During the eigthies an educational project on the recognition and treatment of depressive disorders was carried out in the swedish island of gotland, an island and Swedish count of dramatic societal transition and afflicted by the highest suicidality in sweden at that time. The educational intervention resulted in a decrease of suicides to the lowest figures in sweden, however mainly in females.

After a psychological authopsy of all persisting male suicides, that could not be reached due to their not -helpseeking behaviour and their lack of contact with the health care system, new educational efforts on gotland were completed with a focus on males suicidality, using the ad hoc constructed "Gotland male depression scale" as a main tool in an approach directed even to other societal structures on gotland than the health care system. During the nineties, consequently,even male suicidality decreased on Gotland for the first time. Since than, the "Gotland Study" of educating GPs as a suicide preventive effort in suitable endemic suicide regions has been widely spread and replicated in many countries, regions, and populations of societal transition, often with positive results. Educating GPs according to the Gotland Model is today considered to be one of the essential measures that should be offered in comprehensive,multimodal and multisectorial national programs of suicide prevention.

The literature suggests that nearly 50% of patients with schizophrenia have a co-occurring substance use disorder (SUD), most frequently alcohol and/or cannabis (at a rate about three times as high as that of the general population). Outcomes associated with Comorbid SUD and Schizophrenia are earlier onset of schizophrenia, increased relapses, treatment noncompliance/more side effects, poorer response to antipsychotic medication, more hospitalizations, increased risk for violence, increased medical costs, more affective disturbance. These conditions are also associated with increased suicide risk. The increased suicide risk of substance abusing schizophrenic patients could be the result of a cumulative effect of many factors or events, such as the loss of remaining social control through the consumption of psychotropic substances, noncompliance with antipsychotic medication, presence of paranoia and depression.

Abuse substances worsen both symptoms and prognosis of the illness and are related to higherrelapse rates.

Studies suggest that some of the second-generation (atypical) agents may be helpful for these patients. Some researchers have suggested that the lower incidence of neurologic side effects produced by the atypical antipsychotics, along with the possibility that these agents may be more likely to decrease negative symptoms, make them a logical choice for patients with co-occurring substance use disorder (even though parameters of the metabolic syndrome must be monitored while using these agents).

As medicine and magic began to slowly part ways in the Enlightment era, scientific evidence became the driving force and currency of medicine. As scientific evidence was being defined, the newly established medical schools imparted this knowledge to their students. Those who mastered the evidence, and committed to adhere to it, became physicians who enjoyed public trust and the statutory position that came with it. With some exceptions, the idea that scientific evidence should constitute the only foundation for medical practice has withstood the test of time and the occasional attacks, by well-meaning but naïve individuals as well as charismatic charlatans.

The principal stakeholders of clinical practice - consumers, practitioners, and providers of services and products - are all trying to influence the stream of evidence. The current debate on EBM focuses on what constitutes true scientific evidence, and how best to translate this evidence into clinical practice. The evidence available to the practitioner varies widely in terms of source, quality, and potential for bias, while the relevance of evidence, derived from statistical analyses of data from mega-trials, to the treatment of individual patients is sometimes difficult to grasp.

This presentation will discuss the gap between EBM and clinical practice and ways to bridge the two.

This contribution will explore UK-based research developments in substance misuse and mental illness over the last 20 years. The main body of work revolves around research largely, but not only, funded by the Department of Health from the late 1990s. Early research revolved around alcohol, especially alcoholic hallucinosis: the relationship with schizophrenia-like illness was examined and the conclusion at that time on the basis of twin, family and clinical studies, was that very few cases did develop into schizophrenia. More recently, large general population epidemiological, and medium or small scale clinical studies, have been undertaken on the relationship between substance misuse (sometime specifically on cannabis) and the later development of mental illness especially psychosis. The presentation will aim to draw parallels with the current debate around the link between cannabis and psychosis and urges caution in too rapid an assertion that cannabis is necessarily ‘causal’ and the clinical and policy implications of the misinterpretation of evidence. A proposal will be put forward that the genesis of psychotic illness in alcohol misuse is revisited using more sophisticated research methodologies. Given the changing landscape of substance use in the UK, particularly the fashion of polysubstance use and the recognition that this may be associated with psychotic illness, other drugs that are associated with psychotic illness should be similarly investigated to determine whether there is a common mechanism that might throw light on understanding the relationship between substance use and psychotic illness or schizophrenia.

In order to create hypotheses about the relationship between the effects of cocaine and the development of psychotic symptoms we conducted a pilot study with 55 patients. All patients were personally investigated on their current psychopathology. The 55 patients (more than 80% were males) were distributed in 5 diagnostic subgroups:

1. 1) Addiction without a further AS I diagnosis (n=10)

2. 2) Addiction and psychotic disorder related to cocaine (n=8)

3. 3) Addiction, psychotic disorder related to cocaine and another AS I disorder (n=10)

4. 4) Addiction and a schizophrenic spectrum disorder (not schizophrenia) (n=10)

5. 5) Addiction and schizophrenia (n=17)

We investigated if psychotic symptoms occurred during cocaine use, if these symptoms depended on the dosage of cocaine and if similar symptoms also occurred without cocaine but during stress.

Attention Deficit Disorder is a well recognized developmental disorder in children. The disorder has been found to persist in adulthood in about 50% of the cases with an estimated adult prevalence of about 3.5%. ADD in adulthood is characterized by high rates of one or more concurrent psychiatric disorders like mood disorders, anxiety disorders and personality disorders.

In the last decade interest has increased in the co-occurrence of ADD and substance use disorders (SUD). Approximately 15-25 % of ADD patients have a lifetime diagnosis of SUD involving a wide range of legal and illegal substances. Given the different spectrum of ADD symptomatology as compared to the childhood clinical picture, the high rates of psychiatric co-morbidity and the interference of substances with ADD symptoms and course, diagnosis and treatment of these patients constitute a real challenge.

Recent clinical research is directed at unravelling specific risk factors for developing SUD during the course of ADD in later life. Early diagnosis and adequate treatment seem to diminish this risk. Childhood conduct disorder and increased impulsivity are considered to imply an increased risk for developing not only SUD but also criminality in (early) adulthood. Clinical implications of these findings will be discussed during this presentation.

This presentation describes current knowledge about the treatment of patients with the dual diagnosis of post-traumatic stress disorder and substance misuse, a population that is typically considered “difficult to treat”. We will cover background on PTSD and substance misuse (including rates, the typical client, models and stages of treatment, and clinical dilemmas). Clinical interventions will also be addressed, with a focus on "Seeking Safety", an evidence-based model for PTSD and substance misuse.

Per definition adults with antisocial personality disorder have met the diagnostic criteria of conduct disorder since adolescence at least. Those who have started to show antisocial behavior before the age of ten tend to exhibit even more severe aggressive behavior throughout early adulthood. However, conduct disorder is not a homogenous category that is characterized by a steady development towards a specific antisocial disorder in adulthood. Within the category of conduct disorder there are particularly high differences in emotional processing and an individual's capability to regulate emotions. Regarding the neurobiological correlates of emotional processing in subjects with conduct disorder, psychophysiological data suggest high stability over time with the main finding of hypoarousal in resting states and autonomous hyporeagibility to emotional stimuli. Findings from functional neuroimaging are more heterogeneous probably reflecting subtypes of antisocial disorders which are subsumed under the category of conduct disorder. Developmental research in psychiatry needs a multidimensional diagnostics including a precise psychopathological characterization and subdifferentiation. Although genetic dispositions are stable, they interact with changing psychosocial factors which take influence on the developing brain in more or less vulnerable stages.

In elderly patients who suffer from depressive symptoms and cognitive impairment the clinical decision between the diagnoses of depression and dementia may be difficult. In addition, patients with dementia and depressed patients frequently show a disturbance of sleep. Sleep EEG registration in depression revealed a characteristic sleep EEG profile concerning distinct alterations of sleep architecture and REM-sleep (reduction of SWS, increase and advance of REM-sleep). In dementia polysomnographic assessment has been done less intensively, mainly in patients with dementia of Alzheimer type (DAT). The most significant polysomnographic finding in DAT is a reduction of REM-sleep, which may reflect impaired cholinergic neurotransmission. Therefore, predominantly REM-sleep variables clearly differ between depressed patients and patients with DAT.

In this presentation polysomnographic data and data of cognitive performance in dementia and depression will be reviewed. In addition, own long term studies in patients with different types of dementia and in depressed patients will be presented. The polysomnographic findings of these studies will be discussed with respect to differential diagnosis, prediction of treatment response and the long term course of both diseases. In addition, the results will be related to the current knowledge of the neurochemical and neuroendocrine regulation of sleep.

Mental health care has traditionally been provided within the framework of a verticle mental health services system. Additionally, mental health care is often provided through a variety of agencies or organizations that have a number of different mandates, responsibilties, authorities and accountabilities. These are not well linked with or to each other.

Furthermore, mental health services for children and youth are often not well integrated into adult mental health services. This profusion of confusion regarding mental health care for young people can be much better defined and operationally developed if a model of care based on population mental health care needs and provider mental health care competencies can be applied. This presentation will present the conceptual framework for such a model that allows for mental health care to be intergrated into all levels of health and other systems that provide interventions for young people suffering from a variety of mental health problems.

The physical well-being of people with schizophrenia is remarkably neglected. Physical illnesses in these people are underdiagnosed and undertreated. A recent study in Australia showed that, although people with schizophrenia suffer more frequently from cardiovascular problems than the general population, they receive catheter much more rarely. People with schizophrenia have been also reported to be less likely than the general population to receive HbA1c and cholesterol monitoring, to receive a retinal examination for diabetes screening, and to be treated for osteoporosis. They have been also found to be more likely to be treated for physical illnesses only when the latter become life threatening. Among the factors contributing to this underdiagnosis and undertreatment of physical illnesses in people with schizophrenia are a low motivation of patients and their relatives to access medical services, the isolation of psychiatric services from other medical facilities, and a tendency of psychiatrists to overlook physical health problems in their patients. However, the most important factor is likely to be the stigma surrounding schizophrenia. The neglect of physical health in people with schizophrenia should be regarded as an expression of discrimination and disregard for their dignity and their rights as human beings and citizens. Due to the lack of prevention and intervention strategies, people with schizophrenia and their families bear the costs of the mental disorder and those of the concomitant physical illnesses, which can exacerbate psychopathological manifestations and impair the subjects’ ability to adhere to treatment. Access to physical health care of the same quality as that available to the rest of the population should be considered a basic right of people with schizophrenia and a crucial dimension on which their quality of life has to be evaluated.