Parasuicidal behavior in early stages of psychosis

Introduction Psychotic experiences (PE) are strongly associated with non-suicidal self-harm (NSA). NSA are present throughout life, but are more frequent during adolescence and young adulthood. Early psychotic episodes (PEP) are a particularly vulnerable group compared to later phases of psychosis psychosis. Objectives Analyze risk factors for suicide attempts and NSA, in order to improve early detection and prevention of suicides in adolescents and young adults with PD Methods Review in the literature of the different risk factors associated with parasuicidal behaviors in early psychosis Results Presence of positive psychotic symptoms: auditory hallucinations, Delusional ideation. Social isolation Longer duration of untreated psychosis. Comorbid symptoms: irritability, depression, anxiety, psychotic distress, insomnia. Traumatic events in childhood Difficulty in regulating emotional, impulsivity and sensitivity to reward. Consumption of substances. Psychosocial stress. Conclusions We consider essential the inclusion of early intervention programs aimed at the prevention of suicide and NSA, evaluating all risk factors for suicide and NSA among individuals with a PEP and high-risk mental states. Initial assessment and ongoing assessments of suicide risk and parasuicidal behaviors, positive psychotic symptoms, depression, and the other related risk factors mentioned are required. Integrating trauma management into PEP care is critical. Bibliography: 1.- Honings S, et al. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med. 2016;46(02):237–51. doi: 10.1017/S0033291715001841 2.- Honings S, et al. Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology. Psychiatry Res. 2016;245:267–75. doi: 10.1016/j.psychres.2016.08.002 3.- Nishida A, et al. Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: Findings from a cross-sectional survey of 16,131 adolescents. Schizphr Res. 2014;159(2–3):257–62. doi: 10.1016/j.schres.2014.09.030 39. Disclosure of Interest None Declared

Introduction: Depressive symptoms and suicidal behaviour are common among patients that suffered a first-episode psychosis.Depressive symptoms could occur in different phases of psychosis, including in post-psychotic period.Depression is a well-known risk factor for suicidal behaviour in psychosis with data showing that occurrence of depression in psychosis have a significant correlation with suicide risk.Objectives: The purpose of this paper is todo a brief review on the relation of causality that existes between first episode psychosis and depressive symptoms as well as suicidal ideation.Methods: Brief non-systematic literature review on the topic.Results: First episode psychosis is not uncommonly followed by depressive symptoms and suicidal thoughts.The rate of suicide attempt in psychotic patients range from 10 to 50%.Individuals with first episode psychosis have a greater risk of suicidal behavior compared with normal population and chronic disorders.In several studies, factors identified as being associated with depressive symptoms after first episode psychosis were anomalies of psychosocial development, poor premorbid childhood adjustment, greater level of continuing positive symptoms and longer duration of untreated psychosis.Suicidal behavior was associated with sexual abuse, previous suicide attempt, comorbid polysubstance use, lower baseline functioning, longer time in treatment, recent negative events, older patients, longer duration of untreated positive and negative psychotic symptoms, family history of severe mental disorder, depressive symptoms and cannabis use.Data also indicate that treatment and early intervention programs reduce depressive symptoms and suicidal behavior after first episode psychosis.Conclusions: There is convincing evidence that depressive symptoms and suicidal behaviour have high rates after first episode psychosis.The research for treatment of depressive symptoms and/or suicidal behaviour after first-episode psychosis is very limited, therefore this paper aims to bring to light the importance of more studies on the matter.Introduction: This is the case of a girl, aged 13, starting on 2021 with a first psychotic episode.Before this episode, her psychiatric history was an adjustment disorder because of scholar bullying, fully recovered before the onset of the current symptoms.Objectives: To describe an interesting case of early-onset psychosis.Methods: We have used the interviews with the patient and her profile in Diraya (the medical database software in Andalucía).

Results:
The first symptoms started 6 months before the first hospitalization, and consisted in mild behavioural disorders, with disobedience and rudenesses, which represented a significant change compared with the previous personality of the patient.3 weeks before the first admission she abruptly started to experience disconnection, unmotivated laughs, decreaded academic performance and incoherent speech.Also, she showed motor symptoms, consisting in oral and right-hand stereotypies.Then, she was hospitalized in a Pediatric unit, in order to rule out organicity.The nuclear magnetic resonance showed an image suggestive of venous development anomaly, with no acute injuries.Her cerebral spinal fluid was widely studied, and all the results were negative, including: the technique of PCR for many virus and bacteria that can cause meningitis or encephalitis; a bacterial culture; a biochemical study; antineuronal antibodies; and a limbic encephalitis antibodies study.Besides, the blood count, the biochemistry, the gasometry and serology were also negative.No drugs were detected in the urinalysis.Once the organicity was ruled out, she was treated with Olanzapine and Diazepam, and destinated to my child and adolescent psychiatry unit.During the first hospitalization we observed that she looked very often to the mirror, showed soliloquies and took leaps.During the interviews she was desinhibited.She initiated a delusional speech, focused in sexual topics.She said that she's had a baby in the future with his father, and talked a lot about things she had already made in the future.During this admission, we changed the treatment to Quetiapine and Valproate.The second hospitalization was was done due to a lack of efficacy with the previous treatment and the presence of autolytic thoughts.We switched from Quetiapine to Aripiprazole.After a few days, she showed again a desinhibited behaviour, and kept the delusional speech, that now was more complex, refering that she had more than 20 babies, with many different men.After this we tried Lurasidone and suspended Aripiprazole, she showed a clinical improvement, at the cost of many side effects, though.So we finally changed to Clozapine, in combination with Gabapentin.Since she got clinical levels of clozapine, the delusions have been encapsulated.Conclusions: The differential diagnosis is set with an early-onset schizophrenia and a schizoaffective disorder.Obviously, the evolution of the sypmptoms in the following months and years will have the last word.

EPV0929
Extrapyramidal syndrome in psychotic depression: a case report.
Introduction: Psychotic depression is a subtype of major depression, with worst prognosis but underdiagnosed and undertreated.We introduce the case of a 75-year-old patient who is attended in the hospital presenting sorrow and behavioral disturbances.He also had delusions of ruin and surveillance through his phone, adding amnesia, dizziness, constipation, tremor and bradykinesia.He had suffered a limited depressive episode regarding his wife's death.
Interest: None Declared EPV0927 Parasuicidal behavior in early stages of psychosis Introduction: Psychotic experiences (PE) are strongly associated with non-suicidal self-harm (NSA).NSA are present throughout life, but are more frequent during adolescence and young adulthood.Early psychotic episodes (PEP) are a particularly vulnerable group compared to later phases of psychosis psychosis.Objectives: Analyze risk factors for suicide attempts and NSA, in order to improve early detection and prevention of suicides in adolescents and young adults with PD Methods: Review in the literature of the different risk factors associated with parasuicidal behaviors in early psychosis Results: • Presence of positive psychotic symptoms: auditory hallucinations, Delusional ideation.• Social isolation • Longer duration of untreated psychosis.• Comorbid symptoms: irritability, depression, anxiety, psychotic distress, insomnia.• Traumatic events in childhood • Difficulty in regulating emotional, impulsivity and sensitivity to reward.• Consumption of substances.• Psychosocial stress.Conclusions: We consider essential the inclusion of early intervention programs aimed at the prevention of suicide and NSA, evaluating all risk factors for suicide and NSA among individuals with a PEP and high-risk mental states.Initial assessment and ongoing assessments of suicide risk and parasuicidal behaviors, positive psychotic symptoms, depression, and the other related risk factors mentioned are required.Integrating trauma management into PEP care is critical.Bibliography: 1.-Honings S, et al.Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and metaanalysis.Psychol Med.2016;46(02):237-51.doi: 10.1017/ S0033291715001841 2.-Honings S, et al.Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology.Psychiatry Res.2016;245:267-75.doi: 10.1016/j.psychres.2016.08.002 3.-Nishida A, et al.Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: Findings from a crosssectional survey of 16,131 adolescents.Schizphr Res.2014;159(2-3):257-62. doi: 10.1016/j.schres.2014.09.030 39.Disclosure of Interest: None Declared EPV0928 Early-onset schizophrenia: an adolescent case report C. Alcalde-Diosdado Crespi*, E. K. Alvarado Altuve, S. Cruz Bailén and I. Caparrós del Moral