Treatment with antipsychotic drugs is, despite the introduction of many new compounds, far from optimal in a large proportion of patients. Apart from lack of or insufficient response, various adverse drug reactions often limit the use of otherwise efficient drugs, and increase the risk of non-compliance and poor treatment outcome. Thus, there is considerable need for individualized treatment in order to maximize the therapeutic outcome. This variability in drug response may be related to both pharmacokinetic and pharmacodynamic factors, many of which are genetically regulated. In the presentation, the contribution of allelic variability in genes coding for drug metabolic enzymes (CYP2D6, CYP1A2 and others) and transport proteins (ABCB1), as well as drug targets, to the pharmacokinetics and clinical effects of atypical antipsychotics will be discussed, using olanzapine and clozapine as model drugs. While CYP2D6 had no influence, carriage of two CYP1A2 allelic variants was associated with higher dose-adjusted plasma concentrations of clozapine and its metabolite desmethylclozapine. Patients with elevated insulin levels more frequently carried the *1C and *1D alleles, had higher plasma drug levels, higher blood lipids and HOMA-IR compared to patients with normal insulin levels. Associations were found between HTR2C and HTR2A haplotypes and increased BMI and C-peptide levels. A HTR2C haplotype was also shown to be significantly more frequent among obese than non-obese patients on long-term clozapine treatment. The data illustrate the need of an integrated approach involving both pharmacokinetic and -dynamic aspects in pharmacogenetic studies aiming at personalized antipsychotic treatment.

Pharmacogenetics in schizophrenia comprises pharmacokinetical and pharmacodynamical aspects as well as an approach to identify candidate genes associated with therapy response or side effects. Firstly focussing on classical drug targets like dopaminergic or serotonergic receptors, currently also developmental and regulatory genes presumably associated with effects of antipsychotic therapy are identified. The aim of this study was to investigate associations between therapy response in schizophrenic patients and different polymorphisms previously been identified within a genome wide array in rodents treated with MK-801 and/or haloperidol combined with some well-known schizophrenia candidate genes. We genotyped for 200 different polymorphisms in 285 schizophrenic patients, who were treated with different antipsychotics within randomized controlled trials. Psychopathology was measured weekly using the PANSS scale. Correlations between psychopathology and genotypes were calculated by using a linear model (ANCOVA).

We found significant associations between some well-known candidate genes (e.g. D2-, 5HT1A-, and α1A-receptors) and different PANSS subscales at baseline and after four weeks of antipsychotic treatment considered as therapy response. Furthermore we also identified several significant associations between some genes introduced from the animal model and psychopathology at baseline and towards therapy response. Some of them were formerly described in the literature (e.g. Homer1, Phospholipase C and Transthyretin), but most of them have not been related to schizophrenia or antipsychotic treatment by now (e.g. PLEKHA6, CLIC6 and SOSTDC1).

This indicates an involvement of genes in the pathophysiology of schizophrenia apart from yet known candidate genes and might further help in detecting differential therapy response in individuals with schizophrenia.

The vast majority of alcoholics consumes coffee as well as tobacco in addition to alcohol. The present study investigated the effects of these two psychotropic substances on the alcohol withdrawal syndrome. Therefore, personal structured interviews were performed in 128 alcohol-dependent women and men who were admitted to hospital for alcohol detoxification. They all regularly consumed tobacco and caffeinated coffee. Quantity and frequency of their consumption patterns were recorded. The severity of their alcohol withdrawal syndrome was measured using a validated scale.

A multiple regression analysis revealed a significant positive correlation between quantity of alcohol and the severity of alcohol withdrawal. In addition, we could demonstrate that not only the quantity of alcohol consumed, but also tobacco and coffee consumption influenced the severity of the alcohol withdrawal syndrome. The more the patients smoked and the more coffee they drank, the less they suffered from withdrawal symptoms during alcohol detoxification.

1. 1. Psychotropic medications and use of other treatment modalities for major psychiatric disorders in pregnancy. Victoria Passov, M.D.

2. 2. Chemical dependency issues in pregnancy and treatment modalities currently available. Catherine Friedman, M.D.

3. 3. Developmental outcomes on children born to mothers with psychiatric illness: complications in children of mothers who received treatment for their psychiatric conditions during pregnancy, as well as developmental and psychological consequences in kids born to untreated mothers will be discussed. Leo Passov, M.D.

4. 4. Psychology of reproductive loss and guidelines for helping families cope with the trauma of a miscarriage or stillbirth. We will discuss what makes reproductive loss unique and the physical and psychological sequelae that women experience after the loss of a pregnancy. Jennifer Alt, M.D.

The relationship between films and psychiatry remains an ambivalent one. Mentally ill patients are often portrayed unsympathetically in a comic, villainous or inaccurate manner; and film makers often see their responsibility towards financial aspects rather than educational direction. Increasingly, films are being used for training medical students and trainees in psychiatry. Films can also be used to study therapeutic relationships between therapists and patients, especially observing transference and counter-transference. The portrayal of mental illness in films can be negative for a variety of reasons: stigma, lack of knowledge and understanding with a focus on entertaining rather than on educating. The portrayal of ECT and leucotomy and associated negative connotations have increased stigma against mental illness and even led to a reduction in the prescription of these treatments. Using films to teach is relatively recent in the UK compared with the USA, where couple therapists have used films with their patients in therapy to illustrate relationship difficulties and potential solutions. ‘Cinematherapy’ as a term has been used to work with teenagers to deal with relationship and individuation issues. An advantage of using films in teaching mental illness is that their use does not involve the confidentiality of a real patient. In addition the ‘patient’ can be seen interacting with others, giving a clearer understanding of the impact of the illness on others. Unlike clinical consultations in very narrow settings focussing on symptoms and treatment which are time limited, films can be used to learn about cultures and their embedded values.

According to the Jasperian model, phenomenology ‘gives a concrete description of the psychic states which patients actually experience and presents them for observation’ (Jaspers, General Psychopathology, 1963, 44). Narrative cinema is arguably no less phenomenological in that it employs a phalanx of aesthetic strategies (visual design, framing, editing, camera angle, point of view) to materialise subjective consciousness and thereby facilitate the process of emotional identification with onscreen characters. But in representing psychosis, most popular cinema resorts to a shorthand of Expressionist cliché and crudely objectifying stereotypes. We suggest that the concern for clinicians and responsible filmmakers is much the same: how to treat psychotic conditions empathetically, testing empirical understanding and knowledge against ‘first-person’ accounts of mental illness. Our paper focuses on a case study of a short film in production. Sal Anderson's observational fiction Froth: Whose Drama is it Anyway? juxtaposes the media-fed public perception of epilepsy with its subjective experience. During shooting, the neurological condition was explored through a series of improvisatory workshops where people with epilepsy re-enacted and then reflected on the stages of a seizure. This methodology is proposed as a template for the development of alternative strategies in the portrayal of psychosis on film. Finally, we offer a speculative link between Jaspers’ notion of the ‘ununderstandable’ in relation to psychosis and the intractably resistant nature of the cinematic image.

Schizophrenia, epiphany and Kafka's “The Trial”K. Conrad wrote Die beginnende Schizophrenie in 1958, but his description of the psychopathology of schizophrenia and his concepts of schizophrenia are still very enligthning to contemporary readers. One of several important concepts described is that of epiphany. In his description he stressed that this was a way of experiencing the whole world, perceptions, emotions, notions, etc. The schizophrenic patient not only experiences that every thing has a certain meaning attached to it, also this meaning has something to do with the patient. Nothing seems to be coincidential, but on the contrary seems to be specifically important for the patient. This sudden, intuitive perception of or insight into reality or essential meaning of the world resembles the experience of a revelation (=epiphany from ancient Greek). This way of experiencing/living in the world feels so “natural” to the patient, that he never questionswhat is obvious discrepancies and incompatibilities to others.Frans Kafka has been called the best descriptor of the schizophrenic world. His novel The Trial (Der Prozess) is commonly viewed as a description of bureaucracy, but can also be seen as a matchlessly description of the schizophrenic world. In the film the spectator sees every thing through the eyes of Joseph K and thereby has the opportunity to a first person experience of the self-reference, oddness and inconsistencies of the schizophrenic world. This brings the notion of epiphany to the lived world of the spectator.

“States of Mind” is a documentary about the idea of normality/abnormality in a mental hospital. It was shot inside several mental clinics in Italy in 2005. A small team of filmmakers spent several months inside the clinics with a camera and audio equipment. The team shared with patients and staff every moment and aspect of daily life, from breakfast till night shift. During this intense period patients and operators were constantly exposed to the camera's eye, while neutral observation and friendship quickly melt. Ideas of normality and abnormality, of surface and depth, of exposure and censorship started to blend into each other, creating interesting and unexpected effects. “States of Mind” had its world premiere at the prestigious IDFA (Amsterdam Documentary Film Festival) and has been released in USA and Europe.

Mood disorders can be considered as a pathology of Freedom in human being.

Manic patients feel under-responsible and depressives feel hyper-responsible. Both require from psychotherapist care for risk of suicide and innapropriate behaviour, but also empathy, support, and help from responsible others, relations and doctors. This responsibility is moral, juridic and penal.

We will discuss what Ethic for responsibility can be the right one for clinicians and therapists. We will also discuss which symptom or clinical features are the most hindering for responsibility in depressives. We will conclude that ethical basis is fundamental for right management in therapy.

The paper deals with the change in the attribution of responsibility in the care system during the 2nd half of the last century. The shift went from the rather parentalistic attribution of responsibility to the professional site (psychiatrist, psychiatric institution, its runner) with “de-powerment” of patients, to “em-powerment” and attribution of responsibility to patients and their social systems. This development was influenced by general societal movements (as the human rights), ethical teachings (Hans Strotzka in Austria and Hans Jonas internationally) and a growing awareness for the complex process in the illnes itself and the possibilities to behave under the condition of illness. Nowadays there should be a “topography” of responsibility in care processes with changing foci dependent on the respective capacities to cope with responsibility and the result of negotiating the respective coping power. A fair search for balanced results as fairness in the evaluation of outcomes as well is needed - but not allways reached dependent on the conflicting expectations toward professionals in our societies (as protection versus freedom).

Responsibility can be defined as an obligation or duty that something happens in a situation for which one can be praised or blamed. In this presentation, the constitutive elements of a moral account of responsibility such as whom a moral agent is, under what conditions moral responsibility applies, and the possible objects of responsibility ascriptions will be discussed. The contributions of Aristotle, Strawson, Carl Ginet, Hans Jonas, Daniel Wegner and others to our understanding of responsibility, causal determinism, and the illusion of conscious will be explored. The presentation will conclude by discussion the implications of these ideas for psychiatry particularly with regard to patient autonomy and responsibility.

This presentation aims to illustrate substance addiction from a point of view of the psychopathological responsibility. Substance abuse has been affecting modern society for more than forty years, and the sanitary, social, economic and the psychopathological impact of substance addictions are becoming more and more disastrous. At the moment there are no signs of any decrease in the number of addicts, on the contrary, the trend continues to spread to all social classes. In all these years a psychopathological perspective has never been sistematically applied to the addiction field. A psychopathological perspective is able to achieve a deeper insight into the problem of substances addiction and thus offer new and stimulating possibilities of treatment. From this point of view a psychopathological perspective implies precise responsibility, not only for the individual working within the Health Service, but for the hole organization of the Health System itself.

Aging is a process that affects bio-psycho-social functioning. When people reach upper age groups, the definition of normal and abnormal aging are confounded by the presence of multiple diseases, injuries and losses. As the people leave longer, physical, psychological and social losses may affect the quality of life. In geriatric population, one indicator of quality of life is the ability to perform required activities of daily living. The absence of that feature create negative efects on the psychology of the elderly.

In the consultation process, the geriatric psychiatrists must know the major events which influence elderly's quality of life in late life. Those events are pharmacology, end of life issues and suicides, and clinical syndromes such as delirium, dementia, depression, anxiety, etc. It can be said that life events are closely connected to quality of life and health.

To offer a high quality health and social care to the older patients, we need the knowledge about the conditions, the values and the quality of life of these people which influence their lives.

Good health is an important component of a good quality of life. The availability and the easy access to high quality of care contribute to a good mental health. WHO & WPA have defined the criteria to consider as good the quality of care delivered by services for old people with mental disorders. Services should be:

1. - comprehensive and take into account all aspects of the patient's physical, psychological and social needs and wishes;

2. - accessible, user-friendly and readily available, minimizing the geographical, cultural, financial, political and linguistic obstacles to obtaining care;

3. - responsive, that means to be ready to listen to and understand the problems brought to its attention and acts promptly and appropriately;

4. - individualized and should focus on each person with a mental health problem in her/his family and community context;

5. - transdisciplinary and should go beyond traditional professional boundaries to optimize the contributions of people with a range of personal and professional skills.

6. - accountable and should accept the responsibility for assuring the quality of the service it delivers and monitors this in partnership with patients and their families.

7. - systemic and should integrate all available services to ensure continuity of care and coordinates all levels of service providers including local, provincial and national governments and community organizations.

The challenge today is to extend these criteria to help the Primary Care team to develop strategies in order to promote mental health, to prevent mental disorders and to make their detection as early as possible.