Inflammatory biomarkers are reportedly increased in depressed patients. Several studies have been conducted using neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR). The objective of this systematic review was to study the relationship between these peripheral biomarkers and suicidality in depressed patients with/without suicidal behavior, including suicide attempts and ideation, and healthy controls.

We searched the following relevant terms in the PubMed, Web of Science, and Scopus databases published in the last 5 years. We assessed the methodological quality of included studies using the Oxford criteria and reviewed the evidence following PRISMA guidelines.

Eleven studies were retained for the data synthesis, with a total sample of 1,701 participants, of which the majority (819) were patients with depression and suicidal behavior, 494 were depressed patients without suicidal behavior, and only 388 were healthy participants. Our results reinforce the idea that NLR could be an attractive, convenient, and cost-effective trait marker of suicidal vulnerability in patients with major depressive disorder (MDD).

Future large-scale replication studies are needed to examine the apparently understudied role of PLR and MLR in depressed patients in greater depth.

Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits Introduction: Suicide is a major health concern worldwide, thus, identifying risk factors would enable a more comprehensive understanding and prevention of this behaviour. Neuropsychological alterations could lead to difficulties in interpreting and managing life events resulting in a higher risk of suicide.

Objective: Bibliographic review about the influence of neuropsychological deficits on suicidal behaviour.

Method: A systematic literature search from 2000 to 2020 was performed in Medline (Pubmed), Web of Science, SciELO Citation Index, PsycInfo, PsycArticles and Cochrane Library databases regarding studies comparing cognition of attempters versus non-attempters that share same psychiatric diagnosis. Results: 1.885 patients diagnosed with an Affective Disorder (n = 1512) and Schizophrenia/ Schizoaffective Disorder (n = 373) were included.

In general comparison, attention was found to be clearly dysfunctional. Regarding diagnosis, patients with Schizophrenia and previous history of suicidal behaviour showed a poorer performance in executive function. Patients with current symptoms of an Affective Disorder and a previous history of suicidal attempt had poorer performance in attention and executive function. Similarly, euthymic affective patients with history of suicidal behaviour had worse decision-making, attention and executive function performance compared to euthymic non-attempters.

Patients who have attempted suicide have a poorer neuropsychological functioning than non-attempters with a similar psychiatric disorder in attention and executive function. These alterations increase vulnerability for suicide.

Jessica Fernández-Sevillano is beneficiary of the Pre-PhD Training Programme of the Basque Government. Dr. Gonzalez-Pinto has received grants and served as consultant, advisor or CME speaker for the following entities: Almirall, AstraZeneca, Bristol-Myers

Depressed patients with early traumatic experiences may represent a clinically distinct subtype with worse clinical outcome. Since early traumatic experiences alter the development of systems that regulate the stress response, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behaviour.

To determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behaviour in patients with major depressive disorder (MDD).

The sample included 190 patients [mean age (SD)=53.71 (10.37); females: 66.3%], with current MDD. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity. We developed mediation models by bootstrap sampling methods.

81 (42.6%) patients had previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b=0.007, 95% CI=0.001, 0.015), after controlling for sex, HDRS-Total, and LTE-Total.

Impulsivity could mediate the influence of childhood trauma on suicidal behaviour. This will help understand the role of risk factors in suicidal behaviour and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.

Suicidal behavior has a great impact on world public health. The literature describes the possible existence of an association between neurobiological, clinical and cognitive factors in suicidal behavior.

To determine the possible relationship between clinical variables (history of abuse/maltreatment in childhood), psychopathology (impulsivity traits) and cognitive (decision-making) with a history of suicide attempt and/or current suicidal idea in patients with major depressive disorder.

Cross-sectional study in a sample of adult patients with major depressive disorder in which two types of comparisons are made. In the first case, two groups were compared based on the presence or absence of history of suicide attempt. In the second case, two groups were compared based on the presence or absence of suicidal ideation in the same sample of patients. Finally, sociodemographic, clinical and cognitive variables were evaluated in that population sample.

When the joint influence of sociodemographic, clinical and cognitive characteristics are present, it can be said that being single/divorced/separated, a history of sexual abuse in childhood and an alteration in decision-making, specifically a lower number of choices of deck D in the IGT test, are associated with a higher probability of a personal history of suicide attempt. While a higher score on the Barrat impulsivity scale is associated with a greater probability of presenting current suicidal ideation once the influence of sociodemographic, clinical and cognitive variables has been taken into account.

Different sociodemographic, clinical and cognitive factors are associated with the presence of a history of suicide attempt and/or current suicidal ideation.

No significant relationships.

Information about the perception of suicide attempters regarding prevention of their suicide attempt may be helpful in implementing preventive strategies.

To examine:

1. (i) sociodemographic profile,

2. (ii) distribution of the Suicide Intent Scale, and

3. (iii) differences according to the gender in the sample of participants in a controlled study to determine the effectiveness of case management programme in the prevention of recurrent suicidal behaviour.

106 suicide attempters who attended the Emergency Room of the Hospital of Asturias from July- 2011 to October- 2012 were included in the study [33% males; mean age (SD)= 41.82 (13.16)]. Instruments: Ad hoc Sociodemographic- Questionnaire; Suicide Intent Scale (SIS); SAD-PERSON Scale; Medical Damage Scale; List of Threatening Experiences; Hamilton Depression Rating Scale.

Profile: 45-54 years old (30.4%), married (34%), with bachelor's degree (42.5%), unemployed (29.2%), with children (61.3%) and living with partner (34.9%). 36.2% of the sample had the intention to repeat at the time of the suicide attempt (SA), while 22.6% actually repeated it. The intention to repeat the SA was associated with the commission of SA at 12-months follow-up (p=.002). SIS data: mean total score (SD)=15.99(4.71); mean objective score (SD)=5.69(2.48); mean subjective score (SD)=10.28(3.29). Significant differences in SIS scores were found by gender (p=.007), men scoring higher. Repetition of the SA was related with higher scores (p=.002).

SA severity and its repetition at 12-months follow-up was related with the intention of repetition; nevertheless we didn’t find relation between the SA severity and the repetition of SA one year later.

Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. Although the main justification for shared decision-making is ethical, several randomized controlled trials support its effectiveness in improving the quality of decisions, but robust evidence in objective health outcomes is needed.

Analyze the degree of antipsychotic politherapy or monotherapy in patients discharged after their inclusion in the study and randomized to Share Decision-Making or Treat as Usual. Present preliminary conclusions after 20 months of follow-up.

Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Previous antipsychotic treatment is collected by interviewing patient and family and as included in digital history and health card, discharge and reviews conducted at 3, 6 and 12 months.

Interim analysis shows there are no differences between groups (SDM and TaU) before intervention, we note the following results:

• – the degree of antipsychotic politherapy prior to admission for the entire sample decreased at discharge;

• – at discharge, there is a difference between SDM and TaU. Antipsychotic polytherapy in SDM decreases in a higher level.

The authors have not supplied their declaration of competing interest.

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.

To review the incidence, clinical characteristics, diagnosis and treatment of NMS.

We have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.

A literature review of the NMS was performed using the PubMed database.

The frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.

NMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.

The authors have not supplied their declaration of competing interest.

Glucocorticoids are widely prescribed for a variety of diseases and are known to cause neuropsychiatric as well as somatic side effects.

To review the incidence, clinical characteristics, course and treatment of neuropsychiatric effects of glucocorticoids.

We have described the case of a 86-year-old woman. She had no personal and no psychiatric medical history in her family. She presented wrist arthritis requiring high doses of an oral corticoid treatment (prednisona 20 mg/d). After a week, she started with symptoms characterised by persecutory and surveillance delusions. Organicity was ruled out. The patient got a progressive recovery after starting anti-psychotic medication and progressive reduction of the steroid drugs.

We have performed a literature review of the neuropsychiatric complications of glucocorticoids using the PubMed database.

Neuropsychiatric effects of glucocorticoids involve affective, behavioural, and cognitive manifestations. The incidence is variable, between 2 and 60% of patients who receive steroids. Although the effects of glucocorticoids are unpredictable, the administered dose is the most significant risk factor for the development of neuropsychiatric symptoms. Dosage reduction typically results in clinical recovery. Although the limited data on this subject, it is a problem that clinicians face on their regular basis. The administration of anti-psychotics or mood stabilizers may be beneficial in the prevention and treatment of this syndrome.

The neuropsychiatric effects of glucocorticoids are unpredictable and non-specific. More controlled trials are needed in order to perform evidence-based clinical guidelines for the treatment with glucocorticoids and for the prevention of neuropsychiatric manifestations.

The authors have not supplied their declaration of competing interest.

Eating disorders (EDs) are an important public health problem and not all patients respond adequately to psychotherapy. In the last decade, researchers report a significant comorbidity of EDs and attention-deficit/hyperactivity disorder (ADHD), especially binge eating disorder and bulimia nervosa. Some studies postulate the hypothesis of a common neurobiological substrate, such as noradrenergic pathways among others.

To revise the possible use of atomoxetine, a highly selective noradrenergic reuptake inhibitor, for the treatment of EDs.

We describe the effect of atomoxetine in a young woman with purging disorder and history of ADHD in childhood added to cognitive behavioural therapy (CBT).

patient had selective/restrictive eating behaviours, daily purges and occasional binges for last five years. At age 14 she was diagnosed with ADHD by impulsivity/aggressiveness and poor school performance, but she did not take drugs and left medical consultations. She came to our specific unit of EDs in november-2015. Her BMI was 24.88 kg/m2. We initiated CBT and atomoxetine (80 mg/day). In this first year of treatment binges and purges have disappeared and exposure to new foods and body image have improved partially. We found clear improvement in mood, motivation and attention/concentration in relation with introduction of atomoxetine. These facts have positive impact on the clinical evolution. Her current BMI is 26.90 kg/m2.

Identify comorbid ADHD to assess the use of specific drugs for this disorder could be beneficial in the treatment and prognosis of EDs. However, more studies are needed to determine effectivenes, particularly of non-stimulant drugs.

The authors have not supplied their declaration of competing interest.

Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. There has been extensive and growing interest in its application to long-term illnesses but surprisingly not in severe psychiatric disorders, such as schizophrenia. However, the great majority of schizophrenics are capable of understanding treatment choices and making rational decisions. Although the main justification for shared decision-making is ethical, several randomized controlled trials support its effectiveness in improving the quality of decisions, but robust evidence in objective health outcomes is needed.

Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge.

Of the oral presentation: to present the study design; to make an interim report of the data obtained at the moment of the congress.

Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: Inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.

Currently in the recruiting phase with 55 patients included in the study. An interim analysis of at least half of the target sample size.

We will show the study design and decision tools employed. Conclusions in relation to the effectiveness (adherence and readmissions) and subjective perception.

The authors have not supplied their declaration of competing interest.

Antipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.

To evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.

This was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.

In basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.

Several studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.

The authors have not supplied their declaration of competing interest.

Diverse prescription patterns and differences in length of psychiatry inpatient stay among European and American countries have been reported [1,2].

To describe and compare clinical features and drug prescriptions in two Acute Psychiatric Units from Spain and USA.

Cross-sectional and comparative study. Sample: 73 inpatients from Reno (USA-Inpatients) and 65 from Oviedo (Spain-Inpatients) admitted to public Adult Acute Psychiatric Unit over a two-month period. Sociodemographic/clinical data and drug prescription were collected.

Sociodemographic/clinical comparison (Table 1) and drug prescription differences (Table 2) are shown.

No significant differences in antipsychotics’ prescription except for the most frequently used [risperidone in Spain (36%)/ziprasidone in US (19.6%), Chi2 = 39.7**].

(A) Psychiatric inpatients in US are younger, have longer hospitalization, show more comorbid substance use disorder and differ from Spanish inpatients in frequency of diagnostic categories (schizophrenic disorders represent a larger proportion).

(B) Inpatients in Spain usually receive polytherapy, and are more frequently treated with antidepressants and anxiolytics, especially benzodiazepines. In contrast, USA-Inpatients take lithium more often [1,2].

The authors have not supplied their declaration of competing interest.

Older patients with psychiatric conditions often have other disorders that include different levels of cognitive impairment, modifying the presentation of psychiatric symptoms and requiring treatment adaptations [1].

To describe clinical profile of hospitalized patients > 65 years, and its relationship with the presence of cognitive impairment and the length of hospital stay.

Descriptive and comparative study. Sample: 71 inpatients > 65 years (mean ± SD Age: 72.42 ± 5.96), admitted to “Hospital Universitario Central de Asturias”(Spain) from August 2014 to June 2015. Age, length of hospitalization, diagnosis, cognitive impairment and treatment data were collected (Table 1).

Days of hospital stay (mean ± SD) = 15.89 ± 11.53. No variable showed significant relation except number of antipsychotics taken (r = 0.307, P = 0.009). Cognitive impairment was significantly more frequent in men than women (45.5/15.8%; χ2 = 7.46; P = 0.006). No other variable showed significant differences.

A high percentage of psychiatric inpatients > 65 years present a cognitive impairment (29.6%) which was more frequent in males (45.5%). The length of hospital stay seems to be similar than in the rest of patients and not being affected by any of studied variables. More studies should be carried on to compare those results with similar variables in younger population and to analyze if there are differences between subgroups (65–75 vs > 75) [1].

The authors have not supplied their declaration of competing interest.