Suicidal ideation has repeatedly been reported as a predecessor of suicidal behavior. Several neuropsychological parameters have been associated with suicidal ideation. Emotional intelligence (EI) and resilience, which play an important role in the emergence of psychiatric disorders may also be related with suicidality.

The main objective of this study was to investigate the relationship of trait EI and resilience with suicidal ideation. Moreover, we hypothesized that EI and resilience would be correlated with each other and that they were moderating variables between stressful life events and suicidal ideation.

A total of 277 male and female students without current psychiatric diseases were recruited per online questionnaire asking for lifetime and 4-weeks suicidal ideation and demographic data and containing the Resilience Scale of Wagnild and Young, the Connor Davidson Resilience Scale and, for the measurement of trait EI, the Self-Report Emotional Ability Scale. Additionally, we applied the Social Readjustment Rating Scale to assess stressful life events.

We found significant negative correlations between lifetime and in part 4-weeks suicidal ideation and intrapersonal trait EI as well as resilience. Trait EI and resilience were interrelated. There was no significant moderating effect of trait EI or resilience on the relationship between SRRS score and suicidality.

Assessing EI and resilience as trait factors might be helpful in the prospective identification of suicidal individuals.

The authors have not supplied their declaration of competing interest.

Suicidality is still an understudied problem in Bulgaria especially on a subnational (regional) level.

To collect data on suicidality in two major regions of Bulgaria with a population over 250,000 each (Plovdiv and Pleven) for a six years period (2009–2015).

To analyze demographic, health-related and other characteristics associated with suicidal behavior as well as motives and methods of suicide.

Data were extracted from relevant documentation (medical records, public health reports, etc.) and statistically processed upon collection.

Majority of suicide victims were males between 45 and 64 years while most suicide attempts occurred among 18–29 years old females.

Leading method of suicide was hanging, followed by jumping from high places and use of firearm.

Prevailing suicidal motives were psychotic symptoms, serious somatic illnesses and family problems. Depression accounted for 25% of all suicide cases and in another 25% motivation could not be identified because of insufficient data.

The proportion of unemployed among suicide committers was not significantly higher than that of employed and retired.

Severe mental disorders are a major trigger of suicidal behavior.

Personal relationships should be targeted by suicide prevention interventions.

Somatic illnesses are increasingly important suicide risk factor driven by the ongoing process of population aging.

Frontline healthcare professionals should be trained to explore underlying suicidal motives and actively probe for depression in each case of suicidal behavior.

Unemployment related suicide risk is most likely mediated through an adaptation crisis mechanism induced by the abrupt change of social status.

The authors have not supplied their declaration of competing interest.

Suicide rate in Hungary is among the highest in the European Union (2015: 18.9/100,000 inhabitant). Although there is no national registration system of suicide attempts in Hungary, according to previous studies Hungarian Romas have three times higher suicide attempt rate than non-Romas.

The aim of this study was to explore socio-demographic and mental health risk factors of multiple suicide attempts in Hungary.

A total of 1547 suicide attempts were assessed via retrospective data analysis using patient records. Data on socio-demographic variables, psychiatric diagnoses, methods and reported reasons of suicide attempts were investigated. Binary logistic regression analyses were performed to identify potential risk factors for multiple suicide attempts.

The ratio of multiple attempters were 37.7% in the sample, with a Roma predominance (Roma: 51.8%, non-Roma: 34.8%, χ2(1) = 27.64; P < 0.001). Of the potential factors examined, Roma ethnicity (OR: 2,03; CI: 1.53–2.70; P < 0.001), economic inactivity (OR: 1.7; CI: 1.36–2.18; P < 0.001), mood disorders (OR: 1.58; CI: 1.25–1.99; P < 0.001), personality disorders (OR: 2.09; CI: 1.45–3.01; P = 0.00), organic mental disorders (OR: 1.76; CI: 1.01–3.07; P = 0.44) and mistreatment as reported reasons (OR: 3.95; CI: 1.17–13.32; P = 0.02) were found as significant risk factors of multiple suicide attempts.

National registration of suicide attempts would be necessary for a more thorough analysis. Beside the more advanced treatment of mental health disorders, increased efforts in prevention are recommended with a special focus of low SES groups and Roma ethnicity. The specific background factors in Roma ethnic group should be further examined.

The authors have not supplied their declaration of competing interest.

Nowadays, mobile and Internet communication is widely used and has a special role in mental health prevention. Besides, websites targeting suicide prevention, pro-suicide contents (methods for suicide, suicide pacts) are also easily available, which may increase the risk for suicide in vulnerable people.

Our aim was to assess the relation between Internet use and suicidal behaviour among university students and also to assess online activity regarding suicidal contents and help-seeking behaviour.

Self-administered questionnaires were completed by university students.

Most of the 101 students who completed the survey use the Internet 3 hours or more a day. They are facing suicidal contents numerous times. Professional websites providing information and the common popular sites were mainly visited, sites providing help were less screened (10%). More than quarter of the students felt discomfort when looking at sites dealing with suicide. Almost one-third of the subjects had suicidal thoughts during their lives and 15% already planned suicide. In case of suicidal thoughts, subjects would seek help mainly from friends and family, but online help-seeking was not preferred.

Despite of the extensive Internet use, students rarely seek help for emotional problems on the Internet. Development of websites controlled by professionals is essential, especially for those who would not benefit from traditional psychological/psychiatric care. Future research is needed regarding the characteristics of Internet use and the potentials and limits of help-seeking via the Internet in order to prevent people from pro-suicide websites and to improve professional websites.

The authors have not supplied their declaration of competing interest.

Structural-dynamic model (SDM) of self-destructive behaviour (SdB) is needed for differential diagnostic of numerous features of SdB. SDM is based on an awareness that self-destructiveness has different variants with diversity of psychophysical damage as its outcome. SDM describes whole continuum of SdB variations and helps to differentiate them, to assess risk of suicidal or non-suicidal activity and to do long-term prognosis for SdB development as well.

SDM of SdB is a generalized conception, which is a result of consequent scientific researches. The clinical criteria by ICD-10 and semi-structured suicidological interview were used in all of the surveys. In general, we observed 860 patients with suicidal attempt, suicidal ideas and self-destructive injuries.

Our researches proved that SDM of SdB determine suicidological diagnosis implementing all-round assessment of SdB features of patient using kinds, forms and clinical-pathogenetic types as main categories of this concept. The kinds of SdB are: self-aggressive behaviour, self-destructive behaviour (it includes non-suicidal or psychotic variants) and suicidal behaviour. Each kind of SdB helps to detect pathogenetic mechanisms and dynamic tendencies in development of it. The form of SdB discloses behavioural specification in each case. There are equivalent, internal and external forms. The clinical-pathogenetic types of SdB are: suicidal, parasuicidal, pseudosuicidal or asuicidal. Each of them discloses significant clinical characteristics of actual self-destructive episode (nosology, syndrome, psychological traits, situation peculiarities, etc.). The differential diagnostic of SdB by SDM concept will allow doctors to treat patients more accurately and effectively.

The author has not supplied his/her declaration of competing interest.

Religious obsessions and compulsive acts compromise approximately two thirds of all obsessive compulsive disorder symptomatology in Muslim patients. Imam's mosque is consulted before a psychiatrist.

To explore the Islamic jurist's views and methods in dealing with obsessions and compulsions.

Introduction of guidelines for managing OCD in some Muslim patients.

We began studying the different opinions of scholars in defining obsessive compulsive behaviour focusing on the tight criteria required by the Maliki Jurists to consider the individual being obsessed. This was followed by a thorough review of other Islamic doctrines.

The jurisprudential therapeutic approach includes:

– obsessions are satanic whispers not originating from the self, which is equivalent to “It is not me but my OCD” in modern cognitive behavioural approach;

– diverting attention from the obsessive thought rather than engaging with it;

– not to respond to the obsessional thought (response prevention);

– listing of religious permits;

– focusing attention on acts of worship;

– thought stopping.

At the end we added various jurisprudential rules to be remembered by patients such as certainty does not fade with scepticism, no defiles by doubt, there are no doubts for a man with excessive doubts.

Exposure and response prevention techniques are deeply rooted in Islamic jurisprudence and are practised with conviction by OCD Muslim patients. We produced specific guidelines that could be used by clinical psychologists and other mental health professionals in dealing with OCD patients top ensure their engagement in therapy.

The author has not supplied his declaration of competing interest.

World statistical data show that a large number of mothers suffer from antenatal or postnatal depression and that it is linked with difficulties in personal and emotional development in child.

To present the importance of treatment of antenatal depression.

We present is a 32-year-old woman man, with completed high level of education, married, mother of one child, pregnant in first trimester, who suffered of depression several years ago. Diagnosis was made in line with the ICD 10 (F33), and the following diagnostic instruments were used: HAMA, HAMD, clinical interview.

We present is a 32-year-old woman man, with completed high level of education, married, mother of one child, pregnant in first trimester, severe depression with depressive mood, weight lost, insomnia, agitation, suicidal thoughts.

She was treated in the day hospital of our clinic with SSRI antidepressants, individual and group psychotherapy.

During the day hospital stay patient was treated with pharmacologic agents (SSRI anti-depressants – tbl. Sertralline), which showed a great success, that is reduction in the depression, sleep improvement, normal gain weight and regular pregnancy and baby birth with APGAR score 9/9.

Literature shows that antenatal depression is associated with poor mother self-care during pregnancy including poor visit of antenatal clinics, substance misuse, low birth weight, preterm delivery and significant intellectual and emotional deficits in children whose mothers were suffered of antenatal or postnatal depression.

Treatment of antenatal or postnatal depression is very important for mothers’ mental health and for the normal develops of child also.

The authors have not supplied their declaration of competing interest.

Burnout causes a considerable human cost. Army employees are, in fact, particularly exposed to this risk.

To determinate the prevalence of burnout syndrome among military consultants in psychiatry and to study its socio-familial repercussions.

A cross-sectional study was conducted in a military outpatient clinic in Tunis and included 30 military patients with a seniority of more than 15 years. Burnout and major depression were assessed with the instrument Burnout Measure Short version (BMS-10) and the Patient Health Questionnaire “PHQ-9”, respectively.

Eighty percent of participants (n = 24) had a very high degree of burnout exposure according to BMS-10. Twenty of these (83.3%) had a moderate to severe depression. All married patients (n = 22) having burnout syndrome reported a conjugopathy and a tendency to physical and verbal aggressiveness against their children.

Military employees are particularly vulnerable to burnout. Detecting burnout in time is therefore essential in order to prevent its undeniable socio-familial repercussions.

The authors have not supplied their declaration of competing interest.

Somatic symptoms in depression are not uncommon. There is increased sicidality, poor prognosis, and increased risk of relapse. Neurological and l muscloskeletal symptoms can be explained on basis of increased muscular tension in the body.

An internet search was made using key words muscular tension, SSRIs depression, anxiety, somatic symptoms.

Ninety-eight percent patients reported at least one of somatic symptoms. Forty-five percent reported six somatic symptom. GIT symptoms in 67% patients. Fatigue in 78% % of patients. Weakness in body parts 45% and headache in 43% to 65%. Chest pain more common in male. Patient over 40 showed pain in limbs or joints. Number of symptoms was directly related to severity of depression.

Increased muscular tension is one component of mix anxiety and depression. Main nerves and their branches pass in between muscular bellies. When there is increased muscular tone, it puts extra compression on major nerves and their branches. This will cause dysesthesia in body parts. Stretching of muscles produce pain due to hypoxia. This produces headache, strain neck and backache pain in chest. Fatigue is result of over consumption of energy due to hypertonia. One of their side effect is of SSRIs is muscular hypertonia which will not be very helpful for these symptoms. Drugs like tricyclics, SNRI can have better results when used alone, gabapentine, pregabline tinazidine used as adjunct can alleviate symptoms. Non-pharmacological treatment includes massage, relaxation technique, and warm water therapy.

Somatic symptoms of mix anxiety and depression should be important consideration in its treatment.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Medically unexplained symptoms are common in ambulatory medical patients. Such disorders are consistently more prevalent in women than in men and occurs up to 10 times more frequently in women.

To review published literature about gynecological symptoms related to somatic disorder and which percentage of these patients diagnosed as Somatoform Disorder are referred from gynecologist consultations.

We present the case of a 31-year-old woman diagnosed of a somatic symptom disorder whose first consultation was gynecological. She is referred to Mental Health Unit from Primary Care Center because of having been referred to five different specialists and been diagnosed as “functional somatic syndromes” in all cases. She started a selective serotonin reuptake inhibitor, and attended a relaxation group during two months with good recovery afterwards.

She is asymptomatic nowadays and has not been visited by any other specialist.

Women report more intense, numerous, frequent bodily symptoms than men. This difference appears in samples of medical patients and in community samples, whether or not gynecologic and reproductive symptoms are excluded, and whether all bodily symptoms or only those, which are medically unexplained are examined.

Women may be more aware of and more attentive to weak or diffuse bodily stimuli, which men do not perceive, and some studies suggest that women have greater bodily vigilance and awareness.

This could result from the experiences of menstruation, menopause, pregnancy, and lactation which all serve to repeatedly call women's attention to their anatomy and physiology and to sensitize them to bodily changes.

The authors have not supplied their declaration of competing interest.

The elderly are registered in the program and accompanied by a multidisciplinary team. In nursing consultations, whose base is in the realization of Nursing Process, there is the application of the Geriatric Depression Scale named Yesavage – reduced version (GDS-15) held by students under the supervision of the teacher. After classification of the patient on the scale, they develop the care plan based in the Nursing Interventions Classification (NIC), and the nursing diagnoses that have among their factors related to depression and its symptoms.

In addition to interventions carried out in consultation, involving recovery of self-esteem, encouragement of leisure and recreational activities, and supported self-care, the program staff (psychologists, doctors, nurses and occupational therapists) works in partnership in support group health education, encouraging the integration of the elderly. The well-being and self-esteem of the elderly, thus, reduce the triggers of depression, with the integration of participants, students and professionals.

The authors have not supplied their declaration of competing interest.

Working the cognitive needs, and reducing stressors are appropriate strategies to reduce the anxiety. The care with the health professionals is important to notice the related factors early and improve the strategies.

The authors have not supplied their declaration of competing interest.

In this workshop, I want to broaden the vision on attachment trauma and highlight the importance to acknowledge EAT as a hidden epidemic.

The significance of EAT in the development of anxiety symptoms becomes more and more apparent.

Recognizing the effect, that the quality of the attachment relationship has on the development of a secure attachment bond, is important to understand the factors underlying the development of anxiety symptoms.

The availability, responsiveness, mentalizing possibilities… of the parent create a secure base from which the child can explore and develop.

The absence of those features in the child–parent relationship, causes traumatic stress in the child and impacts his psychological and neurological well-being.

Insecure attachment influences the neurobiology and results in dissociative processes (hyper- and hypo-aroused) expressed in different types of anxiety disorders.

Derived from the neurobiology there is a clear link between anxiety, depression and aggression.

The internal working model (IWM), rises from insecure attachment, influences adversely the child's capability to regulate and relate.

From an intergenerational point of view, an insecure attachment style of the parent implements the absence of affect en stress regulation capabilities and leave the child with the inability to regulate his anxiety.

There is a clear link between EAT and different types of anxiety disorders.

Treatment strategies should integrate neurobiological, attachment and trauma insights resulting in body oriented therapy, development of affect – and stress – regulation strategies, restructuring the internal working model, the therapeutic relationship as attachment bond…

The author has not supplied his declaration of competing interest.

Valid assessments require sufficient effort from the part of the testee. Motivation may be compromised, particularly in psychiatric conditions. We examined associations between response bias on free recall and self-reported symptoms in depressed and PTSD patients.

This is a cross-sectional study. Patients had depression (n = 48), or PTSD or other anxiety disorders (n = 37). A control group (n = 47%) had chronic pain disorder, fibromyalgia or chronic fatigue. The Green Word Memory Test (GWMT) was administered to all subjects. The Structured Inventory of Malingered. Symptomatology (SIMS), and the Beck Depression Inventory (BDI-II) were administered in subsamples. Study outcome was self-reported depressive symptoms in Symptom Validity Test (SVT) negative cases.

Average age of the participants was 45.1 years (SD 9.5), 48.5% were female. GWMT was positive in 52.3% of all cases, GWMT and SIMS were positive in 33.8%, and GWMT and SIMS were negative in 37.7%. No significant group effects on GWMT were found. Average BDI-II scores were 32.8 (SD 13.9) for depressed patients, 28.3 (15.5) for those with anxiety disorders, and 27.6 (14.1) for controls (P = 0.43). Seventy-eight percent of depressed GWMT negative cases reported at least moderate depressive symptoms (BDI-II > 18), and 44.4% severe symptoms (BDI-II > 29). Approximately half of the GWMT negative cases with anxiety disorders and controls scored BDI-II > 18.

Non credible test performance is prevalent in disability claimants with affective, mood disorders. However, depressive symptoms per se do not explain poor effort on cognitive tasks.

The authors have not supplied their declaration of competing interest.

The hypothalamus—pituitary—adrenal axis (HPA axis) dysregulation plays an important role in the pathophysiology of anxiety disorders. Salivary cortisol level is a useful indicator of HPA axis dysfunction.

Most data suggests elevated cortisol awakening response (CAR) in anxiety disorders, but there are studies indicating opposite pattern (flat CAR).

Goal of this study was to determine whether patients with anxiety and personality disorders show a specific daily cortisol patterns and weather this pattern changes after 12 weeks of intensive predominantly psychodynamic combined group and individual psychotherapy.

The studied population comprised 77 patients, mainly females (72.7%), with primary diagnosis of anxiety disorder 40.9% or personality disorder 59.1%. The Symptom Checklist “0” was used to assess the pre- and post-treatment levels of patients’ symptoms. Pre- and post-treatment cortisol levels were measured in three saliva samples collected during one day (at awakening, 30 min after awakening, at 22.00).

The obtained results were partly similar to previous research. We found four different daily CAR patterns: decreased (drop 30 min after awakening), flat (rise 0–49% 30 min after awakening), normal (rise 50–75% 30 min after awakening) and elevated (rise over 75% 30 min after awakening), two of them (flat and elevated) were considered as typical for anxiety disorders. Groups of CAR pattern differed significantly in the level of sleep symptoms, dysthymia symptoms and avoidance/dependency symptoms. The changes in the CAR pattern after psychotherapy were not significant.

Anxiety disorders and personality disorders are characterized by more than two specific daily salivary cortisol patterns.

The authors have not supplied their declaration of competing interest.

Identifying patients’ risk of reacting with suicidal ideation (SI) to psychotherapy is an important clinical problem that calls for empirical verification.

Analysis of associations between patients’ initial neurotic personality dysfunctions not accompanied by SI and emergence of SI at the end of a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in a day hospital.

Neurotic Personality Questionnaire KON-2006 and Life Inventory were completed by 680 patients at the time of admission to a psychotherapeutic day hospital due to neurotic, behavioral or personality disorders. Symptom Checklist KO “O” as a source of information about emergence of SI was completed both at the admission and at the end of the treatment. Among 466 patients without SI at the admission, in 4% SI occurred at the end of the treatment.

A number of neurotic personality dysfunctions (demeanors declared) that significantly predisposed to SI emergence at the end of the treatment were found: physical aggression against close ones (P < 0.001), grandiose fantasies (P = 0.043), tendencies to resignation (P = 0.022) and resignation-related feeling of loss of life opportunities (P = 0.037), tendency to follow predominantly ones intuition (P = 0.035).

In patients who declared the above-mentioned demeanors increased risk of SI emergence than in others (10–30% vs. 4%) indicate that there are particular vulnerable areas of neurotic personality that require especially careful approach during intensive psychotherapy–dealing with those areas may result in distress or anxiety that may lead to SI.

The authors have not supplied their declaration of competing interest.

Patients with OCD usually require higher dosages of serotonin reuptake inhibiting (SRI) drugs than is used for the treatment of depression. This observation resulted in treatment-refractory patients being occasional prescribed selective SRI drugs above the normal upper limit of prescribing. Previous studies have shown that these high doses are well tolerated.

We decided to investigate the blood levels of patients on dosages of sertraline that were above the normal therapeutic range.

Successive patients treated by the National Inpatient Service for OCD/BDD who were treatment refractory and prescribed > 200 mg sertraline per day were included. All had previously received 2+ trials of different SRIs for > 3months each as well as been offered augmentation with dopamine blockers and at 2+ trials of exposure and response-prevention. All patients scored in the profoundly ill range of the Yale Brown Obsessive Compulsive Scale.

Sertraline was titrated in 50 mg increases every 2–4 weeks up to a maximum of 400 mg. Blood samples were taken after their morning dose. This was after the patients had stabilised for at least 2 weeks on the higher doses.

Seventeen patients were included in the study and received sertraline dosages ranging from 225 mg to 400 mg per day. Blood levels were within therapeutic range or below for all patients. Following treatment within the service, these patients generally showed an improvement of an average of improvement of 43% on the YBOCS.

A subgroup of patients with profound refractory OCD seem to either malabsorb or rapidly metabolise sertraline resulting in lower than therapeutic blood levels.

The authors have not supplied their declaration of competing interest.

The main objective of the present study is to investigate effectiveness of mindfulness-based stress reduction in anxiety and depression in patients with multiple sclerosis.

This study is in kind of semi-experimental research in form of pretest–posttest pattern with control group. Statistical population of the study consists of all patients with multiple sclerosis referred to Iran MS Association by 2016. Sampling method in this study is available sampling and based on having inclusion criteria. Among depressed and anxiety patients 30 individuals were selected randomly and were classified in two groups with 15 people in each group. Experimental group was under mindfulness-based training on stress reduction for 8 sessions. Control group was also in waiting list. All patients in experimental and control groups fulfilled depression and anxiety inventories before and after intervention. Obtained data was analyzed using MANCOVA and in SPSS22 software.

Obtained results show that there is significant difference between the two groups in terms of anxiety and depression after intervention (P < 0.001).

Mindfulness-based stress reduction can help reduction of symptoms of anxiety and depression in patients with MS.

The authors have not supplied their declaration of competing interest.

To study the neural substrates of insight in OCD by comparing patients with good insight, patients with poor insight and matched healthy controls using functional MRI.

Subjects were recruited from among patients attending OCD clinic, adult psychiatry services and psychiatry ward inpatients of National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore. They were further divided into ‘good insight’ (n = 30) and ‘poor insight’ (n = 14) using Brown's assessment of belief's scale. Control subjects (n = 30) were recruited from consenting volunteers. 3 T MRI was used mental rotation task was paradigm used for fMRI and analysis was done by SPM 8.

Poor insight patients and good insight patients comparison revealed differential activation in left superior/medial frontal gyrus (corresponding to the DLPFC). A negative correlation between BABS score and activation of right inferior parietal lobule. Mental rotation task behavioural data results: OCD patients as a group had significantly lower accuracy compared to healthy controls. Poor insight group had significantly decreased accuracy ratio compared to good insight group and healthy controls. A negative correlation was noted between BABS score and accuracy ratio, indicating that poorer the insight, greater the errors during the active task.

Insight has been important prognostic factor in OCD. Poor insight patients had specific deficits in left medial frontal gyrus and right inferior parietal lobule as compared to good insight patients and healthy controls. Together, these indicate that insight has a strong neurobiological underpinning in OCD.

The authors have not supplied their declaration of competing interest.