Suicides that occur during psychiatric hospitalization are tragic events causing immense distress to relatives, peers, and physicians. Suicide risk is particularly high in patients with mood disorders.

To identify a clinical risk profile which can be predictive of suicide in patients undergoing a major depressive episode, hospitalized and within three months after discharge.

We are going to include consecutively admitted depressed patients in San Raffaele Turro hospital (Milan), with a diagnosis of major depressive disorder or bipolar disorder, for a longitudinal prospective study. Demographical and clinical characteristics will be assessed. Barratt impulsiveness scale, aggression questionnaire, Hamilton psychiatric rating scale for depression, scale for suicide ideation, Columbia suicide severity rating scale will be administered to evaluate, respectively, traits of impulsiveness and aggression, severity of psychopathology and suicidal ideation. A follow-up program has been established to evaluate suicidal ideation one month and three months after discharge.

Considering suicide rates in other psychiatric wards, we retrospectively analyzed in our mood disorder unit the inpatient suicide rate of the last 3 years. In this period, we admitted 1794 patients. The suicide rate has been cumulatively of 0.17% (4 patients): 0.16% in 2014, 0.16% in 2015, and 0.19% in 2016. In the same period, outpatient suicide rate has been of 0.39%; 57.14% of outpatient suicides happened within three months after discharge.

Hospitalization and discharge are critical circumstances for psychiatric patients. Evaluation of risk factors will contribute to explain our ward suicide rate and hopefully to reduce it in the future.

The authors have not supplied their declaration of competing interest.

Suicide risk is increasing among all population groups, and no effective prevention method has been established due to high variability of risk factors.

To (1) determine risk factors in people, who video-streamed unsuccessful suicide attempt, and (2) assess whether screening video blog websites is an effective suicide prevention.

Participants (n = 24, 14 M and 10F, age range = 19 to 53) with past history of suicidal attempts were recruited online to participate in encrypted video qualitative interview. Three scales assessed suicidal tendencies and Internet addiction: Columbia–suicide severity rating (C-SSRS), suicide assessment five-step evaluation and triage (SAFE-T), validated Internet addiction scale of own design. Reported data are mixed quantitative and qualitative measures.

Participants were stratified into two age categories (students vs. working professionals), and all were determined to be addicted to Internet. Each group engaged in minimum 15 suicides ideation-related postings, prior to attempting suicide. Young participants typically posted impulsive, quick massages capturing distress caused by peers and family conflicts; seeking short-time recognition was evidenced by eliciting more “likes” and “comments” for each post. Working professionals posted less, but each video was lengthier and messages were emotional, usually ending in tearful summary of life events leading up to suicidal thoughts. While students expressed anger with “the system” as motivation to die, working professionals had financial problems and trouble forming long-lasting friendships.

People of all age groups increasingly document intention to die via blog video posts. These messages can be captured by prevention professionals who can reach out to troubled students and working adults.

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

Depression is most common underlying contributor among cases of attempted/completed suicide. There is dearth of information regarding suicidal intent among people with depression and its relationship with hopelessness among Indians.

To evaluate and describe the intent of suicide in people with depression among north Indian population.

This cross-sectional single point, study was performed at the department of psychiatry, King George's Medical University, Lucknow, India. Cases were in the age group of 18–60 years with major depressive disorder as per DSM-IV TR criteria. Following tools e.g. Hamilton depression rating scale (HRS), Beck's hopelessness scale (BHS) and suicide intent questionnaire (SIQ) were used for assessment.

Suicidal intent was observed among 68.1% (n = 49) of study sample (n = 72). There was no significant (P > 0.05) association of suicidal intent with socio-demographic factors except domicile status. Suicidal intent was common among people with moderate to severe depression and those with hopelessness. The hopelessness was present among 70.8% of subjects.

Suicidal intent is prevalent among people with major depression. Intervention at initial stage of suicidal intention would of importance for successful preventive measure. This emphasizes the need for evaluation of suicidal intent in cases of depression.

The authors have not supplied their declaration of competing interest.

We analyzed available registers of completed suicides (CS) and suicide attempts (SA), carried out under reporting of the central statistical office (CSO, in the general population, based on death certificates), Police Headquarters (PH, the number of reported SB in the country) and the Institute of Psychiatry and Neurology in Warsaw (IPiN, the number of SB in all psychiatric institutions) and the department of adolescent psychiatry in Łódź (SB among hospitalized youth).

Reported data on dissemination of SB in Poland are incomplete, which may affect the reliability of the assessment of the effectiveness of implemented strategies for the prevention of suicides. The aim should be to create a central register of SB, which will not only gather a well-defined data but also monitor how it is obtained.

The authors have not supplied their declaration of competing interest.

This is an extremely important problem of determining clinical-psychological and personality-typological characteristics of patients with suicidal intentions. In the complex therapeutic correction of suicidal behavior, there is almost no use of such psychotherapy method as katathym imaginative psychotherapy (KIP).

Study of clinical-psychological and personal-typological peculiarities and development of an optimal adaptation of KIP for the treatment of patients with suicidal thoughts.

The study was included 52 patients with anxiety-depressive disorder and suicidal intentions; was used K. Leongard questionnaire, SCL-90-R, SR-45, J. Vagin questionnaire of suicidal motivation.

The investigated patients were divided into three groups with acute reaction on stress, personality disorder and schizotypal disorder. The first group has revealed the predominance of instrumental, anemic, anesthetic motivation, emotive and anxiety types of accentuation and high level of suicidal readiness. The second has identified anesthetic motivation, anxiety and cyclothymia type of accentuation with a moderate level of suicidal readiness. The third group included patients with symptoms of anemic motivation suicidal motivation, anxiety type of accentuation and a high level of suicidal readiness. The reduction of psychopathological symptoms in patients of the first group occurred in a shorter period of 18.0 ± 2.1 days, compared with the second – 25.0 ± 5.6 days, and the third group – 21.2 ± 2.1 days.

In the main group, the highest suicide rates were in patients with anemic, anesthetic and motivation and anxiety type accentuation. Patients of the first group showed the best response to a comprehensive pharmacological and psychotherapeutic treatment.

The authors have not supplied their declaration of competing interest.

Suicide is serious public health problem. In Brazil, suicides are more frequent in countryside and small cities.

To understand how informants have confronted emotionally the suicide at home by listening to viewpoints reported by such relatives of the deceased.

Qualitative, exploratory design, conducted in a basic health unit area, in “Pau dos Ferros”, a city with 30,000 inhabitants, State of Rio Grande do Norte (RN), Brazil. Sample constructed by technique of “snowball”, in which the health team presented us the first family, whose member informed about the following; and this, the third one. Data collection through semi-directed interviews with open-ended questions in depth, and submitted to thematic analysis.

Individuals from relatives who had family bond with the suicidal people were interviewed. From analysis of transcribed interviews, three categories emerged:

• – “she has never demonstrated” – possible non-perception of potential suicidal behavior by the family;

• – “I got crazy” – feelings of relatives facing a hard scene of suicide and determined cultural questionings;

• – “we have no professional support in following days” – absence of psychosocial support and healthcare problems.

Possible mood oscillations from suicidal persons were masked by opposite emotional reactions of themselves, and/or oscillations were denied by the observers. Suicide scene seems to have provoked feelings of helplessness and guilt for relatives in not being able to avoid the dramatic act. Feelings of discomfort occurred facing curiosity from many persons who would raise uncomfortable assumptions about suicidal motivations. Family members complained about lack of more effective psychosocial care.

The authors have not supplied their declaration of competing interest.

Predicting suicidal behaviors is one of the most complex challenges of daily psychiatric practices. Alterations of RNA editing of neurotransmitter receptors and other proteins have been shown to be involved in etiology of different psychiatric disorders and linked to suicidal behavior. Additionally, an increase in expression levels of ADARs, the RNA editing enzymes, has also been observed.

The objective of the present study was to test whether modifications in RNA editing profile of prime targets allow identifying disease-relevant blood biomarkers and evaluating suicide risk in patients.

A clinical study was performed to identify an RNA editing signature in blood of depressed patients with and without history of suicide attempts. Patient's samples were drawn in PAXgene tubes and analyzed on Alcediag's proprietary RNA editing platform using NGS. In addition, gene expression analysis by quantitative PCR was performed.

We generated a predictive algorithm comprising various selected biomarkers to detect patients with a high risk to attempt suicide. We evaluated the diagnostic performance using the relative proportion of the phosphodiesterase 8A (PDE8A) mRNA editing at different sites as well as the expression of PDE8A and the ADARs. The significance of these biomarkers for suicidality was evaluated using the receiver–operating characteristic (ROC) curve. The generated algorithm comprising the biomarkers was found to have strong diagnostic performances with high specificity and sensitivity.

We developed tools to measure disease–specific biomarkers in blood samples of patients for identifying individuals at the greatest risk for future suicide attempts.

The authors have not supplied their declaration of competing interest.

Approximately 41% of transgender people attempt suicide at least once in their lives compared to the rate of 5% in the general population Transgender patients who have attempted suicide once have a nearly 40% chance for making a third attempt in their lifetime. Addressing the high rate of suicidality among transgender people must be an important clinical concern during treatment. Screening for suicidal ideation is important when working with the transgender community. Knowing the risk factors that affect the transgender community and creating interventions to ameliorate these risk factors can decrease the negative outcomes.

A literature review of articles pertaining to the transgender community and suicide was performed. Of 20 articles reviewed, 14 were pertinent.

The literature review showed several unique risk factors contribute to the high rate of suicide in this population: lack of family and social supports, gender-based discrimination, transgender-based abuse and violence, gender dysphoria and body-related shame, difficulty while undergoing gender reassignment, and being a member of another or multiple minority groups.

Aiding the transgender patient to develop coping mechanisms for dealing with negative societal pressures and skills in widening their social supports may help to reduce risk factors and increase well-being for transgender patients. Assessing suicidal ideation in transgender patients, connecting them with contacts in the transgender community and utilizing CBT based techniques to reduce dysphoria and to aid in coping may reduce risk of suicide attempts. More research is needed in specific interventions in the transgender community.

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

Empathy is critical to the development of professionalism in medical students, but evidence suggests that empathy actually declines over the course of undergraduate medical education.

Improving medical student empathy by encouraging students to think about the person behind the illness.

Two interventions were studied. From December 2015 until November 2016, a fourth year psychiatry medical student book club was conducted. Students were asked to read an autobiography of a lived experience of psychosis. The old age simulation suit aims to simulate the sensory and physical impairments faced by older adults with age related illnesses. A training session provided a transient experience of old age for the students.

Forty-four students completed the feedback on the book club. Twenty-eight (64%) stated that they strongly agreed with the statement ‘the book club encouraged me to consider the person behind the illness’. Thirty-nine (89%) stated that after attending the book club their empathy towards people with mental health problems had increased. Eleven students completed full feedback following the old age simulation session. Empathy statements relating to living in an ageing body improved from the pre-test median score of 4 (range 1–7) to a median score of 6 (range 2–8) post-teaching session. Empathy statements focusing on sensory and physical impairments had pre-test score median of 3 (range 1–7) and post-test median 8 (range 3–9).

Feedback from these sessions has demonstrated that with a little creativity, empathy training can be delivered to medical students with a positive impact.

The authors have not supplied their declaration of competing interest.

North East London NHS Foundation Trust (NELFT) provides an extensive range of integrated community and mental health services for people living in London serving a population of 1.5 million people. With an annual budget of £325 million NELFT is one of the largest community service providers in the United Kingdom (UK). NELFT is responsible for the education and training of the entire workforce and in August 2016, it employed a nurse fellow to work with the medical education fellows so it could focus on multidisciplinary team (MDT) teaching.

• (1) Providing MDT teaching by delivered by a MDT medical education team.

• (2) Improving the training experience of all trainees, nurses and allied health professionals in NELFT.

• (3) Improving physical health knowledge for mental health staff.

• (4) Improving mental health knowledge of physical health staff.

Two psychiatrists and one nurse manager worked together on joint projects to deliver the MDT teaching. Teaching sessions where at least one psychiatrist and nurse manager delivered teaching on serious incidents affecting patient care, identification and management of sepsis in community settings and empathy training using an old age simulation suit.

Multiple teaching sessions were delivered to MDTs within the Trust. Staffs were receptive to learning in MDTs rather than traditional splits according to professions. Due to the success of this teaching and the reputation of the medical education team, neighboring Trusts have expressed an interest in working in partnership with the team to further enhance teaching and learning in acute and community settings.

The authors have not supplied their declaration of competing interest.

Role-playing scenarios are widely used in psychiatry education, both as a means of assessment and for teaching various clinical skills. But can you get as much from them by learning vicariously as an observer? Fourth-year medical students from Queen Mary University of London were invited to a psychiatry practice OSCE (objective structured clinical examination), shortly before end of year exams. We created 96 places, approximately 40% of the year, but to maximize numbers students also rotated through the six-station OSCE circuit in pairs. For each scenario students alternated either undertaking the OSCE task or observing.

We sought to identify if there was a significant difference in student experience depending on whether they were the ‘candidate’ or ‘observer’. Students were asked to rate their learning experience in each station on a five-point Likert scale and this was analyzed using an ordinal logistic regression model.

While students rated their experiences as ‘observers’ marginally lower than that of ‘candidates’, we found no statistically significant difference (OR = 0.629, P = 0.093). Practice OSCEs took place over six half-days with different facilitators and role-players, but we identified no interaction from these factors. For one station on depression, we found a statistically significant interaction in which ‘candidates’ rather than ‘observers’ rated better experiences (P = 0.032).

Observation by learners is frequently used within simulated clinical scenarios and may have a number of potential advantages. However, while unable to examine the direct impact on knowledge or skills, we found no significant difference in student-reported experiences between ‘candidate’ and ‘observer’ positions.

The authors have not supplied their declaration of competing interest.

About one in 20 attendances at emergency departments (EDs) in the UK relate to mental health, yet recent work has shown that a majority of people presenting with mental health crises do not report positive experiences (Care Quality Commission, 2015). Although there are many reasons for this, one may be a lack of mental health training for staff working in EDs. In response to this, a new training module for multi-professional ED staff was developed.

We aimed to assess the impact of this new module on clinicians’ confidence in managing mental health presentations. Thirty-eight ED doctors and nurses across two centers were asked to complete surveys before and after receiving training.

Following training, we found improvements in confidence in each of five domains explored: assessing self-harm; managing someone with personality difficulties; assessing psychotic symptoms; distinguishing between physical and psychotic symptoms; and, managing psychotic symptoms. These improvements were seen for clinicians across both centers.

The results show that training can help to improve confidence around mental health. This is particularly important given that before the training was developed a survey of local ED doctors had shown that 31% felt under-confident in managing mental health conditions. Since developing the training, it has been further enhanced at the request of local EDs to include video-based scenarios. We continue to assess its impact in improving the confidence of ED clinicians (as well as their knowledge, skills and attitudes towards mental health), and ultimately the benefit to patients experiencing mental health crises.

The authors have not supplied their declaration of competing interest.

Since its origins, cognitive analytic therapy (CAT) has become a focused and more effective alternative that can be approached from the first line of action by mental health teams. However, since CAT incorporates in its intervention aspects of other currents, it is possible that its limits and specificity may have blurred. Furthermore, therapists in training use to report difficulties related to this. For that reason, assessing the competence of CAT therapists in training becomes so important, as it promote the reflection of the therapist in its training and provides professionals necessary skills to ensure a better quality care for their patients.

The aim of this study was to design an instrument to identify the main training problems in CAT therapists which allows therapist's competence evaluation.

For this purpose, a specific tool to detect the main problems in the implementation of the psychotherapy by self-report was administered and evaluated by two therapists in training during its clinical practice.

The main implementation problems detected had to do with collusions and the temporary adjustment of the sessions. The therapists reported a high satisfaction with the instrument, which was valued as useful to be aware of the problems in CAT training and with clearly explained contents.

The tool has been shown to be useful to assess therapist's competence and to take awareness of collusions allowing the therapist to avoid them.

The authors have not supplied their declaration of competing interest.

Choosing a medical specialty is not easy. In Spain, when medical students finish the university degree, they have to take an exam called popularly MIR if they want to start a specialty. If the exam is passed, that person receives a number result of his academic record during university and test result. The number indicates the order of election, so number 1 chooses specialty and hospital first and so on. The Spanish healthcare system offers between 220 and 250 places to start the Specialty of Psychiatry in 121 hospitals across Spain.

We designed a semi-structured questionnaire with 30 questions specific for the purpose of this work. The questionnaire was spread by social networks and email to reach as many medical doctors undertaking postgraduate training in psychiatry as we could.

One hundred and thirty people responded to the questionnaire. Fifteen were not psychiatry trainees. We obtained information from 80 hospitals (66%). Thirty-three hospitals (41%) have specific training in psychotherapy. Sixty-nine (86%) apply electroconvulsive therapy regularly. Teaching during training is given together with psychologists and nurses in 36 hospitals (45%), with psychologists in 32 (40%), only psychiatry trainees in 12 (15%). Psychiatry trainees do general emergency guards in 62 hospitals (77%).

At the moment of writing this, the guide has been consulted by 14,600 people and visited over 40,000 times. This guide may help medical students to discover Psychiatry Training and to choose the best hospital that fits their interests.

The authors have not supplied their declaration of competing interest.

Bosnia-Herzegovina (BH) citizens, affected by 1992–1995 war, developed serious mental health posttraumatic consequences. Their needs for EMDR (eye movement desensitisation and reprocessing) treatment increased. The Humanitarian Assistance Programmes UK & Ireland (HAP) work in partnership with mental health professionals in Bosnia-Herzegovina (BH) from 2010.

We aim to build a body of qualified and experienced professionals who can establish and sustain their own EMDR training.

Authors described educational process considering the history of idea and its realization through training levels and process of supervision which was provided from the Humanitarian Assistance Program (HAP) of UK &Ireland with non profit, humanitarian approach in sharing skills of EMDR to mental health therapists in BH.

The trainers from HAP UK & Ireland completed five EMDR trainings in BH (two in Tuzla and three in Sarajevo) for 100 recruited trainees from different BH health institutions from different cities and entities in BH. To be accredited EMDR therapists all trainees are obliged to practice EMDR therapy with clients under the supervision process of HAP UK&Ireland supervisors. Supervision is organized via Skype Internet technology. Up today seven trainees completed their supervision successfully and became European Accredited EMDR Psychotherapists, one of them became European Accredited EMDR Consultant.

Five training of Bosnia-Herzegovina mental health workers to effectively use EMDR with enthusiastic help of EMDR trainers from HAP UK&Ireland resulted with seven European accredited EMDR psychotherapists, and one of them became European accredited EMDR consultant. This will increase psychotherapy capacities in postwar BH.

The authors have not supplied their declaration of competing interest.

Out of hours, there is only one on-site junior doctor. First year psychiatry trainees (CT1s) and GP trainees may have no prior experience in psychiatry. On-call shifts are therefore potentially daunting for new trainees.

Expand the resources available for trainees when on-call.

We issued questionnaires to CT1s asking if they would have appreciated more information about on-call scenarios and in what format.

Based on the questionnaire results we implemented some changes. These were:

• – a printed “pocket-guide” summarising common on-call scenarios;

• – a training video on common on-call scenarios.

The handout was given to new trainees in February 2016 and in August 2016. The video was shown to new trainees in August 2016. Trainees provided feedback on the resources.

Of 24 CT1s, 15 (63%) were “neutral” or “disagreed” that they had felt prepared for on-calls.

CT1s wanted additional resources, especially a paper handout or phone download.

Feedback on the “pocket-guide” from trainees in February 2016 (n = 8) was positive (62.5% reported increased confidence in on-call situations). Feedback is also being collected from trainees who received the guide in August 2016.

Trainees in August 2016 (n = 36) liked the video – no trainees “disagreed” with statements asking if the video had been useful.

The video improved the confidence of trainees about on-call situations by an average of 2.8 points.

We have expanded available resources relating to on-calls and improved confidence. Further improvements would include making resources more easily available in downloadable formats.

The authors have not supplied their declaration of competing interest.

The proportion of international medical graduates (IMGs) in Ireland has increased from 13.4% in 2000 to over 33% in 2010. Many of their countries of origin have different cultures, expectations of the doctor–patient relationship and communication styles than Ireland. These differences can adversely impact on the quality of care provided by IMGs. There is a lack of research on the impact of cultural differences on communication in the Irish context.

Semi-structured interviews were conducted with 16 IMGs in Drogheda Department of Psychiatry. Transcripts were analysed using nVivo10, a specialised computer programme for conducting qualitative analysis and analysed thematically.

General themes emerged relating to IMG experience of cultural differences in medicine and psychiatry and cultural differences in communication. IMGs did not find their proficiency in English to be a barrier to communication but did find accents, culture-specific sayings and non-verbal cues to be challenging. Differences in doctors’ status relative to patients and different expectations of the doctor–patient relationship were challenging and, at times, frustrating and annoying. It was generally recognised that training in cross-cultural communication skills would be beneficial to new IMGs although a small minority recognised no such issues. Significant differences in attitude to patient confidentiality in Ireland versus the country of origin were identified.

Consideration should be given to providing specific cross-cultural communication skills training for all IMGs training in Ireland focusing not just on verbal and non-verbal communication but also differences in the doctor–patient relationship, patient and relative expectations and medical confidentiality requirements.

The authors have not supplied their declaration of competing interest.

During my time in Gothenburg, I have spent my first week with the team on the emergency inpatient ward. During my second week in Sweden, I have visited inpatient assessment unit where in depth psychological and psychiatric evaluations can be conducted. My final day was spend in a secure state institution providing accommodation and care to young people at risk of absconding or presenting with challenging behaviours.

Through the participation in the program I was able to gain first-hand experience of different models of healthcare delivery and I intend to implement some of the positive ideas into the services in the UK. Similarly, I hope that the host organisation may benefit from hearing how care is provided in the UK.

During my trip to Sweden, it was the first time I had an opportunity to deliver a presentation to an international audience. This highlighted new challenges such as language barrier and lack of familiarity with jargon, systems and practices that we take for granted within the NHS. I have learnt from the experience and I have now a better idea how to improve my presentations in the future. I have gained a lot of confidence in my presentation skills by speaking in front of a large audience of clinicians that I have not met before.

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