Bakker, M

De Jong, S

Elfeddali, I

Metz, M

Van der Feltz-Cornelis, CM

Van Nieuwenhuizen, C

English

UCL Discovery

supported by translational models of this disease, even if theantipsychotics derived from this conceptual framework are notyet available on the market. However, the need for new pathogen-esis models for schizophrenia and new generations of antipsychot-ics is acute, therefore, an exploration of the antipsychotics in thepipeline could be helpful in understanding the current stage ofresearch in schizophrenia.Objectives:To assess the evidence supporting the potential benefitsof new antipsychotics in the pipeline.Methods: A literature review was performed through the mainelectronic databases PubMed, Cochrane, Clarivate/Web Of Sci-ence, and EMBASE) and clinical trials repositories (US NationalLibrary ofMedicine andWorld Health Organization Clinical TrialsRegistry Platform) using the search paradigm “antipsychotics”AND “schizophrenia” AND “non-dopaminergic” AND “non-glutamatergic”. All papers published between January 2010 andSeptember 2022 were included.Results: Xanomeline/trospium (xanomeline is a muscarinicM1/M4 receptor agonist at the central nervous system, while tros-pium limits its peripheral effects) was efficient for schizophrenia inone phase III clinical trial. Pimavanserin (a selective 5HT2A inverseagonist and antagonist) was efficient in improving negative symp-toms of schizophrenia in a phase II trial. Roluperidone (a 5HT2Aand σ2 receptor antagonist) has been associated with favorableresults in phase III clinical trials, mainly on negative symptoms ofschizophrenia. SEP-363856 is a TAAR-1 agonist and 5HT1A agon-ist, currently explored in phase III clinical trials for schizophrenia.MK-8189 is a phosphodiesterase 10A inhibitor, investigated inphase III clinical trials for schizophrenia.Conclusions: Based on the retrieved data in the literature, multiplemechanisms, other than glutamatergic and dopaminergic path-ways, are currently being investigated, and many of the anti-psychotics based on these mechanisms are in the advanced stageof research. This is important not only for the clinical need to findmore efficient and tolerable drugs for patients with schizophreniabut also because theymay shed new light on the pathogenesis of thisdisease.Disclosure of Interest: None DeclaredEPP0896Defining the therapeutic reference range forcariprazineM. Kapás, A. Horváth, D. Djuric, R. Csehi* and Á. BarabássyGedeon Richter Plc., Budapest, Hungary*Corresponding author.doi: 10.1192/j.eurpsy.2023.1178Introduction: According to the Consensus Guideline, the “thera-peutic reference range” (TRR) defines ranges of drug blood con-centrations that specify a lower limit below which a drug-inducedtherapeutic response is unlikely to occur and an upper limit abovewhich tolerability decreases or the therapeutic improvement ceases.The TRR can be obtained from concentration measurements(trough (pre-dose) plasma concentration under steady-state con-ditions) in studies at therapeutically effective doses.Objectives: The aim is to examine the TRR for cariprazine (CAR:1.5 mg/day to 6 mg/day) in schizophrenia studies.Methods: The population based TRR for CAR is derived by PK/PDevaluation from phase 2/3 schizophrenia efficacy studies withsparse PK sampling. The population PK simulated TRR is com-pared to the actually measured values obtained from two PKstudies. As the two active metabolites of cariprazine also contributeto the drug effect, plasma exposure is given for Total cariprazine(CAR þ DCAR þ DDCAR) and the parent drug (CAR).Results: PK/PD analyses demonstrated an increase in efficacy withincreasing exposure. These efficacy results are related to Totalcariprazine trough concentrations of ca. 30 nM and 100 nM thatdetermine the lower and upper TRR limits. For the parent drug, thepre-dose mean plasma concentration at 6 mg/day was between 5.7-10 ng/mL in different studies, while at 1.5 mg/day it was 1.9 ng/mL.Conclusions: The TRR of the trough plasma levels at steady state isca. 30 – 100 nM for Total cariprazine and ca. 2-10 ng/mL for theparent drug (unchanged drug) for schizophrenia treatment.Disclosure of Interest:M.Kapás Employee of: GedeonRichter Plc.,A. Horváth Employee of: Gedeon Richter Plc., D. Djuric Employeeof: Gedeon Richter Plc., R. Csehi Employee of: Gedeon Richter Plc.,Á. Barabássy Employee of: Gedeon Richter Plc.Suicidology and suicide prevention 03EPP0897Efficacy of a regional systems intervention for suicideprevention (SUPREMOCOL) in Noord-Brabant, theNetherlandsC.M. Van Der Feltz-Cornelis1*, I. Elfeddali2, M. Metz2, S. de Jong3,M. Bakker4 and C. van Nieuwenhuizen51Health Sciences, University of York, York, United Kingdom; 2CLGG;3GGZ Breburg; 4MTO and 5Tranzo, Tilburg University, Tilburg,Netherlands*Corresponding author.doi: 10.1192/j.eurpsy.2023.1179Introduction: Worldwide, annually more than 800,000 suicidesoccur. In the Netherlands, suicide rates rose from 8.6 per 100,000 in2007 to 11.4 per 100,000 in 2016. Rates in the province of Noord-Brabant were consistently higher than the national average. Noord-Brabant is a province in the south of the Netherlands covering anarea of over 4700 km2 with 2.5 million inhabitants. AlthoughNoord-Brabant has five specialised mental healthcare institutions(SMHIs), and 90% of suicides are deemed related to mental dis-orders, 60% of those who died by suicide did not receive mentalhealth treatment. However, with good access to treatment, suicidecould be preventable.Objectives: To evaluate whether the systems intervention com-pared to the regular care approach led to a reduction in suicides inNoord-Brabant. We aimed to attain a reduction in suicides of atleast 20%.Methods: Co-design and development of a digital monitoringsystem and decision aid. Stepwise implementation per subregionof the systems intervention by the five specializedmental healthcareinstitutions (SMHIs) and their chain partners. Pre-post analysis forthe whole province (Exact Rate Ratio Test, Poisson count).Results: The SUPREMOCOL systems intervention consisted offour pillars, which were all supported by a digital decision aidEuropean Psychiatry S559https://doi.org/10.1192/j.eurpsy.2023.1179 Published online by Cambridge University Pressand monitoring system. This was provided via a desktop computerwith a secured login. The data were kept on a secured encryptedserver. The number of professionals accessing the system waslimited to two per SMHI or other chain partner. They could onlysee patients in their subregion, not in the whole of the province. Thepillars of our systems intervention for suicide prevention are:1. Swift identication of people at risk for suicide by triage on the spotafter a non-fatal suicide attempt.2. Provision of swift access to specialised mental health care forthose at risk3. Accommodating transitions in care following a collaborative careapproach4. Prevention of suicidal attempts after discharge or treatmentdropout by 12 months telephone follow-up.Suicide rates dropped 17.8% (p=.013) from baseline (2017) toimplementation in 2018 and 2019. This is a significant reduction(p=0.043) compared to the non-significant drop in the rest of theNetherlands. Suicide rates dropped further by 21.5% (p= 0.002) in 2021.Noord-Brabant also dropped in the relative rank of the number ofsuicides, from second place in 2015 to third in 2018.Conclusions: During the SUPREMOCOL systems intervention,over a period of 4 years, there was a sustained and significantreduction of suicides in Noord-Brabant. We attained a reductionof 21,5% in total. Noord-Brabant dropped in the relative rank of thenumber of suicides, from second place in 2015 to third in 2018. Thisis a result that warrants further research and implementation intosystem interventions for suicide prevention with digital supportsuch as SUPREMOCOL.Disclosure of Interest:C. Van Der Feltz-Cornelis Grant / Researchsupport from: The Netherlands Organisation for Health Researchand Development, I. Elfeddali: None Declared, M. Metz: NoneDeclared, S. de Jong: None Declared, M. Bakker: None Declared,C. van Nieuwenhuizen: None DeclaredEPP0898Suicide and Violence against Women in Azerbaijan:Risk Factors and Barriers for Seeking MentalHealthcareD. Alonzo* and P. ZubarogluFordham University, West Harrison, United States*Corresponding author.doi: 10.1192/j.eurpsy.2023.1180Introduction:Azerbaijan ranks among the top 3 countries with thehighest rates of suicide in theMuslim world. Yet, research indicatesan underestimate of risk due to cultural stigma related to suicidalbehavior that may influence reporting and given that manyMuslim-majority countries, where populations exceed 100 million,do not report any data on suicide rates. Violence against womenalso occurs at alarming rates in Azerbaijan and is a significant riskfactor for suicide.Objectives:We examine perspectives towards suicide and violenceagainst women and barriers to care among key stakeholders.Methods: Thirty qualitative interviews and 4 semi-structured focusgroups were held with female survivors of suicide andmental healthprofessionals workingwith individuals at risk of suicide to assess forperspectives on suicide and violence against women, factors influ-encing help-seeking, and the nature of existing resources.Results: Most participants viewed suicide (83%) and violenceagainst women (73%) as problems. Nevertheless, 33% reportednegative stereotypes regarding suicide and 50% reported psycho-logical treatment as unaccepted in Azerbaijan. Findings highlightthat domestic violence is the strongly identified as risk factor forsuicide among women in Azerbaijan. Stigma and related culturalvalues regarding gender norms are significant contributors toviolence against women and suicide. Existing services are under-recognized and perceived of as unavailable or insufficient.Conclusions: Employing a social determinants of health lens,multi-level programming is needed that spans micro (individuallevel supports), mezzo (family level supports), and macro (advo-cacy and outreach) levels to support a comprehensive strategy thatbeings with prevention and extends to address intervention, man-agement, and capacity building to halt the increasing rates ofsuicide and deter violence against women.Disclosure of Interest: None DeclaredEPP0900Psychopathological symptoms as clinical phenotypes insuicide attempters: relation in terms of suicidalideation, suicidal related behaviors andmedical damageof the attemptD. Saiz-Gonzalez1,2*, P. Diaz-Carracedo2, A. Pemau2,W. Ayad-Ahmed1, F.-R. Veronica3, M. Navas Tejedor1,A. de la Torre-Luque2,4 and M. Diaz-Marsa1,2,41Psychiatry, Clinico San Carlos Hospital; 2Psychiatry, ComplutenseUniversity, Madrid, Spain; 3Psychiatry, Complutense University,Madrid and 4Psychiatry, CIBERSAM ISCII, Madrid, Spain*Corresponding author.doi: 10.1192/j.eurpsy.2023.1181Introduction: Suicide behaviour is a complex and multifactorconcept that includes different risk factors. According with litera-ture a dimensional concept of illness could help to understand thiscomplexity and clarify clinical aspects of suicide risk.Objectives: The aim of this study is to identify different profiles ofsymptoms in a sample of suicide attempters and the relationshipbetween this profiles and suicide behaviour in terms of outcome:presence and intensity of suicidal ideation, presence and number ofattempts and severity of themedical damage in the current attempt.Methods: 634 patients were recruited at the psychiatry emergencyof eight public general hospitals in Spain between November 2020until February 2022 in the SURVIVE protocol. The patients wereassessed in 15 days using a battery of clinical tools that includesBrief Symptom Inventory, a sociodemographic interview, MiniClinical Interview and C-SSRS, ACSS and BIS-11 scales. Latentprofile analysis was applied to obtain profile symptoms. Logisticandmultivariant regression was used to obtain data about outcome.Results: Three clinical profiles of psychiatric symptoms weredescribed in suicide attempters (p < 0.01): high symptoms (HS)(45.02%), moderate symptoms (MS) (42.5 %) and low symptoms(LS) (12.48%). Significant differences were found between classes infour symptom domains (Figure 1): anxiety, obsessive-compulsive,sensitivity, and somatization (p < 0.01). Participants of the HS classshowed higher values in relation with the BSI summary indexes,and more diagnoses, higher levels of suicidal ideation and suicidalrelated behaviour as well as higher acquired capability for suicide.S560 E-Poster Presentationhttps://doi.org/10.1192/j.eurpsy.2023.1179 Published online by Cambridge University Press

EPP0897

Efficacy of a regional systems intervention for suicide

prevention (SUPREMOCOL) in Noord-Brabant, the

Netherlands

https://discovery.ucl.ac.uk/10196144/1/Van%20Der%20Feltz-Cornelis_Efficacy%20of%20a%20regional%20systems%20intervention%20for%20suicide%20prevention%20%28SUPREMOCOL%29%20in%20Noord-Brabant%2C%20the%20Netherlands_abstract_VoR.pdf

EPP0897 Efficacy of a regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands

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