European Psychiatry - Volume 33 - March 2016

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S22 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55
In this presentation, we will consider the evidence for comorbidity
between ASD and addiction [substance use disorders (SUD)] and
explore the possible underlying explanations.
Methods A literature study on similarities between addiction
and ASD (at a phenotypical and neurobiological level) as well as a
case note review on a year cohort of 120 consecutive admissions in
an adult addiction psychiatry unit and 120 admissions in an adult
ASD unit.
Results In our addiction psychiatry cohort, 8 (men) on 118
patients were diagnosed with autism spectrum disorder. This is
much higher than in the general population (1%). In the ASD cohort,
the results are measured at the moment and the results will be
presented in the presentation.
Autism spectrum disorders and addiction can both be perceived as
developmental disorders inwhich a genetic predisposition and vul-
nerability interact with environmental factors. They can be induced
by early stress thus affecting the proper functioning of the cortico-
striatal dopaminergic regulation systems (and also the HPA axis).
In “pure” ADHD this is attributed to a deregulation in the cogni-
tive loops and the “impulsivity” endophenotype. Whereas in cases
of ASD without an ADHD component the limbic and sensimotore
cortico-striatal regulations loops are also involved.
Conclusions There are clear indications that a possible comor-
bidity of substance abuse disorder should be considered in cases of
individuals with autism spectrum disorders. This finding is impor-
tant for clinicians to take into account in assessing patients with
addiction problems and ASD.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Coercion in psychiatry: Challenges and
perspectives
S14
Ethical challenges in the use of
coercion
M. Kastrup (Speciallæge i psykiatri)
Copenhagen, Denmark
The use of coercive measures remains one of the great challenges
in psychiatry.
Increased focus on patient rights and autonomy, concern from user
and relatives organizations as well as from human rights organiza-
tions all have contributed to that the use of all kinds of coercion is
high on the agenda. And yet, we are still faced with that a number
of psychiatric patients will experience that coercive measures are
used as part of their treatment.
The EPA Ethical Committee carried out a survey comprising the
European associations of psychiatry in which a questionnaire was
circulated regardingwhat the different associations foundwere the
major ethical challenges in their respective countries.
Among the issues that have given rise to particular concern are
the use of physical restraints including why some countries avoid
physical restraints while other – e.g. Denmark – use it extensively.
Why do we find such large differences? Is this due to different
approaches to coercion, different traditions? Shortage of resources?
Another concern is that certain groups seemmore likely to be sub-
ject to coercion compared to others. Thus, it has been demonstrated
that patients belonging to ethnic minority groups are more likely
to experience this.
The paper will focus on ethical problems and issues of concern
related to the use of coercion. The focus will be on facets of inter-
national relevance with the aim to remain critical towards the use
and when needed to strengthen the quality of coercive treatment
care.
URL:
Disclosure of interest The author has not supplied his declaration
of competing interest.
S15
Does the use of coercion improve the
outcome of patients with severe
mental disorders?
M. Luciano
University of Naples SUN, Department of Psychiatry, Naples, Italy
Coercive measures have always been part of the psychiatric arma-
mentarium; however, the clinical and ethical dilemma between the
use of a “therapeutic” coercion and the loss of patients’ dignity
is one of the most controversial issues in mental health practice.
According to International guidelines, coercive measures should
be adopted only when all the other less restrictive approaches
failed and should be considered as the “last restrictive alterna-
tive”. Although coercive measures are frequently used to manage
patients’ aggressive behaviors and self-harm, refusal of medica-
tion and impulsivity, their effect on patients’ outcome is not clear.
In fact, the use of coercive measures can reduce patients’ aggres-
siveness and improve psychiatric symptoms, but can also have a
negative impact in terms of therapeutic relationship, engagement
with mental health services and self-stigma, arising negative feel-
ings on patients and on mental health professionals. International
attempts have been made to improve and harmonize the use of
involuntary treatments. Recommendations of good clinical practice
on the use of coercive involountary treatments and forced medica-
tions have been proposed by the EUNOMIA consortium, and the
effect of coercion on the outcome of patients with severe mental
disorders have been described. Results of this studywill be reported
as well as lessons learnt from other international experiences.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Considering pain to better understand the suicidal
process
S16
Psychological pain and interpersonal
theory of suicide
A. Apter
Schneiders Childrens Medical Center of Israel, Petach Tikva, Israel
Psychological pain is an important variable in the understanding of
suicidal individual.
This presentation describes the how psychological pain interacts
with problems in communication to set up risk for serious suicidal
behavior and describes some empirical studies supporting a model
for using this concept in suicide prevention strategies.
Disclosure of interest The author has not supplied his declaration
of competing interest.
S17
Pain perception in self-injurious
behaviours
C. Schmahl
Central Institute of Mental Health, Psychosomatic Medicine and
Psychotherapy, Mannheim, Germany