In drug and alcohol dependence, detoxification is characterized by a significant reduction in drug-induced dopamine production and release, which has been shown to impair reward anticipation elicited by non-drug-associated stimuli. Drug-associated cues, on the other hand, appear to elicit increased functional activation in the medial prefrontal cortex (MPFC), which has been shown to be associated with impaired dopamine neurotransmission in the ventral striatum (VS). These findings suggest that dopamine dysfunction in alcohol dependence is associated with an attentional and motivational bias towards drug-associated at the expense of non-drug-associated stimuli. In schizophrenia, on the other hand, unmedicated patients show an increase in dopamine synthesis capacity and release in the associative striatum, which may extend into parts of the VS. Here, chaotic or stress-induced dopamine firing appears to interfere with the encoding of salient reward prediction errors, which may result in the attribution of salience towards otherwise irrelevant, neutral cues. In accordance with this hypothesis, functional impairments in the encoding of reward-associated cues were associated with motivational deficits in the VS, while a bias towards processing of negative feedback in the MPFC correlates with the severity of delusions. Computational approaches show that particularly in disorders as schizophrenia, where patients often fail to understand the underlying task structure, it is necessary to model a behavior in order to match patients and controls for the applied strategy - functional activation differences observed when subjects are matched for task strategy then point to a true neurobiological difference, i.e. VS-encoding of prediction errors in schizophrenia.

A main task of psychopathology is to gain a profound understanding of the basic starting points for the work of psychiatrists. Such a psychopathology of understanding depends to a great extent on where the “understanding” psychopathologist is coming from and on what his or her perspectives and concepts are. An understanding of the valency of psychopathological phenomena in the structure of an illness, as an indispensable basis for effective treatment of mental disorders, is impossible without knowledge and understanding of the philosophical roots in the theory of psychopathological research and psychiatric practice. The scientific work on that has found its way into psychiatric literature under headings like theoretical psychopathology, meta-psychiatry or philosophy of psychiatry. What theoretical psychopathology seeks to do is not to address issues of clinical practice per se, but rather using meta-analyses, analyses of the fundaments of psychopathological thinking and practice to contribute to a clarification of seminal and relevant problems of clinical practice and of empirical science. Since self-reflection always entails self-creation within an autopoietic system, theoretical psychopathology as a the self-reflecting sub-discipline of psychopathology plays a central role as a driving force in the development and creation of future psychiatry.

The European Commission funded the ROAMER project, which was launched in October 2011, to develop a roadmap to promote and integrate research on the biological, epidemiological, social and public health aspects of mental health. ROAMER has established six scientific domains (i.e. infrastructures and capacity building; biomedicine; psychological treatments and processes; social and economic aspects; public health; and wellbeing) that are being addressed in parallel. This process is developed in three different phases devoted to conducting an initial state-of-the-art analysis, enumerating gaps in current knowledge, and defining advances needed in research in each field. The project includes the participation of researchers, professionals, service users, families and other stakeholders.

The project is funded by the coordination and support action under the Seventh Framework Programme (FP7). This funding instrument is oriented towards non-research initiatives which require a wide participation of European institutions.

In the session, we will describe the role of coordinators and project managers in European Projects, as well as the current status of funding programs in the EC, the steps to apply to their calls, and the daily issues you should deal with when managing European projects profiting our ROAMER experience.

[ROAMER has received funding from the European Union Seventh Framework Program (FP7/2007-2013) under grant agreement n° 282586]

If Postpartum mood disorders are now considered a major issue both in public health and in psychiatry, the study of maternal Borderline personality disorder (BPD), most often or not associated with peripartum depressive disorder has attracted much less attention. We now know that BPD is common and highly associated with postpartum depression (Apter et al, 2012). This constitutes a high risk group where both mothers and infants are at relational and psychiatric risk; mothers do not acknowledge their mental health issues and therefore do not seek and receive care, whereas their emotional dysregulation negatively impacts interactions. Distorted interactive configurations organize as early as three months postpartum. Mothers show major difficulty in responding to infants and in turn, infants react with dysregulated and/or dismissive behaviors thus reinforcing the risk for an increase of intrusive and inappropriate response from the caregiver. Rapidly mothers and infants seem off beat. At one year, the infants are at high risk of presenting insecure attachment thus heightening their risk of developing future psychopathology. How to recognize, and intervene with these populations will be presented using videos as illustration and tailored management in a perinatal and infant/toddler unit.

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Moreover, research indicates that far from all who suffer from depression and suicidal ideation seek treatment and the determination of suicide risk and prevention of suicide attempts is traditionally difficult. In an era of empowered public and patients awareness, internet may be a more powerful determinant of health-seeking behavior than medical opinion. Suicide information is easily accessible over the web, as are special chat rooms for discussions with likeminded people. Internet can be considered as well as efficiently exploited to help people in severe emotional distress, including those contemplating suicide. Some websites advise acutely suicidal persons to seek help. Promotion and announcement of suicide are forbidden. Some websites offer a variety of professional help, including psychological and health-related information on various troubling issues, questions and answers and professional guidance intended to promote self-help in coping with numerous psychological problems. One promising treatment is activation, two kinds of which are behavioural activation, and one solely focused on physical exercise. These two kinds of activation therapy have the potential to be administered via the Internet, which would both lower the threshold for those seeking treatment, while also providing effective treatment to a low cost.

There is substantial evidence that cognitive behavioral therapy (CBT) works for child anxiety disorders, but this evidence-base mainly rests on efficacy trials with rigorous scientific control conducted in University-clinics. Are results transferable to ordinary clinics? To a large extent, the answer seems to be yes. This presentation will review the state-of-the-art of effectiveness trials for child anxiety disorders. Additionally, data will be presented from a large ongoing randomized controlled trial (RCT) for child anxiety disorders conducted in community child and adolescent mental health clinics in Norway. This is the child part of the Assessment and Treatment - Anxiety in Children and Adults (ATACA) trial, PI's Heiervang and Havik. Children aged 8 to 15 years (N = 182) with a primary diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder were included and randomized to group CBT (GCBT), individual CBT (ICBT) or a waitlist condition (WLC). The treatment program was Barrett's Friends for life manual. CBT outperformed WLC, with no major difference between GCBT and ICBT. Although overall symptom reduction was comparable to previous effectiveness trials, the full remission rates were somewhat lower than in previous trials. The possible reasons behind this will be discussed, and there will be an emphasis on how process factors such as pretreatment motivation, perceived treatment credibility, and the therapeutic alliance, which were all assessed in the RCT, may play a part to influence treatment results.

Mental disorders as a whole are the leading cause of disability worldwide. It is estimated that over 5 million people in Spain suffer from any of these disorders throughout his life. The importance of mental disorders in today's society is enormous. In fact, in the EU mental health spending ranges between 3% and 4% of GDP, mental disorders being the leading cause of early retirement and disability pensions. In addition, mental illness poses a heavy burden, not only economically, but also socially, in the form of personal and family cost. With a mission to improve clinical care and overall mental health of our society through an increasing of translational research generated knowledge in the field of Psychiatry and Neurosciences, on 1 January 2008 the Center for Biomedical Research Network on Mental Health Area (CIBERSAM) was established. Since then, a fruitful network has been created, and its organization and procedures will be shown in this presentation.

Deep brain stimulation (DBS) is able to target with precision specific cerebral networks, thus offering hope for severe and treatment refractory illnesses, as well as to investigate in the detail the subcortical bases. In obsessive-compulsive disorder (OCD), DBS is being tested at several nodes of a prefrontal-subcortical circuit, including the subthalamic nucleus (STN). Functional imaging studies of OCD patients have shown abnormal metabolic activity of the orbito-frontal and cingulate cortices, as well as of the anterior part of the striatum. In animal and human studies, these structures have been associated with performance-monitoring and more generally metacognitive processes, thus suggesting that metacognitive dysfunctions might be central to OCD leading to pathological doubt. In this conceptual framework of hyperactive distrust metacognitive mechanism in OCD, checking behaviour can be regarded as an ill-founded metacognitive strategy designed to restore confidence in the outcome of one's actions. Within the basal ganglia network, the STN could act a crucial part in this process regarding its role in the inhibitory control of behaviour. Moreover, anatomy and neuro-computational models of the basal ganglia show that this nucleus is in the position to implement cortical metacognitive control by increasing the threshold for decision. This framework has the advantage of providing a theoretical basis to the promising clinical results obtained for STN-DBS in severe resistant OCD. Bearing in mind this model, it can be postulated that DBS, by its action on STN, positively interferes with the neural mechanism underlying compulsive behaviour.

A glaring lack of actionable etiological progress has revived a nosological nihilism, which proposes a downplaying of the traditional nosological classes and focusing elsewhere, e.g., on “descriptive syndromes” (e.g., “depression”, “reality distortion”), proxy-variables (endo-phenotypes), or behavioral constructs with partly known neural underpinnings (e.g., RdoC). However, another type of response may consist of a re-examination of the ontological and epistemological assumptions involved in the massive oversimplification of psychopathology, which took place as a part of the so-called “operational revolution”. This lecture will advocate a revival of psychopathology, which, if equipped with adequate epistemological ressources to address consciousness in its experiential and behavioral dimensions, is urgently relevant and acutely needed for psychiatry as a clinical and academic enterprise. As an illustrative example, the concept of self and its disorders will be briefly examined.

Over the past 20 years, the way Mental Health research has been conducted in Europe has changed dramatically. To remain isolated is highly detrimental to the impact of the data collected and is making extremely difficult the dissemination of the results. The key word from the very beginning is collaboration: to facilitate it different European networks have been established.

A network should be considered as a flexible research structure in which the participants have common objectives, are using common tools and are looking for common outputs. To achieve this ambitious aim, instruments (both psychometric and neurobiological) have to be standardized and cross validated, methods for data acquisition have to be shared by all participants, a dedicated center for data management has to be chosen and, in case of specific procedures (neuro-imaging, genotyping etc...), the modalities for storage have to be defined in advance. Without these preliminary steps a network will function more as a patchwork of different centers than as a common repository of procedures, expertise and data. To tell it more directly the purpose of a network is not only to bring in more power by offering large recruitment possibilities, but is also to create an operational database with a true open access and to be the actual basis for a knowledge transfer benefiting to the scientific community. One of the main criticism which can be made to many of the European networks which have been established in the past is that they have functioned in a closed manner with no possibilities for external teams to have access not only to the data but as well to the procedures or to the tools used. The consequence has been the difficulty to replicate the results and the necessity...to recreate new networks, which is a waste of time and a waste of money! To avoid this kind of repetitive duplication of the same types of networks a better identification of existing networks is needed (how many European research networks on schizophrenia for example - a global map will be presented-), clear criteria have to be proposed for considering a network operational and a coordination with established joint programme initiatives has to be implemented.

Depressive and anxiety disorders are prevalent psychiatric disorders that often start early in life. Heterotypic association between depression and anxiety has been well documented, with anxiety typically preceding depression in childhood and adolescence, while a more complex pattern of co-occurrence has been described for adult-onset illness. Even when starting early in life, depression and anxiety disorders are associated with poor outcomes, including not only psychiatric, social and vocational outcomes, but also development of physical problems. Although remission rates are high, in most cases episodes tend to recur, with increasing severity with every recurrence.

Identification and treatment of these conditions, therefore, is of outmost importance regardless their age of onset. However, therapeutic approaches must take into account the effect of development in their clinical presentation, the differential efficacy of the therapeutic approaches, and the adverse effects profile.

Current treatment algorithms for depressive and anxiety disorders include psychotherapeutic and psychopharmachological approaches and their combination. Although up until recently most treatment evidence came from adult studies, recent developments have increased knowledge on efficacy of interventions for younger populations. Treatment effects in children and adolescents are lower than in adults, partially due to the high placebo effect in youth. This presentation will provide an overview of the current approach to the treatment of depression and anxiety. Specificity of treatment at early ages will be stressed out. New promising treatments and their potential utility will be also discussed.

Epidemiological surveys and treatment studies have clearly established that both detection and treatment rates in depression and in anxiety disorders revolve only around 50%. This figure appears to be stable, over a number of decades, despite significant educational and policy efforts to change this pattern. Since depression is a leading cause of disability, lost productivity and health care expenditure, the societal and individual cost of this impasse is tremendous. This talk will review this data and discuss how even small changes in our therapeutic abilities may translate into major advances for patients and their environment. Meeting mental health care needs of individuals, who currently have a low rate of depression treatment, will pose an important challenge to general medical and mental health educators and practitioners. Epidemiological surveys and treatment studies have clearly established that both detection and treatment rates in depression and in anxiety disorders revolve only around 50%. This figure appears to be stable, over a number of decades, despite significant educational and policy efforts to change this pattern. Since depression is a leading cause of disability, lost productivity and health care expenditure, the societal and individual cost of this impasse is tremendous. This talk will review this data and discuss how even small changes in our therapeutic abilities may translate into major advances for patients and their environment. Meeting mental health care needs of individuals, who currently have a low rate of depression treatment, will pose an important challenge to general medical and mental health educators and practitioners.

Outcome measures are (too) often driven by what regulatory bodies request and stick to observer rated depression scales. It is already known that self rating and observer rating scales are not always concordant but recent research even indicates that what physicians and patients expect from outcome is not the same. Physicians put a lot of emphasis on (mainly) depressive symptoms not taking into account the often comorbid anxiety and somatic symptoms while patients put more emphasis on positive mood (vigor, energy, optimism) and on feeling the usual self. Moreover, research indicates that the divergence between physicians’ and patients’ expectations also influence outcome. These differences, how they manifest and what can be done to overcome them so as to provide satisfactory outcomes of treatment, will be further discussed.