- Email: [email protected]
Effects of different antidepressants on pro-inflammatory cytokines in rats undergoing chronic mild stress without lipopolysaccharide induction
602
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
association between HADS depression score 8 or more and prospective A&E attendance (odds ratio = 2.7, 95% CI 1.5,4.7, p = 0.001) and prospective emergency admission (odds ratio = 2.6, 95% CI 1.5,4.4, p = 0.001), over the following 12 months, adjusting for age, gender, severity of COPD and previous use of unscheduled care. Conclusion: Depression is a powerful independent predictor of both attendance at the emergency department and emergency hospital admission in patients with COPD. doi:10.1016/j.jpsychores.2015.03.054
Preventive effects of ramelteon on delirium K. Hatta Juntendo University Nerima Hospital, Department of Psychiatry, Tokyo, Japan Background: No highly effective interventions to prevent delirium have been identified. We examined whether ramelteon, a melatonin agonist, is effective for the prevention of delirium. Method: We performed a multi-center, rater-blinded, randomized placebo-controlled clinical trial in intensive care units and regular acute wards in four university hospitals and one general hospital. Eligible patients were 65–89 years old, newly admitted due to emergency, and able to take medicine orally. Sixty-seven patients were randomly assigned using the sealed envelope method to receive ramelteon (8 mg/day; n = 33) and placebo (n = 34) every night for 7 days. Main Outcome Measure was incidence of delirium as determined by the DSM-IV-TR. Results: Ramelteon was associated with lower risk of delirium (3% vs. 32%, P = .003), with a relative risk of 0.09 (95% confidence interval (CI), 0.01–0.69). Kaplan–Meier estimates of time to development of delirium were 6.94 days (95% CI, 6.82–7.06 days) for ramelteon and 5.74 days (5.05–6.42 days) for placebo. Comparison by log-rank test showed that the frequency of developing delirium was significantly lower in patients taking ramelteon than in those taking placebo (χ2 = 9.83, P = .002). Conclusion: Ramelteon administered nightly to elderly patients admitted for acute care may provide protection against delirium. This finding supports a possible pathogenic role of melatonin neurotransmission in delirium. doi:10.1016/j.jpsychores.2015.03.055
Association between initial psychosocial assessment of candidates for transplantation (PACT) score and mortality among lung transplant recipients at Mayo Clinic, Rochester M.J. Hitschfelda, S.G. Jowsey-Gregoirea,e, C.C. Kennedyb, S.K. Niazic,e, A.R. Vasquezc,e, J.R. Gesked, T.D. Schneeklotha,e a Mayo Clinic, Dept. of Psychiatry & Psychology, Rochester, MN, USA, b Mayo Clinic, Dept. of Pulmonary & Critical Care Medicine, Rochester, MN, USA, c Mayo Clinic, Dept. of Psychiatry & Psychology, Jacksonville, FL, USA, d Mayo Clinic, Dept. of Health Sciences Research, Rochester, MN, USA, e Mayo Clinic, Transplant Center, Rochester, MN, USA Background: The psychosocial assessment of potential transplant candidates is an essential part of the transplant evaluation, and the U.S. United Network of Organ Sharing requires it before being listed. At Mayo Clinic, we have been using the Psychosocial Assessment of Candidates for Transplant (PACT) (Olbrisch et al. 1989) scale since 2000 for transplant psychosocial assessment. The predictive value of this instrument on survival has not been rigorously evaluated among large samples of lung transplantation patients. Our primary aim was to investigate PACT score association with survival following transplantation.
Method: We conducted a historical cohort study among patients who underwent lung transplantation at Mayo Clinic Transplant Center, Rochester, between January 1, 2000 and December 31, 2012. The data were abstracted from the EMR. Patients were screened for psychosocial risk at Transplant Program initial evaluation by a transplant psychiatrist using the PACT, whose final score is the evaluator's global assessment of all items: 0, poor candidate; 1, borderline candidate; 2, acceptable candidate; 3, good candidate; and 4, excellent candidate. After transplantation, survival was assessed until December 31, 2014. During the first year following transplantation, smoking relapse, depression, anxiety disorder, antidepressant use, and acute graft rejection data were obtained. Results: The study included 111 lung recipients with a pretransplant PACT score; 58 (52.3%) were females, 102 (91.9%) Caucasians and mean ± SD age was 56.3 ± 10.7. Previous smokers were 81 (73.0%), and 22 (19.8%) had an Alcohol Use Disorder (AUD) history. Seven (6.3%) patients received a score b2 and 104 (93.7%) patients received scores of ≥2. After adjustment for covariates, to have a PACT score ≥2 was associated with lower mortality at 10year follow-up (HR = 0.32, 95% CI: 0.13–0.80, p = 0.0149). The PACT was not associated with post-transplant new episodes of depression or anxiety disorder, antidepressant first time use, or acute graft rejection at 12-month follow-up. Only 2 (1.8%) patients had smoking relapse at 12-month follow-up. Conclusion: Pre-transplant psychosocial variables assessed by the PACT were associated with post-transplant mortality at 10-year follow-up among lung recipients. Further work is encouraged to identify PACT sub-items associated with mortality and post-transplant psychosocial outcomes. doi:10.1016/j.jpsychores.2015.03.056
Effects of different antidepressants on pro-inflammatory cytokines in rats undergoing chronic mild stress without lipopolysaccharide induction R.C. Ho National University of Singapore, Department of Psychological Medicine, Singapore Background: Recent research evidence indicates that depression leads to pro-inflammatory cytokine hyper-secretion and inflammatory response system activation. Antidepressants reverse these depressive symptoms. However, the relative efficacy between classes of antidepressants to reduce pro-inflammatory cytokines remains unknown. This study aims to compare the effects of eight different antidepressants (agomelatine, amitriptyline, bupropion, escitalopram, fluoxetine, moclobemide, mirtazapine, and venlafaxine) and a mood stabilizer (lithium) on peripheral and central proinflammatory cytokines in rats undergoing chronic mild stress (CMS) without lipopolysaccharide induction. Method: The study included fifty female adult Sprague–Dawley rats divided into the following groups: 8 different antidepressant and a mood stabilizer groups subjected to CMS procedure (CMS/different antidepressant groups), a CMS group with distilled water (CMS/vehicle), and a nonCMS (negative) control group. The following parameters were investigated: sucrose preference, duration of immobility, body weight gain and the levels of pro-inflammatory cytokines (interleukin (IL)-6, IL-17, IL-1β and TNF-alpha) in serum and brain samples. Results: The CMS rats treated with agomelatine, amitriptyline, escitalopram, fluoxetine, mirtazapine, venlafaxine and non-CMS (negative) controls demonstrated significantly lower level of serum IL-1β compared to the CMS/vehicle group (p b 0.05). For brain cytokine levels, both IL-1β and IL-6 were significantly lower in CMS rats treated with agomelatine, amitriptyline and escitalopram and non-CMS control as
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
compared to CMS/vehicle. No significant differences were observed in serum and brain TNF-α and IL-17 levels. Conclusion: Our data suggest that agomelatine, amitriptyline and escitalopram demonstrated significantly lower serum and brain levels of IL-1β, as well as brain levels of IL-6 in an animal model of depression without LPS challenge. This study revealed potential therapeutic effects of agomelatine, amitriptyline and escitalopram by reducing central and peripheral levels of IL-1β and IL-6 in addition to alleviation of depressive symptoms. doi:10.1016/j.jpsychores.2015.03.057
Integrating mental and physical healthcare: Research, training and services (IMPARTS) — A flexible service development platform for general hospital teams M. Hotopf, L. Rayner, A. Simpson, F. Matcham, Jo Taylor Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK Background: The aim of IMPARTS was to facilitate embedded integrated care through 5 core components: web-based screening; care pathway development; training in mental health skills; provision of bespoke selfhelp materials; and research as an outgrowth of patient care. Method: Patients received an information sheet explaining the purpose of screening and completed a series of outcome measures tailored to their condition whilst waiting for their appointment. The data captured populate the electronic patient record (EPR) in realtime; the results are immediately available to the clinician. The system is flexible and administers different questionnaires depending on variables such as diagnosis and date of last assessment. The data captured inform automated algorithms in EPR, which operationalise care pathways agreed with the clinical team. Care pathways vary but may include referral to community services, or mental health services embedded within the acute trust. Results: Feasibility and acceptability data collected from the first four services that implemented screening (rheumatology, limb reconstruction, psoriasis and hepatitis C) show that fewer than 5.1% of patients declined screening. The proportion of patients completing the IMPARTS questionnaire varied widely across services, from 98.2% in psoriasis to 40.1% in hepatitis C. IMPARTS has now been implemented in 22 services across 3 London hospital sites and 2 NHS Foundation Trusts. At 1st February 2015, a total of 7238 individuals have been screened across 11,153 encounters. The prevalence of probable depressive disorder ranges from 4% in posttransplant renal patients to 60% in chronic pain patients. The prevalence of generalised anxiety disorder ranges from 6% in posttransplant renal patients to 30% in rheumatology. Conclusion: The IMPARTS platform is acceptable to patients and can be effectively embedded in routine general hospital practice. The data reveal wide variation in the prevalence of mental disorder, with relatively asymptomatic conditions such as adult congenital heart disease and renal transplant patients showing lower levels of psychological morbidity, than chronic pain, rheumatological, and dermatology patients.
doi:10.1016/j.jpsychores.2015.03.058
A relaxation strategy for reducing chemotherapy side-effects J. Hunterb, A. Chaoula, M. Fischa, M. Harden-Harrisona, R. Bassetta, D. Suia, R. Maunderb, L. Lagronea, L. Cohenc a MD Anderson Cancer Center, Psychology, Houston, USA, b Consultation Liaison Division, Psychiatry University, Toronto, Canada, c MD Anderson Cancer Center, Psychology, Houston, USA
603
Background: Chemotherapy side-effects diminish quality of life and can lead to treatment delay. It is well established that some sideeffects, especially nausea and vomiting, result from classical conditioning, and may be reduced by behavioral interventions. These are often not employed due to time and cost. We studied the effects of ‘Mindfulness Relaxation’ (MR), consisting of a 20-minute meditation, informed by principles of mindfulness, yoga, and guided imagery, on anticipatory nausea and vomiting. Method: Patients undergoing chemotherapy for solid tumours were randomized to MR (n = 204), a relaxing music control (RM)(n = 225) and standard care (SC)(n = 210). The MR was delivered by the chemotherapy nurse prior to the chemotherapy, in an attempt to establish a pre-emptive relaxation response (RM was delivered at the same time point). Subjects also received a tape of MR or RM to be used for home practice, and at all chemotherapy administrations. Anticipatory nausea and vomiting (Morrow Assessment of Nausea and Emesis-MANE) were assessed at the midpoint and end of chemotherapy. Results: Subjects' average age was 54.7 years (range: 21.6–85.0), 92.0% were women, with 86.6% Caucasian, and 11.6% African American. The majority of the patients had breast cancer (84.50%) other malignancies were: GI: 7.01%; lung: 2.55%; Gyn 2.12%. Most patients had early stage disease (stage I: 25.2%; stage II: 57.6%; stage III: 15.8%; stage IV: 1.4%). MR reduced anticipatory nausea compared to SC (adjusted p-value = .043) controlling for age, gender, cancer stage, and emetogenic level of chemotherapy. Examination of its impact on other variables is ongoing. Conclusion: This study demonstrated that a brief, nurse-delivered, behavioral intervention could reduce anticipatory nausea. MR is low cost and widely applicable. Understanding how patient characteristics impact on efficacy will further advance our understanding of the applicability of MR into the chemotherapy setting. doi:10.1016/j.jpsychores.2015.03.059
Illness perceptions of people with chronic illnesses attending the emergency department are associated with suicidality risk independent of depressive and anxiety disorders T. Hyphantisa, A. Ninoua, E. Ntountoulakia, V. Paikaa, A. Carvalhob a University of Ioannina, Dept. of Psychiatry, Ioannina, Greece, b University of Ceará, Psychiatry Research Group, Brazil Background: To assess the factors associated with suicidality risk in people with long-term conditions (LTCs) attending the emergency department. Method: In a cross-sectional design, 349 patients with diabetes, COPD and rheumatic diseases seeking urgent care at our AED during an 18-month period were interviewed with the MINI. We assessed the independent associations of MINI diagnosis of depressive and anxiety disorders and illness perceptions (B-IPQ) with the suicidality risk (Risk Assessment of Suicidality Scale) after adjusting for demographics, comorbidities, and previous history of depression in hierarchical multiple regression models. Results: Eighty patients (22.9%) were considered suicidal, 95 (27.2%) were diagnosed with Major Depressive Disorder and 46 (13.2%) with any Anxiety Disorders according to the MINI. Adverse beliefs about treatment control (p = 0.05), history of depression (p = 0.004), major depressive disorder (p b 0.001) and any anxiety disorder (p = 0.001) were the significant independent correlates of suicidality risk. Conclusion: A remarkable proportion of people with LTCs attending the emergency department present elevated suicidality risk, which is associated with adverse illness perceptions about treatment control, along with depressive and anxiety disorders. Apart from the early recognition of mental illness, clinicians should also pay attention to
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
association between HADS depression score 8 or more and prospective A&E attendance (odds ratio = 2.7, 95% CI 1.5,4.7, p = 0.001) and prospective emergency admission (odds ratio = 2.6, 95% CI 1.5,4.4, p = 0.001), over the following 12 months, adjusting for age, gender, severity of COPD and previous use of unscheduled care. Conclusion: Depression is a powerful independent predictor of both attendance at the emergency department and emergency hospital admission in patients with COPD. doi:10.1016/j.jpsychores.2015.03.054
Preventive effects of ramelteon on delirium K. Hatta Juntendo University Nerima Hospital, Department of Psychiatry, Tokyo, Japan Background: No highly effective interventions to prevent delirium have been identified. We examined whether ramelteon, a melatonin agonist, is effective for the prevention of delirium. Method: We performed a multi-center, rater-blinded, randomized placebo-controlled clinical trial in intensive care units and regular acute wards in four university hospitals and one general hospital. Eligible patients were 65–89 years old, newly admitted due to emergency, and able to take medicine orally. Sixty-seven patients were randomly assigned using the sealed envelope method to receive ramelteon (8 mg/day; n = 33) and placebo (n = 34) every night for 7 days. Main Outcome Measure was incidence of delirium as determined by the DSM-IV-TR. Results: Ramelteon was associated with lower risk of delirium (3% vs. 32%, P = .003), with a relative risk of 0.09 (95% confidence interval (CI), 0.01–0.69). Kaplan–Meier estimates of time to development of delirium were 6.94 days (95% CI, 6.82–7.06 days) for ramelteon and 5.74 days (5.05–6.42 days) for placebo. Comparison by log-rank test showed that the frequency of developing delirium was significantly lower in patients taking ramelteon than in those taking placebo (χ2 = 9.83, P = .002). Conclusion: Ramelteon administered nightly to elderly patients admitted for acute care may provide protection against delirium. This finding supports a possible pathogenic role of melatonin neurotransmission in delirium. doi:10.1016/j.jpsychores.2015.03.055
Association between initial psychosocial assessment of candidates for transplantation (PACT) score and mortality among lung transplant recipients at Mayo Clinic, Rochester M.J. Hitschfelda, S.G. Jowsey-Gregoirea,e, C.C. Kennedyb, S.K. Niazic,e, A.R. Vasquezc,e, J.R. Gesked, T.D. Schneeklotha,e a Mayo Clinic, Dept. of Psychiatry & Psychology, Rochester, MN, USA, b Mayo Clinic, Dept. of Pulmonary & Critical Care Medicine, Rochester, MN, USA, c Mayo Clinic, Dept. of Psychiatry & Psychology, Jacksonville, FL, USA, d Mayo Clinic, Dept. of Health Sciences Research, Rochester, MN, USA, e Mayo Clinic, Transplant Center, Rochester, MN, USA Background: The psychosocial assessment of potential transplant candidates is an essential part of the transplant evaluation, and the U.S. United Network of Organ Sharing requires it before being listed. At Mayo Clinic, we have been using the Psychosocial Assessment of Candidates for Transplant (PACT) (Olbrisch et al. 1989) scale since 2000 for transplant psychosocial assessment. The predictive value of this instrument on survival has not been rigorously evaluated among large samples of lung transplantation patients. Our primary aim was to investigate PACT score association with survival following transplantation.
Method: We conducted a historical cohort study among patients who underwent lung transplantation at Mayo Clinic Transplant Center, Rochester, between January 1, 2000 and December 31, 2012. The data were abstracted from the EMR. Patients were screened for psychosocial risk at Transplant Program initial evaluation by a transplant psychiatrist using the PACT, whose final score is the evaluator's global assessment of all items: 0, poor candidate; 1, borderline candidate; 2, acceptable candidate; 3, good candidate; and 4, excellent candidate. After transplantation, survival was assessed until December 31, 2014. During the first year following transplantation, smoking relapse, depression, anxiety disorder, antidepressant use, and acute graft rejection data were obtained. Results: The study included 111 lung recipients with a pretransplant PACT score; 58 (52.3%) were females, 102 (91.9%) Caucasians and mean ± SD age was 56.3 ± 10.7. Previous smokers were 81 (73.0%), and 22 (19.8%) had an Alcohol Use Disorder (AUD) history. Seven (6.3%) patients received a score b2 and 104 (93.7%) patients received scores of ≥2. After adjustment for covariates, to have a PACT score ≥2 was associated with lower mortality at 10year follow-up (HR = 0.32, 95% CI: 0.13–0.80, p = 0.0149). The PACT was not associated with post-transplant new episodes of depression or anxiety disorder, antidepressant first time use, or acute graft rejection at 12-month follow-up. Only 2 (1.8%) patients had smoking relapse at 12-month follow-up. Conclusion: Pre-transplant psychosocial variables assessed by the PACT were associated with post-transplant mortality at 10-year follow-up among lung recipients. Further work is encouraged to identify PACT sub-items associated with mortality and post-transplant psychosocial outcomes. doi:10.1016/j.jpsychores.2015.03.056
Effects of different antidepressants on pro-inflammatory cytokines in rats undergoing chronic mild stress without lipopolysaccharide induction R.C. Ho National University of Singapore, Department of Psychological Medicine, Singapore Background: Recent research evidence indicates that depression leads to pro-inflammatory cytokine hyper-secretion and inflammatory response system activation. Antidepressants reverse these depressive symptoms. However, the relative efficacy between classes of antidepressants to reduce pro-inflammatory cytokines remains unknown. This study aims to compare the effects of eight different antidepressants (agomelatine, amitriptyline, bupropion, escitalopram, fluoxetine, moclobemide, mirtazapine, and venlafaxine) and a mood stabilizer (lithium) on peripheral and central proinflammatory cytokines in rats undergoing chronic mild stress (CMS) without lipopolysaccharide induction. Method: The study included fifty female adult Sprague–Dawley rats divided into the following groups: 8 different antidepressant and a mood stabilizer groups subjected to CMS procedure (CMS/different antidepressant groups), a CMS group with distilled water (CMS/vehicle), and a nonCMS (negative) control group. The following parameters were investigated: sucrose preference, duration of immobility, body weight gain and the levels of pro-inflammatory cytokines (interleukin (IL)-6, IL-17, IL-1β and TNF-alpha) in serum and brain samples. Results: The CMS rats treated with agomelatine, amitriptyline, escitalopram, fluoxetine, mirtazapine, venlafaxine and non-CMS (negative) controls demonstrated significantly lower level of serum IL-1β compared to the CMS/vehicle group (p b 0.05). For brain cytokine levels, both IL-1β and IL-6 were significantly lower in CMS rats treated with agomelatine, amitriptyline and escitalopram and non-CMS control as
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
compared to CMS/vehicle. No significant differences were observed in serum and brain TNF-α and IL-17 levels. Conclusion: Our data suggest that agomelatine, amitriptyline and escitalopram demonstrated significantly lower serum and brain levels of IL-1β, as well as brain levels of IL-6 in an animal model of depression without LPS challenge. This study revealed potential therapeutic effects of agomelatine, amitriptyline and escitalopram by reducing central and peripheral levels of IL-1β and IL-6 in addition to alleviation of depressive symptoms. doi:10.1016/j.jpsychores.2015.03.057
Integrating mental and physical healthcare: Research, training and services (IMPARTS) — A flexible service development platform for general hospital teams M. Hotopf, L. Rayner, A. Simpson, F. Matcham, Jo Taylor Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK Background: The aim of IMPARTS was to facilitate embedded integrated care through 5 core components: web-based screening; care pathway development; training in mental health skills; provision of bespoke selfhelp materials; and research as an outgrowth of patient care. Method: Patients received an information sheet explaining the purpose of screening and completed a series of outcome measures tailored to their condition whilst waiting for their appointment. The data captured populate the electronic patient record (EPR) in realtime; the results are immediately available to the clinician. The system is flexible and administers different questionnaires depending on variables such as diagnosis and date of last assessment. The data captured inform automated algorithms in EPR, which operationalise care pathways agreed with the clinical team. Care pathways vary but may include referral to community services, or mental health services embedded within the acute trust. Results: Feasibility and acceptability data collected from the first four services that implemented screening (rheumatology, limb reconstruction, psoriasis and hepatitis C) show that fewer than 5.1% of patients declined screening. The proportion of patients completing the IMPARTS questionnaire varied widely across services, from 98.2% in psoriasis to 40.1% in hepatitis C. IMPARTS has now been implemented in 22 services across 3 London hospital sites and 2 NHS Foundation Trusts. At 1st February 2015, a total of 7238 individuals have been screened across 11,153 encounters. The prevalence of probable depressive disorder ranges from 4% in posttransplant renal patients to 60% in chronic pain patients. The prevalence of generalised anxiety disorder ranges from 6% in posttransplant renal patients to 30% in rheumatology. Conclusion: The IMPARTS platform is acceptable to patients and can be effectively embedded in routine general hospital practice. The data reveal wide variation in the prevalence of mental disorder, with relatively asymptomatic conditions such as adult congenital heart disease and renal transplant patients showing lower levels of psychological morbidity, than chronic pain, rheumatological, and dermatology patients.
doi:10.1016/j.jpsychores.2015.03.058
A relaxation strategy for reducing chemotherapy side-effects J. Hunterb, A. Chaoula, M. Fischa, M. Harden-Harrisona, R. Bassetta, D. Suia, R. Maunderb, L. Lagronea, L. Cohenc a MD Anderson Cancer Center, Psychology, Houston, USA, b Consultation Liaison Division, Psychiatry University, Toronto, Canada, c MD Anderson Cancer Center, Psychology, Houston, USA
603
Background: Chemotherapy side-effects diminish quality of life and can lead to treatment delay. It is well established that some sideeffects, especially nausea and vomiting, result from classical conditioning, and may be reduced by behavioral interventions. These are often not employed due to time and cost. We studied the effects of ‘Mindfulness Relaxation’ (MR), consisting of a 20-minute meditation, informed by principles of mindfulness, yoga, and guided imagery, on anticipatory nausea and vomiting. Method: Patients undergoing chemotherapy for solid tumours were randomized to MR (n = 204), a relaxing music control (RM)(n = 225) and standard care (SC)(n = 210). The MR was delivered by the chemotherapy nurse prior to the chemotherapy, in an attempt to establish a pre-emptive relaxation response (RM was delivered at the same time point). Subjects also received a tape of MR or RM to be used for home practice, and at all chemotherapy administrations. Anticipatory nausea and vomiting (Morrow Assessment of Nausea and Emesis-MANE) were assessed at the midpoint and end of chemotherapy. Results: Subjects' average age was 54.7 years (range: 21.6–85.0), 92.0% were women, with 86.6% Caucasian, and 11.6% African American. The majority of the patients had breast cancer (84.50%) other malignancies were: GI: 7.01%; lung: 2.55%; Gyn 2.12%. Most patients had early stage disease (stage I: 25.2%; stage II: 57.6%; stage III: 15.8%; stage IV: 1.4%). MR reduced anticipatory nausea compared to SC (adjusted p-value = .043) controlling for age, gender, cancer stage, and emetogenic level of chemotherapy. Examination of its impact on other variables is ongoing. Conclusion: This study demonstrated that a brief, nurse-delivered, behavioral intervention could reduce anticipatory nausea. MR is low cost and widely applicable. Understanding how patient characteristics impact on efficacy will further advance our understanding of the applicability of MR into the chemotherapy setting. doi:10.1016/j.jpsychores.2015.03.059
Illness perceptions of people with chronic illnesses attending the emergency department are associated with suicidality risk independent of depressive and anxiety disorders T. Hyphantisa, A. Ninoua, E. Ntountoulakia, V. Paikaa, A. Carvalhob a University of Ioannina, Dept. of Psychiatry, Ioannina, Greece, b University of Ceará, Psychiatry Research Group, Brazil Background: To assess the factors associated with suicidality risk in people with long-term conditions (LTCs) attending the emergency department. Method: In a cross-sectional design, 349 patients with diabetes, COPD and rheumatic diseases seeking urgent care at our AED during an 18-month period were interviewed with the MINI. We assessed the independent associations of MINI diagnosis of depressive and anxiety disorders and illness perceptions (B-IPQ) with the suicidality risk (Risk Assessment of Suicidality Scale) after adjusting for demographics, comorbidities, and previous history of depression in hierarchical multiple regression models. Results: Eighty patients (22.9%) were considered suicidal, 95 (27.2%) were diagnosed with Major Depressive Disorder and 46 (13.2%) with any Anxiety Disorders according to the MINI. Adverse beliefs about treatment control (p = 0.05), history of depression (p = 0.004), major depressive disorder (p b 0.001) and any anxiety disorder (p = 0.001) were the significant independent correlates of suicidality risk. Conclusion: A remarkable proportion of people with LTCs attending the emergency department present elevated suicidality risk, which is associated with adverse illness perceptions about treatment control, along with depressive and anxiety disorders. Apart from the early recognition of mental illness, clinicians should also pay attention to