Understanding variations in knowledge and attitudes of psychiatrists to psilocybin therapy is important for the collective discourse about the potential impact on clinical practice and public health in Ireland.

A 28-item questionnaire was designed based on previous studies and distributed to psychiatrists in Ireland via online mailing lists and at in-person academic events.

151 psychiatrists completed the questionnaire (73.3% were under 40 years of age, 76.0% were trainees, and 49.0% were female). In the total sample, 81.5% agreed that psilocybin therapy shows promise in the treatment of psychiatric disorders and 86.8% supported funding research, 86.8% would be willing to refer a patient if it was licensed and indicated, and 78.1% would consider the treatment for themselves, if indicated. Conversely, 6.6% agreed that psilocybin therapy was unsafe even under medical supervision, and 21.9% thought it was potentially addictive. 15.9% of the total sample reported at least one concern including, lack of robust evidence, long-term effectiveness, superiority to current interventions, potential harmful effects, cost and accessibility, and impartiality. Less than half of respondents felt knowledgeable (40.0%) and 9.9% felt adequately prepared to participate in psilocybin therapy. Consultant psychiatrists trended towards less optimism for a potential role in bipolar depression and emotionally unstable personality disorder compared to trainee psychiatrists.

Overall psychiatrists in Ireland held positive attitudes towards psilocybin therapy. However, there was a lack of knowledge evident. Addressing the knowledge gap and aligning with the best available evidence will be key if psychedelic therapy is to prevail in a clinical setting.

Complex regional pain syndrome (CRPS) is a rare condition associated with chronic pain. It is an inflammatory and neuropathic disorder principally characterized by involvement of the autonomic nervous system. The etiology of the syndrome is not clear and the known treatment modality is also very complicated.

Extant literature has shown the relationship between CRPS and suicidal behaviours in adults but less data are available in adolescents. This literature review aims to synthesize and evaluate the existing studies assessing suicidality in CRPS adolescents.

A narrative review of the literature focusing on CRPS and chronic pain in adolescents and their associations with suicidal behavior including suicidal ideations, suicide attempts and death by suicide.

The studies of suicidality factors in adolescents evaluated chronic pain in general. Those who studied CRPS specifically did not look for its association with suicide risk. In fact, adolescents who suffer from chronic pain present increased risk for suicide ideations and suicidal attempts. Furthermore, no available data have demonstrated the association between chronic pain and suicide. Additionally, among adolescents with CRPS, the risks of somatization, anxiety, and depression are higher. The duration of pain, depression and eating disorders has been shown to be associated with increased suicidality.

Our findings suggest that CRPS is associated with higher risks for suicidal ideation, suicidal attempts compared to the general population. The risk factors underlying suicidal behavior in CRPS patients are not studied enough and require further investigation.

None Declared

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by the deficit in communication and social interaction as well as restricted and repetitive interests and behaviors. In addition to the involvement of the environmental component in ASD, it is currently established the significant contribution of genetic factors such us the 16p13.11 duplication. We report the case of a patient carrying this anomaly in whom an ASD was diagnosed, the genetic study of the parents objectified the same anomaly in a clinically healthy father.

This case report aims to expand the clinical findings associated to this genomic abnormality and provide further knowledge of the pathogenic involvement of this duplication.

Our patient, aged 4 years and 10 months, presented developmental peculiarities from birth. The difficulties became more evident with the language delay, the deficit of social interactions and the appearance of motor stereotypies as well as sensory specificities. The diagnosis of ASD was confirmed by the passation of the ADI and the ADOS.

Further genetic exploration with a CGH-Array request was performed due to a normal 46 XY karyotype. She objectified a 16p13.11 duplication comprising 25 genes including NDE1. The assessment was completed by the search for potentially associated malformations, particularly cardiac and skeletal. We continued the family investigation with genetic samples for the parents and the siblings finding the same anomaly in the father who does not present any particular phenotype.

The 16p13.11 duplication is associated with a variable clinical spectrum including behavioral disorders, attention deficit/ hyperactivity disorder, intellectual disability, cardiac and skeletal malformation, epilepsy as well as ASD and language delay presented by our patient. Eight annotated genes are present in this region including NDE1, the candidate gene for the neurocognitive phenotype. This microduplication can be found in the normal population, but it is increasingly detected in patients with ASD, schizophrenia or presenting cognitive disorders due to incomplete penetrance that can explain the presence of the duplication despite the absence of any disorders in the patient’s father.

The link between the 16p13.11 duplication and ASD is increasingly recognized in the literature. The heterogeneity of its clinical expression and especially its incomplete penetrating make genetic counseling difficult. Collaboration between child psychiatrists and geneticists remains essential to detect, link their clinical evaluation and optimize care.

None Declared

As part of a process to improve bipolar disorders (BPD) treatment and outcome in France, AFBP developed recommendations in the management of patients with bipolar disorders for French practitioners. The recommendations aim to reflect both evidence-based practice and real-world experience. Here, we will focus on the management of BPD with comorbid addictive disorders.

A formalized method by expert consensus panel was used. 239 questions were developed and sent to a panel of 40 French experts in order to assess six domains:

1. 1) screening and diagnosis,

2. 2) acute phase treatment,

3. 3) maintenance and non pharmacological treatment,

4. 4) somatic comorbidities,

5. 5) psychiatric comorbidities and suicide risk management and

6. 6) special populations.

Special attention was made to situations where evidence based treatment are lacking.

The treatment of BPD and comorbid addictive disorders should be concurrent. The only exception is during an alcohol withdrawal where mood state may be reassessed for a second time. Experts recommend the use of atypical antipsychotics or anticonvulsants during a manic, mixed or depressive episode as well as in prophylaxia. During a depressive episode, the adjunction of an antidepressant may be considered. If adjunctive sedative treatment is necessary, a sedative classical antipsychotic seems to be a better choice that benzodiazepine. Substitution treatment for opioid must not be stopped. A psychotherapy focused on the addiction should be systematic in susbtance dependence and proposed in substance abuse.

The French expert panel recommends different therapeutic options for patients with dual diagnosis compared to usual BPD patients.

The method chosen for these guidelines is a formalized consensus of experts. It enables, through a series of specific clinical situations proposed to the experts, to provide recommendations for the management of bipolar disorder. The situations where defined because they are not associated to evidence-based recommendations according to the lack of controlled studies.

40 experts participate to this consensus. As in most of the guidelines for the treatment of bipolar disorder, more than 50 % of experts (51,3 to 72,9%) recommend the same therapeutic strategies to treat major depressive episode whichever the type (bipolar I or II).

Unlike to other guidelines, French experts propose different therapeutic according to the presence or absence of rapid cycling. For major depressive episode without rapid cycling, 63% experts recommend a combination of an antidepressant with a mood stabilizer. In rapid cyclers, 51% experts recommend the use of a mood stabilizer in monotherapy or in combinaison, but never associated with antidepressant.

This methodological approach enables to get closer to everyday clinical practice and integrate specificities of prescription through a national panel of experts. On the other hand, this type of methodology highlights the research perspectives: i.e. management of acute depression with rapid cycle in bipolar disorder.

People with eating disorders (ED) are at high risk for suicidal behavior. Among different ED, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of completed suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an ED.

Case-control study in cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity.

AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4–7.9), with a higher expectation of dying (OR = 3.7, 95% CI 1.1–13.5), and an increased risk of lethality (OR = 3.4, 95% CI 1.2–9.6). BN patients did not differ from the control group.

There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Deaths from suicide in AN may not be the result simply of their greater physical frailty.

Childhood trauma and aggressive traits are considered risk factors for suicidal behavior. The hypothesis we aimed to test in this study was the existence of an association between childhood trauma and aggression in two distinct samples of Italian and French suicide attempters.

Study participants comprise 587 subjects with different psychiatric diagnoses according to DSM-IV-TR criteria. Three different samples were analyzed and compared: a group of French suicide attempters (N = 396; mean age 40.47 SD = 13.52; M/F: 110/286); a group of Italian suicide attempters (N = 103; mean age 38.60 SD = 12.04; M/F 27/76) and an Italian psychiatric comparison group (N = 88; mean age: 41.49 SD = 12.05; M/F; 37/51). Patients were interviewed with the Brown–Goodwin Assessment for Lifetime History of Aggression (BGLHA) and the Childhood Trauma Questionnaire (CTQ) 34-items for Italian data and 28-items for French data.

When compared with the comparison group, Italian suicide attempters had significantly higher scores on the BGLHA scale and reported higher scores on the CTQ scores for physical abuse, sexual abuse and emotional abuse. Significant correlations between childhood trauma and aggression were found in both groups, Italian and French, of suicide attempters.

The hypothesis tested was supported as psychiatric patients who had attempted suicide reported significantly more childhood trauma and aggression. Significant correlations were found between aggressive behavior, and childhood trauma in suicidal patients. This finding was replicated in two independently recruited samples in two countries with different prevalence of suicidal behavior.

A better understanding of the pathophysiology of suicidal behaviour (SB) may enable the discovery of more specific treatments and a better identification of vulnerable patients. The vulnerability to SB appears to be underlied by genetic factors coding for traits rendering the individual less able to cope with stressing situations, and more likely to be engaged in a suicidal process.

During the recent years, neuroscientific studies begun to identify potential endophenotypes.

We have shown that disadvantageous decision making (DM) was involved in the vulnerability to SB. DM impairment appears to be independent of comorbid psychiatric disorders, associated with emotional dysregulation (i.e. affective lability trait and skin conductance responses), and modulated by serotonergic genotypes associated with SB. In recent fMRI studies, the region that is likely involved in DM, is overactivited in response to angry faces, suggesting a higher sensitivity to specific negative social stimuli. Deficit in risk evaluation and excessive response to specific emotional stimuli may represent key processes in the vulnerability to SB.

These potential endophenotypes may represent future relevant markers of vulnerability for the identification of vulnerable patients, and relevant targets for the development of new treatments.

Smoking and suicidal behavior are two major public health problems associated in epidemiological and clinical studies. Smoking has been associated with suicidal ideation, suicide attempts, and suicide, independently of mental disorders. Yet, the mechanism that links smoking and suicidal behavior is unknown. We investigated the relationship between the level of tobacco dependence and the severity of suicidal outcomes among suicide attempters.

We examined a sample of 542 adult suicide attempters to compare the characteristics of the attempts depending on the level of tobacco dependence. All participants had made a suicide attempt in the previous two years (criterion for suicidal behavior disorder). Level of tobacco dependence was assessed with the Fagerstrom test. Diagnoses were ascertained with the Mini International Neuropsychiatric Interview and suicidal behaviors were assessed, among others, with the Risk Rescue Rating Scale and the Suicidal Intent Scale. Impulsivity was measured with the Barratt Impulsiveness Scale.

Independently of potential confounders, heavy smokers (Fagerstrom≥7) made more attempts and reached higher medical lethality than non-smokers (OR=2.42; 95%CI= 1.43-4.11, p=0.001, and OR=1.88; 95%CI=1.09-3.24; p=0.03, respectively). Light smokers (Fagerstrom<7) were not associated with features of severity in their suicide attempts. The combination of high impulsiveness and severe tobacco dependence showed an additive effect on the number of suicide attempts (OR=3.55; 95%CI= 1.75-7.21).

A high level of tobacco dependence could indicate a specific vulnerability leading to more severe suicide attempts, which was only partially explained by impulsivity traits.

Pre- and perinatal insults, childhood maltreatment, and personality traits have been separately related to suicidal behavior.

To explore if all these factors act in an additive fashion.

To examine characteristics of suicide attempts in a life course perspective.

Sample and procedure: Cross-sectional study of 1042 suicide attempters. Indexes of pre- and perinatal adversity were hospitalization in neonatology, very premature birth (< 31 weeks of pregnancy), tobacco during mother's pregnancy, and mother's and father's age at patient's birth. All suicide attempters were evaluated using the French version of the Childhood Trauma Questionnaire, and the Tridimensional Personality Questionnaire. Characteristics studied in suicide attempters included violence of suicide attempt, age at first suicide attempt, and number of suicide attempts. Statistical Analyses: Comparisons between groups was made using c2 with crude and adjusted odds ratios, and 95% confidence intervals. All analyses were adjusted for gender, age, study level, Alcohol dependence or abuse, Substance dependence or abuse, Tobacco, Episode of major depression, Bipolar, Anxiety, Eating disorders, and Schizophrenia.

We found an additive effect between prematurity and sexual abuse (OR[95%] = 3.57[1.03–12.50];p < 0.001), emotional abuse (OR[95%] = 4.54[1.76–12.50];p < 0.05), novelty seeking (OR[95%] = 9.09[1.76-12.50];p < 0.001), and harm avoidance (OR[95%] = 5.88[2.38-14.28];p < 0.001) for a younger age at first suicide attempt. Tobacco during mother's pregnancy, and harm avoidance also had an additive effect on the age at first suicide attempt (OR[95%] = 4.76[1.96–11.11];p < 0.05) and number of suicide attempts (OR[95%] = 3.31[1.37–7.99];p < 0.05).

Pre- and perinatal insults, childhood maltreatment, and personality traits influence in an additive fashion characteristics of suicide attempts.

Several studies have demonstrated various neuropsychological dysfunctions in patients with EDs [1]. Among them, cognitive inhibition deficits has been studied. While Eating Disorders (ED) are characterized by difficulties to inhibit feeding behavior, there is no consensus regarding neuropsychological studies about cognitive inhibition deficits [2, 3]. The goal of this study is to examine the contribution of the type of measurement used (self-report questionnaires versus neuropsychological tests) to explain these differences between studies.

Patients (ED) suffering from anorexia nervosa (AN; n=33), bulimia nervosa (BN; n=27) with no psychiatric comorbidity and free of psychotropic medication, and healthy controls (HC; n=xx) with no psychiatric history were assessed using the Hayling Test (neuropsychological test) and BIS-10 (self-report questionnaires).

1. [1] Significant differences in self-report questionnaires (BIS-10) were observed between ED and HC. BN showed more pronounced cognitive inhibition deficits then AN.

2. [2] No significant differences in neuropsychological tests (Hayling Test) were observed between ED and HC.

This study confirms dissociation between measures of self-report questionnaires and neuropsychological tests of cognitive inhibition and impulsivity in people with ED.

Despite the multidimensionality of suicidal behavior, to date there is no precise depiction of suicide attempters according to their features. In this study we investigate if a sample of suicide attempters can be clustered in homogeneous subgroups according to the characteristics of their suicidal behavior. Once the main clusters were identified, we have compared the main risk factors between the groups to establish clinical profiles.

Patients between 18 and 84 years old were recruited as part of a suicide attempters study (n=1009). They were consecutively hospitalized and survivors of a current suicide attempt in a specialized unit of the Montpellier University Hospital. We used an Ascending Hierarchical Classification following Ward's method to identify clusters among suicide attempters. Clusters were then compared with regards to phenotypic and genetic variables.

Three clusters were identified. Attempt planning, substance use, and few possibilities of rescue characterized the first cluster (‘reflexive’, n=40). The second cluster (‘moderate’, n=604) did not plan the attempts but used non-severe non-violent means. Finally, the third cluster (‘impulsive’, n=365) made the first attempt at an earlier age, made more attempts, and more violent attempts. Significant differences between clusters were also found regarding gender, tobacco smoking, childhood abuse, family history of suicide and several genetic polymorphisms.

Three clearly differentiated clusters of suicide attempters were identified. Phenotypic and genetic differences allow the identification of these clusters in clinical settings. Prevention programs might be improved by targeting specific subgroups of attempters.

CYP2D6 and CYP2C19 are involved in the metabolism of widely used antidepressants and other drugs with psychotropic activity. They also participate in the metabolism of endogenous substrates, and are expressed in the brain.

This study examined, for the first time, whether a high CYP2D6-CYP2C19 metabolic capacity combination increases the likelihood of suicidal intent severity in a large study cohort.

Survivors of a suicide attempt (n=587; 86.8% women) were genotyped for CYP2C19 (*2, *17) and CYP2D6 (*3, *4, *4xN, *5, *6, *10, wtxN) genetic variation and evaluated with the Beck Suicide Intent Scale (SIS).

Patients with a high CYP2D6-CYP2C19 metabolic capacity showed an increased risk for a severe suicide attempt (P<0.01) as measured by the SIS-objective circumstance subscale (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.05-1.78; P=0.02). Importantly, the risk was greater in those without a family history of suicide (OR=1.82; CI=1.19-2.77; P=0.002).

Further research is warranted to evaluate whether the observed relationship is mediated by the role of CYP2D6 and CYP2C19 involvement in the endogenous physiology or drug metabolism or both.

This work was supported in part by Union Europea Fondo Social Europea (FEDER/FSE), Instituto de Salud Carlos III-FIS (PI10/02758) and Gobierno de Extremadura Consejería de Economía, Competitividad e Innovación (IB13186 and PD10199). CHU Montpellier (PHRC UF 7653), Agence Nationale de la Recherche (ANR NEURO 2007 'GENESIS').