European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S8–S52 S41
Factor analyses of large datasets have established two dimen-
sions of negative symptoms: expressive deficits and a motivation.
This distinction is of relevance as the dimensions differ in their
cognitive and clinical correlates (e.g. with regard to functional out-
come). Using functional MRI, we examined the neural correlates
of the two negative symptom dimensions with brain activation
during social-emotional evaluation. Patients with schizophrenia
(n = 38) and healthy controls (n = 20) performed the Wall of Faces
task during fMRI, which measures emotional ambiguity in a social
context by presenting an array of faces with varying degrees of
consistency in emotional expressions. More specifically, appraisal
of facial expressions under uncertainty. We found severity of
expressive deficits to be negatively correlated with activation in
thalamic, prefrontal, precentral, parietal and temporal brain areas
during emotional ambiguity (appraisal of facial expressions in
an equivocal versus an unequivocal condition). No association
was found for a motivation with these neural correlates, in con-
trast to a previous fMRI study in which we found a motivation
to be associated with neural correlates of executive (planning)
performance. We also evaluated the effects of medication and
neurostimulation (rTMS treatment over the lateral prefrontal cor-
tex) on activation during the social–emotional ambiguity task. The
medication comparison concerned an RCT of aripiprazole versus
risperidone. Compared to risperidone, aripiprazole showed differ-
ential involvement of frontotemporal and frontostriatal circuits
in social-emotional ambiguity. We conclude that deconstruction
of negative symptoms into more homogeneous components and
investigating underlying neurocognitive mechanisms can poten-
tially shedmore light on their nature andmay ultimately yield clues
for targeted treatment.
Disclosure of interest AA received speaker fees from Lundbeck.
Symposium: Clinical Management and Treatment
of Suicidal Patients
S110
Clinical Use of Biomarkers in Suicidal
Behaviors
P. Courtet
CHU Lapeyronie, Emergencic Psychiatry, Montpellier, France
The epidemiology, risk factors, and biological basis of suicidal
behaviors have been the object of an ever–increasing research in
the last three decades. During this period, researchers all over the
world have identified potential biomarkers of risk and developed
several theories about the mechanisms leading to suicidal behav-
ior. However, the lack of common terminology, instruments, and
cooperation has been a major deterrent. Today, the community has
established the bases for this collaboration and evidence coming
from neuroscientific studies can already be applied to the field of
suicidology. We present here a potential semiology based on cur-
rent evidence coming from biological, clinical, and neuroimaging
studies.
Disclosure of interest The author declares that he has no compet-
ing interest.
S111
The Patient is Suicidal: What Should I
Do as a Clinician?
V. Carli
Karolinksa Institutet, National Centre for Suicide Research and
Prevention of Mental lll-Health NASP, Stockholm, Sweden
Suicidal behaviour is the most common psychiatric emergency. A
large proportion of suicidal behaviour can be prevented, particu-
larly in cases associated with mental disorders. Early recognition of
suicidality and reliable evaluation of suicide risk are crucial for the
clinical prevention of suicide. Evaluation of suicidal risk involves
assessment of suicidal intent, previous suicide attempts, under-
lying psychiatric disorders, the patients’ personality, the social
network, and suicide in the family or among acquaintances as well
as other well-known risk factors. Suicide risk assessment should
take place on several levels and relate to the patient, the family and
social network but also to the availability of treatment, rehabili-
tation and prevention resources in the community. As suicide risk
fluctuates within a short period of time, it is important to repeat the
suicide risk assessment over time in an emphatic and notmechanis-
tic way. The suicidal person may mislead both family members and
hospital staff, giving a false sense of independence and of being able
to manage without the help of others. Although extreme ambiva-
lence to living or dying is often strongly expressed by the suicidal
individual, it is not seldom missed by others. If observed in the
diagnostic and treatment process, dialogue and reflection on such
ambivalence can be used to motivate the patient for treatment and
to prevent suicide. If ambivalence and suicidal communications
go undiscovered, the treatment process and the life of the patient
can be endangered. Today, several measurement tools of suicide
risk exist, including psychometric and biological measurements.
Some of these tools have been extensively studied and measures
of their sensitivity and specificity have been estimated. This allows
for the formulation of an approximate probability that a suicidal
event might happen in the future. However, the lowprecision of the
predictions make these tools insufficient from the clinical perspec-
tive and they contribute very little information that is not already
gained in a standard clinical interview. Psychiatrists and othermen-
tal health professionals have always longed for reliable and precise
tools to predict suicidal behavior, which could support their clini-
cal practice, allow them to concentrate resources on patients that
really need them, and backup their clinical judgement, in case of
eventual legal problems. In order to be useful, however, the approx-
imate probability that a suicidal event might happen in the future
is not sufficient to significantly change clinical routines and prac-
tices. These should rely on the available evidence base and always
consider the safety of the patient as paramount.
Disclosure of interest The author declares that he has no compet-
ing interest.
S112
Diagnosing and treating suicidal
adolescents
J. Balazs
1 Eotvos Lorand University- Institute of Psychology- Budapest-
Hungary, Department of Developmental and Clinical Child
Psychology, Budapest, Hungary
2 Vadaskert Child Psychiatry Hospital and Outpatient Clinic,
Budapest, Hungary
Suicide is the second leading cause of death in Europe among
15–29 year olds. Adolescence is a sensitive period during develop-
ment with several age specific factors, which can increase suicidal
risk.