P02-267 From evidence-based practice in suicide prevention to the real world: How long is the leap?

This presentation aims to shed light on effective suicide prevention activities that often are missing in the everyday clinical practice. Too often in fact suicidal individuals seek help from mental health professionals that nevertheless fail to recognize suicide risk. For instance, on average, 45% of suicide victims had contact with primary care providers within 1 month of suicide. Likewise, the real world often presents challenges that impair proper utilization of the evidence-based practice. Also, the alarming suicide rates around the world points to lack of effective preventive understanding of suicide. This presentation will present key point of the evidence-based practice, how to implement such approach and how to overcome difficulties in the real world. It will deal with the state of the art of preventive measures of suicide, what the missing elements are and how to make the most from personal experience without risking relying on clinician's intuition in management of suicidal individuals

Epidemiology of suicide: from population to single cases

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Determinants of international tourist choices in Italian provinces: a joint demand-supply approach with spatial effects

Research trying to explain tourism flows and expenditures for different destinations has so far adopted either a tourism-demand or a tourism-supply approach. Whereas on the one hand the former ignores the product specificities (Papatheodorou, 2001), the latter, on the other, fails to take into account the characteristics of the tourist origin markets. In recent years attempts to merge the two views have come from scholars using spatial econometric techniques, i.e. origin-destination models (O-D), which have been able to consider both effects simultaneously (Marrocu and Paci, 2013; Massidda and Etzo, 2012). This paper contributes to this literature by investigating the determinants of the expenditures of foreign tourists in 103 Italian provinces (NUTS 3). We depart from the previous literature in that our dependent variable is not tourist flows but foreign tourist expenditures. This variable, recently made available by the Bank of Italy for the years 1997-2012, is more informative than tourist flows in that it captures not only the number of arrivals but also their contribution to a destination's GDP. The observations of our cross-section database reflect the tourist expenditure for each Italian province from each of the 20 highest spending countries of origin, accounting for 85% of total receipts. Without having to use O-D models, we will disentangle the effects of both demand and supply variables on a province's tourism exports. Among the former ones, per capita GDP levels at origin and a measure of relative price will be considered. Among the latter ones: per capita GDP levels at destination and supply variables such as capacity constraints of tourist accomodations; tourism and transport infrastructures; crime, cultural and environmental capital, climate, settlement structure typology, etc. Moreover, we will take into account the role of the distance between origin and destination, which is also a proxy of transportation costs, and the possible spillover effects originating by the supply variables in contiguous provinces. Following Halleck Vega and Elhorst (2013), spatial effects will be analysed using the spatial lag of some of the independent variables and by parameterizing the spatial matrix W. Moreover, we will use a Poisson pseudo-maximum-likelihood method as suggested by Santos Silva and Tenreyro (2006) since this method is robust to different patterns of heteroskedasticity and provides a natural way to deal with zeros in trade data

Completed suicide during pregnancy and postpartum

Both pregnancy and the postpartum are typical periods for the onset or relapse of psychiatric symptoms and disorders, with depression and anxiety being the most common. The prevalence of suicide spectrum behaviour is significantly higher among women with a diagnosis of depressive or bipolar disorder. Suicide during pregnancy and postpartum is a multifactorial phenomenon and a history of psychiatric illness is only one of the possible risk factors involved in suicide spectrum behaviour. The present paper highlights the importance of a complete screening for both depression and suicide risk during peripartum

Questioning on consistency of a stagnation scale in medication overuse headache. one more added to a plea of emperor's clothes?

No abstract availabl

Neuropsychiatric disturbances in atypical Parkinsonian disorders

Multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD) are the most common atypical parkinsonisms. These disorders are characterized by varying combinations of autonomic, cerebellar and pyramidal system, and cognitive dysfunctions. In this paper, we reviewed the evidence available on the presence and type of neuropsychiatric disturbances in MSA, PSP, and CBD. A MedLine, Excerpta Medica, PsycLit, PsycInfo, and Index Medicus search was performed to identify all articles published on this topic between 1965 and 2018. Neuropsychiatric disturbances including depression, anxiety, agitation, and behavioral abnormalities have been frequently described in these disorders, with depression as the most frequent disturbance. MSA patients show a higher frequency of depressive disorders when compared to healthy controls. An increased frequency of anxiety disorders has also been reported in some patients, and no studies have investigated apathy. PSP patients may have depression, apathy, disinhibition, and to a lesser extent, anxiety and agitation. In CBD, neuropsychiatric disorders are similar to those present in PSP. Hallucinations and delusions are rarely reported in these disorders. Neuropsychiatric symptoms in MSA, PSP, and CBD do not appear to be related to the severity of motor dysfunction and are one of the main factors that determine a low quality of life. The results suggest that neuropsychiatric disturbances should always be assessed in patients with atypical parkinsonisms

Gene variants with suicidal risk in a sample of subjects with chronic migraine and affective temperamental dysregulation

BACKGROUND: Risk factors for suicide are at least partially heritable and functional polymorphisms of targeted genes have been suggested to be implicated in the pathogenesis of this phenomenon. However, other studies examining the association between specific gene variants and suicide revealed inconsistent findings. We aims to evaluate the possible association between MAO-A3, CYP1A2*1F and GNB3 gene variants, hopelessness and suicidal risk in a sample of subjects with chronic migraine and affective temperamental dysregulation. METHODS: 56 women were genotyped for MAO-A3, CYP1A2*1F and GNB3 gene variants. Participants were also assessed using Beck Hopelessness Scale (BHS), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A), and the Suicidal History Self-Rating Screening Scale (SHSS). RESULTS: Patients with higher total scores on affective dysregulated temperaments are more likely to have higher BHS (11.27 +/- 5.54 vs. 5.73 +/- 3.81; t19.20 = -3.57; p = 9 indicating high levels of hopelessness. No association was found between MAO-A3, CYP1A2*1F and GNB3 gene variants and suicidal risk as assessed by BHS and SHSS. CONCLUSIONS: This study did not sustain the association between MAO-A3, CYP1A2*1F and GNB3 gene variants and increased suicidal risk in patients with chronic migraine and affective temperamental dysregulation. Further studies investigating the gene-environment interaction or focusing on other genetic risk factors involved in suicidal behaviour are needed

The relationship among the health-related quality of life, illness severity, personality and psychiatric symptoms in patients with psoriasis: an empirical investigation

Background: Psoriasis is a complex and chronic inflammatory skin disorder. The mechanisms underlying this immune-mediated disease are not clear, but some evidence indicates that specific personality features and symptom patterns may play an important role in the development and clinical presentation of the disorder and influence the quality of patients’ lives. This study aimed at evaluating the associations among the quality of life, illness severity, psychiatric symptoms and personality patterns in patients with psoriasis treated with biological or topical therapy. Methods: Fifty psoriatic patients were evaluated with self-report measures: the Symptom Checklist-90-R (SCL-90R) and the Psoriasis Index of Quality of Life (PSORIQoL). Their personality and psychological functioning were assessed by external raters using the Shedler-Westen Assessment Procedure (SWAP-200) applied to the Clinical Diagnostic Interviews (CDI). Finally, the severity and the area of psoriatic lesions were evaluated by dermatologists with the Psoriasis Area Severity Index (PASI). Results: Significant differences between the groups (biological vs topical therapy) were found in PASI scores: patients assigned to biological therapy showed lower levels of illness severity. No differences were found in PSORIQoL scores. The quality of life was negatively associated with various dimensions of SCL-90R and with borderline (r = .39; p< .01), dependent (r = .41; p< .01) and avoidant (r = .35; p< .05) personality styles/disorders; conversely, it did not relate to PASI. Conclusions: The results seem to suggest that the quality of life in psoriatic patients is more influenced by personality characteristics and psychiatric symptoms than by the severity of psoriatic lesions

How to save a life. From neurobiological underpinnings to psychopharmacotherapies in the prevention of suicide

The impact of suicide on our societies, mental healthcare, and public health is beyond questionable. Every year approximately 700 000 lives are lost due to suicide around the world (WHO, 2021); more people die by suicide than by homicide and war. Although suicide is a key issue and reducing suicide mortality is a global imperative, suicide is a highly complex biopsychosocial phenomenon, and in spite of several suicidal models developed in recent years and a high number of suicide risk factors identified, we still have neither a sufficient understanding of underpinnings of suicide nor adequate management strategies to reduce its prevalence. The present paper first overviews the background of suicidal behavior including its epidemiology, age and gender correlations, and its association with neuropsychiatric disorders as well as its clinical assessment. Then we give an overview of the etiological background, including its biopsychosocial contexts, genetics and neurobiology. Based on the above, we then provide a critical overview of the currently available intervention options to manage and reduce risk of suicide, including psychotherapeutic modalities, traditional medication classes also providing an up-to-date overview on the antisuicidal effects of lithium, as well as novel molecules such as esketamine and emerging medications and further molecules in development. Finally we give a critical overview on our current knowledge on using neuromodulatory and biological therapies, such as ECT, rTMS, tDCS, and other options.(c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)