Professional burnout among medical workers is a significant global concern characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. In Ukraine, the ongoing war has exacerbated this issue due to additional stressors such as exposure to traumatic events, resource limitations, and constant threats to personal safety. Medical professionals are facing unprecedented challenges, including increased patient loads from wartime casualties and psychological strain from working in high-risk environments.

Develop an online psychological training program to address professional burnout among Ukrainian medical workers during wartime, evaluate its feasibility in a conflict setting, and assess its preliminary effectiveness in reducing burnout levels and improving adaptive coping strategies.

An online training was developed by specialists from Charité University Clinic (Berlin) and Bogomolets Medical University (Kyiv) under the “SOLOMIYA” project (https://solomiya.net.ua/).

Participants: 27 medical workers from Ukraine.

Study design was mixed-methods with quantitative assessments at three time points.

Intervention was delivered online via Zoom in Ukrainian to accommodate regional participants and wartime restrictions. Total duration was 4 hours over two 2-hour sessions, including psychoeducation, practical exercises, and interactive discussions.

Data collection scales: Maslach burnout inventory, Brief COPE, Professional Self-Efficacy, WHO-5 index, participant satisfaction survey.

Preliminary data from the 27 participants indicate a high level of satisfaction with the training program. The mean satisfaction score was 8.7 out of 10 (SD = 1.2), with scores ranging from 6 to 10 and a median of 9. The distribution of satisfaction scores was as follows: excellent (9–10): 59% (16 participants), very good (8): 15% (4), good (7): 19% (5), satisfactory (6): 7% (2).

These results suggest that the majority of participants found the training to be highly valuable and relevant to their needs. Participants reported that the exercises and coping strategies provided were useful for managing stress. Interactive discussions were noted as particularly helpful, demonstrating the importance of social support in reducing burnout. Due to the ongoing nature of data collection, comprehensive statistical analyses of changes in burnout levels, coping strategies, professional self-efficacy, and well-being are not yet available. However, initial observations indicate positive trends in these areas.

Preliminary findings show that online psychological training is feasible and well-received by Ukrainian medical workers during wartime. High satisfaction scores suggest potential benefits. While definitive conclusions on effectiveness are premature, the positive reception aligns with research on tailored interventions in high-stress environments.

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The University of Bristol Medical School, United Kingdom, has student-selected components (SSC) making up a substantial proportion of its curriculum. This practice is common among UK medical schools. SSCs can inspire interest in specialities that students may have less exposure to during undergraduate training, such as psychiatry. Psychiatry has a broad range of sub-specialities and themes which can be explored in an SSC. The author supervised one such project in which a student researched and produced a series of podcasts about the science of happiness.

To explore the use of student-selected components (SSC) in increasing exposure to psychiatry in the undergraduate curriculum

To explore the impact of student-selected components (SSC) in increasing recruitment into psychiatric training

An initial literature review was performed with the following keywords using Medline on OvidSP.

Fourteen papers addressed the use of psychiatry student-selected components (SSC) in undergraduate medical education and their influence on career specialty choice.

Student-selected components (SSC) are an important strategy for increasing exposure to psychiatry in undergraduate medical education and recruitment into psychiatry.

Medical undergraduate education, elective, student-selected components, special study modules, psychiatry, mental health.

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Case-based learning holds a crucial place in psychiatric education. Through methods such as written scenarios, video presentations, patient simulations, or observing real patients, students are expected to gain clinical reasoning skills by observing psychiatric cases.

This study aims to generate case scenarios using ChatGPT-4 and create multiple-choice questions based on these cases.

A prompt was developed based on the literature to generate case scenarios for 12 psychiatric diagnoses, along with five related questions for each case (Figure) (Kıyak. Rev esp educ méd 2023; 4(3)). The scenarios and questions were organized into six forms, each containing two cases and ten questions.

A total of 12 psychiatrists, (5.33 ± 1.31 years of practice) evaluated each form in pairs. The results of the case evaluations are presented in Table 1, and the question evaluations in Table 2.

The evaluation confirmed that the case scenarios were typical for the respective disorders and included appropriate mental status examinations for diagnosis (23/24). The cases were deemed suitably challenging for medical students (20/24) and effective in assessing clinical reasoning skills (21/24). However, the questions did not meet certain criteria, such as appropriate difficulty (75/120), the presence of a single correct answer (86/120), and the plausibility of distractors (91/120). It is suggested that further work on the prompt is needed to improve the quality of the questions. While ChatGPT is suitable for generating case scenarios, the questions should be reviewed before use.

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This knowledge exchange program was designed to enhance the clinical training of a Cambodian psychiatrist in general psychiatry and addiction care. Conducted between July 1, 2024, and August 30, 2024, the program involved immersive clinical experiences in the Netherlands and South Africa. The exchange facilitated engagement with leading mental health institutions, offering valuable insights into advanced psychiatric practices and addiction care models.

The primary objectives of the program were to improve clinical competencies in diagnosing and managing psychiatric and addiction disorders, to gain exposure to multidisciplinary and community-based care models, and to develop cultural competence in adapting psychiatric practices to low-resource settings like Cambodia. These goals were pursued through a combination of clinical visits and participatory learning activities.

The psychiatrist participated in clinical visits and hands-on learning at Radboud University Medical Center and Pro Persona in the Netherlands, as well as Rustenburg Addiction Care in South Africa. These experiences included observing advanced treatments and participating in community-based psychiatric care programs. The program’s structure combined hands-on training and multidisciplinary teamwork to provide a comprehensive learning experience.

The program yielded significant improvements in the psychiatrist’s ability to manage complex addiction cases and implement community-based care. Additionally, the experience fostered greater cultural competence, enabling the application of psychiatric practices suited to the Cambodian context. The collaboration also promoted potential future psychiatric training initiatives and international partnerships.

The knowledge exchange program was successful in enhancing the psychiatrist’s clinical skills and cultural awareness. It underscored the importance of international collaboration in psychiatry and addiction care, providing a model for how mental health professionals from low-income countries can benefit from exposure to global best practices and community-based care strategies.

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The European Federation of Psychiatric Trainees (EFPT) unites general adult psychiatry (GAP) and child and adolescent psychiatry (CAP) trainees’ associations across Europe, fostering collaboration, education, and professional growth. Trainees across Europe can become EFPT members through their national associations (NTA). Residency can be challenging, with demanding workloads and academic pressures. Having a supportive network like EFPT can ease these difficulties by providing access to valuable resources, support, and collaboration. This abstract highlights the benefits of active participation in EFPT for GAP and CAP trainees across Europe.

To explore the diverse benefits provided by EFPT for GAP and CAP trainees across Europe, focusing on professional development, research collaborations, and international exchanges. This abstract highlights strategies for maximizing these opportunities and overcoming the challenges of international psychiatric training.

A review of EFPT’s initiatives, project descriptions, website data, and participant feedback was conducted. This analysis covered webinars, courses, research projects, clinical exchanges, and cultural experiences. Data were gathered from EFPT’s resources and European trainees’ feedbacks, emphasizing networking, research collaboration, and cultural exchange as key benefits for trainees.

EFPT offers a broad range of benefits for GAP and CAP traineesroughout Europe, including:

• - Networking Opportunities: Trainees can establish professional connections with peers and experienced psychiatrists from across Europe, fostering collaboration, mentorship, and knowledge sharing.

• - International Participation: Trainees have access to international congresses, webinars, and specialized courses that enhance clinical and research skills, exposing them to diverse perspectives and practices.

• - Clinical Exchange Programs: Through EFPT’s exchange programs, trainees gain insights into different healthcare systems, broadening their understanding of child and adolescent mental health treatment across Europe and enhancing their cultural competence.

• - Cultural Enrichment: EFPT’s annual forum, including events like Cultural Night, allows trainees to engage in cultural exchange through music, food, and dance, fostering camaraderie and promoting overall well-being among young psychiatrists.

Active participation in EFPT offers European psychiatric trainees unique opportunities beyond traditional training, contributing to both professional growth and personal development. By encouraging involvement in EFPT, trainees can enhance their skills, broaden their networks, and foster international collaboration, ultimately strengthening the psychiatric community across Europe.

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Medical and psychiatric conditions often coexist, with complex interrelationships that affect patient outcomes. Medical conditions can induce mental illness through psychological or physiological effects, while mental illness may hinder engagement in medical care due to barriers such as poor motivation and functional impairment. Anxiety and depression are among the most common psychiatric conditions encountered on medical floors, and improved management of these conditions can enhance patient outcomes and increase post-discharge follow-up.

The objective of this project was to improve the confidence of medical professionals in treating anxiety and depression on the medical floor by establishing an evidence-based approach for identifying and managing these conditions. The guidelines developed serve as a protocol for rapid, safe interventions, improving outcomes and reducing inefficient healthcare utilization.

A survey was conducted among 18 medical residents to assess their confidence in evaluating and managing anxiety and depression, and determining when a psychiatric consult is necessary. After completing the initial survey, residents were provided with a stepwise guideline for managing anxiety and depression on the medical floor. A post-guideline survey was then conducted to assess changes in their confidence levels and understanding.

Pre-intervention survey results showed 85.7% of residents were comfortable identifying anxiety, 64.3% with identifying major depressive disorder (MDD), and 71.4% with differentiating MDD from bipolar depression. However, only 64.3% felt comfortable treating anxiety, and 50% initiating treatment for MDD. Post-guideline survey results showed improvements in several areas, including 90% confidence in identifying anxiety and 70.2% in diagnosing MDD. Notably, all residents felt comfortable continuing treatment for depression, and knowledge of medication side effects increased to 100%.

The results suggest that medical residents on the floor showed improved confidence in evaluating and managing anxiety and depression after receiving the guideline. There was increased comfort with knowledge of medications and their side effects, although some discomfort remained in initiating treatment and titrating medications. Implementing universal screening protocols and further educational interventions, such as didactic sessions on specific medications and their side effects, can help address these gaps and enhance psychiatric care on the medical floor.

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Psychiatry residency programs in Spain offer diverse clinical rotations to ensure comprehensive training. However, certain rotations may require adjustments in length or structure to meet the evolving educational needs of residents. This study assesses the opinions of psychiatry residents regarding which rotations should be extended, shortened, or maintained.

To evaluate the perceived need for adjustments in rotation length across various subspecialties of psychiatry, including child and adolescent psychiatry, dual pathology, and psychotherapy, among others.

Data was collected through a national survey of psychiatry residents in Spain. Respondents were asked to indicate whether specific rotations should be lengthened, shortened, or maintained. Quantitative analysis was performed on responses for seven key rotations: child psychiatry, dual pathology, psychotherapy, research, neuropsychiatry, community psychiatry, and geropsychiatry.

A total of 109 psychiatry residents participated in the survey. The most frequently requested extension was for geropsychiatry, with 57% of respondents advocating for a longer rotation, followed closely by community psychiatry (48%). In contrast, rotations in research (26%) and child psychiatry (24%) were identified as those most needing to be shortened. Most residents supported maintaining the current duration of dual pathology (86%) and neuropsychiatry (83%) rotations.

The results suggest a strong desire among psychiatry residents to extend rotations in geropsychiatry and community psychiatry, while shortening research and child psychiatry. These findings highlight the need for training programs to reevaluate the duration of certain rotations to better align with resident learning needs.

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The progressive acquisition of autonomy, balanced with adequate supervision, is essential during psychiatry residency. However, the adequacy of supervision and the smooth transition to autonomy remains a concern among residents. This study evaluates psychiatry residents’ perceptions of the current process of acquiring autonomy from the first to fourth year of training.

To assess the perceptions of psychiatry residents in Spain regarding the process of progressively acquiring autonomy and how supervision is managed throughout their residency.

A qualitative analysis was conducted on responses to the survey question: “What should be improved in the progressive acquisition of autonomy and supervision from R1 to R4?” Data from free-text responses were coded thematically, with common themes identified and quantified.

Responses from 109 residents were analyzed. Thematic analysis revealed that 35% of residents emphasized the need for clearer and more structured feedback from supervisors, while 30% suggested more direct supervision during critical learning periods, particularly in the first two years. Additionally, 20% highlighted the inconsistency of supervision across different units, with some units providing much less oversight than others. Other suggestions included better scheduling of supervisory sessions (10%) and more frequent formal evaluations of their autonomy progression (5%).

Residents identified several key areas for improvement in the process of acquiring autonomy, with a particular focus on the need for more structured feedback and increased supervision during the early years of training. Addressing these concerns may improve the overall quality of psychiatric education and resident preparedness.

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External rotations allow psychiatry residents to gain exposure to different clinical settings and practices. However, the availability and quality of these rotations vary significantly across training units. This study evaluates residents’ experiences with external rotations and identifies areas for improvement.

To assess the time allocated for external rotations in different training units and explore residents’ suggestions for improving these rotations.

A cross-sectional survey was distributed to psychiatry residents in Spain. Quantitative data regarding the total time allowed for external rotations was collected, and qualitative responses were analyzed to identify recurring themes for improvement.

A total of 109 responses were analyzed. Quantitatively, 60% of residents reported being allowed 1 to 3 months for external rotations, while 25% stated they had more than 3 months. Only 15% indicated that external rotations were not offered in their unit. Qualitative analysis revealed that the main areas for improvement included more flexibility in choosing rotation locations (40%), better financial support for rotations outside of the home institution (35%), and greater clarity in the application process for external rotations (25%).

The majority of psychiatry residents are allocated 1 to 3 months for external rotations, but many see room for improvement in terms of flexibility, financial support, and clarity in the application process. Enhancing these aspects could make external rotations more accessible and beneficial for residents.

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Docimology is the science that assesses the quality of tests and items, based on different indices and coefficients.

The purpose of our study was to perform a docimological analysis, based on docimological indices, of the items and exams of Child psychiatry of psychiatry certificates porposed for the students of the Third Year of the Second Cycle of Medical Studies in the Faculty of Medicine of Tunis.

We carried out a retrospective and descriptive study. We have included the scores of main sessions’ psychiatry certificate exam of six academic years (2016-2017 to 2021- 2022). We did not include the scores of this certificate obtained at the control sessions during the period of our study. We carried out a global docimological analysis of the psychiatry exam, of the child psychiatry exam and its items.

We included a total of 2780 exam scripts spread over 12 main sessions. We found an annual pass rate of 96.7% in the psychiatry certificate and 85.3% in the discipline of child psychiatry. The study of the internal homogeneity of the psychiatric tests showed that the Alpha index of Cronbach varied between 0.64 and 0.82 with an average index of 0.74 which corresponds to an internal homogeneity at least acceptable. We found that the maximum scores obtained in the discipline of child psychiatry varied from 16.5 to 19.75 out of 20. The average rate of students, who passed the psychiatry certificate test without passing the discipline child psychiatry, was 11.9%. The questions were easy in 51.7% (62 questions) ans have at least good discrimination in 31.7%. We found also that 25 questions (65,7%) were “ideal”.

Child psychiatry examination in the Faculty of Medicine of Tunis meets globally the docimologic recommendations. This is the first step to build up a bank of items regularly enriched with “ideal” questions with metric qualities known in advance.

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Medical students often harbor entrenched and somewhat negative views towards psychiatry, which can impact their interest in pursuing this specialty and pose challenges to recruitment efforts.

To assess whether exposure to clinical placements in psychiatry can positively shift medical students’ perceptions and influence their career decisions towards this field.

This study employed a “before/after” longitudinal design over an eight-month period involving 5th-year medical students who were starting their 4-week psychiatric rotation. Evaluations were carried out at the beginning and end of the internship using a comprehensive questionnaire that covered sociodemographic details, clinical exposure, and students’ career inclinations towards psychiatry. The questionnaire also explored various reasons influencing their specialty choice, aiming to identify shifts in perspective directly attributable to their internship experience.

A total of 41 students (n=41) participated in the study. There was a notable positive shift in attitudes towards psychiatry observed at the conclusion of the internship. At the start of the rotation, only 29% of students considered choosing psychiatry as a potential career path. By the end of the internship, this figure had increased to 49%. This substantial increase underscores the transformative potential of direct, immersive experiences in altering career considerations among medical students.

Consistent with the literature, the results of this study demonstrate the positive impact that clinical placements in psychiatry can have on medical students’ attitudes towards the specialty and their subsequent choice of it as a career path. This improvement highlights the critical role that such internships play not only in enhancing educational outcomes but also in shaping the future workforce in psychiatry. It is evident that integrating robust psychiatric placements into medical training programs is essential for nurturing an informed, motivated, and committed next generation of psychiatrists. Our findings support the continued advocacy for and expansion of these experiential learning opportunities within medical curricula to foster a deeper understanding and appreciation of psychiatry.

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Suicidal tendencies are among the most common problems faced by adolescents who encounter difficulties, issues, or challenges affecting various aspects of their psychological and social lives, often leading to high suicide rates. Bipolar disorder, various depressive disorders, substance abuse disorders, psychosis, and eating disorders are among the most common leading causes of suicide and suicidal tendencies among adolescents. Dialectical Behavior Therapy (DBT) is an integrative therapy employing a combination of techniques. DBT aims to assess the individual’s ability to regulate emotions, manage relationships effectively, tolerate distress, reduce maladaptive responses, and decrease impulsive and self-destructive behaviors.

The current study aims to investigate the effect of using Dialectical Behavior Therapy (DBT) techniques in reducing suicidal tendencies (ST) among adolescents of both genders who suffer from bipolar disorder. Additionally, to verify the sustained effectiveness of these techniques in reducing suicide risk among adolescents.

A one-group experimental design was used. The study sample consisted of a (31) adolescents with high or moderate levels of suicidal tendencies who were diagnosed with bipolar disorder. Initially, the Bipolar Disorder Scale was used to identify adolescents exhibiting symptoms of the disorder for more than 6 months. This was followed by administering the Suicidal Tendencies Scale. Individuals with high or moderate suicidal tendencies scores on this scale were selected to participate in the study. They then underwent 23 sessions of psychotherapy based on DBT. After the completion of the therapy program, the Suicidal Tendencies Scale was administered again, and a third administration took place two months after the completion of the program. The research tools included a DBT-based therapy program consisting of 23 sessions, with an average of 3 sessions per week, each lasting 45-60 minutes.

The results indicated a significant improvement among adolescents after the completion of the program. Participants reported benefiting from the program, expressing reduced feelings of despair and increased hope and optimism about life. The adolescents’ scores on the Suicidal Tendencies Scale decreased after the program ended compared to their scores before the program. Additionally, their scores remained lower two months after the program ended compared to their pre-program scores. This indicates a positive impact of the counseling program in reducing suicidal tendencies among adolescents, as well as the sustained effectiveness of the program.

Dialectical Behavior Therapy (DBT) is effective in reducing suicidal tendencies and can be applied effectively to a range of other psychological disorders. It is essential to manage suicidal tendencies among adolescents to help decrease suicide rates.

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Suicide attempts during dissociative fugue states pose distinct challenges in assessing self-harm risk. Dissociative fugue is characterized by sudden, unplanned travel away from familiar surroundings, coupled with amnesia for personal identity and significant changes in behavior. This case report describes a 31-year-old male who attempted suicide during a dissociative fugue episode.

To present a case of a suicide attempt during a dissociative fugue state, highlighting the unique challenges in assessing self-harm risk, and examining the role of substance use and prior psychological trauma in influencing patient behavior.

This case report describes a single patient. The methodology involves a comprehensive examination of the patient’s clinical presentation, including diagnostic work-up, treatment adjustments, and outcomes.

A 31-year-old male was admitted to the emergency department after intentionally ingesting 25 diazepam tablets. Eight months earlier, he had survived a suicide attempt via carbon monoxide poisoning, also during a dissociative fugue state. These fugue episodes were marked by sudden, unplanned disappearances, memory loss, significant behavioral changes, and temporary loss of personal identity. The latest episode followed an emotional conflict with friends, leading to a three-day disappearance, during which the patient traveled to various locations, frequented pubs, and slept in his vehicle. He attempted suicide on the final day by overdose. Medical assessments, including physical and neurological exams, blood tests, and cranial computed tomography (CT) scans, showed no abnormalities. The patient admitted to using alcohol and cocaine, but urine toxicology revealed no other substances. During psychiatric evaluation, he denied any current or past suicidal ideation and exhibited no psychotic or manic symptoms. He reported mild affective decline over recent months and a complex life history, but did not meet the DSM-5 criteria for post-traumatic stress disorder (PTSD).

The key diagnostic challenge in this case is distinguishing between substance intoxication and dissociative fugue. Although the patient was intoxicated with alcohol and cocaine during parts of the episode, intoxication was not consistent throughout the entire period. Moreover, the onset of symptoms was abrupt and triggered by an emotional conflict. Given the patient’s history of dissociative fugue and the nature of the current symptoms, dissociative fugue remains the most plausible diagnosis. This case highlights the complexity of managing self-harm risk in patients with dissociative symptoms, where suicide attempts complicate the development of effective safety plans and pose significant challenges to intervention strategies.

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One of the great challenges for Mental Health Services is dealing with users who repeatedly use the facilities. This phenomenon, beyond representing an increase in the economic cost and in terms of human resources, generates high levels of frustration and dissatisfaction, both in professionals and in the consultants themselves. These users have been called “hyperfrequent users”. Users can frequent different services, including the Emergency service. The phenomenon of hyperfrequent use can lead to an inappropriate use of the Emergency services and gives rise to substantial costs for the health system, as well as a decrease in the efficiency of the service.

The objective of our work is to describe those factors associated with the hyper-frequent use of Mental Health Hospital Emergency Services by users who engage in suicidal behavior.

A descriptive, observational study was carried out. The population included all users of the Hospital Emergency Department treated by the Mental Health Service in one year who consulted for suicidal behaviour (self-harming ideas, suicidal attempts or self-harm). Patients who consulted on 4 or more occasions in the hospital psychiatric emergency departments for consultations related to suicidal behaviour were considered as frequent users.

860 consultations were attended to, corresponding to 546 users who consulted in the psychiatric hospital emergency departments for suicidal behaviour (self-harming ideas, suicidal attempts or self-harm). Of these users, 314 consulted on more than one occasion. Taking as a frequent user >=4 consultations, we have 14 users in one year. Regarding sex, the female sex stands out 86% over the male sex 14%. One user is considered a great frequent user, attending on 17 occasions. The most frequent reasons for suicidal consultation among frequent users are consultations for self-harm ideation (33%) and self-harm attempts (60%) and self-harm (7%). Anxiety and alcohol consumption are the most frequent comorbid diagnoses among frequent users. By sex, self-harm behavior stands out in both women and men and self-harm is more frequent in women. Regarding discharge after assessment, referrals to a community mental health specialist stand out in 45% after consultation and 28% of frequent users required hospital admission after care for suicidal behavior.

In our work, it is observed that the profile of frequent users with suicidal behavior is adult women who consult for self-harm attempts in their majority. These hyper-frequent users continue to demand attention from the health network devices, so knowing their needs would help to improve health care and use resources more efficiently and effectively for these users who engage in suicidal behavior.

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Suicide is one of the leading causes of preventable death.

The PRISURE program is developed with a series of objectives and actions aligned with the Mental Health Strategy of the National Health System - (Spain), Strategic Plan for Mental Health and Addictions of the Community of Madrid 2022-2024 and the Prevention Plan suicide in the community of Madrid 2022-2026, based on the experience of the suicide risk prevention program developed between 2014 and 2023 at the Retiro Mental Health Center (CSM) of the Institute of Psychiatry and Mental Health of the General University Hospital Gregorio Marañón.

Presentation of a secondary suicide prevention program in the Community of Madrid with 10 years of implementation and reinforcement of the therapeutic team in the last year.

Treatment outcomes, assessment of patients’ suicide risk progression during follow-up, referral to patient discharge, and outcome indicators in the past year are measured.

Description of the functioning of the PRISURE program and descriptive study of sociodemographic and clinical characteristics, suicidal crises, evolution and discharge referrals, of all patients treated in PRISURE. The program’s performance indicators, as well as its results, are evaluated over one year from its implementation.

Sociodemographic and clinical characteristics are analyzed, including psychometric evaluation at baseline, 3, 6, 9, and 12 months after referral to PRISURE from August/2023 to August/2024. The suicide risk profile, treatment adherence, program implementation indicators and initial results are evaluated.

PRISURE is a comprehensive care process that includes the prevention, intervention and postvention of suicidal behavior.

It includes interventions indicated for the prevention of suicidal behavior aimed at people in whom relevant signs or symptoms that anticipate the development of a mental disorder, or biological or psychological markers that indicate a high suicidal risk, have been identified.

PRISURE encompasses a set of activities aimed at early detection and indicated prevention, support and care of suicidal behavior, as well as research and promotion of mental health.

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The significance of intimate life in a person’s personal and social experience cannot be overstated. This aspect is intricately woven into the clinical and internal picture of intentional (suicidal or non-suicidal) self-harm (SX), making it a crucial area of study.

Study of position on the issue of sexual problems and SX among participants of an open forum.

We conducted interviews with forty participants (90% women) with a mean age of 27 (range 17-43) years, using an original semi-structured questionnaire. This approach allowed us to delve into the issue of sexual problems and SX among participants of an open forum.

Тen thousand people were interested in the survey during two months of posting on the site, but < 0.5% participated. All questions were answered by 95%. The sample comprised young women, like most of our online polls. For almost 70% of respondents, issues of sexual life are burning and pressing questions, but only ¼ discuss «this» with a psychiatrist and only in terms of drug side effects. During routine visits, the doctors were not interested in the sexual life of about 80% of patients; ¾ of the women were not interviewed about the menstrual cycle or (all men) about erections or galactorrhea. Only ¼ of doctors are interested in the intent of SX. >70% indicate that forced abstinence «worsens» their mental state (makes them irritable), >¾ of singles and ½ family people masturbated 1-3 times a week («to feel alive»). >½ of married women are afraid of pregnancy, but refuse birth control as «harmful». >80% of family problems were associated with apathy and irritability and are considered the main obstacle to regular sex. > ½ report «habitual» weakness, lack of interests (including sexual), and suicidal thoughts for more than three months. <½ respondents link treatment to impotence and frigidity. ½ had SX experience (indistinguishable from suicide attempts) due to the loss of a loved one during their life. Patients considered SX to be a «natural» reaction to shame and mental pain and allowed repetition in a similar situation. Doctors do not regularly assess a patient’s risk of suicide.

The findings of this study underscore the need to bring sex and SX topics into the focus of routine psychiatric practice. The passive role of psychiatrists in clarifying patients’ problems that influence treatment adherence, well-being, and undertreatment of depression is a significant issue that needs to be addressed. The survey highlights two subtopics of greatest interest to patients: indestructible sex drive and micro social problems as ‘reasons’ for depression and SX. The ‘gray zone’ of therapeutic contact and satisfaction with care is an area that warrants further exploration.

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Chronic medical conditions are increasingly recognized as significant contributors to suicide risk, especially in patients without prior psychiatric diagnoses (Østergaard et al. JAMA Psychiatry 2024). This case examines the psychiatric impact in a 65-year-old male admitted to general surgery for abdominal pain, who subsequently underwent an ileocolectomy for suspected gastrointestinal malignancy.

To explore the psychiatric impact of medical morbidity on suicide risk, emphasizing recent findings suggesting heightened attention for patients without a psychiatric history.

The patient, with no prior psychiatric history, was observed by liaison psychiatry after verbalizing suicide ideation without intent or plan. The ideation was associated with worsening mood, particularly over the past week. Emotional distress escalated after perceived medical setbacks and was compounded by familial dynamics, particularly the wife’s expressed anxiety. A diagnosis of adjustment disorder with depressive symptoms was considered, with initial treatment involving mirtazapine and psychosocial support.

The case reflects evidence supporting the idea that suicide risk may follow a dose-response pattern based on the disability burden in patients without prior psychiatric history (Østergaard et al. JAMA Psychiatry 2024). This suggests clinicians may need to be particularly vigilant in medically ill patients without a psychiatric background, as their suicide risk may increase as disability burdens mount – contrary to the understandable and maybe more intuitive focus on those with established psychiatric diagnoses.

This case highlights the importance of thorough suicide risk evaluation in patients without psychiatric histories, particularly following a major medical diagnosis. While suicide risk remains high in psychiatric patients, clinicians must be equally or even more vigilant with medically ill patients without psychiatric histories. Psychiatric care should be integrated early, with attention to the timing of suicide risk, the disability burden, and psychosocial stressors. This highlights the need for careful monitoring and early intervention, particularly in the acute phase following medical complications, where risk evaluation may be more nuanced.

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Depression among older adults is a significant public health issue that often goes underrecognized, despite its profound impact on their quality of life and mental well-being. With advancing age, many individuals encounter challenges such as loneliness, chronic illness, and bereavement, which heighten their vulnerability to depressive symptoms. These symptoms are not only detrimental to overall health but are also strongly associated with an increased risk of suicidal behaviours. Although these suicidal behaviours are preventable, much research should be done to disentangle development pathways in older adults.

The aim of this research is to identify the symptomatic profiles of depression in the elderly population and to relate this profile to suicidal outcomes.

We utilized data from the “Edad con Salud” cohort study, a longitudinal household survey conducted on a nationally representative sample in Spain (aged 18+ years). Participants who could not be personally interviewed and those under 50 years old were excluded, resulting in a final sample of 3,533 participants (54.31% female, age = 66.42(10.27)). Suicidal behaviours and depressive symptoms were assessed using the Composite International Diagnostic Interview (CIDI 3.0). A Latent Class Analysis (LCA) was performed at base level to identify participant profiles based on 8 depressive symptoms. We followed this with a survival analysis to assess differences between profiles in the progression of suicidal ideation and attempts in the different waves. Finally, Cox regression was used to examine the impact of sociodemographic and clinical covariates on suicidal behaviours.

The three-cluster model provided the best fit. The first class (72.52%) included most participants without depressive symptoms; the second class (13.67%) included participants with three symptoms (depressive mood, diminished interest or pleasure and fatigue); and the third class (13.81%) included participants with all eight symptoms (see Image 1). Survival analysis revealed significant differences between the groups over time for both suicidal ideation (χ2=1332, p < .01) and suicide attempts (χ2=215, p < .01), with the third group having the highest number of cases. Cox regression indicated that suicidal ideation was associated with the second (HR = 5.38) and third classes (HR = 59.8), age (HR = 0.97), and loneliness (HR = 0.91), among other variables. Suicide attempts were associated with the second (HR = 6.08) and third classes (HR = 25.3), age (HR = 0.92), and loneliness (HR = 1.02).

Image 1:

Participants with depressive symptoms, even at a subclinical level, have an increased risk of suicidal behaviours, especially when other risk factors such as loneliness are present.

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Benzodiazepines are widely prescribed for the management of common mental health disorders. Although a direct relationship between benzodiazepines and suicide risk reduction has not been described, they can be an adequate choice to palliate anxiety and insomnia in patients with suicidal ideation. This is of special interest considering that both anxiety and insomnia are risk factors for suicidal behaviours themselves (May and Klonsky. Clin Psychol: Science and Practice. 2016; 23 5–20)(Park et al. J Psychiatr Res. 2020; 131 1-8). Nonetheless, paradoxically, there is a rising concern regarding an increase in suicide risk associated to benzodiazepine use, as some recent evidence seems to suggest (Dodds. Prim Care Companion CNS Disord 2017; 2;19)(McCall et al. Am J Psychiatry 2017; 1;174 18-25). Clarifying this potential association can help guide clinical decision-making to promote suicide prevention.

To review the currently available evidence regarding the relationship between the use of benzodiazepines for common mental disorders and subsequent suicide, suicidal behaviours and self-injurious behaviours.

A systematic review of the literature was conducted using a combination of search terms related to “suicide” and “benzodiazepine” to assess publications from inception to February 2024 in 3 different databases (Scopus, PsychInfo, MEDLINE). Eligibility criteria included experimental, observational studies and previous systematic reviews while excluding conference proceedings, case reports/series, editorials, opinion papers and letters. Studies involving individuals with severe psychiatric disorders, dementia or personality disorder were also excluded. Risk of bias was assessed in RCTs with the RoB 2 tool while EPHPP Assessment Tool 2010 was applied for other study types.

A total of 2090 titles and abstracts were screened; 19 papers were reviewed for inclusion and 8 were included in this review for data extraction. Most of the included publications consisted of observational studies. Results tended to indicate a higher risk of suicide, suicidal behaviour and/or self-injurious behaviours in relation to benzodiazepine use although data was contradictory and affected by confounding.

Evidence seems to suggest a positive relationship between benzodiazepines and suicide, suicidal behaviour and/or self-injurious behaviours although, due to the predominant observational study designs and the presence of unadjusted confounding, these results must be extrapolated with care and no causality can be inferred. An interesting approach for future research to palliate such limitations could be Target Trial Emulation (Hernán and Robins. Am J Epidemiol 2016; 15;183(8) 758-64), which has already been adopted to guide decision-making in absence of randomized trials in many fields of medicine.

M. Oliveró: None Declared, M. Martínez García: None Declared, V. Pérez Grant / Research support from: Has received honoraria or grants from AB-Biotics, AstraZeneca, Bristol-Myers-Squibb, CIBERSAM, FIS- ISCiii, Janssen Cilag, Lundbeck, Otsuka, Servier and Medtronic., Consultant of: Has been a consultant to AB-Biotics, AstraZeneca, Bristol-Myers-Squibb, CIBERSAM, FIS- ISCiii, Janssen Cilag, Lundbeck, Otsuka, Servier and Medtronic., M. T. Campillo: None Declared, G. Martínez-Alés Grant / Research support from: American Foundation for Suicide Prevention grant ECR-1-101-23, Brain and Behavior Research Foundation grant NARSAD 31312 and National Institutes of Mental Health grant 1R25MH129256-01A1, L. Cano: None Declared, D. Guinart Grant / Research support from: CM21/00033, Consultant of: Has been a consultant and/or advisor or has received honoraria from: Angelini, Otsuka, Lundbeck and Teva., P. Mortier Grant / Research support from: This work was supported by grant CP21/00078 from the ISCIII-FSE Miguel Servet

The collaboration between nursing, psychology, and psychiatry is essential for delivering comprehensive and effective mental health care. A multidisciplinary approach ensures that patients receive holistic support where everyone is aligned on the patient’s needs, treatment progress, and level of risk, and drawing on the unique skills and expertise of each discipline. Without proper coordination, there is a higher risk of gaps in care, conflicting interventions, or misunderstandings that could negatively impact the patient’s safety and well-being.

To highlight the importance of collaborative work between nursing, psychology, and psychiatry within the context of an acute, short-term, intensive outpatient program for suicidal ideation, such as PRISURE, is essential. For patients at high risk of suicide, particularly those experiencing acute symptoms, a combined multidisciplinary approach is critical to providing effective and timely care.

The program distinguishes between two types of interventions: an intensive program and a regular program, both offering a couple months long intervention but differing in the frequency of visits. The entire team meets weekly to assess new cases and discuss patients within the intensive program. An additional meeting is held to coordinate care for patients in the regular program between nursing and psychiatry. Regular multidisciplinary meetings are key to ensuring a coherent and unified approach across both programs. Appointment schedules are carefully coordinated to minimize the time between consultations, ensuring continuous and consistent follow-up for patients. The program also coordinates with regular mental health out-patient clinics within the public health system, to garantee a good transition of care.

During these collaborative meetings, each specialist shared their assessments and observations on the patient’s progress, enabling the team to develop a unified therapeutic plan. Any changes in symptoms or new events are promptly communicated among all treating professionals, allowing for a rapid and coordinated multidisciplinary response. The diverse perspectives of each team member contribute to a more nuanced and comprehensive understanding of the patient’s needs and treatment.

In summary, the collaboration between nursing, psicology and psychiatry creates a synergistic approach that is essential for delivering high-quality, patient-centered mental health care, particularly for those experiencing suicidal ideation.

None Declared