This presentation reports on the outcomes of a practice-based and science-based enterprise in the Netherlands to develop a comprehensive national prevention program focused on children of parents with a mental illness. An outline of the multicomponent program is presented which includes a wide set of interventions that address evidence-based risk factors and protective factors in multiple domains, including children in different age groups, parents and families, social networks, professionals and the community as a whole.

The 20-year history of this program illustrates the importance of long-term collaborative investments that are required of practitioners, policymakers and scientists to develop and implement a nationwide, comprehensive approach for addressing the prevalent transmission of psychiatric problems from parent to child. The results of recently undertaken controlled efficacy studies of various preventive interventions are presented, as well as findings from process evaluations. Also, strengths and weaknesses of the current program are discussed and recommendations will be offered for the main challenges ahead in terms of program innovation, implementation and research.

Up to 10% of mothers and 5% of fathers in Europe have mental illness. Family, educational and social lives of children and adolescents with parental with mental illness (CAPRI) are disrupted by deprivation & repeated hospitalization. This is an urgent political & public health concern: The European Union's CAMHEE report recommends better information on CAPRI risks and resilience and to enable interventions to target the highest risk. This is important because although large numbers of children are in the riskset, most remain resilient. Research needs to support delivery of the CAMHEE initiative by understanding who is at risk and how we can target them early before their life trajectories are fatally disrupted.

To do this, we aim to create groundbreaking cross- national datasets providing robust data on CAPRI prevalence & life trajectories needed to plan future services.

But epidemiology alone cannot expose how risk creates effects at the individual level. We need to know which CAPRI to target with potentially expensive, time-consuming specialist services

Powerful neuroscience techniques such as functional near infrared spectroscopy are now available with which we can link epidemiological risk to elucidate effects of exposure within individual infant brain. This unique interdisciplinary approach yokes robust epidemiological evidence to cutting-edge optical imaging that can be undertaken in very young infants.

This allows us to target developments in clinical interventions for CAPRI to those in greatest need and potentially to those most vulnerable with the future aim to identify early biomarkers of abnormality for targeting intervention in CAPRI.

Depression is associated with more than 100,000 patent applications for its diagnosis and prognosis, the highest number among mental disorders. This is followed by schizophrenia with 47,000, bipolar disorder with 32,110 and hypomania with 11,377. Among diagnostic tools, magnetic resonance imaging is associated with more than 31,000 patent applications. Among recent technologies, biomarkers are associated with more than 12,000 epigenetics with about 970 metabolomics with 515 genome-wide association study (GWAS) with 486 and bionics with 497 patent applications. The patent applications related to diagnosis and prognosis of psychiatric diseases peaked in 2008 and was overall decreasing until 2016, with a local peak in 2013. This trend has been observed despite the value addition of recent technologies like machine learning, big data and internet of things. However, more conservative diagnostic tools from the last decade like magnetic resonance imaging, epigenetics, bionics and neuro-psychological testing are improved by the recent technologies. For example, bionics is improved by sensors of internet of things to collect the data from patients around the world and use the big data analytics to efficiently diagnose the psychiatric diseases. The Regents of the University of California and Human Genome Sciences Incorporation are the respective academic and non-academic institutions leading the innovations related to diagnosis and prognosis of psychiatric diseases.

Social cognition (SC) refers broadly to the domains of cognitive functions that are employed in socially relevant situations. These disturbances have been found to be strongly related to disorganized and negative symptoms in schizophrenia. Each of the disorganization symptoms suggests a diminishment or absence of organization. There seems to be a loss of the ability to be directed toward or committed to a particular focal topic or goal. Such conditions are likely to impact patients’ drives or motivations to initiate goal-directed activities that could yield pleasurable opportunities. Moreover, it has been suggested that disorganized symptoms are an integral link in cognitive pathways, with connections between cognitive processes weakening as disorganized symptoms increase. Thus, it seems that when disorganized symptoms are present, people with schizophrenia are no longer able to effectively utilize the neurocognitive abilities necessary for performing social cognitive or metacognitive tasks. It is also in line with models of disorganization in schizophrenia (Bleuler, 1911) that a “loosening of associations”—similar to current conceptualizations of disorganized symptoms—is at the core of these cognitive disruptions. Previous research has linked disorganization to cognition (neurocognition and SC) and cognition to social functioning, although in separate studies. The present study was conducted to explore a model, where disorganization predicted social functioning both directly both through indirect effects on other determinants (neurocognition, SC and negative symptoms) in a large, and well-characterized sample of patients with schizophrenia recruited in the context of a multi-center study of the Italian Network for Research on Psychoses (NIRP).

Factor analyses of large datasets have established two dimensions of negative symptoms: expressive deficits and a motivation. This distinction is of relevance as the dimensions differ in their cognitive and clinical correlates (e.g. with regard to functional outcome). Using functional MRI, we examined the neural correlates of the two negative symptom dimensions with brain activation during social-emotional evaluation. Patients with schizophrenia (n = 38) and healthy controls (n = 20) performed the Wall of Faces task during fMRI, which measures emotional ambiguity in a social context by presenting an array of faces with varying degrees of consistency in emotional expressions. More specifically, appraisal of facial expressions under uncertainty. We found severity of expressive deficits to be negatively correlated with activation in thalamic, prefrontal, precentral, parietal and temporal brain areas during emotional ambiguity (appraisal of facial expressions in an equivocal versus an unequivocal condition). No association was found for a motivation with these neural correlates, in contrast to a previous fMRI study in which we found a motivation to be associated with neural correlates of executive (planning) performance. We also evaluated the effects of medication and neurostimulation (rTMS treatment over the lateral prefrontal cortex) on activation during the social–emotional ambiguity task. The medication comparison concerned an RCT of aripiprazole versus risperidone. Compared to risperidone, aripiprazole showed differential involvement of frontotemporal and frontostriatal circuits in social-emotional ambiguity. We conclude that deconstruction of negative symptoms into more homogeneous components and investigating underlying neurocognitive mechanisms can potentially shed more light on their nature and may ultimately yield clues for targeted treatment.

The epidemiology, risk factors, and biological basis of suicidal behaviors have been the object of an ever–increasing research in the last three decades. During this period, researchers all over the world have identified potential biomarkers of risk and developed several theories about the mechanisms leading to suicidal behavior. However, the lack of common terminology, instruments, and cooperation has been a major deterrent. Today, the community has established the bases for this collaboration and evidence coming from neuroscientific studies can already be applied to the field of suicidology. We present here a potential semiology based on current evidence coming from biological, clinical, and neuroimaging studies.

Suicidal behaviour is the most common psychiatric emergency. A large proportion of suicidal behaviour can be prevented, particularly in cases associated with mental disorders. Early recognition of suicidality and reliable evaluation of suicide risk are crucial for the clinical prevention of suicide. Evaluation of suicidal risk involves assessment of suicidal intent, previous suicide attempts, underlying psychiatric disorders, the patients’ personality, the social network, and suicide in the family or among acquaintances as well as other well-known risk factors. Suicide risk assessment should take place on several levels and relate to the patient, the family and social network but also to the availability of treatment, rehabilitation and prevention resources in the community. As suicide risk fluctuates within a short period of time, it is important to repeat the suicide risk assessment over time in an emphatic and not mechanistic way. The suicidal person may mislead both family members and hospital staff, giving a false sense of independence and of being able to manage without the help of others. Although extreme ambivalence to living or dying is often strongly expressed by the suicidal individual, it is not seldom missed by others. If observed in the diagnostic and treatment process, dialogue and reflection on such ambivalence can be used to motivate the patient for treatment and to prevent suicide. If ambivalence and suicidal communications go undiscovered, the treatment process and the life of the patient can be endangered. Today, several measurement tools of suicide risk exist, including psychometric and biological measurements. Some of these tools have been extensively studied and measures of their sensitivity and specificity have been estimated. This allows for the formulation of an approximate probability that a suicidal event might happen in the future. However, the low precision of the predictions make these tools insufficient from the clinical perspective and they contribute very little information that is not already gained in a standard clinical interview. Psychiatrists and other mental health professionals have always longed for reliable and precise tools to predict suicidal behavior, which could support their clinical practice, allow them to concentrate resources on patients that really need them, and backup their clinical judgement, in case of eventual legal problems. In order to be useful, however, the approximate probability that a suicidal event might happen in the future is not sufficient to significantly change clinical routines and practices. These should rely on the available evidence base and always consider the safety of the patient as paramount.

Suicide is the second leading cause of death in Europe among 15–29 year olds. Adolescence is a sensitive period during development with several age specific factors, which can increase suicidal risk.

As it is in all cases, the first step of the diagnostic procedure of suicidal adolescents is creating an appropriate environment for the evaluation and rapport building.

More than 90% of suicidal adolescents has ongoing and usually untreated psychiatric disorder/s and about three-quarters of them has at least one subthreshold diagnosis. Potential common risk factors of adolescence suicide include both internalizing and externalizing disorders, such as major depressive episode, substance use and conduct disorder. The comorbidity of psychiatric disorders–both subthreshold and threshold - has been associated with increased risk for suicide. The careful assessment of subthreshold and full psychiatric disorders of suicidal adolescent is important in suicide prevention and the treatment of suicidal adolescents. The diagnostic procedure includes both clinical assessment and using validated (semi) structured diagnostic interviews. Rating scales can provide information on the severity of the patient's symptoms. Next to the assessment of the symptoms it is important to take the history and to get know about adolescents’ possible life events. Clinicians should carefully screen potential suicidal behavior itself, which includes both clinical assessment and validated interviews and tests.Complex treatment of suicidal adolescents can include, if it is necessary hospitalization due to the management of acute suicide risk and the appropriate treatment of subthreshold and threshold psychiatric disorders with the consideration of possible life events.

Over fifty percent of psychiatrists will have at least one patient die by suicide while in treatment and some will have more than one patient suicide during the course of their career. The impact of patient suicide on the personal and professional lives of those psychiatrists can be profound. Personally, many suffer a grief reaction than can progress to depression in some cases. Almost all experience a sense of shock upon first learning of the event. Feelings of guilt are also common. Professionally, many fear disapproval from peers and may never again treat a suicidal patient. Some psychiatrists leave the field completely or go into administration so that they never have to treat patients again.

Surveys of training programs have found that most provide training in the assessment of suicide risk and in the management of the suicidal patient but there is minimal training in how to deal with the aftermath of a patient suicide. There is a need to teach and to help practicing psychiatrists, at whatever stage in their career, cope with the stress that occurs when one of their patients dies by suicide during the course of therapy. Important issues are how and when to contact family members and other survivors, whether or not to attend a funeral or memorial service and what and what not to do regarding discussing the case with others. The risk of litigation also is influenced by how psychiatrists behave after patient suicide occurs. The case of Ernest Hemingway is used as an example to illustrate some of these concepts.

What started with telepsychiatry (videoconference) has been turned into e-Mental Health (eMH) due to rapid development of IT technology, decreased prices and increased user experiences. Access to mental health care is one of the identified problems within EU mental health services. Increased migration into and within EU cause the increased demands for clinicians with selected skills. Telepsychiatry is the oldest and most common eMH application. The first international telepsychiatry collaboration established between Sweden and Denmark back in 2006 was a success. This model might be used as collaboration prototype while speaking about current refugee crisis in Europe and treatment of mentally ill migrants. The experiences from this pioneer international transcultural telepsychiatry service in combination with various eMH applications may be used as an inspiration for conducting of larger international eMH service capable to provide mental health care toward diversity of patient populations underserved on their mother tongue within EU.

eMH applications could improve quality of care and access to mental health care in rural, remote and under-served as well as in metropolitan areas all around EU.

Gambling Disorder (GD) is a complex psychopathological phenomenon, characterized by the interaction of multiple etiological factors and a very heterogeneous symptomatological expression. Currently many questions remain concerning the best way of treating GD. Indeed, the traditional used (cognitive) behavioral interventions have at best a modest effect size. In addiction, there remains a large treatment gap, i.e. less than 10% of pathological gamblers ever seek help and enter treatment. E-health interventions could potentially help to close this gap. Cognitive bias modification (CBM) refers to a class of cognitive training paradigms that target specific automatic attentional, behavioral or evaluative biases triggered by addiction-related cues. These biases have repeatedly been shown to play an important role in addiction. Recently a number of studies have shown that modifying these biases has been effective in the treatment of different types of addictions, e.g. alcohol use disorders. An online Approach Bias Modification program, testing both Attention Bias Modification (ABM) and Approach Bias Modification (AppBM), is currently tested with Belgian and Dutch problem and disordered gamblers. Personalized motivational feedback has been added to the training program, to increase training adherence and prevent dropout. The same research group is also launching a second web-based study combining online AppBM with an online standard, protocoled, cognitive behavioral Therapy (CBT) program with guidance of a trained therapist. Participants receive nine CBT sessions through online chat with the therapist and, concurrently, nine sessions of AppBM. Preliminary results will be discussed.

eMental Health is the use of information technology (ICT) to support and improve mental health; it includes online resources, social media and smartphone applications, as well as videotelephony.

It used to be the new frontier, ungoverned but time has led to a maturity such that the novel is now commonplace and what was once Tomorrow's World is here today. From the experience of the networked Scandinavian countries, to the populations that novel techniques are reaching out to; QR codes in the UK, teens in Australia; from determining levels of Internet Addiction in Poland, to the use of that medium to treat anxiety disorders.

An innovation from Law Enforcement has massive implications for patients recording consultations. Other experiments with risk management led to the failure of ‘Radar’, but paved the way for social care providers to develop safer systems that can care for large populations with few therapists.

It is this use of Artificial Intelligence that may be the most challenging. Over 90 companies are developing the use of AI in diagnostics and related fields, with 14 US and Canadian hospitals involved with IBM's Watson. Will Drs become unnecessary? However the most innovative aspect of ICT in medicine is in research whether to greatly accelerate the process, or to ensure that educational tools genuinely answer patients’ questions.

eHealth is an expanding field, that holds new promise, and opens question about who we are, what is our role, who do we care for and how; that today, ‘No man is an Island’, everyone should be connected.

Transition for young people from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services often creates considerable disquiet for young people and their families in the United Kingdom. There are examples of good services. However, this is a longstanding problem. Professionals know what to do but solutions have been difficult to implement. There is no single solution because services differ across the country. The question becomes how to understand the difficulties of establishing good transition services. What needs to change to achieve this? This presentation will try to address some of these issues.