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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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.829

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:

http://www.mariannekastrup.dk

Disclosure of interest

The author has not supplied his declaration

of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.830

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.831

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.832

S17

Pain perception in self-injurious

behaviours

C. Schmahl

Central Institute of Mental Health, Psychosomatic Medicine and

Psychotherapy, Mannheim, Germany