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Introduction Suicide is a serious public health problem since it accounts for nearly 900,000 deaths each year worldwide. Globally in 2019, 10.7 persons out of 100,000 died by suicide. Psychiatric disorders are related to an overwhelming proportion of these cases. In the last years, several specific interventions and action plans for suicide prevention have been implemented in a number of European countries. Objectives Our aim was to analyze recent epidemiologic trends of suicide mortality rates in Europe. Methods Annual national statistics of suicide mortality rates derived from Eurostat public databases from 2011 to 2019 were analyzed for 38 European countries. The suicide mortality rate was estimated per year/100,000 population. Linear regression models were used to study temporal trends of suicidal mortality. Analyses were performed using RStudio. Results Available data show a statistically significant reduction in suicide mortality rates from 2011 to 2019 in 15 European countries, and a significant increase for Turkey (ES=0.32, SD=0.06, p=0.037) (Fig 1). The greatest significant decrease was reported in Lithuania (ES=-1.42, SD=0.02, p=0.02), followed by Hungary (ES=-1.13, SD=0.11, p=0.0007), Latvia (ES=-0.76, SD=0.11, p=0.007), and Poland (ES=-0.73, SD=0.10, p=0.001). Italy reported the lowest significant reduction in suicide mortality rates (ES=-0.13, SD=0.018, p=0.003). The remaining 16 countries showed no significant changes in suicide mortality trends. Image: Conclusions In the last years, Europe registered an overall reduction in reported suicide rates. However, more recent data (i.e., suicide rates after COVID-19 pandemic, age and sex-related effect on suicide rates) should be analyzed and used to implement future recommendations. Current and future suicide prevention strategies aim to contribute to a greater reduction of suicide rates in the different European countries. Disclosure of InterestNone Declared

Clozapine is a second generation antipsychotic drug, which has been acknowledged as the gold standard for treating both positive and negative symptoms of treatment-resistant schizophrenic patients, despite its severe side effects, such as neutropenia. Evidence suggest rechallenging after clozapine-induced neutropenia. Nevertheless, no official guidelines exist in case that rechallenge fails. We present the case of a fifty-six year old man suffering from treatment resistant schizophrenia. The patient was diagnosed with chronic psychosis and was treated with clozapine, presenting good response. The patient developed clozapine induced neutropenia, only to be rechallenged after the neutrophil count returned at a normal range. However, another neutropenia incidence followed, and clozapine had to be ceased once more. Determining that the benefits outweighed risks, we attempted a second rechallenge with the adjustment of clozapine’s dosage and the addition of Lithium carbonate. Since then, the patient did not develop any blood dyscrasia. What is more, the improvement in both psychopathology and functionality is ongoing. The mechanism of clozapine’s action upon neutrophils remains unclear. The same goes for Lithium. Since literature suggests that both drugs have an effect on the bone marrow, resulting in opposite actions it only seems logical that Lithium could be used in preventing clozapine-induced neutropenia. Considering that the lack of guidelines leads to a restrain towards clozapine rechallenge after neutropenia incidence, more so after double induced neutropenia, more research is needed on the matter in the interest of a better quality of life for treatment resistant schizophrenia patients.