Poster Index

Clinical phenotyping of suicidal individuals

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 phenotyping of suicidal individuals


(123) PO-123. Are there clinical and care differences between patients with or without history of suicide attempts who are treated in an outpatient clinic?

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Juan Valdes-Stauber . University of Ulm, Department of Psychiatry and Psychotherapy I, Ravensburg- Germany
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 Introduction:
Epidemiological research regarding care needs, treatment intensity and costs is important for more accurate allocation of outpatient treatment resources in community.
 Goals:
First, to assess clinical, sociodemographic and treatment differences between patients with a history of suicide attempts and those without. Second, to assess the possible differences between the principal diagnostic groups.
 Methodology:
The sample consisted of 1,672 patients suffering from severe mental disorders attending a German rural outpatient clinic during a 1 year period. Differences were assessed using Chi-square tests and ANOVA tests. Associations were calculated using robust multivariate regression analyses.
 Results:
Patients with suicide attempt history were younger, lived more often alone, showed lower functionality (GAF) and higher impairments (CGI), more psychiatric as well as somatic comorbidity and had a longer illness history. All assessed treatment variables demonstrated more intensive care for this group: annual outpatient, hospitalization and psychopharmacological costs were higher as was the number of lifetime psychiatric hospitalizations. For the assessed one-year period, the number of contacts as well as the cumulative treatment time was larger. Living alone, having lower functionality, suffering from a personality disorder or having psychiatric comorbidity was associated with greater care intensity. Patients with a history of suicide attempts suffered more frequently from personality disorders and schizophrenia and less frequently form organic mental and psychosomatic disorders.
 Conclusions:
This investigation confirms results from the research literature regarding the after-discharge care needs of patients with a history of suicide attempts. Patients with a history of suicide attempts exhibit through all assessed variables a higher degree of impairment and outpatient care. These results reflect naturalistic care efforts that do not necessarily correspond to the real care needs.


(146) PO-146. The association between alcohol and patterns of self-harm during public holidays

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Eve Griffin . National Suicide Research Foundation, Cork, Ireland
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 Introduction:
Temporal fluctuations in hospital-treated self-harm have previously been observed, with peaks emerging during holiday periods. Alcohol is frequently involved in self-harm presentations. However, research exploring alcohol as a contributory factor to seasonal variations in self-harm is limited. Thus, the aim of this study was to examine patterns of hospital-treated self-harm in Ireland during public holidays and associations with alcohol involvement.
Data on self-harm presentations to all emergency departments (EDs) from 2007-2013 were obtained from the National Self-Harm Registry Ireland. Descriptive and risk ratio analyses were used to explore the relationship between self-harm presentations and alcohol consumption on public holidays compared to all other days in the year.
Between January 2007 and December 2013, a total of 82,057 episodes of hospital-treated self-harm were recorded by the Registry. The mean number of self-harm presentations were 32 (±7) daily and 36 (±11) on public holidays. Overall, alcohol was involved in 40% of all self-harm presentations to hospital. More specifically, alcohol was involved in 46% of all self-harm presentations on bank holidays compared to 39% on all other days. Alcohol consumption in males increased on public holidays (51%) compared to all other days (45%). During public holidays, self-harm presentations had a 17% increase in risk of involving alcohol consumption compared to all other days (RR: 1.17, 95%CI: 1.12-1.21). Self-harm presentations to hospital on Christmas Eve, Christmas Day and New Year?s Day had a 34%, 36% and 32% increase in risk of involving alcohol consumption compared to all other days, respectively.
The results from this study indicate that self-harm presentations are elevated on public holidays and that alcohol consumption is more strongly associated with self-harm presentations on public holidays compared to all other days in the year. Therefore national strategies aiming at reducing alcohol consumption and misuse should be intensified before and during public holidays.


(163) PO-163. Is suicidal behavior related to higher severity in patients with Bipolar Disorder?

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Lorena De La Fuente-Tomás . Universidad de Oviedo, Oviedo - Spain
- Gemma Safont Lacal - Belén Arranz Martí - Pilar Sierra San Miguel - Mónica Sánchez - Leticia García-Álvarez - Mª Paz García-Portilla -

 Introduction:
Despite suicide attempts remain prevalent among patients with bipolar disorder (BD) [1, 2], there are no many research exploring suicidal behavior in BD understood as a systemic illness [3, 4] and its negative consequences.
 Goals:
To examine the differences in demographic, clinical (psychiatric and somatic), functioning and quality of life (QoL) variables according to history of suicidal attempts.
 Methodology:
Cross-sectional, naturalistic, multicenter study. Sample: 224 outpatients with BD (DSM IV-TR criteria). Patients were divided in the following 3 groups: nonattempters (NA), one suicidal attempt (OSA) and repeated suicidal attempters (more than 1 suicidal attempt) (RSA). Assessment: demographic and clinical information (bipolar illness characteristics, comorbidity (psychiatric and somatic); biological information: anthropometric and lab results; cognition: SCIP; functioning: FAST and GAF; and QoL: SF-36.
 Results:
Mean age 47.28 (SD=12.46); 65.3% females; 71.3% Bipolar I; CGI-S=3.63 (SD=1.41); length of illness 11.62 (SD=10.04). RSA significantly have greater number of manic episodes and worse functioning (FAST, GAF) than the other two groups. NA patients were less severe, took a small number of drugs, and were widowed/divorced, had a pension benefit and comorbid personality disorders in a lower proportion than the other two groups. RSA had greater clinical severity (number of: hospitalizations, depressive and mixed episodes), worse physical health (BMI, abdominal perimeter, insulin and calcium levels) and worse QoL (mental health) than NA.
 Conclusions:
- Patients with suicidal attempts (both OSA and RSA) have a more severe bipolar disorder and greater negative consequences.
- Repeated suicidal attempts are associated with worse level of functioning and greater number of manic episodes.
- Physical health and clinical characteristics of the BD differentiate between nonattempters and repeated suicidal attempters, while demographic characteristics, severity of the illness, and number of drugs prescribed distinguish between nonattempters and the other two groups.

 References:
1. Goffin, K.C., et al., Different characteristics associated with suicide attempts among bipolar I versus bipolar II disorder patients. J Psychiatr Res, 2016. 76: p. 94-100.
2. Jimenez, E., et al., Clinical features, impulsivity, temperament and functioning and their role in suicidality in patients with bipolar disorder. Acta Psychiatr Scand, 2016. 133(4): p. 266-76.
3. Berk, M., et al., Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention. Bipolar Disord, 2011. 13(1): p. 87-98.
4. Grande, I., et al., Mediators of allostasis and systemic toxicity in bipolar disorder. Physiol Behav, 2012. 106(1): p. 46-50.


(183) PO-183. Identifying risk factors for suicide according to clinical severity: retrospective and descriptive study in Sabadell (Spain)

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Marti Guinovart Julian . Corporacio Sanitaria Parc Tauli, Sabadell - Spain
- Eva Aguilar Morales - Isabel Parra Uribe - Diego Jose Palao Vidal -

 Introduction:
There is disparity when we analyze suicide attempts. The most severe attempts are those associated to a higher risk of completing suicide. Detecting patients with higher risk may help to prevent suicide.
 Goals:
To identify risk factors related to severe suicide attempts, as they often translate into a higher risk of completing suicide.
 Methodology:
We selected all cases of suicide attempts seen at the emergency room of the Sabadell Hospital between 2008 and 2013. Mild attemps required less than 24 hours of medical follow-up, moderate attempts between 24-48 hours and severe attempts more than 48 hours, surgery or admission in a medical unit.
 Results:
From 2501 attempts, 300 (11.6%) were severe. Compared to mild or moderate ones, severe attempts were more frequent in men (39.3% vs 31.6%) and older population (mean age 45.7 vs 39.9). The most prevalent diagnosis was depressive disorder, but its incidence was increased in severe attempts (33.8% vs 21.5%). Other axis I disorders were also more prevalent in severe attempts (psychotic disorder 13.9% vs 5.5%, bipolar disorder 7.4% vs 2.9%). Among severe attempts, 76% had an axis I disorder, whereas in mild and moderate attempts the proportion of axis I disorders was lower (44.9%) and higher in axis II disorders (42.6% vs 34.4%).
 Conclusions:
Most attempts were not severe. Severe ones were more prevalent in men and older population. In agreement with other authors, most patients suffered depressive disorder, but psychopathology was more important among severe suicide attempters. Identification of clinical and demographic features related to severe suicide attempts is essential to establish prevention strategies.
 References:
Mento C et al. Serious Suicide Attempts: Evidence on Variables for Manage and Prevent this Phenomenon. Community Ment Health J. 2015 Sep 23. Parra I et al. Attempted and completed suicide: Not what we expected? Journal of Affective Disorders 150 (2013) 840-846.


(187) PO-187. Profile of patients presenting to emergency departments with high-risk suicidal behaviour

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Jacklyn Mccarthy . National Suicide Research Foundation, Cork
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 Introduction:
Self-harm is one of the strongest predictors of suicide. Individuals who have engaged in high-risk suicidal behaviour share similar characteristics to those who die by suicide. A limited number of studies have focused on high-risk suicidal behaviour, especially in an Irish context.
 Methodology:
As part of the larger SSIS-ACE study, presentations of high-risk suicidal behaviour were identified through the two Cork Emergency Departments from June 2014 to December 2015. A number of items were recorded including characteristics of the presentation and socio-demographic variables.
 Results:
During the 15-month period 113 eligible patients presented to the EDs following an episode of high-risk suicidal behaviour. The majority of participants were male (62%). The average age across both genders was 36 years. There was a peak in those aged 30-35 years. Half of the presentations involved self-poisoning. Other common methods of self-harm included hanging (19%) and serious self-cutting or stabbing (14%). Despite having engaged in high-risk suicidal behaviour only 5% scored high (10-14) on objective suicide intent. Patients who had engaged in more lethal methods of self-harm such as carbon monoxide poisoning, strangulation and hanging scored higher overall.
 Conclusions:
This study is one of the first to examine Irish presentations of high-risk suicidal behaviour. Our findings suggest important similarities (gender) and differences (methods) between this group and those who die by suicide. Suicide intent varied by method. Despite having engaged in high-risk suicidal behaviour the majority of patients showed no significant physical injuries. This is especially relevant considering the poor survival rates of individuals who engage in attempted hanging, which is a frequently used method of highly lethal self-harm.


(196) PO-196. Seasonality in three different profiles of suicidal adolescents

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Francisco Villar Cabeza . Servicio de Psiquiatría y Psicología del Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat (Barcelona), España
- Carmina Castellano-Tejedor - Tania Prieto-Toribio - Tomás Blasco Blasco -

 Introduction:
Research on seasonal effects on suicide rates suggests that the prevalence of suicide is greatest during the late spring and early summer months[1] despite the common belief that suicide rates peak during the winter season. Additionally, it might be possible that seasonality could be related to different individuals with different suicidal behaviour trajectories. To clarify this, the three categories of adolescents who engage in suicidal behavior suggested by Fortune et al[2] will be considered, although they did not provide data on seasonality when proposing the classification.
 Goals:
To explore if suicide attempts are season-related in three different prototypic profiles of adolescents who engage in suicide behaviors[2].
 Methodology:
Longitudinal descriptive study. All admissions to a Specialized Suicide Unit in a Pediatric Hospital were registered by a clinical psychologist during two years (2014-2015). Each episode was classified according to Fortune et al[2] categories: Group I: longstanding difficulties which spanned the developmental domains of home, school and peers. Group II: Evidence of an established psychiatric disorder; subgroup I: individuals with a protracted suicidal process which lasted 5-9 years approx., subgroup II: those with a brief suicidal process lasting 1 year approx. Group III: emergence of suicidal process as an acute response to life events among people who appeared to have previously been functioning well, without apparent mental illness or known selfharm.
 Results:
Figures I-III show suicide rates for each group during two-year period. Globally, seasonality is observed in Group III with rates of suicide attempts notably increased during April and August compared to previous months and specifically, March, July and October. No seasonal pattern is observed for Groups I and II.
 Conclusions:
Contrary to previous research, groups I and II (90% of the sample) showed no seasonal pattern. Our preliminary results only showed a certain seasonal pattern for group III. The identification of a seasonal pattern would suggest the influence of an important environmental modulator that can reverberate to suicide prevention strategies. Further studies controlling interfering variables for this phenomenon would be needed.
 References:
[1] Christodoulou C, Douzenis A, Papadopoulos FC, Papadopoulos A, Bouras G, Gournellis, R, Lykouras L. Suicide and Seasonality. Acta Psychiatr Scand, 2012;125(2):127-46. [2] Fortune S, Stewart A, Yadav V, Hawton K. Suicide in adolescents: using life charts to understand the suicidal process. Journal of Affective Disorders, 2007;100:199-210.


(202) PO-202. Is lifetime history of suicide attempts related to worse physical health in patients with schizophrenia?

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Leticia García-Álvarez . Cibersam, Oviedo
- Julia Basteiro-Monje - Maria Paz García-Portilla - Juan Carlos Leza - Javier Rubén Caso - Leticia González-Blanco - Pilar Alejandra Saiz - Lorena De La Fuente-Tomás - Patricia Burón-Fernández - Julio Bobes -

 Introduction:
Suicide attempts had been associated with female gender, higher levels of education, substance abuse/dependence, depression, and childhood physical abuse in patients with schizophrenia (1, 2). Furthermore, many studies have shown a link between suicidal behavior and low lipid levels, especially cholesterol, in patients with schizophrenia (3).
 Goals:
To examine the differences in demographic, clinical (psychiatric and somatic, including inflammatory parameters), functioning and quality of life (QoL) variables according to history of suicide attempts.
 Methodology:
Cross-sectional, naturalistic study. Inclusion criteria: DSM-IV diagnosis of schizophrenia; age >17 years; and written informed consent given. Sample: 123 patients with schizophrenia (DSM IV-TR criteria). Patients were divided in the following 3 groups: nonattempters (NA), one suicide attempt (OSA) and repeated suicide attempters (more than 1 suicide attempt) (RSA). Assessment: demographic and clinical information (length of illness, comorbidity (psychiatric and somatic); biological information: anthropometric and lab results; cognition: SCIP; functioning: PSP and EEAG; and QoL: SF-36.
 Results:
Mean age 40.75 (10.37), 67.5% males. CGI-S=4.20 (SD=1.03); length of illness 13.85 (SD=10.88). Patients with OSA have greater levels of PGE2 (F=4.976, p=0.009), greater proportion of patients with high creatinine levels (Chi-square=11.971, p=0.018) and hypertension (Chi-square=13.273, p=0.010) than the other two groups. Patients with RSA have greater number of hospitalization (F=8.032, p=0.001) and have in a greater proportion low levels of cholesterol (Chi-square=9.543, p=0.049) and diagnosis of cancer (Chi-square=8.839, p=0.012), hepatitis C (Chi-square=22.374, p<0.0001) and bronchitis (Chi-square=13.370, p=0.001). Furthermore, they have low levels of calcium (F=6.529, p=0.002) and smoke a greater number of cigarettes per day (F=5.245, p=0.007) than those patients with OSA.
 Conclusions:
Low levels of cholesterol, higher number of hospitalizations and the diagnosis of severe somatic illnesses are associated with repeated suicide attempt. - Other lab results are significant but they need a deeper causal study.
 References:
1. Fuller-Thomson E, Hollister B. 2016. Schizophrenia and Suicide Attempts: Findings from a Representative Community-Based Canadian Sample. Schizophr Res Treatment, 3165243. doi: 10.1155/2016/3165243. 2. Hor K, Taylor M. 2010. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol, 24 (4), 81–90. 3. Ainiyet B, Rybakowski JK. 2014. Suicidal behavior in schizophrenia may be related to low lipid levels. Med Sci Monit, 20, 1486-90.


(207) PO-207. Multicentre Study of Self-harm in England

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Galit Geulayov Geulayov . Department of Psychiatry, University of Oxford, Oxford
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 Introduction:
Multicentre Study of Self-harm in England – rationale, methodology and results Self-harm (intentional self-poisoning and self-injury) is a major health problem in many countries. Individuals who self-harm have a markedly elevated risk of subsequent suicide and at least half of all persons who die by suicide have a history of self-harm, with a quarter having episodes in the year before death. Self-harm is also associated with increased risk of non-suicidal premature death and with poorer psychosocial outcomes and increased economic costs. Reliable and accurate data on self-harm presentations are important for understanding national trends and risk factors for self-harm and for informing potentially effective preventative measures. Systematic monitoring of self-harm in many countries, including England, has tended to be confined to single centres. However, these are limited in terms of generalizability of findings. We describe the rationale and methodology of the Multicentre Study of Self-harm in England which was developed as part of the National Suicide Prevention Strategy for England. This involves systematic and comprehensive data collection on self-harm presentations to five large general hospitals in three cities (Oxford, Manchester and Derby).
 Methodology:
We present findings from this 14-year (2000-2014) project (N persons=52,567, N episodes of self-harm=94,498), including trends in self-harm and how these relate to trends in suicide, the impact of the recent economic recession and the risk of suicide following self-harm. We also discuss key challenges pertaining to methods of data collection across centres.
 Conclusions:
This presentation will be relevant to those wishing to establish a systematic collection on self-harm, clinicians working with this population and policy makers interested in the importance of clinical services for self-harm patients in relation to suicide prevention.


(219) PO-219. Drugs used in international drug overdose: Finding from the National Registry of Self-Harm, Ireland.

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Caroline Daly . National Suicide Research Foundation, Cork-Ireland
- Eve Griffin - Darren Ashcroft - Roger Webb - Ella Arensman -

 Introduction:
Intentional Drug Overdose (IDO) is the most common form of hospital treated self-harm in Ireland [1]. To date there has been no detailed breakdown of individual drugs frequently used in self-harm in Ireland.
 Goals:
This research aims to examine the profile of persons who present following IDO, and to determine the drugs most frequently used in IDO acts.
 Methodology:
This research includes data from the national registry of self-harm, recording presentations involving drug overdoses (ICD-10 codes x60-64) to emergency departments in ireland, for the period 1st January 2012 to 31st December 2014. Drugs are classified according to the Anatomical Therapeutic Classification System.
 Results:
18,329 presentations involving IDO were recorded. the majority of these presentations were made by females (10767,59%), aged 15-24 (5195,28%), with alcohol involved in 41% (7446) of acts. half of presentations involved polydrug use (6961,53%) and 49% of acts, where quantity is known, involved the ingestion of >20 tablets (7217;49%). two thirds (12021,66%) of ido's involved nervous system drugs, mainly psycholeptics (4827.40%), including anxiolytics (2309) and hypnotics and sedatives (1736). antidepressants were involved in 14% (2492) of IDO's. illegal drugs were involved in 5% of acts, including mainly cocaine and heroin. Seven of the top 10 drugs used in ido were prescription, 4 were benzodiazepines (2916,16%). paracetamol was the most common drug used (2845,16%) followed by diazepam (1367,8%) and alprazolam (558,3%).
 Conclusions:
intentional drug overdose occurs more frequently in females, under 25 years and is often associated with alcohol. prescription drugs specifically psycholeptics and antidepressants are frequently used in overdose. paracetamol is the most commonly used drug in ido. there is a need for further research and also to review prescribing practices, adherence to prescription medications and also restrictions to accessing drugs frequently used in overdose.
 References:
[1] national self harm registry annual report ireland. cork: national suicide research foundation; 2014 p.5. Available: http://nsrf.ie/publications/reports/


(259) PO-259. Self-reported triggering events for suicide attempts in a representative community sample of adolescents and young adults in Germany

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Catharina Voss . Institute of Clinical Psychology and Psychotherapy, Behav. Epi., Technische Universität Dresden, Dresden - Germany
- Kerstin Diel - Eva Asselmann - Hans-ulrich Wittchen - Roselind Lieb - Katja Beesdo-Baum -

 Introduction:
Why suicide? Several theories have tried to understand the reasons for suicide attempts (O’Connor & Nock, 2014). Though, only a few studies have directly assessed reasons and triggering events for suicide attempts in subjects with previous attempts.
 Goals:
Therefore, the current analysis examines self-reported triggering events that led to the decision to commit suicide in adolescents and young adults.
 Methodology:
The Early Developmental Stages of Psychopathology Study (EDSP) interviewed a representative community sample of N=3,021 adolescents and young adults from Germany, at baseline (T0, age 14-24y) and in up to three follow-up assessments over 10 years (T1-T3). Diagnoses of mental disorders were assessed at each wave using the Munich Composite International Diagnostic Interview (M-CIDI). In addition, all participants were asked at T2 and T3 about lifetime suicide attempts including triggering events and other suicide characteristics. Triggering events were noted with written responses to the following item: Which event or events have led to the decision to commit suicide? Based on previous research, participants’ first answer was categorized by two independent raters into four main categories: interpersonal conflicts, intra-psychological conflicts, traumatic events, and socio-economic conditions (Cohen’s Kappa: .81-.92).
 Results:
Results indicated that 133 participants reported a lifetime suicide attempt (59.2% women); 115 participants provided information about triggering events. The most frequently reported triggering events were interpersonal conflicts (40.9%) followed by intra-psychological conflicts (35.0%), socio-economic conditions (14.3%) and traumatic events (8.3%). Associations between categories, socio-demographic variables and mental disorders were examined.
 Conclusions:
Results may be useful for targeted prevention and early intervention among subjects at increased risk for suicide. Further studies should examine differences in triggering events between individuals with suicidal ideations or plans compared to those with suicide attempts. These results could help to differentiate between individuals at higher and lower risk for a subsequent suicide attempt.
 References:
O'Connor, R.C., Nock, M.K. (2014). The Psychology of Suicidal Behaviour. Lancet Psychiatry, 1, 73-85.


(262) PO-262. Description of suicide attempts attended in a coastal community mental health unit during one year

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Maria Luisa Barrigón . Hospital Fundacion Jimenez Diaz, Madrid-Spain
- Margarita Guerrero Jiménez - Carmen Maura Carrillo De Albornoz Calahorro - Braulio Girela Serrano - Mercedes Méndez Santa Olalla - Antonio Rodríguez -

 Introduction:
Concurrent with the recent global economic crisis there is a rising concern about the effect of recession on suicide mortality rates. In our country, this crisis has hit in specially in touristic and agricultural areas such as the coastal area of Granada in Andalucia, biggest region in Spain. In this way, to study the profile of suicide attempts in this area could highlight this relationship.
 Goals:
To record patients treated urgently in Community Mental Health Unit of Motril, Granada(Spain) by attempted suicide.
 Methodology:
We conducted a descriptive study recording patients treated urgently in Motril Community Mental Health Unit who have done any suicide gesture from February 2015 until December of that year.
 Results:
In total 39 urgent assessments were recorded during the observational period. The month of highest incidence was November, with 6 visits followed by August and October (5). The most common method was voluntary drug intake (29 of the total of 39 patients) Origin: -23 out of 39 (59%) were remitted from the general hospital emergency department. -Critical care and emergency ambulatory devices: 1 -Primary Care: 10 -Another Specialist: 2 -Own initiative: 2 Discharge diagnosis: -14 of 39 (35.8%) individuals did not meet criteria for any mental disorder, although some of them were classified with V or Z diagnosis according to ICD-10 for making a reactive gesture to a emotional crisis, couple breakups or economic problems ... -11 Of them meet criteria for various anxiety disorders, obsessive compulsive and adaptative crisis.
 Conclusions:
Discussion: Primary and preventive care amongst psychiatric disorders is not as resolute as other specialties. Due to this deficiency, the patient attends the emergency room in hospital for help and guidance more frequently. Knowing some peculiar characteristics in suicidal populations as well as the most prevalent pathologies, it could be adapted both the profile of nurse attendance and the type of resources needed to ensure effective patient care. Conclusion Profile of patients attended for suicide attempt in an outpatient setting in a semi-rural coastal area is variated. It is worth to mention that one-third of this population did not meet criteria for any mental disorder.
 References:
• Vijayakumar, Lakshmi; Nagaraj, K.; Sujit Jhon. Suicide and suicide prevention in developing countries, Desease Control Priorities Project. Working Paper Nº 27, June 2004 • Meyer RE, Salzman C, Youngstrom EA, Clayton PJ, Goodwin FK, Mann JJ, et al. Suicidality and risk of suicide definition, drug safety concerns, and a necessary target for drug development: a consensus statement. J Clin Psychiatry. 2010;71(8):e1-e21.


(278) PO-278. Liaison Psychiatry - the experience of the Suicide Research and Prevention Unit

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Sandra Neves . Suicide Research and Prevention Unit ,Coimbra Hospital University Centre, Coimbra, Portugal
- Filipe Vieira - Sandra Silva - Nuno Madeira - Adelaide Craveiro - Francisco Alte Da Veiga - José Carlos Santos - Carlos Saraiva -

 Introduction:
A subgroup of patients in medical wards corresponds to those who had severe suicide attempts requiring hospitalization (1). These patients should be referred to liaison psychiatry during their hospitalization as a crucial step in order to achieve long-term stabilization (2). Since 2014 our Liaison Unit at a general university hospital has been providing that support, ensuring a quick (24h-48h) and targeted response.
 Goals:
This study aims to provide a comprehensive overview of sociodemographic and clinic profile of patients who attempted suicide and were subsequently hospitalization.
 Methodology:
All Liaison patients referred to our Suicide Research and Prevention Unit in Coimbra Hospital University Centre, since January 2014 to March 2016, were included. Data were collected using electronic and paper medical records. Statistical analysis was performed with SPSS.
 Results:
Females were the majority (59%) of the sample and the average age was around 51 years. The most frequent suicide method in women was drug poisoning (87,5%), while men preferred violent methods such as defenestration, hanging or firearms. Respecting to violent methods, only 19% of the women (compared to 81% of men) had chosen them, with a highly significant association (p = 0.001).
 Conclusions:
Our findings were in agreement with literature, yet sample size is relatively small. Further studies could provide a more comprehensive approach, optimizing suicidal behavior recurrence. Patients seem to have benefited from an earlier referral to our Liaison support, leading to better psychiatric care during admission and discharge planning, with potential benefits in the long-term.
 References:
(1) Alberdi-Sudupe J, Pita-Fernández S, Gómez-Pardiñas SM, et al. Suicide attempts and related factors in patients admitted to a general hospital: a ten-year cross-sectional study (1997-2007). BMC Psychiatry. 2011;11:51. (2) Royal College of Psychiatrists. Position Statement PS3/2010. Self-harm, suicide and risk: a summary. London, England: Royal College of Psychiatrists; 2010.


(285) PO-285. Suicidal behavior: Methods and personality traits.

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Filipe Vieira . Centro Hospitalar e Universitário de Coimbra, Coimbra-Portugal
- Sandra Neves - Sandra Silva - Nuno Madeira - Francisco Alte Da Veiga - Adelaide Craveiro - José Carlos Santos - Carlos Braz Saraiva -

 Introduction:
Accurate information about preferred suicide methods is important for devising strategies and programs for suicide prevention. Our knowledge of the methods used and their variation across personality traits is limited (1).
 Goals:
The aim of this study was to provide the first comprehensive overview of personality trait patterns of suicide methods.
 Methodology:
All patients referred to the Suicide Research and Prevention Unit in Coimbra Hospital University Centre from 1994 until 2016, following a suicidal behavior, were included in the study. The instrument used to collect information was the Suicidal Behavior Assessment Interview – EACOS (2). Statistical analysis was performed with SPSS.
 Results:
After excluding patients due to missing data, the final sample consisted of 444 patients with a mean age of 29 years. 28% were males and 72% females. Most patients (69,1%) used drug poisoning as their suicide method. Moreover, 12,6% used other toxins, 9,7% used phlebotomy and 8,6% other methods (such as drowning or hanging) as suicide method. The use of drug poisoning was positively associated with histrionic personality traits (p<0,001) and the use of other methods was negatively associated with such personality traits (p<0,006). The use of other toxins as a suicide method was positively associated with antisocial (p<0,024) and impulsive (p<0,002) personality traits. Phlebotomy as a suicide method was positively associated with borderline (p<0,002) and avoidant (p<0.009) personality traits.
 Conclusions:
Understanding the choice of suicide methods and its relationship with personality can provide more effective and personalized suicide prevention strategies.
 References:
(1) Lester D. Choice of Method for Suicide and Personality: A Study of Suicide Notes. Omega (Westport). 1971; 2:76-80 (2) Saraiva CB. Entrevista de Avaliação dos Comportamentos Suicidários (EACOS). Psiquiatria Clínica. 1998; 19(4): 251-274.


(286) PO-286. The relationship between suicide behavior and personality traits with physical and sexual abuse in childhood

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Filipe Vieira . Centro Hospitalar e Universitário de Coimbra, Coimbra-Portugal
- Sandra Neves - Sandra Silva - Nuno Madeira - Francisco Alte Da Veiga - Adelaide Craveiro - José Carlos Santos - Carlos Braz Saraiva -

 Introduction:
Physical and sexual abuses during childhood are major public health problems worldwide (1). They can cause permanent neurobiological and neuroendocrine changes that lead to increased vulnerability in the development of psychopathology throughout life.
 Goals:
This study aims to find an eventual association between physical and sexual abuse in childhood with personality traits in a population of adults with suicidal behavior.
 Methodology:
All patients referred to the Suicide Research and Prevention Unit in Coimbra Hospital University Centre from 1994 until 2016, following a suicidal behavior, were included in the study. The instrument used to collect information was the Suicidal Behavior Assessment Interview – EACOS (2). Statistical analysis was performed with SPSS.
 Results:
Our final sample consisted of 418 patients: mean age of 29 years; 27% were males and 73% females. 14,6% and 35,4% of patients suffered from sexual and physical abuse, respectively. The most frequent personality traits in adults with suicidal behavior exposed to childhood sexual and physical abuse were borderline traits (25,9% and 26,2%, respectively). In adults with suicidal behavior, the presence of sexual abuse during childhood was positively associated with borderline traits (p<0.048); physical abuse during childhood was negatively associated with obsessive-compulsive traits (p<0.017).
 Conclusions:
There is a correlation between sexual abuse during childhood and borderline personality traits in adults with suicidal behavior. It is crucial to further understand this relationship, given its role in mental health promotion in adulthood. Early intervention, at a biopsychosocial level and focusing on children and their families, is of key importance.
 References:
(1) Hillis SD, Mercy JA, Saul JR. The enduring impact of violence against children. Psychol Health Med. 2016 Mar 16:1-13. (2) Saraiva CB. Entrevista de Avaliação dos Comportamentos Suicidários (EACOS). Psiquiatria Clínica. 1998; 19(4): 251-274.


(287) PO-287. Suicide attempters admitted to a Psychiatric Ward Versus ones with others psychiatric consultation outcomes in an Emergency Room

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Claudia Delicato . Department of Traslational Medicine - University of Eastern Piedmont, Novara - Italy
- Carla Gramaglia - Isabella Coppola - Eleonora Gattoni - Sarah Di Marco - Luigi Girardi - Gian Carlo Avanzi - Luigi Castello - Fabrizio Bert - Patrizia Zeppegno -

 Introduction:
Many people who attempt suicide require medical attention. The contact with health services may be an opportunity for suicide risk detection and referral for specialized treatment. This is particularly relevant in emergency settings, where a significant percentage of suicide attempters receives first care aid. However, the approach regarding the psychiatric assessment of suicide attempters can vary considerably from one emergency room (ER) to another.
 Goals:
To compare suicide attempters admitted to a psychiatric ward after the ER referral and attempters with different psychiatric consultation outcomes.
 Methodology:
We recruited consecutive patients referring to the ER of the “Maggiore della Carità” Hospital in Novara during the period 2009–2014. No exclusion criteria were applied: all patients aged >16 years referring to the ER and requiring a psychiatric evaluation were taken into consideration. The psychiatric assessment of patients was performed by experienced psychiatrists with a clinical interview, including the assessment of suicidal intent, suicidal behaviours and attempts. For each patient, a data sheet was filled in by the psychiatrist, in order to gather demographic features, type of referral to the ER, psychiatric history and present clinical issues, type of acute intervention delivered to patient, and psychiatric admission rates.
 Results:
Less than half of suicide attempters was discharged while about one third of them was hospitalized. The remaining percentage was admitted, almost in equal proportion, were admitted to the Short Stay Unit, referred to a Day Hospital or an outpatient service. Only a small percentage was either hospitalized in other specialized Wards or self-discharged.
 Conclusions:
Implications will be discussed.
 References:
Fleischmann A, Bertolote JM, Wasserman D, De Leo D, Bolhari J, Botega NJ, De Silva D, Phillips M, Vijayakumar L, Värnik A, Schlebusch L, Thanh HT. Effectiveness of brief intervention and contact for suicide attempters: A randomixed controlled trial in five countries. Bull World Health Organ. 2008 Sep;86(9):703-9. Jo SJ, Lee MS, Yim HW, Kim HJ, Lee K, Chung HS, Cho J, Choi SP, Seo YM. Factors associated with referral to mental health services among suicide attempters visiting emergency centers of general hospitals in Korea: Does history of suicide attempts predict referral? Gen Hosp Psychiatry. 2011 May-Jun;33(3):294-9. Baraff LJ, Janowicz N, Asarnow, JR. (2006). Survey of California emergency departments about practices for management of suicidal patients and resources available for their care. Ann Emerg Med. 2006 Oct;48(4):452-8, 458.e1-2. 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 Feb 5;15:13.


(291) PO-291. Suicidal behavior and no satisfaction towards survival

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Sandra Silva . Centro Hospitalar e Universitário de Coimbra, Coimbra - Portugal
- Filipe Vieira - Sandra Neves - Nuno Madeira - Francisco Alte Da Veiga - Adelaide Craveiro - José Carlos Santos - Carlos Braz Saraiva -

 Introduction:
The greater the magnitude and persistence of suicidal thoughts, the greater the risk of suicide. Some authors have hypothesized that death awareness precipitates withdrawal from a goal of continuing life when it is experienced as dissatisfying and hope for the future is grim (1). Hence, satisfaction with survival after a suicide attempt is an interesting and useful parameter to consider in assessing the risk of recurrence of suicidal behavior.
 Goals:
This study aims to describe the sociodemographic profile of patients who are not satisfied with survival after a suicide attempt and finding an eventual association with the methods used.
 Methodology:
All patients referred to the Suicide Research and Prevention Unit in Coimbra Hospital University Centre from 1994 until 2016, following a suicidal behavior, were included in the study. The instrument used to collect information was the Suicidal Behavior Assessment Interview – EACOS (2). Statistical analysis was performed with SPSS.
 Results:
After excluding patients due to missing data, the final sample consisted of 184 patients who were not satisfied with survival. Females were the majority (73%) and average age stood at 32 years old. Most (48%) are single or married (39%). About half lived in urban areas. Besides, 87% had an occupation (job or students) and 13% were unemployed or retired. No satisfaction towards survival is positively associated with drug poisoning as suicide method (p< 0,003) and negatively associated with other toxins (p< 0,001).
 Conclusions:
In order to better evaluate patients and reducing the recurrence of suicidal behavior, there is a need for a qualitative approach, enhancing patient's narrative, far beyond the symptoms.
 References:
1. Hayes J, Ward CL, McGregor I. Why bother? Death, failure, and fatalistic withdrawal from life. J Pers Soc Psychol. 2016 Jan;110(1):96-115. 2. Saraiva CB. Entrevista de Avaliação dos Comportamentos Suicidários (EACOS). Psiquiatria Clínica. 1998;19(4):251-274.


(335) PO-335. Characterization of suicide attempts using high lethal methods

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

Topic: Clinical phenotyping of suicidal individuals

Authors:João Fonseca . Hospital Senhora da Oliveira Guimarães, Portugal
- Nélson Almeida - Rosa Rodrigues -

 Introduction:
Suicidal behavior is considered a major health problem, given the social and economic burden it brings for the communities. Suicide attempt (SA) is defined as a non-fatal, self-directed potentially injurious behavior, being considered the single most important risk factor for death by suicide in the general population. Therefore, it is important to identify the suicidal patterns inside the communities in order to designed more effective prevention strategies.
 Goals:
To characterize the patients observed in the ER of Hospital Senhora da Oliveira (Guimarães, Portugal) for attempted suicide using a high lethal method.
 Methodology:
We retrospectively collected the records of all SA medically assisted in our hospital between January 2010 and December 2015. 81 out of 840 cases were included because of the use of methods considered more lethal. A statistical descriptive analysis was conducted regarding patients’ sociodemographic and clinical data.
 Results:
Serious SA corresponded to 9.6% of all the registered cases during the five-year period considered. The majority of the patients was male (54.3%) with a mean age of 44.8 years, married (55.6%), professionally non-active (60.5%). 39.5% had a history of prior SA. When it comes to the methods used, self-poisoning by pesticides/insecticides was the most used (52 patients), followed by association of methods (8), hanging (5), drowning (4), self-poisoning by caustic alkali (4), phlebotomy (4), jumping from a high place (3) and self-harm by sharp object (1). The most prevalent clinical diagnoses were Mood Disorders (40.7%), Personality Disorders and Alcoholism (21%, each). Family and marital conflicts were the most pointed precipitating factors pointed out by the patients in 34.6% and 22.2%, respectively.
 Conclusions:
Self-poisoning by pesticides/insecticides is still a prevalent suicide method, probably given the rural way of life of some hospital catchment areas. A middle aged, non-working male suffering from a mood disorder seems to be at a higher risk of attempting suicide in this community.
 References:
Carlos Braz Saraiva, Bessa Peixoto, Daniel Sampaio. Suicídio e Comportamentos Autolesivos. Lisboa: Lidel; 2014. Portuguese World Health Organization. Preventing suicide: A global imperative, 2014. Avaiable from: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/


(349) PO-349. Analysis of completed suicides in Pleven county for 6 year period

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Vladimir Nakov . National Center of Public Health and Analyses, Sofia, Bulgaria
- Kaloyan Stoychev - Liudmil Tumbev - Krasimir Ivanov - Dancho Dekov -

 Introduction:
Suicide is a growing public health problem worldwide: approximately one million people die by suicide each year. In 2002 suicide was ranked as the 14-th leading cause of death globally and with its projected increase it is expected to move to 12-th position in this list by year 2030. Factors associated with acute and chronic suicide risk are still poorly understood.
 Goals:
To identify potential socio-demographic and clinical suicide risk factors in a sample of patients with psychiatric diagnosis who have completed suicide.
 Methodology:
Our study covers a 6 year period /2009-2014/. All known cases of suicide passed through the Forensic Medicine department in Pleven were studied (a total of 198 individuals) and subjects with medical records for mental illness were extracted and analyzed using documentary and historical method. Relevant socio-demographic and clinical data were elicited by a specially designed information form.
 Results:
Of all 198 suicide completers for the studied period 41 (25 men, 16 women) had an ICD-10 mental disorder (20.7%). Leading diagnoses were Schizophrenia (18 cases) and Depressive disorders (14 cases), 4 patients had alcohol dependence and 4 had other psychiatric disorder. The mean age of suicide victims is 54.69 years (52.5 for males and 58.2 for females), significantly lower for patients with schizophrenia (42.75 years) and higher for those with depressive disorders (68 years)
 Conclusions:
Preliminary data (information is still being processed) show that chronic mental disorders significantly increase suicide risk. Schizophrenia seems to be associated with higher suicide risk than all other psychiatric disorders especially in younger patients.
 References:
American Foundation for Suicide Prevention www.asfp.org Hawton, K., Casanas, C., Haw, C., & Saunders, K. (2013). Risk factors for suicide in individuals with depression. Journal of Affective Disorders, 147, 17-28. Khan, A., Khan, S., Kolts, R., & Brown, W. A. (2003). Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. American Journal of Psychiatry, 160 (40), 790-792. Mathers, C.D. & Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 3(11), e. 442 Ruiz, P. (2014). Global epidemiology of suicide. In: S.H. Koslow, P. Ruiz & C.B. Nemeroff (eds): A Concise Guide to Understanding Suicide. Cambridge University Press; pp. 13-16)


(372) PO-372. Analyze the number of emergency care and the reasons

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Laura Montes Reula . Servicio Navarro de salud- Osasunbidea, Pamplona, Spain
- Almudena Portilla Fernández - Rebeca Elorza Pardo - Patricia Macaya Aranguren - Lucía Janda Galán - Adriana Goñi Sarriés -

 Introduction:
For years suicide is considered a major public health problem worldwide. It is a medical and social interest to study of factors surrounding this event.
 Goals:
Observe how many times the patients attending an emergency department of psychiatry, the motives and if they repeated suicide attempts.
 Methodology:
A total of 440 patients were included in the study, recruited in the emergency department of the Hospital of Navarra and the Reina Sofía Hospital of Tudela in period between January and October 2015. Cases are patients who were attending in emergency room for attempted suicide, and controls, who received psychiatric care for a different reason of autolytic attempt. Of all patients is being carried out follow-up six months after the first emergency care. It has chosen a monitoring group until January 31, 2016 with a sample size of 295 patients with 150 cases and 145 controls.
 Results:
It is observed that 35% of the follow-up sample repeated at least once emergency care, the most common reason was anxiety. Some of them repeat until seven times without differences between cases and controls. 16% of the cases achieve again an attempt autolytic, that the most common method was triggered by drug use.
 Conclusions:
It is observed that patients with mental illness often come to the emergency services, the most frequent causes are anxiety, demand for treatment and psychopathological decompensation. The method of making an autolytic attempt most frequent, as described literature, the drug use.
 References:
Andoni Ansean Ramos. Suicidios, Manual de Prevención, Intervención y Postvención de la conducta Suicida.2ª ed revisada. Madrid: Fundación Salud Mental España; 2015


(376) PO-376. Can Suicide be prevented in Cancer Patients?

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Martha Cristina Cancino Botello . Consorcio Hospital General Universitario de Valencia , Valencia, Spain
- Miler Andrés Cuéllar Rivas - Juan Miguel Hernández Sánchez - Fernanda Molina López -

 Introduction:
Cancer diagnosis provokes physical and psychological suffering. The emotional impact intensity and the resulting behavior (adaptive or maladaptive as in the case of suicide), has been related to different factors. According to this, authors indicate that suicide may be twice as prevalent among patients with cancer compared to general population. We present the case of a >65 year-old man with bladder neoplasm, who at the moment of diagnose had pulmonary metastatic lesions. Before the onset of any oncological treatment, the patient decided to commit suicide.
 Goals:
We aim to identify possible risk factors associated to suicide in patients with cancer.
 Methodology:
We searched articles in English and Spanish on PubMed database, using the following keywords: neoplasm, suicide, and malignancy.
 Results:
The available literature describes that suicide risk in patients with cancer is highest during the first three year since diagnose, and suicide ideation among this population has been associated with depressive disorders and hopelessness feelings. The most related entities with higher suicide rates are pulmonary, oropharyngeal, breast and pancreatic cancer. In the case of genitourinary cancer (as in this case) there is not sufficient data. Given the emotional distress provoked by these pathologies, it has been proposed some guidelines (like the one of the National Comprehensive Cancer Network) addressed to identify risk factors on cancer patients that can be useful for clinicians.
 Conclusions:
All clinicians should be aware of risk factors for suicide in these patients, specifically for those older than 60 years old, unmarried status and advanced disease at diagnose, so once identified can be implemented appropriate intervention with a multidisciplinary approach.
 References:
National Comprehensive Cancer Network. Distress management. Clinical practice guidelines. J Natl Compr Canc Netw. 2003;1:344-374. Klaassen Z, Jen RP, DiBianco JM, Reinstatler L, Li Q, Madi R, Lewis RW, Smith AM, Neal Jr DE, Moses KA, Terris MK. Factors Associated With Suicide in Patients With Genitourinary Malignancies. Cancer. 2015 Jun; 121:1864-1872 Fang F, Fall K, Mittleman MA et al. Suicide and cardiovascular death after a cancer diagnosis. N Engl J Med 2012;366(14):1310–1318. Valverde JJ, Gómez M, Navarrete A. Guía Clínica de Comunicación en oncología. 1st ed. Desclée de Brouwer, S.A; 2014


(394) PO-394. Love Till the End? A Longitudinal Dyadic Study on Suicidal Ideation among Former Prisoners of Wars and their Wives

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Yossi Levi-Belz . Ruppin Academic Center, Israel
-

 Introduction:
War captivity is one of the most severe human-inflicted traumatic experiences with wide and substantial long-term negative effects. However, only one retrospective study examined suicidal ideation (SI) among ex-prisoners of war (ex-POWs). Several studies have revealed the toll of war captivity on secondary traumatization' (ST) of ex-POWs' wives.
 Goals:
This study aimed to prospectively assess SI among ex-POWs and its associations with posttraumatic stress disorder (PTSD) symptoms over a 17-years period. Moreover, is also aimed to assess SI among ex-POWs' wives and the longitudinal associations with their husbands' PTSD and their own ST.
 Methodology:
A sample of 233 Israeli couples (142 ex-POW couples and a comparison group of 91 veteran couples) completed self-report measures of PTSD symptoms, SI and depression at two time points: T1 (2003) and T2 (2008), 30 and 37 years after the 1973 Yom Kippur War.
 Results:
Latent growth curve modeling (LGM) results showed that ex-POWs reported higher levels of SI at T2 and T3 and a pattern of increase in SI levels trajectory over time, compared to control veterans. Furthermore, among ex-POWs, PTSD symptoms at T1 contributed to the increase in rate of change in SI overtime. In related to the wives, among controls' wives, but not among ex-POWs' wives' the more ST symptoms wives reported, the higher their level of SI. Furthermore, for both research groups, PTSD and ST were positively associated with their own levels of SI. Surprisingly, an Actor-Partner Interdependence Modeling (APIM) analysis revealed that only among ex-POWs' couples, the more the husband suffered from PTSD and SI, the more moderate the increase of the wife's SI between T1 and T2.
 Conclusions:
Clinical implications of these findings for the relations between captivity trauma and suicidality as well as for veteran's couples are discussed.


(430) PO-430. Social anxiety and suicidal (anti-vital) behavior

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Olga Sagalakova . Altai State University, Barnaul, Russian Federation,
- Dmitry Truevtsev -

 Introduction:
The high frequency of suicidal and anti-vital behaviors among adolescents (in the example of Altay territory) shows that significant needs of this age group frustrated. The reason for this is both dysfunctional environment does not provide the strategies and techniques of constructive self-realization. The needs of adolescents are associated with social activity. They need recognition, success, approval, love and acceptance in the group. To achieve these goals, it is important to have social skills, social courage, to be able to mediate in situations of anxiety assessment and respond to failure. When unformed these competences increasing social anxiety, which is difficult to regulate and mediate. We saw an increase in dissatisfaction with the teenager, helplessness, hopelessness and anti-vital experiences, actions, suicide risk.

 Goals:
Identify the relationship of social anxiety and anti-vital experiences, behaviors, and suicide risk in adolescence / early adulthood. Identify markers of SA to prove a violation of the targeted action regulation in evaluation situations. Show that features of the selectivity and distribution, focus (focus mental activity) leads to disruption of activities, reducing its effectiveness, violation of mastering emotions and behavior as SA, to the accumulation of negative affect and stress in the mind due to the accumulation of unmediated affect and pathology of the dynamical system regulation in its various phases
 Methodology:
The sample of subjects. The sample of subjects consisted of 981 adolescents (2015) and 1163 young people (in 2014 - the preliminary research phase). The test was attended by students from different areas of the Altai Territory. The analysis of cases of completed suicides among adolescents and para suicide (2013-2015, in the report - data 2015). Formed map of suicides in the province. 25 teenagers participated in an experiment to study the characteristics of vigilance and selective attention in social anxiety with pronounced anti-vital experiences.
Research methods and procedures. To assess SA used validated questionnaire “Social Anxiety and social phobia” (29 points, the questions focused on the main symptoms of social anxiety in typical social situations) and to assess the viability, anti-vital and suicide risk used a validated questionnaire “Viability and Anti-vitality ” (72 points and blank test - 6 survey points about family situation, age, gender) (Sagalakova, Truevtsev, 2013-2015) . Used eye-tracker (SMI mobile). We research the properties of visual attention (focus mental activity): motivational bias, allocation, concentration, switch. Empirical indicators: fixation and saccades, the analysis of interest areas. Groups of teenagers are divided into groups by the level of SA (high, low, intermediate values ​​were also evaluated, but not presented in the report). Methods of statistical data analysis: analysis of variance, correlation analysis, cluster analysis, nonparametric measure differences. The data is processed in the program SPSS 22, STATISTICA 10.

 Conclusions:
1. Social anxiety highly significant in all experiments connected with anti-vital experiences, actions and suicide risk in adolescents. Social anxiety - a marker of significant frustration for the crisis of adolescence needs.

2. Both verbal and non-verbal stimuli, causing a threat to the social or emotional risk assessment, with high SA perceived more disorganized (attention is focused not only on target, but irrelevant stimuli).

3. Correlation between social anxiety and post-situational rumination shows that dysregulation is not only at the stage of its course, but also in the phase of completion. Accumulated dynamic tension indicates prolonged circulation of the regulatory system (circle drive), formed by social problems. This is the result that the phase of system shutdown does not occur, the person continues to be recorded on a "mental image" of how he/she was perceived by others in the situation. Long-term accumulation of negative affect leads to the disruption of activities, resource depletion psyche, mental stress buildup and anti-vital and / or suicidal behavior.

4. It’s not correct to oppose these particulars of attention (vigilance or avoid). We see a specific fix (selective focus) and large amplitude saccades in adolescents with high levels of anxiety and the presence of anti-vital experiences. Areas of interest in these adolescents are more concerned with negative implications, associated with emotional stress. Zones of interest significantly more vigilant attention is expressed in several ways (fluctuations of attention). This reduces the efficiency of the situation task (the priority tasks performed worse). The duration of saccades (both in terms of stimulus segments, and as a whole), and amplitude of saccades during the perception of evaluation situations is higher in subjects with high SA than low. This constitutes a violation of the activity target regulation in a situation assessment. This trend we have observed in all the experiments with different stimuli.

5. The average duration and frequency of fixations do not differ in groups. The differences were significant in the parameter amplitude saccades in all conditions. Fixation, the area of interest and saccades with low SA do not depend on the type of stimulus (facial expressions). At high SA saccadic amplitude is very high. The maximum amplitude provided the angry and frightened expression.


(431) PO-431. Conceptual models of social anxiety and social anxiety disorder in a study of anti-vital behavior (suicidal and parasuicidal)

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

Topic: Clinical phenotyping of suicidal individuals

Authors:Olga Sagalakova . tai State University, Barnaul, Russian Federation,
- Dmitry Truevtsev - Anatoly Sagalakov -

 Introduction:
The basic model of social anxiety (SA) and social anxiety disorder (SAD) distinguished mechanisms of cognitive and metacognitive disorders that lead to changes in behavior and consolidation strategy of avoidance.
The authors presented one of the most developed and empirically proven SAD concepts - the cognitive-behavioral SAD model, based on attention disturbance as a factor in the generation and maintenance of anxiety in social-evaluative situations. The authors describe the “self-focused” position, typical for anxious individuals (Hope, Gansler, Heimberg, 1989). A person with SAD being in a social situation, constructs a mental image of what he looks like in the eyes of others and then begins to behave as if he were under the close supervision of other people.

 Goals:
Develop a conceptual model of SA and SAD on the basis of cultural and active methodology. Identify SA syndrome (primary, secondary and derivatives violations of mental activity). Show that the primary syndrome acts constitute a violation of the regulation of activities in situations of evaluation, which leads to disorganization and failure. Secondary infringement - bias in the motivational system and the accumulation of contradictions, tensions. Demonstrate a methodical diagnostic decision determining syndromic features of SA. Relate data pilot patho-psychological examination of the results of the study questionnaires and selective focus using an eye tracker.

 Methodology:
The sample of subjects. The sample of subjects consisted of 981 adolescents (2015) and 1163 young people (in 2014 - the preliminary research phase). 25 participated in an experiment to study the characteristics of SA.
Research methods and procedures. At this stage, we studied the prevalence of SA among young people, the most common situations that cause anxiety, and feelings of anxiety for the effects of the psyche and personality of the individual with unformed strategies of mediation and regulation of emotions in situations of evaluation.
To assess SA used validated questionnaire “Social Anxiety and social phobia” (29 points, the questions focused on the main symptoms of social anxiety in typical social situations) and Experimental methods of diagnosis patho-psychological «Social evaluation situations sorting test» (Sagalakova, Truevtsev, 2013-2015) .
Used eye-tracker (SMI mobile). We research the properties of visual attention (focus mental activity): motivational bias, allocation, concentration, switch. Empirical indicators: fixation and saccades, the analysis of interest areas. Groups of teenagers are divided into groups by the level of SA (high, low, intermediate values ​​were also evaluated, but not presented in the report). Methods of statistical data analysis: analysis of variance, correlation analysis, cluster analysis, others. The data is processed in the program SPSS 22, STATISTICA 10.

 Results:
Our testing consistent with those of studies of the orientation and distribution of attention (the mental activity as a whole) using the eye tracker. Determine the specific dysregulation (emotions prevail over cognitive mediation of anxiety), semantic motivational priorities and contradictions. To achieve the goals and motives are sought the most appropriate means. All mental activity is organized and aimed at this goal. At SA we see bias of attention not only to the target, but do not target stimulus situation (violation of focus and allocation of attention - multitasking), the shift selectivity in the target regulation (disorganization). The regulation is broken. The primary factor in forming the syndrome of SA and transition to SAD acts violating the regulation of target activities. Disruption due to regulatory violations in the system causes a fluctuation of attention (fixing multitasking, characterized by large amplitude saccades). The activity becomes ineffective. Further, there is an accumulation of negative experiences. Formed relative stability of SA mental map of the world (fixation on negative semantics as a potential threat). The shift to a secondary meaning motives in the situation (as the voice of what I look like in the eyes of others, someone laughed, and so forth.). Multitasking becomes an end in itself forced.
 Conclusions:

Based on psycho-pathological SAD model, the authors argue that the main psychological techniques related to the disorganized assessment affect, as well as to the formation of adaptive and flexible regulation of mental activity, are the following:
1) The introduction of sign-symbolic mediation of cognitive-communicative, perceptual activity in speaking to the audience and other situations are more effective regulators than direct willpower (via self-instruction, inner speech and inner action planning, the introduction of assistance tools, having direct response, the introduction of mediation-based "rules" of the decision-taking);
2) Formation of a flexible goal-setting system (the psychological distance between the immediate and long-term purposes);
3) Stabilization of self-esteem regardless of situational success / failure, forming the semantically integrated and adaptive image of success and failure, formation of positive experience in the application of adaptive tactics related to activity structuring.
4) Informing of the anxiety mechanisms and training mental activity regulation along with goal priority retention, allocation of attention in the social assessment situations.