Burn-Out (BO) is commonly described as a growing situation of work stress and conceptualized as a combination of emotional exhaustion, depersonalization/cynicism and reduced personal efficacy. Some professionals are exposed to a higher risk, depending on their specific work mansions (most typically the so called helping professions) and on personal and contextual conditions. Evidence from scientific literature has confirmed that being younger and working in the field of mental health are very significant risk factors for BO. Furthermore, BO is an essential target for preventive strategies: prevention of BO, rather than treatment of potential psychopathological consequences, has been proved to be more effective and cost-effective, though unfortunately very often disregarded or left to individual initiatives.

Physical activity, diet, and other features of a healthy life-style are core targets of interventions aimed at prevention of BO. Increasing evidence is collected on the effectiveness of mindfulness-based techniques and yoga. Supervision, and more specifically Balint-inspired models of group case discussions. Scientific and professional associationism is also effective as a strategy to avoid isolation. Finally, interventions aimed at improving work organization, targeting logistic aspects (eg. Time schedules), infrastructures (eg. Parking places) or dynamics and human interactions, are also essential and effective.

Mental health care settings have long been associated to a specific and long-standing emotional involvement, eventually determining professional stress and burnout in psychiatrists. However, recent evidence demonstrated that also non-doctor mental health workers may be at high risk of developing job dissatisfaction. Previous studies also suggested that the longer exposure to psychiatric settings the higher the levels of burnout. We report here data from a survey conducted among first-year students of rehabilitation courses in psychiatry (n = 44) and logopedics (n = 39), before and after the first exposure to an health care environment over a 6-month term. We investigated their psychological wellbeing and risk of psychiatric morbidity (by means of GHQ-12), levels of burnout (with the Maslach Burnout Inventory) and knowledge about mental health (by means of the MAKS schedule). The two groups were comparable as for the main socio-demographic characteristics as well as for their knowledge about mental health before training. We found a significant difference between students in mental and general health care, with significantly higher emotional exhaustion and depersonalization and lower personal accomplishment levels in the former group, after 6-month training. Such changes were significantly correlated to variations in knowledge about mental health issues and risk of psychiatric morbidity. The implementation of a specific peer support group was perceived as extremely useful by the majority of the students (96%) and had a positive impact on their burnout levels and psychological wellbeing.

In this presentation we propose to speak about specific stressors/protective factors that might be present in different settings of work (working in prison, working in addition, working with babies, liaison...) and individual factors that might be linked with more/less perceived stress. It will be done by means of a review of the literature.

Mental illness affects 1 in 5 women during pregnancy and the first year postnatal and in about 1 in 20 women the condition is serious. When a woman with major mental illness becomes pregnant she and her child face a number of risks. These include poor pregnancy and neonatal outcomes and a sharp rise of psychiatric admissions after childbirth. Mental illness is also one of the leading causes of maternal death. Risks to children are impaired parenting and developmental disadvantage in emotional, behavioral and cognitive domains. Parental mental illness also has a significant role in infanticide and abuse-related serious harm to children, with infants <1 year old being most at risk.

A recent analysis has shown that the resulting economic costs to public services and the wider society are extremely high. In view of the wide-ranging consequences, a number of European countries have set up specialized perinatal mental health services. These consist of specialized inpatient units and community teams. The essential components of their service are preconception counselling, expert advice on the use of medication during pregnancy and breastfeeding, joint inpatient admissions of mothers and babies, interventions to improve parenting, and advice to children's social services. None of these countries, however, are yet offering universal access.

In order to improve service provision and outcomes it is important that perinatal mental health is acknowledged more widely as a public health priority. The workshop will provide an opportunity for participants to discuss approaches to raise awareness and promote perinatal service developments.

During the perinatal period, women may experience severe mental health problems. Research has shown the potential negative impact of mother-baby's separation and of parental psychiatric illness, on the child. MBUs care requires different staff's expertise in order to: treat women with psychiatric disorders, ensure child care and development, and support appropriate mother–infant interaction with “good enough” mothering. For this, a multidisciplinary team is needed. Specific attention is also given to the child's father. Most MBUs may admit women with infants from birth till one year old and during several weeks or months.

More than two third of admitted women are discharged either symptom-free or greatly improved. An efficient follow up at discharge should be prepared with the women, the child's father, when presents, and linked to familial, social and medical resources. Moreover, MBUs staff should collaborate with other psychiatrists, obstetricians, midwives, pediatricians, and social workers. Mother–baby units should be part of a local health perinatal network including maternity unit, neonatal care, and community resources.

Referral for admission in MBUs may be required for women with a first acute episode, or a relapse, of a severe psychiatric disorder such as postpartum psychosis, manic disorder, major depressive episodes, schizophrenia, personality or behavior disorders. Moreover for prevention purposes, referral of women with known chronic mental health problems may start already during pregnancy.

Challenge of benefice and limit of MBUs’ care will be discussed with participants.

The importance of the “1001 critical days” (conception to age 2) underlies the need to act early in life to enhance children's developmental outcomes. Lack of intervention is likely to affect the children of today but also the generations to come. For adults, transition to parenthood is a major stressful life event. The strong emotional load of this experience can make this transitional period much more challenging for adults with psychological, social and economic vulnerabilities, and lead to unadjusted interactions.

Then, applying the “transactional model of development” (Sameroff, 2009) to the early perinatal period helps us to understand how the needs of infants can easily affect a parent's mental state and induce inadequate parenting behaviors. These in turn make the infant's interactions more difficult and the infant's development more likely to be impaired. Perinatal mental health is thus an important public health challenge for it is essential to provide services to enhance maternal and infant emotional well-being at a moment that is simultaneously when the mother's social and emotional vulnerabilities are at their height and a critical time in the child's development.

Perinatal mental health policies, including joint care of parents and infants, must provide positive support for the potential virtuous circle between the skills and vulnerabilities of the infant and the parents.

This presentation will explore the different types of joined perinatal care for parents and infants that cover a range of services, from parent-infant psychotherapies to joint mother-baby hospitalizations.

This presentation will inform the audience about the workforce issues in England in relation to Perinatal Psychiatry. The talk will illustrate the methods being utilised within the Royal College of Psychiatrists to develop the skills and competencies of clinicians. Intensive training courses, curriculum development and an innovative bursary scheme for consultant psychiatrists will be described.

Evidence indicates that migrant and ethnic minority groups have an elevated risk of psychosis in a number of countries. Social disadvantage is one of the hypotheses put forward to explain these findings. The aim of this study is to investigate main effects, association and synergism between social disadvantage and migration on odds of psychotic experiences. We collected information on social disadvantage and migration from 332 patients and from 301 controls recruited from the local population in South London. Two indicators of social disadvantage in childhood and six indicators of social disadvantage in adulthood were analyzed. We found evidence that the odds of reporting psychotic experience were higher in those who experienced social disadvantage in childhood (OR= 2.88, 95% CI 2.03-4.06), social disadvantage in adulthood (OR= 9.06, 95% CI 5.21–15.74) and migration (OR = 1.46, 95% CI 1.05–2.02). When both social disadvantage and migration were considered together, the association with psychosis was slightly higher for social disadvantage in childhood and migration (OR 3.46, 95% CI 2.12–5.62) and social disadvantage in adulthood and migration (OR 9.10, 95% CI 4.63-17.86). Migrant cases were not more likely than non-migrant cases to report social disadvantage (p = 0.71) and no evidence of an additive interaction between migration and social disadvantage was found (ICR 0.32 95% CI -4.04–4.69). Preliminary results support the hypothesis that the association between social disadvantage and psychosis is independent of migration status.

Research provides strong evidence of an elevated risk for developing psychotic symptoms and psychotic disorder among various ethnic and other minority groups. Furthermore, ethnicity may modify the risk for autism-spectrum disorder, but the evidence of this is still thin. Misdiagnosis, selective migration and other methodological artefacts are implausible explanations for the findings on psychotic disorder. Instead, we propose that ‘social defeat’, defined as the chronic experience of being excluded from the majority group, may increase the risk for psychotic disorder by sensitizing the mesolimbic dopamine system. Future challenges lie in connecting the underlying biological mechanisms to behavioral expression in socially excluded groups, as well as in bridging the gap with the clinical field and the wider society by stimulating the implementation of strategies that strengthen the position of minority populations.

Based on a systematic review on TRS 285 studies were included regarding definitions of TRS (n = 11), genetics (18), brain structure and functioning (18), cognition (8), other neurobiological studies (16), medication (158), psychotherapy and cognitive rehabilitation (12), electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) (15), prognosis (21), and other miscellaneous studies (8). Definitions of TRS varied notably. TRS was associated with 3 to 11-fold higher healthcare costs than schizophrenia in general. One-fifth to one-third of all patients with schizophrenia were considered to be resistant to treatment. Based on limited evidence of genetics, brain structure and functioning and cognition, TRS may present as a different disorder with different etiology compared to non-TRS. Clozapine, olanzapine, risperidone, ECT and cognitive-behavioral therapy have shown effectiveness, although the number of studies and quality of research on interventions is limited. About 40% to 70% of TRS patients had an unfavorable prognosis. Younger age, living in a rural or less urban area, primary education level, more psychiatric hospital treatment days in the year before first schizophrenia diagnosis, inpatient at first schizophrenia diagnosis, paranoid subtype, comorbid personality disorder and previous suicide attempt may be risk factors associated with TRS.

TRS is a poorly defined, studied and understood condition. To create a framework of knowledge for TRS, as a basis to develop innovative studies on treatment, there is a need for a consensus on the definition of TRS. Prospective long-term prognostic and novel treatment intervention studies are needed [1].

This speech aims to overview ongoing research trends on the integration of mobile health and sensors based behavioral analysis in therapeutics programs for subjects with mental health symptoms or disorders. The variety of easily acquirable personal data by smartphones and wearables in a transparent and unobtrusive way, offers the opportunity to describe the person in terms of his/her lifestyle and behavior at physical, cognitive and environmental level. An appropriate management of these data may initiate a new line in healthcare management characterized by tailored and timely interventions. However, despite the huge amount of data that could be acquired, an effective contribution of such information to the improvement of the quality of care in mental-health is still not sufficiently explored. The sensors and data which have been used in studies on mental status include accelerometer, gyroscope, GPS, microphone, calls, messages, screen, apps usage, environmental light, heart rate, skin conductance, and temperature. The primary outcomes build on correlations between sensor data and mental health status/severity of symptoms. These data are provided from studies on bipolar disorders and depression, using validated clinical scales (Patient Health Questionnaire-9; Hamilton Rating Scale for Depression; Young Mania Rating Scale; Center for Epidemiologic Studies Depression Scale; etc.).

m-RESIST consortium is fully aware of the importance to describe behavioral patterns of patients with schizophrenia that could be used to setup remotely based therapeutic tool. m-RESIST is setting up a framework for the creation of a Clinical Decision Support System based on a mobile therapeutic intervention for treatment-resistant schizophrenia.

Exploring service and care needs of patients with treatment-resistant schizophrenia is necessary for a better understanding of their psychosocial functioning, in order to develop rehabilitation goals as well as to provide them with better care.

m-RESIST is an innovative project aimed to empower patients with resistant schizophrenia, to personalize treatment by integrating pharmacological and psycho-social approaches, and to develop knowledge related to the illness using predictive models designed to exploit historical and real-time data, based on environmental factors and treatment outcomes.

m-RESIST is a system based on computer and cellular applications and wearable computing devices. The system will serve patients, caregivers and clinicians, and include the following functions: Information, Assessment, Monitoring, Communication, and Intervention.

The first step in the development process included definition of the end user needs and preferences, in order to involve users in the design of the system. Outpatients with treatment-resistant schizophrenia, informal carers (relatives), and clinicians were included in the sample. There were a total of 9 focus groups, 3 in each pilot country. Each group was composed of one of the participant profiles. Additionally, 35 individual interviews were performed, which were unevenly distributed throughout the 3 institutions.

The current workshop section will present the outcomes of this process: perceived advantages and disadvantages of the technological solution, as well as conclusions for further development. In addition, methodological issues, future challenges, relevant for the evolution of the m-RESIST project, in particular, as well as technological developments in the field of mental health, in general, will be discussed.

This communication aims to present m-RESIST, the first mHealth program for patients with treatment resistant schizophrenia (TRS). The main objective of this European project is to develop an intervention programme to allow TRS patients to self-manage their condition, which is associated with persistent positive symptomatology, extensive periods of hospital care, and a greater risk of excess mortality and multi-morbidity.

m-RESIST could offer a new tool for mental health professionals to better monitor TRS patients, providing a tailored and optimized therapeutic intervention. In this sense, m-RESIST will develop and validate a mHealth tool aimed to reduce the severity of episodes and further complications. Moreover, this tool will involve and promote a proactive role of patients and caregivers in the therapeutic process, promoting an active and collaborative role with the medical team in the treatment decision-making procedure.

m-RESIST intervention, will integrate: (1) a sensor data analysis module, which will process data coming from smart phone and wearable devices, providing passive information such as movement or social activity; (2) a predictive modeling engine, which will enable prediction of clinically significant events, such as hospitalization, risk behaviors and social isolation; and (3) a clinical decision support system (CDSS), which will provide the users with necessary information to support health-related and clinical decision-making.

The pilots of this project will take place in Tel-Aviv, Budapest and Barcelona during May, June and July of 2017. Although cost-effectiveness variables will also be measured, the main assessment will be focused on acceptability, usability, satisfaction, empowerment and quality of life outcomes.