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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S8–S52


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



= 38) and healthy controls (


= 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


Clinical Use of Biomarkers in Suicidal


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


Disclosure of interest

The author declares that he has no compet-

ing interest.


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.


Diagnosing and treating suicidal


J. Balazs

1 , 2


Eotvos Lorand University- Institute of Psychology- Budapest-

Hungary, Department of Developmental and Clinical Child

Psychology, Budapest, Hungary


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