRR limits. For the parent drug, the pre-dose mean plasma concentration at 6 mg/day was between 5.7-10 ng/mL in different studies, while at 1.5 mg/day it was 1.9 ng/mL.

The TRR of the trough plasma levels at steady state is ca. 30 – 100 nM for Total cariprazine and ca. 2-10 ng/mL for the parent drug (unchanged drug) for schizophrenia treatment.

M. Kapás Employee of: Gedeon Richter Plc., A. Horváth Employee of: Gedeon Richter Plc., D. Djuric Employee of: Gedeon Richter Plc., R. Csehi Employee of: Gedeon Richter Plc., Á. Barabássy Employee of: Gedeon Richter Plc.

Worldwide, annually more than 800,000 suicides occur. In the Netherlands, suicide rates rose from 8.6 per 100,000 in 2007 to 11.4 per 100,000 in 2016. Rates in the province of Noord-Brabant were consistently higher than the national average. Noord-Brabant is a province in the south of the Netherlands covering an area of over 4700 km2 with 2.5 million inhabitants. Although Noord-Brabant has five specialised mental healthcare institutions (SMHIs), and 90% of suicides are deemed related to mental disorders, 60% of those who died by suicide did not receive mental health treatment. However, with good access to treatment, suicide could be preventable.

To evaluate whether the systems intervention compared to the regular care approach led to a reduction in suicides in Noord-Brabant. We aimed to attain a reduction in suicides of at least 20%.

Co-design and development of a digital monitoring system and decision aid. Stepwise implementation per subregion of the systems intervention by the five specialized mental healthcare institutions (SMHIs) and their chain partners. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count).

The SUPREMOCOL systems intervention consisted of four pillars, which were all supported by a digital decision aid and monitoring system. This was provided via a desktop computer with a secured login. The data were kept on a secured encrypted server. The number of professionals accessing the system was limited to two per SMHI or other chain partner. They could only see patients in their subregion, not in the whole of the province. The pillars of our systems intervention for suicide prevention are:

1. Swift identication of people at risk for suicide by triage on the spot after a non-fatal suicide attempt.

2. Provision of swift access to specialised mental health care for those at risk

3. Accommodating transitions in care following a collaborative care approach

4. Prevention of suicidal attempts after discharge or treatment dropout by 12 months telephone follow-up.

Suicide rates dropped 17.8% (p=.013) from baseline (2017) to implementation in 2018 and 2019. This is a significant reduction (p=0.043) compared to the non-significant drop in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = 0.002) in 2021.

Noord-Brabant also dropped in the relative rank of the number of suicides, from second place in 2015 to third in 2018.

During the SUPREMOCOL systems intervention, over a period of 4 years, there was a sustained and significant reduction of suicides in Noord-Brabant. We attained a reduction of 21,5% in total. Noord-Brabant dropped in the relative rank of the number of suicides, from second place in 2015 to third in 2018. This is a result that warrants further research and implementation into system interventions for suicide prevention with digital support such as SUPREMOCOL.

C. Van Der Feltz-Cornelis Grant / Research support from: The Netherlands Organisation for Health Research and Development, I. Elfeddali: None Declared, M. Metz: None Declared, S. de Jong: None Declared, M. Bakker: None Declared, C. van Nieuwenhuizen: None Declared

Azerbaijan ranks among the top 3 countries with the highest rates of suicide in the Muslim world. Yet, research indicates an underestimate of risk due to cultural stigma related to suicidal behavior that may influence reporting and given that many Muslim-majority countries, where populations exceed 100 million, do not report any data on suicide rates. Violence against women also occurs at alarming rates in Azerbaijan and is a significant risk factor for suicide.

We examine perspectives towards suicide and violence against women and barriers to care among key stakeholders.

Thirty qualitative interviews and 4 semi-structured focus groups were held with female survivors of suicide and mental health professionals working with individuals at risk of suicide to assess for perspectives on suicide and violence against women, factors influencing help-seeking, and the nature of existing resources.

Most participants viewed suicide (83%) and violence against women (73%) as problems. Nevertheless, 33% reported negative stereotypes regarding suicide and 50% reported psychological treatment as unaccepted in Azerbaijan. Findings highlight that domestic violence is the strongly identified as risk factor for suicide among women in Azerbaijan. Stigma and related cultural values regarding gender norms are significant contributors to violence against women and suicide. Existing services are underrecognized and perceived of as unavailable or insufficient.

Employing a social determinants of health lens, multi-level programming is needed that spans micro (individual level supports), mezzo (family level supports), and macro (advocacy and outreach) levels to support a comprehensive strategy that beings with prevention and extends to address intervention, management, and capacity building to halt the increasing rates of suicide and deter violence against women.

None Declared

Suicide behaviour is a complex and multifactor concept that includes different risk factors. According with literature a dimensional concept of illness could help to understand this complexity and clarify clinical aspects of suicide risk.

The aim of this study is to identify different profiles of symptoms in a sample of suicide attempters and the relationship between this profiles and suicide behaviour in terms of outcome: presence and intensity of suicidal ideation, presence and number of attempts and severity of the medical damage in the current attempt.

634 patients were recruited at the psychiatry emergency of eight public general hospitals in Spain between November 2020 until February 2022 in the SURVIVE protocol. The patients were assessed in 15 days using a battery of clinical tools that includes Brief Symptom Inventory, a sociodemographic interview, Mini Clinical Interview and C-SSRS, ACSS and BIS-11 scales. Latent profile analysis was applied to obtain profile symptoms. Logistic and multivariant regression was used to obtain data about outcome.

Three clinical profiles of psychiatric symptoms were described in suicide attempters (p < 0.01): high symptoms (HS) (45.02%), moderate symptoms (MS) (42.5 %) and low symptoms (LS) (12.48%). Significant differences were found between classes in four symptom domains (Figure 1): anxiety, obsessive-compulsive, sensitivity, and somatization (p < 0.01). Participants of the HS class showed higher values in relation with the BSI summary indexes, and more diagnoses, higher levels of suicidal ideation and suicidal related behaviour as well as higher acquired capability for suicide. Participants of the LS class were more likely to be women, older and unemployed and was related, according the analysis, with severe medical damage when compared with other groups (P< 0.01).

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According with the predictive model the study suggests different symptom-frequency clusters related with suicide attempt outcomes. Suicide ideation presence and intensity is related with HS class and acquired capability of suicide. Suicide ideation intensity is also related with number of diagnosis and number of previous attempts. Suicide behaviours presence is associated with being student and number with HS profile. Both presence and number were related with number of diagnosis as well as number of previous attempts (the higher all these clinical factors, the more intense of ideation in the last month). Finally, the severity of medical damage was related with LS profile and unemployed/retired work status. The dimensional symptom profile could be useful to predict suicide attempt outcome. Further study is needed to clarify this relation.

None Declared

Adverse childhood experiences (ACEs), defined as abuse, neglect, or a dysfunctional household in childhood, have been associated with suicidality (Fjeldsted et al., 2020). Every type of ACE has a direct impact on suicide ideation, self-harm and/or suicide attempt (Angelakis et al., 2019).

We aim to quantify the association between types of ACEs (including emotional, physical, sexual abuse, and emotional and physical neglect) and the number of suicide attempts in lifetime.

We included 748 patients who attempted suicide at least once. They were asked to complete the Columbia-Suicide Severity Rating Scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Logistic regression models were run to assess the association between each ACE type and the number of suicide attempts.

Poisson univariate regression analyses show a linear trend in the relationship between having a higher number of suicide attempts and having suffered every ACE type in childhood (p<0.05). Our results show a lower percentage of previous suicide attempts among participants without ACEs, and an increasing tendency among patients with various types of ACEs. The rate of ACEs types is significantly higher in the group with previous suicide attempts than in the first-attempt group (p=0.000).

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This study contributes to clarify the role of childhood trauma in the number of suicide attempts in lifetime. This has important implications for reducing suicide rates, and preventing future re-attempts. Further studies analysing every construct of childhood trauma may contribute to the detection of suicidal behaviour.

This work was supported by the Instituto de Salud Carlos III (grant number: PI19/00941 SURVIVE) and co-funded by the European Union (grant numbers: COV20/00988, PI17/00768), the European Union’s Horizon 2020 research and innovation programme Societal Challenges (grant number: 101016127), and the Fundación Española de Psiquiatría y Salud Mental

SURVIVE project (PI19/00941)

Suicide attempt, Adverse Childhood Experiences

Angelakis, I., Gillespie, E. L., & Panagioti, M. (2019). Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis. Psychological Medicine, 49(7), 1057-1078. https://doi.org/10.1017/S0033291718003823

Fjeldsted, R., Teasdale, T. W., & Bach, B. (2020). Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients. Nordic Journal of Psychiatry, 74(4), 280-286. https://doi.org/10.1080/08039488.2019.1702096

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Suicide is a complex problem in which individual, family social factors are interrelated. The 1997 Asian financial crisis caused a major economic crisis in Korea, and Korea received bailout support from the International Monetary Funds(IMF) from December 23, 1997 to August 23, 1997.

This study aimed to investigate the relationship between the suicide rate of children and adolescents who grew up during this economic crisis in Korea.

Suicide rates are calculated according to gender, region, and age of 5 years (10-14 years old, 15-19 years old, 20-24 years old) using suicide death data from the Korea National Statistical Office from 2000 to 2017. The cohort of interest in the study is the group that was in childhood and early adolescence between 1997-2000 and corresponds to 1986-1995 in terms of birth year. Cohorts are divided into 1986-1989 (G1), 1990-1992 (G2), and 1993-1995 (G3) according to birth year. These groups were 8-14 years old for G1 and 5-10 years old for G2, 2-7 years old for G3 during 1997-2000, during the economic crisis. The Age-Period-Cohort analysis and linear mixed-effects regression models are used and the moderating effect on region and age is also analyzed.

The 10-24 year-old suicide rate was higher in males than females, in older age groups, earlier in birth years in the birth cohort, and in rural than urban areas. Suicide rates between the ages of 20-24 years were particularly high among men living in rural areas. During the national economic crisis, the suicide rate was higher among adolescents than preschoolers (G3 < G1) (p<0.001), and this trend was observed for both men and women. However, the main effect of the cohort was not observed at a statistically significant level.

The national economic crisis has a negative impact on the mental health of children and adolescents, and it is more negative for adolescents than for children, which can increase the suicide rate between the ages of 20-24.

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Suicide is a health concern among individuals diagnosed with schizophrenia. Telehealth technology has become an emerging intervention that may afford opportunities for reaching this at-risk group. Consideration of the implementation of telehealth systems in the treatment of patients diagnosed with schizophrenia and suicidal behavior calls for a review of the evidence.

The present aim was to explore the literature on the effectiveness of suicide prevention telephone delivered interventions among patients with schizophrenia and related disorders.

The bibliographic search was performed in the electronic databases PubMed, PsycInfo, Scopus, and Web of Science following PRISMA guidelines. Two reviewers independently conduct screenings, data extraction and methodological quality assessment. A total of 352 articles were retrieved, of which five studies met the eligibility criteria.

Based on the limited data available, the use of modalities involving telephone contacts appears to be feasible in patients with schizophrenia and suicidal behaviors. In addition, preliminary evidence suggests this system appears to reduce suicidal ideation.

The current data presented here reflect an early stage of effectiveness of telephone-delivered interventions targeted at suicide prevention in patients with schizophrenia. Further research is needed to design evidence-based future interventions and to determine whether this approach can improve patient outcomes.

Fundings: This work was supported by the Instituto de Salud Carlos III (grant number: PI19/01484 SURVIVE).

Acknowledgements: SURVIVE project (PI19/01484).

Keywords: schizophrenia, suicide, telehealth, monitoring.

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Suicidal thinking is relevant in patients with First Episode Psychosis (FEP). However, longitudinal studies specifically examining treatment response for suicidal ideation in FEP are still relatively scarce, especially with long-term design and in real-world clinical settings.

The aims of this research were (A) to longitudinally assess suicidal thoughts in people with FEP along a 2-year follow-up period and (B) to overtime investigate any significant association of suicidal ideation levels with the specific treatment components of an ‘Early Intervention in Psychosis’ (EIP) protocol along the 2 years of follow-up.

At entry, 232 FEP participants (aged 12–35 years) completed the Brief Psychiatric Rating Scale (BPRS), including a ‘Suicidality’ item subscore. Multiple linear regression analysis was then performed.

Across the follow-up, FEP subjects showed a relevant decrease in suicidal thinking levels overtime. This was specifically predicted by the total number of individual psychotherapy sessions offered within the 2-year EIP protocol and antidepressant dose (at least as regards the first year of our intervention).

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Suicidal ideation is clinically relevant in FEP but seems to improve overtime together with the provision of specific, patient-tailored and integrated EIP treatments, especially individual psychotherapy.

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Cannabis is the most widely used illicit drug; 3.8% of the world’s population consumes cannabis on a regular basis. Cannabis use–associated alterations in the domain of cognition have been extensively studied.

To research memory deficiency in the young consumers of cannabis in Tunisia.

This is a transversal descriptive study conducted during two months (January and February 2022). The research involved about 137 participants aged between 18 and 35 years old, exhaustively recruited amid emergency patients of Mahdia Hospital regardless of the reason for their health care seeking. The patients were declared as consumers of cannabis and accepted to be part of this study. Therefore, Data were collected on a pre-determined data sheet that included various information (age, sex, lifestyle, personal and family psychiatric history, age when first used cannabis and the rate of cannabis use …).

Principally, a Functional Impact Assessment (ERF: French abbreviation for échelle d’évaluation des Répercussions Fonctionnelles ) scale was used to assess and review working memory.

In our study population, there was a noticeable male predominance of 71%. Hence, the age structure ranged between 18 years old and 35 years old. Among the latters, 65.9% were single, and 29.7% experienced school failure. In this sample, 23.2% had a psychiatric history like depression, bipolarity, etc. The average age of the first use of cannabis was between 18 and 25 years old in 70% of cases.

Besides, a high percentage of association of other substances was found among cannabis users as follows: use of alcohol 72.5%, tobacco 74.6%, ecstasy 41.3%, and cocaine 25.4%. First and foremost, the use of cannabis was considered as a means of indulgence for 66.7% of the study population, as an anxiolytic for 26.8%, and as a sedative for 23.9%.

Additionally, the effect of cannabis use on working memory deficiency according to the functional impact assessment scale was: no deficiency in 19% of cannabis users, minimal in 34%, mild in 32%, moderate in 9%, fairly severe in 4%, very severe in 1%, and extreme in 1% of cases.

More importantly, the percentage of consumers with significant memory deficiency (moderate to extreme) was 15%.

The assumption of the effect of cannabis on memory and cognitive deficiency remains controversial and leads us to suggest further in-depth study of this subject.

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