European Psychiatry - Volume 33 - March 2016

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S54 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55
alterations in the serotonin transporter and the 5-HT1A receptor
that are similar to those seen in suicides and moreover the sever-
ity of the abnormality in 5-HT1A binding is correlated with the
lethality of suicidal behavior. Other studies examining CSF levels of
5-HIAA are consistent with imaging data and extend the findings
to the noradrenergic and dopaminergic systems. Finally, we will
present data on use of these biomarkers to predict treatment out-
come. Abnormal decision-making and mood regulation in suicidal
patients is linked to abnormal brain biology and has direct implica-
tions for clinical practice in terms of selecting specific types of med-
ication and how thesemay be best combinedwith psychotherapies.
Disclosure of interest The author has not supplied his declaration
of competing interest.
S113
Age and pharmacotherapy of suicidal
depressed bipolar patients
M.A. Oquendo ∗ , H. Galfalvy
1 Columbia University and New York State Psychiatric Institute, New
York, NY, USA
2 Columbia University, Biostatistics and Psychiatry, New York City,
NY, USA
∗ Corresponding author.
The mortality and morbidity due to suicidal behavior associated
with bipolar disorder is the greatest among psychiatric diagnoses.
To address this problem, it is essential to find predictors of future
risk as well as protective factors. Studies from several international
teams have demonstrated that for bipolar disorder, the presence
of a depressive episode is the most robust predictor and risk
increases as does depression severity. Protective factors such as
older age and religious affiliation are also key moderators. The
role of pharmacotherapy in suicidal behavior has been studied
mostly utilizing data that are either observational and naturalis-
tic, rather than experimental. Only one randomized, double-blind
clinical trial has been conducted to date, although another one is
underway. The comparison of lithium and valproate in terms of
effect on suicidal behavior revealed no differences. Although the
trial was not powered to detect small effect sizes, results suggest
that the Relative Risk ratio generated from meta-analytic studies
(RR∼ 5) is too optimistic. The trial also suggested that younger indi-
viduals may respond differently to pharmacotherapy, suggesting
opportunities to personalize treatment approaches. Robust phar-
macotherapy targeting both mood stabilization and depressive
symptoms is essential and may assist in the quest against suicidal
behavior.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
Treatment of people with dual diagnosis
S114
Treating adult ADHD and comorbid
substance-related disorders
J.A. Ramos-Quiroga
Hospital Universitari Vall d’Hebron, Universitat Autònoma de
Barcelona, Department of Psychiatry, CIBERSAM, Barcelona, Spain
Attention-deficit/hyperactivity disorder (ADHD) is a complex, and
multifactorial and chronic neurodevelopmental disorder. Comor-
bid psychiatric disorders are highly prevalent in individuals with
a diagnosis of ADHD. There is a solid overlap between ADHD and
substance use disorders (SUD). Prevalence of SUD is high among
patients with ADHD, so that SUD are approximately double as com-
mon among individuals with ADHD than in general population, and
individuals with SUD have much higher rates than expected of a
comorbid ADHD. Studies shown that treatment during childhood of
attention-deficit/hyperactivity disorder with stimulant medication
neither protects nor increases the risk of later substance use disor-
ders. Nevertheless, recent studies found that patients with ADHD
and SUD can reduce ADHD symptoms and SUD with stimulants
and cognitive-behavioral therapy. Treatment of ADHD in patients
with SUD requires a comprehensive diagnostic assessment. It is rec-
ommendable to stabilize the addiction prior to treating the ADHD.
In this talk, the recent literature for the treatment of adults with
co-occurring ADHD and SUD will be reviewed.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Value-based health care
S115
Value in mental healthcare: The
patient aspect
Y. Cohen (Acting president)
GAMIAN-Europe, Azor, Israel
From the patients’ point of view, valued-based mental healthcare
is mental healthcare based on a holistic vision of care, according to
which patients are actively involved in their treatment to achieve
the best possible outcomes. They are invited to collaborate with
both mental health care providers such as psychiatrists and pri-
mary caregivers to determine what types of treatment are the most
effective.
GAMIAN-Europe believes that the best package of care includes the
following four elements:
– medication – antipsychotic medication is consensually regarded
as first-line treatment for people with mental health problems;
– psychotherapy/counselling – although antipsychotic medica-
tions are the mainstay of treatment for mental health problems,
pharmacotherapy alone produces only limited improvement in
negative symptoms, cognitive function, social functioning and
quality of life. Additionally, many patients continue to suffer from
persistent positive symptoms and relapses, particularly when they
fail to adhere to prescribed medications. These situations empha-
size the need for multimodal care, which includes psychosocial
therapies as adjuncts to antipsychotic medications in order to alle-
viate symptoms and to improve social functioning and quality of
life;
– psycho-education – the more a patient learns about his/her
condition the better placed he/she will be to take control of
it. Psycho-education embodies this principle by using a clearly-
defined therapeutic programme, in which a trained therapist
delivers targeted information designed to reduce both the fre-
quency and the severity of symptoms. Psycho-education increases
patients’ knowledge and understanding of their illness and treat-
ment options and helps them cope more effectively. Many people
find that they benefit not only from the information they receive
during psycho-education, but also from the learning process itself.
There are several different ways in which psycho-education can be
delivered, including one-to-one sessions with a therapist, sessions
aimed specifically at carers and family members, group sessions
attended by several people coping with mental illness and mixed
group sessions attended by people withmental illnesses and family
members;