The result of many studies is that developmental problems are coused by many socio-psychological factors in the environment of children. The purpose of the study is to investigate those factors.

The factors have been examined: characteristics of family functioning in a primary family and in a parents’ families; methods that parents use in upbringing and commitment of parents to the function of upbringing; basic personality structure of mother including her psychopathology. The sample: 90 children from a development counselling services and 61 children with no diagnosed disorders. Instruments: questionnaire about socio-demographic characteristics, GRADIR-test (measures family functioning), NEO FFI (measures basic personality structure), DELTA-9 (measures psychoticism proneness).

By factor analysis: a) two factors of characteristics of child behaviour (1. socially adapted child and 2. child with weak impulse control) b) three factors of characteristics of father (1. punishing father, 2. disinterested father, 3. traumatised father) c) three factors of characteristics of mother: (1. traumatised mother 2. mother who is not a victim 3. permissive mother) were extracted. One canonical discriminatory function has been extracted (r=0, 59; Wilks` Lambda=0,653; χ2=46,60923 ; t< 0,003) that expresses a system consisting of a well functioning mother, aggressive, punishing father and a child with a weak impulse control (externalisation).

The identified differentiating structure represents the composition of children symptoms, parents’ personality/behaviour and family problems that is most often detected by paediatricians as problematic and recommended for further treatment in a development counselling services.

Allelic variation in the promoter region of the serotonin transporter (5-HTTpro) contributes for the risk of alcohol dependence (AD). The short allele (S) of this polymorphism has been associated with co-occurring clinical features in severe AD such as depression, early onset or impulsivity. We studied the putative link between this allele and relapse in AD.

60 male alcohol dependent patients were followed for 3 months after withdrawal. Persistent abnormalities in lab tests (GGT and CDT) or failure to show up at scheduled interviews were considered as relapse. PCR amplifying the 5-HTTpro polymorphism from genomic DNA were performed. The impact of the S allele on relapse was assessed by a non-parametric Pearson χ2 test.

67.27 % of the patients relapsed during follow-up. The S allele of the 5-HTTpro was significantly associated with relapse (χ2 = 7.66 ; p < .006) while no other factor influenced relapse.

Responsible for a 5-HT hypo-functioning, the S allele of the 5-HTTpro may be associated with relapse in abstinent alcohol dependent patients, possibly through intermediate phenotypes such as personality features or lack of behavioral inhibition.

Psychiatric patients are more often tobacco smokers than the general population. These finding indicate a causal relation between tobacco smoking and occurrence of psychiatric diseases. Therefore in the study presented psychiatric comorbidity of smokers and non smokers were investigated in ”healthy“ probands being either smokers or non smokers.

Students of medicine or of psychology (mv 25,3 Jahre, SD ± 5,3), 70 healthy smokers and 83 healthy non smokers (both groups without known psychic disorder or treatment) were studied according to psychic axis-1-disorders by Mini-DIPS, a questionare for the DSM IV-or ICD 10 criteria of nicotine dependence, Fagerström-test, craving visual scale, CAGE-test, a questionare for sociodemographic factors, organic and psychic diseases and psychiatric/ psychotherapeutic treatments. Urine analysis of addictive drugs and cotinin levels in urin and saliva were estimated.

From 70 smokers according to DSM IV 40 dependent and 30 non dependent smokers were found. According to Fagerström –test 51 of the 70 were dependent smokers. The urine cotinin level was significantly higher in dependent smokers and correlated with the range of dependence acc. to Fagerström (p <0.001). The saliva cotinin level significantly correlated with the range of craving (p < 0.006). In 12 (9f, 3m) of the 40 dependent smokers phobic and anxiety disorders and high levels of cotinin were found, but not in the groups of non dependent smokers or non smokers.

A relationship of dependent smoking with higher cotinin and craving levels and phobic / anxiety disorders seem to exist, especially in females.

The prevalence of mood disorders (anxiety and depression) during pregnancy seems to be similar to the women of the same group without pregnancy. Women with recurrent depression and euthimic women who discontinued antidepressants medication during pregnancy are particularly at high risk for depressive illness. Data about perinatal effects of SSRI antidepressants are gradually accumulating and are controversial. Two meta-analyses and some controlled studies don't find increased risk for major malformations in SSRI-exposed newborn. However, other studies find an increased risk of congenital malformations, poor birth outcomes and neonatal complications.

Neonatal morbidity in infant newborn of women treated with antidepressant drugs.

We examine the relation between the pharmacological treatment of the maternal anxiety/depression during the pregnancy and acute morbidity in infant newborns.

Study group of 66 infant newborn of pregnant women with a diagnoses of major depressive episode or defined anxiety disorders according to DSM-IV, who were in treatment with antidepressant drugs during pregnancy. Control group: 120 newborn of healthy pregnant women, who did not receive any treatment, and were contemporary of the same gestational age and sex. Criteria of exclusion: demonstrated toxic consumption (alcohol, cocaine, cannabis, opiates, drug of synthesis). Studied variables: Type of childbirth and analgesia; weight and age of gestation; pH of umbilical artery and Apgar test; presence of malformations; morbidity; feeding; withdrawal syndrome.

Infant newborn of mothers exposed to the antidepressant treatment suffered from more pathology than those of the control group (16/66 vs. 14/114; 24.2% vs.12.3%; p=0.038). Two smaller malformations in the study group were observed, a preauricular appendix (group A) and one moderate pielocilicilar ectasy (group C), both in mothers who received paroxetine (2/60; 3.3% vs. 0/114; 0%, p=0.05, Fisher p=0.118, NS). Only one infant newborn displayed compatible clinical signs with moderate withdrawal syndrome (irritability, vomits) from a mother treated with venlafaxine. No case of convulsions was observed. Breast feeding was less frequent in the group of antidepressant treated mothers (38/66, 57.6% vs. 86/116, 74,1%, p=0.032).

The treatment with antidepressant drugs during pregnancy is necessary for some women. The clinician must weigh the relative risks of various treatment options and take into account individual patient wishes. Although the antidepressant drugs suppose an increased risk for the newborn, it could be assumable for the benefit that represents maintain the mother in an euthimic situation.

We propose to discuss the clinical management, as well as, the accuracy of the psychiatric and obstetric controls to minimize the neonatal complications.

Randomised controlled trial. Two hundred and thirty mothers with major depression attending primary care clinics were randomly allocated to either a multi-component intervention or usual care. The multi-component intervention involved a psychoeducational group, systematic monitoring and treatment compliance support, and pharmacotherapy if needed. Data were analysed on an intention-to-treat basis. The main outcome measure was the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6 months post randomisation.

Approximately 90% of randomised women completed assessments. There was a marked difference in all outcome measures at 3 months, in favour of the multi-component intervention. However, these differences between groups decreased after 3 months. In our primary analysis, the adjusted difference in mean EPDS between the two groups at 3 months was -4.5, 95% C.I. -6.3 to -2.7, p<0.001. There was a sharp decline in the proportion of women on antidepressants after 3 months in both groups.

This intervention considerably improved the outcome of depressed low-income mothers compared to usual care for the first 3 months. However, some of these clinical gains were not maintained thereafter, most likely because a large proportion stopped taking medication. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.

Patients who exhibit violent behaviour or refuse medication during in-patient treatment are a challenge for clinical management. The management of those clinical situations is different in European countries with respect to legislation and clinical routine.

We selected three case vignettes which were considered as most typical and relevant by a vote among members of the European Violence in Psychiatry Research Group (EViPRG). Case 1 represents a voluntary in-patient who assaults a staff member, case 2 an involuntary patient who does not behave violently but refuses medication, and case 3 an out-patient who is violent against family members. In all three case vignettes the respective patients were presented as suffering from schizophrenia. From 12 European countries, each two experts were interviewed by a questionnaire about the typical clinical management and its legal requirements in these cases. Consensus among the country experts was reached after further discussion, if necessary.

Considerable differences were found with respect to involvement of jurisdiction and police, application of involuntary medication, requirements for a transfer to forensic psychiatry, and use of coercive measures. Physical restraint, seclusion, and mechanical restraint each are common in some countries and forbidden or definitely not used in others.

More evidence from sound studies is required regarding safety, outcomes and ethical aspects of coercive treatment.

Physical (‘hands-on’) restraint is used widely in mental health services around the world to control imminent and actual dangerous behaviour by people suffering acute mental illness. Its deployment in a supposedly caring environment generates acute ethical dilemmas for staff because of the risk of death, physical injury and/or psychological distress for both patients and staff. As a coercive intervention, it is increasingly framed professionally as a treatment failure and there is a significant effort around the world to develop alternatives at the individual and organisational level. This presentation will summarise some key findings from a series of UK studies on the psychological and social context surrounding the decision by staff to restrain a patient on the floor.

The studies have variously employed standardised instruments (e.g. ACMQ), audit data and qualitative interviews to examine the attitudes and experiences amongst patients and staff relating to restraint episodes.

Attitudes toward restraint vary according to demographic factors and exposure to the technique and the decision to restrain the patient on the floor is associated with a number of contextual factors.

These findings will be embedded within a discussion of some relevant theories of human aggression and stress. In this way it is anticipated that our understanding of the interaction between staff and patients during crisis situations can be improved and ultimately decision-making by professionals during these episodes can be enhanced.

Prevention of patient violence should be initiated very early in the aggression process. In order to improve the early preventive interventions on a psychiatric intensive care unit (PICU), we introduced a training programme including the Bröset Violence Checklist (BVC) and structured preventive care plans.

We developed a standardized list of goals and interventions for patients at risk of becoming violent towards others, covering aspects of patient participation, information, support, general care, environment, observation and coordination. All members of staff were obliged to read the patients' care plans before entering the ward and carry out the interventions. The BVC estimates the patient's level of risk for violence during the next 24 hours. In the checklist six behaviour items are noted as present or not present; confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects. On the PICU, a nurse was assigned on each shift to assess the patients. If more than two items were present, interventions to prevent a violent incident had to be initiated.

The staff found the BVC easy to learn and use. An evaluation of the predictive capacity of the BVC on the PICU showed that the risk for violence in a short term perspective could to a high degree be predicted by the nursing staff. Similarly, we found that the standardized list for care plans was experienced as helpful and an often necessary tool, well suited to be combined with the BVC.

Recommendation (2004) 10 Concerning the Protection of the Human Rights and Dignity of Persons with Mental Disorder binds member states of the Council of Europe to the principles of least restriction / least intrusiveness. There are however marked differences in how these principles are being interpreted in the context of coercive interventions across Europe. Current practice is the result of the emergence of national consensus on what is acceptable rather than evidence based with procedures banned in one country such as seclusion, in common use in another. In the light of moves towards greater European consensus on mental health issues more generally the absence of a European consensus is striking.

To identify how moves towards a consensus on the use of coercive interventions might be facilitated.

Literature review, discussion.

The paper proposes a taxonomy of coercive interventions and critically examines the criteria that might be employed in determining what constitutes the least restrictive/least intrusive intervention in a given situation.

A pan-European consensus is possible but depends on better data collection across Europe on the use of coercive interventions in order to inform its development and a willingness by practitioners to critically reflect upon the cultural determinants of practice in their setting.

General population studies have found that the positive symptoms of psychosis are prevalent in the general population. The majority of the individuals experiencing these “symptoms” are not in need of care. However, longitudinal studies indicate that they may nevertheless have an increased risk of developing a clinical disorder. The aim of this study is to elucidate the mechanisms that mediate transition from having one or two psychotic symptoms to becoming a patient with a psychotic disorder.

Data from two large longitudinal general population studies (the NEMESIS study and the EDSP study) were analysed in order to investigate the risk-increasing effect of three important environmental risk factors, namely cannabis, urbanicity, and childhood trauma, as well as their interaction with pre-existing liability to psychosis.

Based on these studies, cannabis not only survives as a risk factor for psychosis, but the evidence is showing concrete synergistic effects between cannabis and pre-existing psychosis liability. The urban environment is, in terms of attributable risk, the most important proxy environmental risk factor and there is emerging evidence that it interacts with genetic risk. Early trauma is another important aspect of the environment that can be linked prospectively to psychosis, particularly for those with a pre-existing liability.

The mechanism by which the environment is likely to impact on risk is through cognitive and emotional pathways on the one hand, and biological pathways, possibly involving dopamine sensitisation, on the other.

Contemporary psychopathology, together with the conceptual reappraisal of the notions of schizotaxia, schizotypy and schizotropic liability (i.e. anomalous subjective experiences), is witnessing the rebirth of attention to attenuated (subclinical) trait phenotypes that may indicative of latent vulnerability to spectrum conditions.

To extract heuristic, clinically-useful, target dimensions indicative of enhanced, genetically mediated, schizotaxic risk.

Schizotypal traits and anomalous subjective experiences were assessed in a sample of unaffected siblings of schizophrenics by means of a condensed, ad hoc developed, semi-structured exploratory checklist (i.e. Brief Experiential Vulnerability Assessment) and compared with two experimental control groups (i.e. unrelated healthy subjects and DSM-IV Schizotypal Personality Disorder patients).

Unaffected siblings exhibited intermediate, non pathological scores in all the schizotypal dimensions (i.e. “Positive”, “Negative” and “Oddness”) and in some self-experiential domains as compared to the control samples.

Regression analyses indicate that schizotypal interpersonal deficit (i.e. Negative factor) and subjective experience of anomalous autopsychism (i.e. Self-disorders), are the best predictors of schizotaxic risk.

Self-disorders and the interpersonal factor of schizotypy delineate a combined target phenotype which plausibly reflects the heritable schizophrenia spectrum predisposition and may be relevant for identifying vulnerable subjects in non-clinically-overt conditions.

Theoretically, schizotypal features should be prevalent in patients at ultra high risk of psychosis. In connection to the European Prediction of Psychosis Study (EPOS), we could study their prevalence in this group using three different ways of assessing schizotypality.

EPOS dataset comprises a large sample (n=246) of UHR patients, who were followed up for 18 months. Schizotypal features were assessed in connection to SIPS interview (SIPS-STY, researcher assessment), and with PDQ-R and SPQ scales (self-assessment). Descriptive data and intercorrelations between different measures are described. Concurrent validity of these three measures is assessed by externals validators (genetic risk/ neuropsychology).

The prevalence of schizotypal pdo was 13.4% with SIPS-STY and 34.6% with PDQ-R-STY. These categorial measures were poorly correlated (k=0,11). Of continuous measures PDQ-R-STY and SPQ scores were highly correlated (r=0,78, P<,000), but SIPS-STY score was only weakly correlated with these other measures (r=0.24).

As to external validation, FDRs of psychotics did not differ from other subjects on the level of schizotypal features. PDQ-R-STY but not SIPS-STY was associated with lower verbal IQ (P=0.004). In verbal fluency test, both SIPS-STY and PDQ-R-STY contributed to poor performance, but SPQ did not add to this. Schizotypal status did not associate with results of the Spatial working memory paradigm (SWMT).

Different measures of schizotypality produce somewhat inconsistent results when studied in a high psychosis risk sample. PDQ-R questionnaire seemed to give results most consistent with the current notion of schizotypicality.