Deep Brain Stimulation (DBS) is emerging as a possible treatment for treatment refractory depression. in this pilot study 8 patients who had depression and had not responded or had stopped to respond to treatment accepted to participate in this double-blind partial cross-over study of DBS. on average they had received 18 psychotropics alone or in combination, 45 ECT sessions and all had had psychotherapy. Our neurosurgical technique allows to confirm the precise location of contacts during surgery. Four electrodes were inserted, two bilaterally in the subgenual cingulate with a trajectory of about 30 degrees to the horizontal and two bilaterally in the posterior part in the nucleus accumbens and in the ventral anterior capsule. There were 2 men, the average age was 49, patients had MDD diagnosed 19 years previously, an average current episode of 11 years and were above the 99th centile in SCL-90 scores. Average MADRS was 39 and GAF was 30. Sustained response and remission was obtained in three patients with stimulation in the ventral anterior capsule and in the anterior subgenual cingulate. Two patients achieved response/ partial response with stimulation if both targets. Three patients had no response. While temporary improvements were recorded with accumbens and posterior subgenual cingulate stimulation these were transient. Accumbens stimulation was associated with more serious adverse events. This approach needs to be studied in a larger group of people to confirm or refute these informative findings.

Non-specific efficacy of psychotropic (and also other) drugs can be influenced by placebo effect including fashion and cultural differences in expectations, by genetic variability, e.g. in degrading enzymes and therefore in drug availability and pharmacokinetics, and largely by adherence to treatment. In other words, the drugs which we trust in, metabolize slowly and swallow obediently are much more efficient than that with minimum psychological effect, rapidly destroyed or even not used. These three variables also interact with each other.

The term „burnout” does not denote a psychiatric category, but a psychological label for the experience of a long-lasting exhaustion and loss of interest. Burnout is not an explicitly recognized disorder in prominent classifications of diseases. It is rather a state of emotional exhaustion and reduced sense of personal accomplishment than a syndrome or a disease. It can be assessed, e.g., by The Maslach Burnout Inventory which uses a three dimensional description of exhaustion, cynicism, and inefficacy. Some authors argue for an “exhaustion only” model that sees exhaustion as the hallmark of “burnout”. Engagement, which is characterized by energy and efficacy, may be regarded as the opposite to burnout, which is characterized by exhaustion, cynicism and inefficacy. On the other hand, this condition is described in the ICD-10 as “Problems related to lifemanagement difficulty” (Z73, i.e., not among mental disorders but among Factors influencing health status and contact with health services, Z00-99). As this condition is also described in DSM-IV as “adjustment disorder”, the concept of „burnout” seems to be redundant and useful only out of medicine as a journalistic label for a reaction which can be classified otherwise.

The presentation summarizes follow-up of EPA initiative on Guidance on Conflicts of Interests (CoI) results of which were presented at 19th and 20th European Psychiatric Congresses and published in extenso in European Psychiatry (Höschl and Fialová, 2012). Guidance paper focuses on situations in which primary interest (well-being of patients, independence of medical education, and objectivity of medical research) might be influenced and compromised by secondary interests, such as financial profit, recognition and professional career advancement. CoI might arise in clinical practice, research, and education, and might include not only individuals but also institutions. The main purpose of EPA guidance paper on CoI is to contribute to CoI policy in psychiatry on the European level and therefore to the integrity of the psychiatric profession, to protection of the interests of our patients, and to public trust in our discipline.

Media are considered to be the public's primary source of information regarding mental illness. Evidence suggests that media representations of people with psychiatric disorders are frequently negative and contribute to their stigmatization. On the other hand, media can play an important role in reducing this stigmatisation by providing adequate information about this topic. An example of an use of a standardised and objective measurement of the stigma of mental illness in print media using clearly operationalized definitions will be shawn. The Picture of Mental Illness in newspapers (PICMIN) instrument is based on the principles of content analysis and used in an analysis of the coverage on mental health/illness issues in Czech, Croatian, and Slovak print media. Some of the most interesting findings based on the analysis include; a similarly high level of stigmatizing articles across countries, clearly exceeding the ones with destigmatizing statements; overrepresentation of schizophrenia and eating disorders and underrepresentation of anxiety disorders and dementia when comparing the correlation of their actual rate in the populations; the proportion of articles depicting mental disorders together with aggressive deeds being as high as onethird of all articles; homicide being most frequently mentioned in the context of psychotic disorders, while affective disorders being most frequently associated with completed suicides, etc. As the influences of the media and the stigma of psychiatric disorders are heterogeneous, activities that should tighten the mental health together with media professionals should be initiated in an ultimate effort to improve media coverage of mental illness issues.

A significant proportion of individuals with substantial functional impairment who either identify themselves as psychiatric patients or who are referred for psychiatric evaluation by their families/teachers or other clinicians may not receive a standard diagnosis based on the current classification systems due to an insufficient number or duration of symptoms. Their conditions are labeled as subthreshold mental disorders. This presentation aims to give an overview on the current knowledge on adolescent subthreshold depression and anxiety.

Based on the literature the presence of subthreshold depression and anxiety is associated with more medical comorbidity, more workdays lost, greater use of services for medical and mental health problems and increased suicide risk. Adolescents with subthreshold conditions have an increased risk for developing future full syndrome disorders than individuals without these conditions. People with subthreshold conditions report significantly more social dysfunction and disability compared to those with several common general medical conditions such as hypertension or diabetes.

The results of the Saving and Empowering Young Lives in Europe (SEYLE) study - as the risk for increased burden of disease and suicide risk among adolescents with subthreshold-depression/anxiety is between the risk for those non-depressed/nonanxious and full syndrome depressed/anxious - contribute to the current discussions about the advantages and disadvantages of categorical and dimensional classification systems: these findings suggest that subthreshold and full DSM-IV-TR depression/anxiety could be on the same continuum. Inputting subthreshold disorders into the diagnostic systems could provide a bridge between categorical and dimensional diagnostic models.

The balance of involvement between staff and service user in clinical decision making can be conceptualized as a continuum from paternalistic or passive through shared to informed or active. There is some evidence suggesting that shared decisionmaking contributes to better treatment outcomes. People with mental illness want a say in their care and it has been shown that sharing medical decisions is possible, even with people with severe and acute mental illness. However, despite shared decision making being increasingly recommended in treatment guidelines, paternalistic decision-making remains common. Especially psychiatrists seem to be skeptical and hesitant to integrate principles of shared decision making in their daily practice.

Research so far has mainly focused on how to help patients make decisions, or on how to understand the degree of involvement in decision making desired by the patient, but not on vital aspects of decision-making in routine care. This presentation will give a practice-oriented overview of research on decision making in mental health care including a discussion of the reasons for the lack of adoption of shared decision making in daily practice.

Migration is the process by which individuals change their place of residence to another largely for permanent or semipermanent periods. The reasons for migration are many and include economic, social, political, medical or recreational reasons. With increasing globalisation, unprecedented numbers of people are moving across various regions and this process causes stress not only for those who move but also for those who are left behind. With movement across different cultures the cultural identity of the individual and the actual process of acculturation play a role in enabling the individual to settle down in the new environment. Preparation in the pre-migration phase, the actual experience and process of migration, existing and new social support along with acceptance by the new culture may contribute to making the process manageable and less traumatic. The reasons for migration will affect experiences related to the trauma and ensuring stress. Clinicians must be aware of assessing special needs of the migrants. Guidance for clinicians on how to manage the clinical status of migrants will be discussed.

This session summarises the EPA Guidance on prevention of mental ill health and promotion of mental well being using the development of UK policy as structure and presented within the European and global context. The promotion of mental health and the prevention of mental illness are a significant component of any clinician's clinical work load. However, often this aspect is omitted from training and service delivery due to insufficient resources and the sheer volume of clinical load. Considerable evidence confirms that prevention can significantly reduce the onset of and subsequent related burdens to mental illness, and associated personal, social and economic costs. Acute mental illness usually prevents positive mental health or wellbeing, yet similarly someone without mental illness can have poor mental health and poor well being. Prevention of mental illness relates closely to and can result from promotion of mental health and associated resilience. Prevention can be categorised in many ways and most clinicians regularly utilise secondary and tertiary prevention. Primary prevention addresses wider determinants across whole populations. Selective prevention targets groups at higher risk of developing disorder. Secondary prevention involves early detection and intervention and corresponds to indicated prevention.

Mental disorders are a leading cause of chronic disease and disability in the EU.

Supporting Member States in addressing depression and suicide (including under use of eHealth), replacing institutional by community-based,socially-inclusive treatment and care models (including through the use of EU-Structural Funds), strengthening promotion and prevention as core mission of mental health systems are key objectives of EU-mental health policy. Increasing the mental health literacy of citizens and empowering patients are further priorities.

Psychiatry plays a key role: where necessary, it needs to strengthen patient-centred treatment models and their practice in the community, engage more in multisectorial cooperation for early interventions, promote social inclusion of people with mental health problems, support other sectors (workplaces, schools, local communities), strengthen ties with other medical disciplines to improve their training on mental health and better treatment of co-morbidity of physical and mental disorders.

In 2008, the European Commission launched the European Pact for Mental Health and Well-being. Ministers of Health adopted Council Conclusions in 2011. A Joint Action on Mental Health and Well-being co-financed from the EU-Health Programme was launched early 2013, involving more than 20 Member States. The Joint Action will review the scientific evidence and country situations, deliver country-specific policy recommendations and develop a common framework for action on mental health and well-being.

Mental health is embedded in the context of EU-health policy on chronic disease.

Good practices in policy and stakeholder action are collected and disseminated through the database EU Compass for Action on Mental Health and Well-being (http://ec.europa.eu/health/mental_health/eu_compass/index_en.htm).

Internet-based cognitive behaviour therapy (ICBT) is a new and promising treatment for psychiatric and other medical disorders. The aim of this presentation is to determine the applications, clinical efficacy and cost-effectiveness of ICBT.

Results from several studies using RCT protocols provide consistent evidence to support clinical efficacy with large effect size of ICBT for depression, panic disorder and social phobia. in addition, preliminary evidence for large effect size is seen for several other disorders such as e.g. severe health anxiety, irritable bowel disorder, eating disorders, cannabis use and pathological gambling. Moderate or small effects are indicated for some other conditions.

Cost-effectiveness analyses suggest that ICBT is cost-effective compared to no treatment or to conventional CBT, respectively. in addition, each therapist can treat at least four to five times more individuals with ICBT as compared to conventional CBT. This is critical since the number of qualified CBT therapists is small compared to the treatment needs.

It is concluded that ICBT currently is a well-established and highly cost effective treatment for depression, panic disorder and social phobia. Moreover, in general ICBT is as effective as conventional CBT for respective disorders, i.e. if conventional CBT works then ICBT works.

Whenever antipsychotic medication is not effective, the first intervention should be to check adherence. If the intake of the oral medication is “relatively” sure and no relevant side effect occurs, the dosage should be increased, if necessary to the maximal tolerated dosage. If side effects do not allow any further increase of the dosage and the antipsychotic drug is taken without any relevant improvement, switching to another antipsychotic is an option most often used. Several issues should be considered:

Change only one drug at a time, switch to an antipsychotic with a different pharmacological profile, ask the patient for his/her collaboration, document psychopathology and tolerability before switching and plan to do again two to four weeks after switching to assess success of switching. The switching strategy has been investigated in several studies and no major difference has been found. However, cross tapering for a period of three to seven days is most often used and probably the safest procedure. The efficacy of switching the antipsychotic, although often used in daily practice, has not well been investigated yet. The few clinical studies will be presented. Data can be summarized: to switch from the first atypical antipsychotic to the second, is effective in 20 to 30%, the switching to a third atypical antipsychotic (if not clozapine) is very seldom successful. After two unsuccessful attempts a switch to clozapine should be thoroughly considered.

Clinical psychopathology aims at the identification of symptoms that are significant in view of nosographical distinctions. Schneider affirms that this discipline aims at becoming the “psychopathological doctrine of symptoms and diagnosis” - the link between descriptive psychopathology and nosography. It restricts the task of the psychopathological inquiry to the search for diagnostically relevant symptoms being interested in eliciting first and foremost those abnormal psychic phenomena that help the clinician to establish a reliable diagnosis.

Although clinical psychopathology is at risk of flattening the practice of psychopathology to that of nosographical diagnosis, it also serves an epistemologically important function since it is concerned with generalizing the individual case and subsuming it into a general category. It complements the view of descriptive psychopathology (which keeps the individual and its complexity in focus) in that the patient here is also an instantiation of a general category, rather than merely a primordially real individual. Psychopathology is not only about the description of phenomena idiosyncratically taking place in a single individual - although its first aim is to do justice to the individuum. It also envisions the individual as an exemplar of a given general type.

Psychopathology is a kind of scientific knowledge since it allows generalizations. It keeps in tension the knowledge about the real individual (e.g this person with schizophrenia) with the horizonal knowledge of an abstract kind (what psychopathology knows about the condition called ‘schizophrenia’). Knowledge emerges as the mutual enlightenment between the individual and the genre he is attributed to.

Post-partum depression is a significant public health problem. Birth and neonatal outcomes suffer as a result of maternal depression. As such, effectively treating depression is imperative to the overall health of mother and child.

Psychopharmacological interventions are effective in alleviating depresses symptoms. However, the evidence of the safety of their use during nursing is inconclusive. Moreover, women themselves express the desire for non-psychopharmacological options when deciding to manage their depression.

The efficacy of specific psychological interventions for the prevention and treatment of post-partum depression has been addressed recently by several studies. in 2011, the Mental Health Department of the Italian National Institute of Health (ISS) received a grant from the Ministry of Health to assess, in Italy, the feasibility and efficacy in actual practice of the demonstrably effective approach based on clinical work and research conducted by Milgrom J. at the Infant Clinic of the Parent-Infant Research Institute, Austin & Repatriation Medical Centre, in Melbourne, Australia (Milgrom J, Negri LM, Gemmill AW, McNeil M, Martin PR., 2005). The preliminary results of that assessment will be presented at the congress.