New technologies have always brought new challenges even as they solve old problems. The 21st century is seeing a revolution in scientific, technical and medical publishing. The stage was set a few years ago, when publishers began migrating their content to the online environment, in parallel with continued print publication, first journals, then books. Initially, the premise was still that the print product was primary and the electronic version just a way of reaching a larger audience. As new functionality was introduced, expectations were raised and content now has to be much more than an electronic version of a printed page: it must include easy cross-referencing both internally within a document and to external sources, without regard to the owner or publisher of those sources; it must accommodate audiovisual material; and all this must be done rapidly and seamlessly.

But the target has already moved further away: the real challenge now is to deliver the interactivity that will be expected from the generation that communicates through MySpace and Facebook. How do we maintain the status of the textbook when students look for answers on Wikipedia? Who will read a journal paper describing a particular gene when they can log into GenBank? What is the role of the clinical reference work when doctors carry PDAs loaded with guidelines and treatment algorithms? The publishing house that successfully answers these questions will be the one that survives to face the challenges of the next decade.

In the context of this Joint Section Workshop – jointly organized by the AEP Sections 'Women's Mental Health’ and ‘Philosophy and Psychiatry’ - on 'Scientific reading and writing in psychiatry' the title of this talk poses the question of the rapport between two kinds of knowledge: theoretical knowledge and practical knowledge. Some clinical problems and a paradox derive from this: Does theoretical knowledge stand in the way of practical skills like the immediate grasping of the other's experience as in empathic understanding? Does theoretical knowledge act as a set of prejudices tackling "taking inside" the other's thoughts and feelings? The paradox is the following: Do we understand other persons thanks to our prejudices (or a set of commonly shared prejudices)? A tentative way out from these problems and paradoxes are Giordano Bruno's concept of "docta ignorantia" or Edmund Husserl defintion of the phenomenologist as an "eternal beginner". The notion of epoché, i.e. bracketing one's background knowledge in order to highlight it, may prove useful too.

Mental health services in Denmark are rapidly changing in terms of heightened focus on outpatient and assertive treatment. Community mental health services are closely connected with inpatient treatment and comprises comprehensive services with easy accessability. There is a strict division between the responsability of mental health services and social services concerning the individual patient. This puts emphasis on the necessity to provide continuity and to coordinate services between the sectors. The changes in service delivery which has been taking place during the 10 years since the start of Danish National Schizophrenia project will be described and related to key issues of the treatment as usual.

Very few research projects describe the clinical routines and every day treatment procedures, and correlate these to the outcome.

Psychopathological symptoms are the hallmark characteristics in all schizophrenia constructs all along the history since non-clinical domains have never been included in any of the major diagnostic criteria systems applied to schizophrenia.

Despite the critical importance of the DSM system in psychiatric nosology, a problem that is still not completely solved is clinical heterogeneity of patients, which it is not the exception but the rule. The magnitude of the problem is well illustrated by an example: There are 25 different combinations of characteristic symptoms (Criterion A), 5 schizophrenia subtypes and 9 longitudinal courses for ‘DMS-IV-TR’ schizophrenia disorder. Taken together, 1125 different clinical forms are possible for the same diagnosis.

Categorical approach to the assessment of symptoms and syndromes/disorders should be supplemented by dimensional analyses both at clinical and research levels. In fact, treatments for schizophrenia patients are mainly selected by their predominant symptoms and not exclusively by their diagnoses.

Cognitive impairment has been at the forefront of schizophrenia research and clinical interest for the last 2 decades. The prevailing clinical impression is that individuals who meet criteria for schizophrenia also suffer from easy observable and at times severe cognitive impairment. However, when large populations of schizophrenics undergo classic psychological testing, the normal distribution of their composite scores is "shifted to the left" only moderately. There exist a very large overlaps between patients and controls in terms of cognitive scores regardless of the tests employed. An hypothesis that would reconcile the clinical observations with the research data on large population would suggests that the quality and degree of cognitive impairment that cognitive impairment in schizophrenia is heterogeneous both in quality and severity and that some subgroups of individuals perform within or above normal range on all aspects of cognition. Adding to this heterogeneity is the fact that for some individuals the cognitive impairment is static while for others it is progressively declining.

Since different aspects of cognitive impairment might have different biological substrate, investigating and sub-typing cognitive impairment could be essential to finding a therapeutic remedy.

Some authors observed episodic memory impairments in all the patients with schizophrenia. Others sustained that distinct episodic memory profiles could differentially be expressed across clinical subtypes (Brazo et al. 2002).

Mental health care in the Netherlands generally has been characterized by a relatively high number of hospital beds, and moreover during the last 15 years by an increase of sheltered living accommodation (also beds) in the community – without decreasing significantly the hospitals beds. Psychiatric hospitals have survived and transformed themselves into large organizations providing various forms of out-, day- and inpatient treatment programmes and sheltered living arrangements in a circumscribed geographical catchment areas. Deinstitutionalization has a special meaning in this context: no actual blocking of hospital admissions like in Italy or closing buildings like in the USA but more in the sense of gradually decreasing numbers long stay patients, of shortening duration of admission stay, providing within days a kind of aftercare (continuity of care), extending sheltered living accommodation in the community by independent institutes and outreaching community care. This process of extramuralization seems to be ‘frustrated’ or maybe ‘facilitated’ - depending on the eye of the beholder - by recent changes in the organization and financing of mental health care. Not the government but the providers and the insurance companies – and to a lesser extent the client resp family movement – will be decisive for the outcome. This could have far reaching consequences for the ultimate goal of integration of care.

After the United States Switzerland provides the second most expensive health care system worldwide. Likewise in all other industrialized countries, there is an intensive debate about cost containment. In general care several models are under evaluation not only to reduce costs but also to improve quality of treatment and care in highly fragmented health care systems. These models deal with primary care providers as gate keepers or managed care. There is also a discussion about the introduction of DRGs in inpatient treatment.

There is not a comparable development at present in mental health care. There are few case management models tested, trying to integrate and coordinate a multitude of institutions involved in the treatment and care of chronically mentally ill. The most progressive trial is under consideration at the University of Zurich, where patients after admission to inpatient treatment immediately are referred either to continuing inpatient treatment or to acute day-hospital treatment or to outpatient treatment. This model is the closest on the way to a patient-centered model of treatment in care while the above mentioned models all try to deal with the disadvantages of fragmented institutional care systems.

Mental health is a core issue in primary care and primary care is now becoming a key collaborator in developing and delivering quality mental health care with ongoing, underpinning support from a raft of government policy directives. These include the introduction of new roles into primary care such as Graduate Primary Care Mental Health Workers and the introduction of a number of new quality outcome indicators to the new GP contract and the opportunity for GPs to undertake commissioning of mental health services.

Recently changes to the new GP contract have increased the focus on reliable diagnosis, monitoring and management of chronic mental health problems in primary care. In addition, the new roles, designed to help in the support and management of individuals with mental health problems offer an alternative to traditional ways of managing mental health problems in primary care. These innovative changes have impacted on traditional ways of working and helped promote a more collaborative integrated approach to care of patients with SEMI.

Despite this emphasis on improving organisational relationships and partnership working through the introduction of these new policy initiatives, evidence suggests that the implementation of policy and development of mental health services, has to date been varied. The experience of those working within, and delivering mental health services suggests a rhetoric reality gap between policy formulation, implementation and service organisation and delivery. This has particular implications for people with mental health problems, many of whom have little choice or voice within society and need integrated services.

Psychiatric diseases already have a great impact with regard to personal and social impairment and socioeconomic costs. The burden of psychiatric diseases on societies is even expected to grow in the years to come. The WHO for example predicts that Major Depression will be the disease with the most disability-adjusted-life-years (DALY's) by the year 2030 in the industrially developed countries.

New approaches and concepts for the treatment of psychiatric illnesses are therefore needed in research and in care.

A critical point will be the establishment of timely, goal-orientated and scientifically founded therapeutic interventions (e.g. according to national or international treatment guidelines) in psychiatric diseases. Such an improvement of the structures of psychiatric care is to be expected by the new models of integrative care.

The “Integrated care of depression” has been established in the Aachen region in 2006 as a model for a best-practice cooperation of inpatient and outpatient care. The aims of this network are the early detection of depression, the optimization of the treatment, the prophylaxis of relapses and especially the improvement of the transitions between the medical practitioners, other therapists and the hospitals involved.

An improvement of the care of psychiatric diseases will be one major step in the quest to prepare the society for the burden of psychiatric diseases to come in the near future.

Alien psychiatrists, most of them from Europe, provided what was known about the mental health and illness of Africans until a few decades ago. Even after departure from the shores of Africa, their views remained dominant among indigenous psychiatrists. Many of those views were based on limited empirical evidence. Some other views, based on well-conducted research, may have been affected by the perennial problem of valid ascertainment of mental and social phenomena. Recent studies, many of them conducted by local scientists, are beginning to offer different perspectives about the nature and profile of mental illness among Africans but are themselves not immune to paradoxes. An examination of both old and new perspectives provides an opportunity to reflect on the challenges of research in psychiatry and how far we still are from achieving consensus.

This symposium will bring together leading mental health specialists from Europe and Africa. It will aim at describing patterns of common mental disorders on both continents and will also seek explanations for any observed differences. The objective of the symposium will be to bring out lessons that can be learnt from the two continents with the expectation that these lessons will not only bring about a better understanding of the mental disorders, but that opportunities for joint research projects between Europe and Africa will be explored, using existing research data from the two continents. The symposium will explore the fields of the psychosis and seek to bring out the current state of the debate on the prognosis of, for example, Schizophrenia in Africa versus Europe as the Africans present the latest findings from their continent. Conversion syndromes, Anorexia Nervosa, drug and substance abuse are all conditions that show patterns that are different in the two continents and pose new and challenging opportunities for collaborative research. Though present on both continents, PTSD and the challenge of HIV/AIDS is greater on the African continent partly due to social, economic and political factors that seem to fuel both. European psychiatrists might value opportunities to hear the state of these conditions in Africa and the way Africa is responding to the challenge.

Epidemiological findings and projections indicate that over two-thirds of all the people now living with HIV/AIDS globally live in Africa, South of the Sahara desert and over 80% of the World's AIDS deaths have been reported in the region and yet Africa has only 22% of the world's population with very limited resources.

The paper outlines the current HIV/AIDS epidemiological status in Sub-Saharan Africa, the common psychiatric presentations as well as the magnitude of the psychosocial effects including that of orphanhood. The Health care systems and the available resources are reviewed as they influence psychiatric responses in the region.

In conclusion, the successes realized, challenges so far encountered and lessons learnt in some Sub-Saharan African countries are pointed out with some suggestions as a way forward to improve the HIV/AIDS psychiatric interventions in Sub-Saharan Africa.

The countries of Africa are significantly different from one another. A first possible division is by their use of English, French, Spanish or Portuguese as their predominant second language.. The imposition of one of the European languages as the lingua franca for the countries that “belonged” to the same colonial power was always accompanied by the imposition of other contents of the colonizers’ culture, the traces of which can still be seen in many ways today. In addition to these group differences there are many other, individual differences, stemming from the local culture, previous history of the country and other sources. The differences are not only present among countries: within them there are subgroups of the population that differ sharply, in many ways from other citizens living within the same frontiers.

The heterogeneity of the continent makes it difficult to propose the development of mental health programmes for Africa. The rapidly developing large countries will have to build programmes that are different from those that should be developed in the small and often extremely poor countries. Features such as the level and speed of urbanization, the geography, economy and the predominant religion are probably more powerful determinants of programmes in Africa than the fact that the country is on the African continent. International collaboration is therefore particularly important for mental health programmes of the African countries.

The Collegiate Trainees Committee (CTC) of the Royal College of Psychiatrists was founded in 1976 following an initiative of the then President, Professor Andrew Sims. It represents trainees from both the United Kingdom and also Ireland. Members are elected to a two year term of office by trainees in each of thirteen constituencies, with elections held in half of these in any given year. This session describes in detail the history, development, structure, role and functions of the CTC with special emphasis on the successes and the challenges encountered over the years. The factors crucial to the viability and strength of the CTC will be critically analysed and discussed, and comparisons will be drawn with national trainee associations elsewhere in Europe.