Poster Index

Clinical and neurocognitive studies of suicidal behavior

Clinical and neurocognitive studies of suicidal behavior (17)  |  Clinical phenotyping of suicidal individuals (23)
Culture, ethnicity and spiritual approaches. New paradigms in suicidology (11)  |  Ethical and methodological challenges and solutions in suicide research (5)
Genetic, epigenetic and gene expression contributors to suicide risk (2)  |  Intervention research for prevention of suicidal behavior (30)
Lifespan differential aspects (from infancy to elderly) (7)  |  Miscellany (assisted suicide, minorities, legal aspects, etc.) (9)
Neurobiological underpinnings of suicidal behavior (3)  |  Novel monitoring strategies for detecting changes in risk over time (4)
Psychosocial variables: protective and risk factors. Resilience & vulnerability (38)  |  Testing the effectiveness of prevention strategies (6)




Clinical and neurocognitive studies of suicidal behavior


(126) PO-126. Factors associated with awareness of mental disorder

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Manuel Canal-Rivero . Universitat Autònoma de Barcelona/ Hospital Universitario Virgen del Rocío, Sevilla- Spain
- Jordi E Obiols Llandrich - Miguel Ruiz Veguilla -

 Introduction:
Theory of mind (ToM) impairment is common in patients with schizophrenia. ToM is "the ability to infer intentions, dispositions and beliefs of others". Poor insight has also been linked to poor outcome in schizophrenia. Clinical insight refers to one´s awareness of having a mental illness that requires treatment and includes dimensions of Awareness of Illness, Relabeling of Symptoms and Need for Treatment.
 Goals:
The objective of this study is analyze the factors associated with awareness of mental disorder.
 Methodology:
Sixty-five patients in their first episode of non-affective or affective psychosis participated in this study. Subjects were recruited during their first contact with any of the mental outpatient or inpatient health services. All patients were initially screened by phychiatrist for the presence of psychotic symptoms, and were subsequently diagnosed using an SCID structured interview. We excluded patients with a previous diagnosis of neurological disease or a history of head trauma with loss of consciousness. All the participants gave their written informed consent, and the research protocol was approved by local Ethics Committees. Scale of Unawareness of Mental Disorder (SUMD) was used to evaluate insight. This scale consists of three general items: awareness of mental disorder, awareness of the effects of medication and awareness of the social consequences of the disorder. Furthermore, the SUMD accounts for 17 items related to specific symptoms, which are divided into two subscales, awareness and attribution. Theory of mind was evaluated ussing Hiting task adapted for Corcoran et al. (1995). Five of the original ten vignettes were used. Each vignette described an interaction between two characters along with an extract of their dialogue and ended with one character dropping a hint to the other. Participants were required to state what the character really meant by their utterance. A correct response is therefore scored as 2 or 1 depending on when the response was given.
 Results:
Significant relationship (P?0.05) was found between impairment in ToM with awareness of mental disorder (r=0.28). No significant relationships were found between impairment in ToM and others dimensions of insight or total score.
 Conclusions:
These results suggested that treatments targeting mentalization abilities that contribute to representations of self and others may improve insight deficits associated with poor outcome in schizophrenia.
 References:
1. Ng R, Fish S, Granholm E. Insight and theory of mind in schizophrenia. Psychiatry Res. 2015;225(1-2):169?74.


(167) PO-167. Decision making under ambiguity and under risk in depressed suicide attempters, depressed non-attempters and healthy controls

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Eberhard A. Deisenhammer . Medical University of Innsbruck, Dep. of General and Social Psychiatry, Innsbruck - Austira
- Steffen K. Schmid - Georg Kemmler - Bernadette Moser - Margarethe Delazer -

 Introduction:
Decision making (DM) abilities are altered in a number of psychiatric disorders. With respect to depression study results are conflicting. Also regarding suicidal behavior, impaired abilities as well as no alteration have been reported before. However, most studies have focused on DM under ambiguity only and included patients with a lifetime history of suicide attempts.
 Goals:
In this study, we applied two instruments which assess different forms of DM and limited the time frame of suicide attempt history to six months.
 Methodology:
The study sample consisted of three groups. Group 1 (SA) were currently depressed inpatients (ICD-10: F3 or F43) having attempted suicide within the previous six months. Group 2 (NSA) consisted of depressed inpatients without a lifetime history of suicide attempts. Group 3 (CG) was a healthy control group. Besides depression severity, impulsiveness and suicidal intent (SA group only) DM patterns were investigated using the Iowa Gambling Task (IGT) for DM under ambiguity and the Game of Dice Task (GDT) for DM under risk.
 Results:
A total of 78 participants (SA group, n=21; NSA group, n=31; CG, n=26) were included into the study. Significant between group differences were found regarding marital status, current partnership, smoking status, depression score, impulsiveness score and family history of psychiatric disorders (all discriminating controls from patients but not between SA and NSA groups).
The three groups did not differ with regard to IGT scores. Concerning GDT, the SA group showed significantly lower scores compared to the two other groups, implying a readiness for more risky decisions in suicide attempters versus non-attempters and controls. No significant difference was found between the NSA and CG groups.
 Conclusions:
Suicide attempters appear to make more risky decisions compared to depressed non-attempters as well as healthy controls even if the DM under ambiguity patterns do not differ.


(182) PO-182. Implicit associations with death: First validation of the German version of the suicide Implicit Association Test

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Dajana Rath . Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen - Germany
- Nina Hallensleben - Lena Spangenberg - Heide Glaesmer - Tobias Teismann - Thomas Forkmann -

 Introduction:
Nock and colleagues [1] developed an implicit association test [2] measuring the implicit association between ‘self’ and ‘death’ (suicide-IAT) and demonstrated that psychiatric patients, who already attempted suicide, showed stronger implicit associations with ‘death’ than with ‘life’ (compared to patients without suicide attempt history).
 Goals:
The present study had two aims: (1) to provide a first validation of a new German version of the suicide-IAT and (2) to investigate how implicit associations (suicide-IAT) relate to suicidal ideation, suicidal behaviour, and the central concepts of the Interpersonal Theory of Suicide [3].
 Methodology:
The sample (n=32) consisted of 16 patients with a current Major Depression as well as 16 healthy controls (no prior or current mental disorders, matched for age, gender and education). The suicide-IAT [1] was translated into German according to the guidelines of the ISPOR Task Force for Translation and Cultural Adaption [4]. Implicit associations were computed as D-scores (positive D-scores representing stronger associations between self and death). Additionally, all participants completed the Suicide Behaviours Questionnaire-Revised [5], Beck Scale for Suicide Ideation [6], Interpersonal Needs Questionnaire [7], German Capability for Suicide Questionnaire [8], and Beck Hopelessness Scale [9].
 Results:
Patients showed less negative IAT-D scores than healthy controls. In the entire sample (n=32), positive correlation coefficients between IAT and SBQ-R and GCSQ were significant and higher than correlation coefficients between IAT and BSSI, thwarted belongingness and perceived burdensomeness (INQ), and BHS.
 Conclusions:
First, we found stronger self-death associations for patients than for healthy controls. Second, the stronger the implicit association between ‘self’ and ‘death’ the more suicidal behaviour (attempts in the past) and acquired capability was reported. Associations with less behaviour-oriented measures, e.g., suicidal ideation, thwarted belongingness, perceived burdensomeness, or hopelessness were small. Results corroborate the validity of the German suicide-IAT, however, replications in larger, sufficiently powered studies are needed.
 References:
[1] Nock MK, Park JM, Finn CT, Deliberto TL, Dour HJ, Banaji MR. Measuring the Suicidal Mind: Implicit Cognition Predicts Suicidal Behavior. Psychological Science. 2010;21(4):511-517. [2] Greenwald AG, Nosek BA, Banaji MR. Understanding and Using the Implicit Association Test: I. An Improved Scoring Algorithm. Journal of Personality and Social Psychology. 2003;85(2):197-216. [3] Joiner TE. Why people die by suicide. Cambridge, MA: Harvard University Press; 2005. [4] Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. VALUE IN HEALTH. 2005; 8(2):94-104. [5] Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal behaviours questionnaire - revised (SBQ-R): Validation with clinical and nonclinical samples. ASSESSMENT. 2001;8(4):443-454. [6] Beck AT. Beck Scale for Suicide Ideation. The Psychological Corporation, San Antonio, TX; 1993. [7] Van Orden KA, Cukrowicz K, Witte TK, Joiner TE. Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment. 2012; 24:197-215. [8] Wachtel S, Vocks S, Edel M-A, Nyhuis P, Willutzki U, Teismann T. Validation and psychometric properties of the German Capability for Suicide Questionnaire. Comprehensive Psychiatry. 2014;55(5):1292-1302. [9] Beck AT, Steer RA. Manual for the Beck Hopelessness Scale. Psychological Corporation, San Antonio; 1993.


(186) PO-186. Suicide risk after self-harm - the impact of depression and severe suicidal ideation

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Åsa Lindh . Karolinska Institutet, Stockholm - Sweden
- Axel Haglund - Ellinor Salander Renberg - Margda Waern - Bo Runeson -

 Introduction:
It is often recommended that a structured risk assessment instrument should be used in suicide risk assessment, but the evidence for this recommendation is weak (1). The impact of a current depression on the risk for suicide attempt needs further investigation.
 Goals:
We aim to describe the prevalence of suicidal ideation of high severity and intensity in correlation to current depression in a patient cohort with suicide attempt and non-suicidal self-injury, and evaluate the impact of these characteristics of suicidal ideation on future suicide risk.
 Methodology:
Swedish multi-centre study of adults who have made a suicide attempt or a non-suicidal self-injury, presenting at a psychiatric emergency ward. These patients are interviewed with the Mini International Neuropsychiatric Interview and the Columbia Suicide Severity Rating Scale (C-SSRS) (2) and followed through review of medical records. Outcome is suicide attempt, lethal and non-lethal, within 6 months from the index attempt.
 Results:
Almost 800 participants have been included in the study. In the Stockholm subset, n = 479, the age span is 18 – 95, 69 % are women, 82 % have made a suicide attempt and 68.7% had a current depression at baseline. Baseline data indicates higher C-SSRS scores of both severity and intensity (frequency and duration) of suicidal ideation in the depressed group: high scores on frequency was found in 66 % of depressed patients but only in 17 % of patients without a current depression.
 Conclusions:
C-SSRS could be a valuable tool in characterising suicidal ideation in depressed suicide-attempters, thereby identifying potential risk factors for future suicide attempt.
 References:
1. SBU. Instrument för bedömning av suicidrisk. En systematisk litteraturöversikt. Stockholm: Statens beredning för medicinsk och social utvärdering, 2015 242. 2. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American journal of psychiatry. 2011;168(12):1266-77.


(189) PO-189. Anorexia Nervosa, comorbidity and suicidal behaviour

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Irene Baños Martín . Santa Cristina University Hospital, Madrid, Spain
- Paula García Jorge - Tania Delgado Fernández - Natalia Sanz Velasco - Belén Velado Pulido - Enrique Gómez Guerra -

 Introduction:
Patient suffering from Eating Disorders have higher risk of suicide, which increases the added personality disorders, depressive disorder and traumatic events. In Anorexia Nervosa there is greater awareness of lethality, while in Bulimia Nervosa the methods are more violent, finding among the latter, greater number of attempts. There are a greater number of suicide attempts in patients with alexithymia, as suicidal behaviour may be a way of expressing discomfort.
 Goals:
Clinical case presentation to study the factors influencing the occurrence of suicidal behaviour: personality disorder, depressive symptoms and difficulties in emotional regulation.
 Methodology:
Literature review and clinical case exposure. Data collection through individual clinical interviews, family interviews and the administration of questionnaires.
 Results:
Female 32 years entered in Unit TCA H.U. Santa Cristina diagnosed with Anorexia Nervosa Mixed, Borderline Personality Disorder and pathological grief. Patient begins outpatient follow-up to 12 years for restrictive eating symptoms. With 26 years retakes outpatient follow due to depressive symptoms after the father's death. Since then multiple emergency department visits and miscellaneous income. Current illness: Patient has restrictive eating symptoms and compensatory behaviors: vomiting, laxatives and exercise. She presents difficulty in impulse control, episodes of agitation and externalizing attitude. Results scales: • Significant ratings for Obsessive Compulsive Disorder and Borderline Disorder (SCID-II). Schizoid, Limit and Avoidant Disorder (IPDE). • Severe depression with suicidal risk (Beck). • High levels in ineffectiveness, asceticism and social insecurity (EDI-2). Treatment: Group and family psychotherapeutic approach, psychopharmacological treatment, occupational therapy, nutrition education and nursing care.
 Conclusions:
The patient has suicidal risk in relation to their eating disorder, personality disorder and depressive symptoms for complicated grief. The problems of emotional management worsen their prognosis and cause difficulties in adherence to the therapeutic team.
 References:
1- Eunice Yu Chena, Milton Zebediah Brownb, Melanie Susanna Harnedc, and Marsha Marie Linehanc. A comparison of borderline personality disorder with and without eating disorders. Psychiatry Res. 2009 November 30; 170(1): 86–90. 2- Rosa Calvo Sagardoy, Gloria Solórzano, Carmen Morales, Mª Soledad Kassem, Rosana Codesal, Ascensión Blanco, Luis Tomás Gallego Morales. Procesamiento emocional en pacientes TCA adultas vs. adolescentes. Reconocimiento y regulación emocional. Clínica y Salud 25 (2014) 19-37 - Vol. 25 Núm.1 3- Cynthia M Bulk, P HD, Laura Thornton, P HD, Andréa Poyastro Pinheiro et al. Suicide Attempts in Anorexia Nervosa. Psychosomatic Medicine 70:378–383 (2008).


(197) PO-197. Impulsiveness and depression symptoms related to self hurting conducts in patients with bulimia nervosa: about one case

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Irene Baños Martín . Santa Cristina University Hospital, Madrid, Spain
- Natalia Sanz Velasco - Belén Velado Pulido - Tania Delgado Fernández - Paula García Jorge - Enrique Guerra Gómez -

 Introduction:
Eating behaviour disorders show the highest mortality index amongst all mental disorders, including deaths by suicide and those produced as a result of complications related to this disorders. Rate of suicide attempts is much higher in those patients diagnosed with bulimia nervosa. More specifically, suicide risk is more frequent, according to recent studies, in those cases showing a predominance of depressive and impulsive symptoms.
 Goals:
Studying the existent relationship between depressive symptoms, impulsiveness, and self-harm behaviour in people diagnosed with bulimia nervosa, and the comprehensive approach to them as a way to prevent suicide.
 Methodology:
Bibliographical review and exemplification through a 31 year old woman patient clinical case diagnosed with bulimia nervosa and its comorbidity, who is under intensive treatment in the Eating Behaviour Disorders Unit in Hospital Santa Cristina de Madrid, and clinical evolution study after psychotherapeutic (group, familiar and individual) and psychopharmacological (aripiprazol, topiramate and fluoxetine) approach, occupational theraphy, nutritional education and constant nursery care.
 Results:
Affective symptoms improvement was seen after 10 months of intensive and multidisciplinary treatment; besides, there was a reduction in impulsive conducts in eating behaviour (no binging or purging) and self-harm tendencies (no new self-harm actions detected ). However, family dysfunctional relationship and identification with the disorder still appear.
 Conclusions:
Comprehensive and intensive approach on those patients with bulimia nervosa with affective comorbidity and impulsive control problems often carries a remarkable improvement in clinical prognosis and prevention against self-harm behaviour.
 References:
Vaz-Leala, F.V. Rodríguez-Santos, L M. A García-Herráiza, C. A. Chimpén-Lópeza, L.Rojo-Morenob, L. Beato-Fernándezc, M.I. Ramos-Fuentesa. Papel de la depresión y la impulsividad en la psicopatología de la bulimia nerviosa. Revista de Psiquiatría y Salud Mental January–March 2014. Volume 7, Issue 1, Pp. 25–31 Corcos M, Taı¨eb O, Benoit-Lamy S, Paterniti S, Jeammet P, Flament MF. Suicide attempts in women with bulimia nervosa: frequency and characteristics. ActaPsychiatrScand 2002 :106: 381–38


(260) PO-260. Suicide in subjects with schizophrenia: more impulsive although not more aggresive

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Yolanda Morant . Hospital Arnau de Vilanova-Llíria, Valencia-España
- Eva María Barranco - Ángela Arcenegui - Mªcarmen Ruíz - Antonio Rico - Julio A. Guija - Lucas Giner -

 Introduction:
Entre un 4-5% de los sujetos con esquizofrenia muere por suicidio (1). Se estima un riesgo 8 veces mayor que en la población general (2). Los estudios de suicidios consumados indican que entre un 5-10% de los suicidios tienen diagnóstico de esquizofrenia (3,4). En el primer año tras el debut de la esquizofrenia se ha comunicado una incidencia del 11% de intentos de suicidio y entre el 0.3-2% de suicidio consumado (5).
 Goals:
Se pretende comparar los niveles de impulsividad y agresividad como rasgo en sujetos suicidados con esquizofrenia/T. esquizoafectivo (ESQ) en comparación con sujetos suicidados sin ESQ.
 Methodology:
Se estudian 316 suicidios mediante autopsia psicológica a través de los familiares. Se evalúa la impulsividad como rasgo mediante la Barrat Impulsivity Scale (BIS-11) y la agresividad por Brown-Goodwin Assessment for Lifetime History of Aggression.
 Results:
De los casos estudiados, 28 sujetos (8.9%) obtuvieron diagnóstico de ESQ. Al comparar con aquellos que no tenían este diagnóstico se observó que los ESQ tenían una edad media menor (42,32 DE: 12.89 vs 54,7639 DE: 19.58; t:-4.61; p<0.001), misma proporción de sexos. En cuanto a la impulsividad, los sujetos con ESQ presentaron mayor impulsividad y mayor agresividad. Impulsividad total: ESQ=61.44 (DE: 5.21) vs 48.91 (DE: 1.49). t=2.46; p=0.028). No hubo diferencias en niveles de agresividad de adolescente ni de adulto en ambas poblaciones.
 Conclusions:
El porcentaje de sujetos suicidados con diagnóstico de esquizofrenia o t. esquizoafectivo en España se encuentra en el mismo rango que en estudios previos internacionales La impulsividad como rasgo es mayor entre los sujetos con esquizofrenia o t. esquizoafectivo suicidados frente a otros sujetos suicidados con otros diagnósticos Son necesarios más estudios para comprobar esta relación así como estudios con muestras más amplias para poder describir factores propios del suicidio en esquizofrenia y trastorno esquizoafectivo.
 References:
1. Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry. 2005;62(3):247-53. 2. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170:205-28. 3. Heila H, Isometsa ET, Henriksson MM, Heikkinen ME, Marttunen MJ, Lonnqvist JK. Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia. American Journal of Psychiatry. 1997;154(9):1235-42. 4. McGirr A, Turecki G. What is specific to suicide in schizophrenia disorder? Demographic, clinical and behavioural dimensions. SchizophrRes. 2008;98(1-3):217-24. 5. Nordentoft M, Jeppesen P, Abel M, Kassow P, Petersen L, Thorup A, et al. OPUS study: suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis. One-year follow-up of a randomised controlled trial. BrJ Psychiatry Suppl. 2002;43:s98-106.


(261) PO-261. The Suicide Ideation and Behavior Assessment Tool: Development of a Novel Measure of Suicidal Ideation and Behavior and Perceived Risk of Suicide

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Larry Alphs . Janssen Scientific Affairs, LLC, Titusville, NJ, USA
- Carla Canuso - Lian Mao - David Williamson - Sibat Consortium -

 Introduction:
Better tools are needed to permit identification of persons at risk for suicide and for assessment of change following treatment intervention. The Suicide Ideation and Behavior Assessment Tool (SIBAT) has been developed to address these needs.
 Goals:
The goal of this report is to describe the development of the SIBAT and provide results of its review by clinical psychiatrists and adolescent patients who were not involved with its development.
 Methodology:
The SIBAT Consortium, a group of about 30 clinical trial and academic experts in scale development, suicidology, and clinical management of suicidal patients, met regularly over 30 months and developed a modular instrument. Feedback from patients with a recent history of suicidal ideation and from an online patient community of individuals who self-identified as being at risk for suicide (PatientsLikeMe) was incorporated into the SIBAT and approved by the SIBAT Consortium. Thereafter, psychiatrists and adolescent patients not involved with the SIBAT’s development were interviewed regarding its strengths and weaknesses. Results of these reviews are presented.
 Results:
The SIBAT has been developed as a 10-module instrument for suicide identification and assessment of change with patient-report and clinician-rated sections. It has high face validity for assessment of suicidal ideation and behavior. It captures both patient and clinician estimates of short-term and long-term risk. Early work suggests that it is sensitive to changes in these estimates. Review of the SIBAT by clinicians and adolescents provide evidence of its acceptable burden and potential value to likely end-users.
 Conclusions:
Results from this validation program support the SIBAT’s use as an instrument that efficiently and comprehensively documents clinical severity and changes in imminent and long-term suicide risk.
 References:
Lindenmayer JP et al. Schizophr Res. 2003;63:161-170.


(263) PO-263. Using the Suicide Ideation and Behavior Assessment Tool (SIBAT) to Characterize Persons With Major Depressive Disorder at Imminent Risk for Suicide

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Larry Alphs . Janssen Scientific Affairs, LLC, Titusville, NJ, USA
- Carla Canuso - Rosanne Lane - Pilar Lim - Yun Zhang - Carol Jamieson -

 Introduction:
Worldwide, nearly 1 million people die by suicide each year. Approximately two-thirds of those who complete suicide have depressive symptoms at the time of their deaths. Better treatments are needed to reduce the risk for suicide, and better clinical scales are needed to identify those at risk for suicide and to document their response to treatment interventions.
 Goals:
The goal of this presentation is to demonstrate the value of the Suicide Ideation and Behavior Assessment Tool (SIBAT) for characterizing suicidality in persons with major depressive disorder (MDD) at imminent risk for suicide. In addition, it will demonstrate the facility of the SIBAT to capture change in response to treatment.
 Methodology:
The SIBAT was used to characterize subjects with MDD at imminent risk for suicide who had consented to treatment in a 25-day double-blind study comparing placebo plus treatment-as-usual (TAU) and esketamine plus TAU. Patients were treated for 4 weeks and then followed on TAU for an additional 56 days. Patients rated themselves on demographics, suicidal behaviors, risk/protective factors, current suicidal thinking, and self-assessment of risk. Clinicians provided ratings of suicide risk and optimal treatment management.
 Results:
The ratings of 68 subjects enrolled in this study were compared. At 4-hours post–initial dose and the following day (Day 2), changes in the SIBAT clinical global judgment of suicide risk were superior in the esketamine group compared with the placebo group. Changes in the component modules of the SIBAT were also evaluated.
 Conclusions:
This study supports the facility of the SIBAT for identifying persons at risk for suicide and for demonstrating rapid change in response to treatment interventions when it is used in patients with MDD at imminent risk for suicide.
 References:
Diaz-Granados N et al. J Clin Psychiatry. 2010;71:1605-1611.


(275) PO-275. Clinical management of suicide attempt in depressed inpatients

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Eleonora Gattoni . Department of Translational Medicine - University of Eastern Piedmont , Novara - Italy
- Paola Bergamasco - Alessandro Feggi - Carla Gramaglia - Debora Marangon - Isabella Coppola - Claudia Delicato - Sarah Di Marco - Fabrizio Bert - Patrizia Zeppegno -

 Introduction:
Psychiatric management of inpatients with suicidal behavior involves psychiatrists and psychiatric nurses. Specific precautions should be adopted: observation on a one to one basis with the cooperation of qualified nurses and accommodating the patient in a room close to the infirmary is usually recommended. An ongoing assessment of suicidal risk is warranted to check the response to treatment over time.
 Goals:
To compare the severity of depressive symptoms in depressed inpatients admitted after an attempted suicide and in depressed inpatients admitted for any other reason; to assess the severity of attempted suicide and the management of suicidal risk in the clinical setting.
 Methodology:
We divided the sample in two subgroups: patients with a diagnosis of depression admitted for a suicide attempt (SA) and depressed patients without current suicide attempt (NSA). Socio-demographic and clinical features were gathered; assessment included the Montgomery-Asberg Depression Rating Scale (MADRS) and the Nurses’ Global Assessment of Suicide Risk (NGASR).
 Results:
46 patients were eligible for our study: 20 were SA and 26 NSA. The multivariate analysis yielded a statistically significant correlation between the use of antidepressants and current suicide attempt. The occurrence of suicidal attempt was not significantly related to the severity of depressive symptoms. In the SA subgroup, NGASR suicide risk levels at discharge were significantly lower than those measured at admission. SA had a higher number of suicide attempts in their clinical history, compared to NSA.
 Conclusions:
We found no significant correlation among psychiatric diagnosis, severity of depressive symptoms and current suicide attempt. Antidepressant therapy was found to play the role of protective factor for suicide attempts. History of suicide attempts is one of the major predictor for reattempted suicide. A more thorough understanding of the complex phenomenon of suicide and of the reasons underlying suicidal behaviours is warranted.
 References:
APA, Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Psychiatric Association, 2003 Cutcliffe J. R. & Barker P. The Nurses’ Global Assessment of Suicide Risk (NGASR): developing a tool for clinical practice. Journal of Psychiatric and Mental Health Nursing 11, 393–400 (2004) Zeppegno P, Gramaglia C, Castello LM, Bert F, Gualano MR, Ressico F, Coppola I, Avanzi GC, Siliquini R, Torre E. Suicide attempts and emergency room psychiatric consultation. BMC Psychiatry. 2015; 15: 13.


(307) PO-307. Description of a sample of suicide attempts in psychiatric emergency visited

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Victor Perez Sola . INAD, PARC DE SALUD MAR, Barcelona
- Carles Masip Montero - María Dolores Sánchez-Cabezudo - Itziar Ezquiaga - Gemma Sanchez - Montserrat Bernad - Jorge Coletas - María Teresa Campillo Sanz -

 Introduction:
From a total of 23,860 psychiatric emergencies attended between the two emergency services managed by our institution in two diferent nearby villages, 1579 emergencies were attended for suicidal attempts and another 1001 emergencies for suicidal ideation without attempt during the period of study (2012-2014).
 Goals:
To describe the clinical characteristics of the sample of suicidal attempts.
 Methodology:
All suicidal attempts attended at psychiatry emergency services (2012-2014) were registered. Clinical and demographic data were collected from the medical records.
 Results:
Suicidal attempts represented 6.6% of all psychiatric emergències during this period, with 77.7% of women and 22.3% of men. Mean age was 43 years (range 17-83). All attempts registered corresponded to 1326 patients, being 14.6% out of the whole 1579 emergencies registered repeated attempts. In 31% of cases non-syndromic diagnosis was made, the most frequent diagnosis was adjustment disorders (26.3%), followed by mood disorders (16.68%), personality disorders (14.73 %) (borderline and inespecífic the most) and substance use disorders (9.17%). This study is included in a follow-up study of suicidal attempts evaluated in our emergency psychiatry services during this period.
 Conclusions:
Further efforts to identify clinical risk variables in order to improve medical care for these patients should be conducted.
 References:
José L. Ayuso-Mateos , Enrique Baca-García, Julio Bobes, José Giner, Lucas Giner, Víctor Pérez , Pilar A. Sáiz , Jerónimo Saiz Ruizh Recomendaciones preventivas y manejo del comportamiento suicida en España (Recommendations for the prevention and management of suicidal behaviour) Revista de Psiquiatría y Salud Mental. 2012;5(1):8-23 Zeppegno et al. Suicide attempts and emergency room psychiatric consultation DOI 10.1186/s12888-015-0392-2 BMC Psychiatry (2015) 15:13


(314) PO-314. Characteristics of suicide attempts preceded by acute use of alcohol

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Virginija Adomaitiene . Psychiatry clinic of the Lithuanian University of Health Sciences , Kaunas- Lithuania
- Kristina Dambrauskiene - Rimantas Zalinkevicius - Vigintas Vilkas - Jariene Giedre - Dunderiene Loreta -

 Introduction:
Lithuania is the country where the prevalence of completed suicide among men is the highest in Europe (51 per 100,000 men in 2012) [1]. Many studies reported that a median of 37% of completed suicides and 40% of suicide attempts are preceded by acute use of alcohol [2]. Acute alcohol intake are known to increase the risk of impulsive suicide attempt even in non-depressed patients.
 Goals:
Goals: to assess the prevalence and factors associated with acute alcohol use among suicide attempters.
 Methodology:
Methodology: The current study included 148 patients hospitalized in Psychiatry Department of the Hospital of Lithuanian University of Health Sciences after a suicide attempt. Odd rates (OR) were estimated. The differences were statistically significant if p<0.05.
 Results:
Results indicated that 85 (57%) suicide attempts were committed with acute alcohol consumption. Acute alcohol ingestion posted 1.53 time (95%CI 1.37- 1.72, p=0.043) greater risk for suicide attempt. Alcohol consumption before suicide attempts was associated with middle age (the mean age was 38.5, SD12.95), more common among women (OR= 1.85, 95%CI 1.6-2.16, p=0.02), urban residents (n=63/85;74.1%), lonely persons (n=50/85;58.8%), persons with low (less than 325 €) month incomes (n=51/85;60.0%), less educated. Low-risk methods were used more often (n=71/83.5%). The men were at increased odd ratio of attempting suicide after acute alcohol consumption (OR=5.06, 95%CI 4.16-6.14, p<0.0001). Low body alcohol levels posted greater risk for suicide attempt among women (OR=21.78, 95%CI 17.18-27.63, p<0.0001).
 Conclusions:
Conclusion: A positive association was found between acute use of alcohol and suicide attempts. Findings suggest the importance of considering acute alcohol use when evaluating risk for suicide attempts. Female gender, loneliness, living in urban region, having low incomes, low education were associated with acute alcohol use among suicide attempters.
 References:
1. http://apps.who.int/gho/data/node.main.MHSUICIDE?lang=en 2. Cherpitel CJ, Borges GLG, Wilcox HC. Acute alcohol use and suicidal behavior: a review of the literature. Alcohol Clin Exp Res 2004;28(5S): 18S–28S.


(329) PO-329. Decision-Making and Suicidal Behaviour: Systematic Review

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Marco Antonio Rios . University of Glasgow , Glasgow - United Kigdom
- Rory O'connor - Jonathan Evans -

 Introduction:
Contemporary models of suicidal behaviour emphasize the multifactorial nature of suicide risk and have identified decision-making as an important component within the suicidal process. Although there is increasing evidence for a relationship between impaired decision-making and suicidal behaviour the nature of the relationship is unclear.
 Methodology:
In light of the mixed findings in the research literature, we conducted a systematic review which aimed to synthesize all studies of decision-making and suicidal behaviour, to determine the extent to which decision-making is associated with suicide risk in different populations. The following databases were systematically searched: Web of Science, EBSCO, and Ovid. Following application of inclusion and exclusion criteria, 32 papers reporting investigations of the relationship between decision-making and suicidal behavior were included. Synthesis of study results provides evidence of an association between performance on standardized measures of decision-making, problem solving, impulsivity and suicidal behaviour.
 Results:
The findings suggest that impaired decision-making plays a key role in the cognitive process that contributes to suicide vulnerability. The results stress the complex interactions among suicidal behaviour and impairments in the decision-making process.
 Conclusions:
The extent and nature of this link remains unclear, highlighting the need for further research to understand the mechanisms involved. A better understanding of this relationship may improve prevention and treatment interventions for suicidal behaviour.


(331) PO-331. Differences in cognitive and metacognitive variables in patients with recent onset psychosis with and without history of suicide attempts.

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:María Luisa Barrigon . Hospital Fundacion Jimenez Diaz, Madrid
- Sergio Sanchez-Alonso - Pedro Gutierrez Recacha - Raquel López-Carrilero - Susana Ochoa - Isabel Ruiz Delgado - Berta Moreno Küstner - Spanish Metacognition Study Group -

 Introduction:
Previous studies suggest that suicidality in psychotic disorders is not correlated with neurocognition unlike in mood disorders (1, 2)
 Goals:
To compare cognitive and metacognitive variables in patients with a psychosis of recent onset (first five years of their illness) with and without previous history of suicide attempts (SA)
 Methodology:
Patients included in this study were patients with psychosis of recent onset participating in a multicentric clinical trial on the efficacy of Metacognitive Training developed in Spain (data submitted for publication). For 120 of these patients, data on previous SA were available. In all of them we assessed sociodemographic and clinical variables and compared variables related with metacognition [Jumping to conclusions (Beads Task), Attributional Style (IPSAQ), Theory of Mind (Hinting Task), self-esteem (Rosenberg’s scale) and facial recognition] and neurocognition [Trail Making Test A and B, WAIS’ subtest digits, Wisconsin Card Sorting Test, Stroop and WAIS’ subtest vocabulary for estimate IC]
 Results:
In our sample, 97 patients had no history of SA and 23 have committed at least one SA. Concerning metacognitive variables, we found no differences in JTC, Hinting Task or facial recognition and found lower scores in external-personalizing bias of attributional style in non-SA patients (-0.56 vs.1.14; p=0.053) and lower scores in Rosenberg’s self-esteem scale (24.96 vs. 28.37; p=0.011). Concerning neurocognition, we found no differences between SA-patients and non-SA patient for any of the assessed variables.
 Conclusions:
Our findings confirm previous studies’ hypothesis on the absence of a relationship between neurocognition and suicidality in psychosis. Furthermore, patients with a previous suicide attempt showed low self-esteem.
 References:
1 .Huber, C. G., Schöttle, D., Lambert, M., Hottenrott, B., Agorastos, A., Naber, D., & Schroeder, K. (2012). Brief Psychiatric Rating Scale - Excited Component (BPRS-EC) and neuropsychological dysfunction predict aggression, suicidality, and involuntary treatment in first-episode psychosis. Schizophrenia Research, 134(2-3), 273–278. http://doi.org/10.1016/j.schres.2011.12.002 2. Potkin, S. G., Anand, R., Alphs, L., & Fleming, K. (2003). Neurocognitive performance does not correlate with suicidality in schizophrenic and schizoaffective patients at risk for suicide. Schizophrenia Research, 59(1), 59–66. http://doi.org/10.1016/S0920-9964(02)00159-7


(355) PO-355. Attentional Bias Toward Suicide-relevant Information in Suicide Attempters: A Cross-Sectional Study and a Meta-Analysis

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Stephane Richard-Devantoy . McGill Group for Suicide Studies, McGill University, Department of Psychiatry & Laboratoire de Psychologie des Pays de la Loire EA 4638, Université de Nantes et Angerse, Montréal & Nantes
- Yang Ding - Gustavo Turecki - Fabrice Jollant -

 Introduction:
Attentional Bias Toward Suicide-relevant Information in Suicide Attempters: A Cross-Sectional Study and a Meta-Analysis . Previous studies using a modified Stroop test suggested that suicide attempters, in contrast to depressed patients with no suicidal history, display a particular attentional bias toward suicide-related cues. However, negative results have also been reported.
 Goals:
In the present study, we collected new data and pooled them as part of a meta-analysis intended to shed further light on this question.
 Methodology:
We conducted 1) a cross-sectional study comparing performance on the modified Stroop task for suicide-related, positively-valenced and negatively-valenced words in 33 suicide attempters and 46 patient controls with a history of mood disorders; 2) a systematic review and a meta-analysis of studies comparing performance on the modified Stroop task among patients with vs. without a history of suicidal acts in mood disorders.

 Results:
The cross-sectional study showed no significant difference in interference scores for any type of words between suicide attempters and patient controls. A meta-analysis of four studies, including 233 suicide attempters and 768 patient controls, showed a significant but small attentional bias toward suicide-related words (Hedges’g=0.22, 95%CI [0.06 – 0.38], Z=2.73, p=0.006), but not negatively-valenced words (Hedges’g=0.06, 95%CI [-0.09 – 0.22], Z=0.77, p=0.4) in suicide attempters compared to patient controls.
 Conclusions:
Our data support a selective information-processing bias among suicide attempters. Indirect evidence suggests that this effect would be state-related and may be a cognitive component of the suicidal crisis. However, we could not conclude about the clinical utility of this Stroop version at this stage.
 References:
Richard-Devantoy S, Ding Y, Turecki G, Jollant F. Attentional Bias Toward Suicide-relevant Information in Suicide Attempters: A Cross-Sectional Study and a Meta-Analysis. Journal of Affective Disorders 2016 ;196:101-108.


(374) PO-374. Many people experience suicidal thoughts and images without acting on them

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:V. Hinze . ,
- K. Hawton - J. Holmes - D. Johnson - E. Chatburn - C. Crane - Bergljot Gjelsvik -

 Introduction:
Many people experience suicidal thoughts and images without acting on them. For some, suicidal thoughts feel comforting (Crane et al, 2013). For others, the thoughts are highly intrusive and the person might become preoccupied with suppressing them or ruminating about them. Such attempts to suppress or ruminate about the intrusive thoughts and images can backfire, exacerbating the suicidal impulses.One possible mechanism underlying the urge to suppress or ruminate about intrusions is the belief that intrusions have behavioural consequences, potentially exacerbating their aversive quality and thus the felt need to either get rid of them or ruminate over them. However, there is also evidence that some people are able to experience suicidal intrusions without trying to suppress or ruminate about them (Williams et al., in press).
 Goals:

 Methodology:
We will present data from an ongoing study comparing individuals with a history of recurrent suicidal depression with two non-suicidal control groups, examining the relationship between beliefs about intrusions, suppression, rumination and dispositional mindfulness.
 Results:
The degree to which these associations are specific to individuals with a history of suicidal depression will be examined.
 Conclusions:
Implications for clinical practice will be discussed.
 References:
Crane, C., Barnhofer, T., Duggan, D. S., Eames, C., Hepburn, S., Shah, D., & Williams, J. M. G. (2013). Comfort from suicidal cognition in recurrently depressed patients. Journal of Affective Disorders, 155, 241-246.
Williams, J. M. G., Duggan, D. S., Crane, C., Hepburn, S., Hargus, E., & Gjelsvik, B. (in press). Modes of mind and suicidal processes. In R. O’Connor, S. Platt and J. Gordon (Eds), International Handbook of Suicide Prevention. Research, Policy and Practice (2nd Ed.). London: Wiley-Blackwell.


(379) PO-379. Suicidal Behaviour and Related Factors in patients who visit emergency department of General Hospital in Cantabria (Spain)

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Clinical and neurocognitive studies of suicidal behavior

Authors:Ana Isabel De Santiago-Díaz . Hospital Universitario Marqués de Valdecilla (Servicio Cántabro de Salud), Santander
- María Isabel Bolado-Alonso - Jesús Ángel Artal-Simón -

 Introduction:
Suicide attempts and suicidal ideation are common phenomena in general and psychiatric populations. Identifying factors associated with suicidal behaviour may contribute to the early identification, prevention and treatment of suicide.
 Goals:
The aim of this study is to describe the epidemiology of emergency department (ED) visits for attempted suicide and suicidal ideation to determine associated socio-demographic and clinical features in a naturalistic sample of General Hospital.
 Methodology:
An observational-descriptive study of patients admitted to the ED of Valdecilla University Hospital (Spain) during the 4-months period was conducted. 143 consecutive patients from March to June 2015 were assessed by the on-call Psychiatrist Unit (mean age=43,57; age range: 16-84; 61% women). Lifetime suicidal behaviour was assessed with routine outcome monitoring, including socio-demographic parameters, DSM-IV-R diagnosis, protective factors, number of previous suicide attempts, acute psychopathology and personality traits.
 Results:
Nearly half the patients were repeated attempters, 26% the first suicide-attempter, and 41% ED visits were suicidal ideation. Psychiatric diagnosis associated with suicide behaviour was found for Mood or Affective Disorders (62%) and Personality Disorders (26%). Suicide attempt was often impulsive (88%) and the most common method of injury was self-poisoning (69%). The fourth part of patients needed a Psychiatric admission (24% of suicide attempts and 27% of suicidal ideations).
 Conclusions:
ED visits for attempted suicide and suicidal behaviour are relatively common, at least two persons per day, most frequent among women. One of four of this suicidal behaviour need of psychiatric hospitalization. The high association of mood and personality disorders found suggests these issues should be considered during management and disposition. Results may be useful for an optimal planning of preventive measures against suicide attempts in psychiatric outpatients.
 References:
1. World Health Organization, 2014. Preventing suicide: a global imperative. ISBN 978 92 4 156477 9 (NLM classification: HV 6545) 2. Oquendo MA, Currier D, Mann JJ. Prospective studies of suicidal behavior in major depressive and bipolar disorders: What is the evidence for predictive risk factors? Acta Psychiatr Scand 2006; 114:151-158. 3. Doshi A1 & all. National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001. Ann Emerg Med 2005;46(4):369-75. 4. Alberdi-Sudupe J1 & all. Suicide attempts and related factors in patients admitted to a general hospital: a ten-year cross-sectional study (1997-2007). BMC Psychiatry 2011; 31:11-51.