Suicide is one of the leading causes of death worldwide, and the third leading cause of death among people aged below 25. Mental health promotion is a central aspect of the battle against suicide and mental ill-health. The internet and the media are effective tools for disseminating information and education to adolescents and improving their mental health and well-being. in 2011 there were 2.1 billion Internet users world-wide. in a random sample of over 3000 American adults, it was found that 58% of the Internet users reported searching for health information for themselves (Atkinson et al. 2009).

The main objective of the SUPREME project is to develop a website aimed at mental health promotion and to investigate its efficacy. A secondary goal is to compare two different strategies for promoting the use of the website: one where peers are the main promoters and another with mental health professionals. The study is partly funded by the EACH and comprises 7 European countries: Estonia, Hungary, Italy, Spain, United Kingdom, Lithuania and Sweden.

Adolescents in this study approached in a random sample of schools, in each participating country, yielding a total of 2100 participants. The schools were randomized into control (minimal intervention), and intervention conditions (minimal intervention + website access). Pre-, post- and follow-up measures are used to test the efficacy of the intervention. Each intervention school is also randomized into peer and pro dissemination groups for comparison of recruitment efficiency. Preliminary results are presented.

ADHD is a common developmental disorder with onset in childhood that persists into adulthood in two-thirds of cases. The disorder is defined by symptoms of inattention, overactivity and impulsivity; however case-control, family and twin studies all find high rates of emotional lability that strongly co-vary with the core ADHD syndrome. 80% or more of adults with ADHD report significant levels of emotional lability, often severe, and causing impairments beyond that accounted for by inattention, hyperactivity or impulsivity. Drug treatments for ADHD have all been shown to improve symptoms of emotional lability. in children, a robust effect of methylphenidate has been demonstrated on aggression, although this has not been linked directly to the control of emotional symptoms. in contrast, the adult literature has focused more on emotional dysregulation, including affective lability, temper control and emotional over-reactivity. All these symptoms have been shown to improve following treatment with methylphenidate or atomoxetine, and to the same extent as core ADHD symptoms. Characterising the nature of the emotional symptoms in ADHD more detail, we found an increase in negative emotions such as frustration, anger and irritability, as well as an increase in their moment-to-moment variability. We conclude that patients with chronic forms of emotional instability should always be screened for ADHD, due to proven effectiveness of available treatments in the subgroup of emotionally labile patients who meet clinical criteria for ADHD.

2004 there have been other reviews on specific treatments (forms of psychotherapy Cochrane review)_ and (medication World Biological Psychiatry).

In essence however the gist of treatment for eating disorders has not altered over the last 10 years. Involving the family is helpful as an early intervention for anorexia nervosa. It is possible that interventions with several families seen together may be more cost effective.

Less is known about which form of treatment is most helpful for those with a more chronic, adult form of illness. Common factors may be relevant as no form of therapy has found robust advantages over another.

CBT is effective for about 50% of cases of bulimia and the addition of medication and self directed treatment may increase the remission rate. A similar pattern is apparent for binge eating disorder. More evidence is becoming available on guided self directed care which aside of the advantages of lower cost and transferability appears to have benefits for long term effects even for those with complex presentations. The results of several RCTs are due to be disseminated. Also more brain based interventions are being tried.

Time based composite measures of disability have replaced the traditional use of death rates to evaluate society's mental health status as a more meaningful measures for the burden of diseases and the need for treatment and care. These measures have revealed with some variability and increasing precision that mental and neurologic disorders account for a major and further increasing proportion of the all-cause disability burden worldwide.

In Europe, mental and neurologic conditions combined are already now the most disabling diseases. A recent pan-European study covering 30 countries and the EU-population of 514 million people, recently examined comprehensively the size and burden and cost of mental and other “disorders of the brain”. Findings e. g.:

• Each year, 38.2% of the EU population (64.8 million people) suffers from a mental disorder.

• The treatment situation remains highly deficient. Only 1/3 of all cases affected receive treatment, those receiving treatment do so with considerable delays of several years and rarely with appropriate, state-of-the-art therapies

• Additionally, many millions patients suffer from neurologic disorders such as stroke and Parkinson's disease, cases that may add on top of the above estimates.

• The total cost burden is immense (approx 800 billion €), mainly due to indirect costs. The low direct (treatment) cost proportion is unique to mental disorders and markedly different from other prevalent somatic diseases (e.g. cancer, diabetes).

During the last few years the economic crisis has focused attention on the dual need to protect the wellbeing of the population and safeguard the care and treatment of people with mental disorders. Many countries are facing budget cuts, resulting in higher rates of unemployment, which is associated with depression and suicide. Countries are also committed to reform in mental health. This commitment is attributable to a combination of the aim to stop obsolete institutional forms of care, awareness of modern and effective forms of treatment, concerns about human rights and a stronger voice of advocacy groups. This combination of factors is raising the priority of mental health, and in response the WHO Regional Office for Europe is drafting the European Mental Health Action Plan, outlining strategic objectives to address the need for effective and efficient mental health promotion and for the prevention and treatment of mental disorders. The European Action Plan is developed in close cooperation with the Global Action Plan.

The European Mental Health Action Plan puts forward actions that have the potential to improve wellbeing of populations and access and quality of services. Particular emphasis is given to the point that service structure, however excellent, is necessary but on its own insufficient. Safety, effectiveness and absence of stigma as experienced by patients and their families will determine acceptability and outcome of care.

This is an important time to advocate for sustained investment in mental health care. The European Action Plan offers a platform for such consensus.

Bipolar disorder is a chronic, severe illness with high rates of relapse, suicide rates, and a remarkable psychosocial burden. Despite the existence of well tested newer drugs that, together with classic mood stabilisers constitute quite a large number of pharmacological treatment options, bipolar patients are symptomatic for almost half their lives.1 This might be due to several accompanying features of bipolar disorder, including poor pharmacological adherence, unhealthy habits, and lack of illness insight. This is why pharmacological treatment, although essential, may not be enough for most patients. Thus, complementary interventions are needed to reach syndromal and functional recovery. Psychoeducation, a user-friendly, common-sense-based psychosocial strategy, has been shown to prevent all sorts of relapses at 5-year follow up and to be efficacious even with fully adherent patients, so the effect does not rely completely on adherence enhancement.2 The content of the Barcelona Psychoeducation Program focuses on the illness, its causes and its consequences, rather than on other issues such as personality, psychodynamic features and so forth.3 Topics are divided in five main areas:

• Illness insight

• Adherence enhancement

• Early detection of prodromal symptoms and early intervention

• The importance of avoiding street drugs

• Routines and stress management

This presentation will discuss the role of psychoeducation in improving social functioning and long-term outcomes in maintenance treatment for bipolar I disorder. Through the use of a case study, this presentation will provide practical considerations of how to implement psychoeducation techniques into routine clinical practice.

Following remission of an acute episode, patients with bipolar I disorder remain at a high risk for relapse, regardless of the nature of their index episode.1 in particular, if the medication regimen in the acute phase is different than that used in the maintenance phase, there may be a potential loss of efficacy or a change in adverse-event burden associated with the switch. Therefore, choosing the right pharmacotherapy is essential to allow patients to achieve and maintain stability, and prevent the recurrence of mood episodes.

Current clinical practice guidelines recommend combination therapy of atypical antipsychotics and lithium or valproate as firstline treatment in acute patients, or for maintenance treatment in patients with an inadequate response to monotherapy with mood stabilisers.2 Therefore, exploring the long-term benefits and risks of monotherapy compared with combination therapy are essential for improving patient outcomes in the course of routine clinical practice.3 Recent clinical trial evidence suggests that combination therapy is effective in patients with an inadequate response to monotherapy, and that there are relatively lowrisk options regarding adverse events and comorbid physical conditions that are frequently encountered in patients with bipolar I disorder.3

This presentation will explore how to manage patients with a partial response to pharmacotherapy or with persistent residual symptoms long term, and how to address the unmet needs of this patient population in the context of recent clinical trial evidence.

Bipolar I disorder is associated with a number of physical health concerns and a higher prevalence of eating, anxiety, and substance abuse disorders compared with the general population. in addition, patients are prone to exhibit risk factors for cardiovascular disease such as obesity, hypertension, hyperglycaemia, dyslipidaemia, and type 2 diabetes.1 Moreover, pharmacotherapy has been linked to metabolic abnormalities that may exacerbate the physical health risk factors and comorbidities prevalent in patients with bipolar disorder.

Choosing an initial treatment regimen that takes into account the significant physical health risks associated with bipolar disorder may minimise the subsequent common problem of polypharmacy and may reduce the side-effect burden associated with the disease. Regular monitoring of physical health in the months after initiating pharmacotherapy is essential in preventing and correctly managing comorbidities. Clinicians should gain a comprehensive insight into patient lifestyle choices and should, as part of preventative care, choose treatments according to individual patient risk profiles. If required, clinicians should make recommendations to specialists or facilities offering therapies to minimise key risk factors.2

This presentation will review the physical health risks associated with bipolar disorder and with chronic exposure to pharmacotherapy. Because practice guidelines recommend regular physical health monitoring in patients with bipolar disorder, this presentation will discuss approaches to incorporate regular monitoring in routine clinical practice.

The choice of pharmacotherapy for the treatment of bipolar I disorder should balance acute efficacy and long-term effectiveness with minimal side effects. During acute treatment, the primary goal is rapid stabilisation of symptoms, whereas the goal for the long-term management of bipolar I disorder should include relapse prevention, maintenance of a stable mood, and minimise risk of comorbid conditions.1

Despite the shift in treatment goals between the acute and the maintenance phase, if a patient responds well to the agent used in the acute phase, this agent frequently will be continued in the maintenance phase. However, achieving continued stability may collide with the goals of minimising the adverse-effect burden associated with treatment, and the subsequent goal of improving patient functioning and quality of life. Sometimes, changing medication regimens may help achieve a balance between efficacy and side-effect burden. However, switching may also be associated with an increased risk of destabilisation. Evidence has shown that patients with bipolar I disorder often have a predominant episode polarity, which is a predictor of treatment response.2 Therefore, when assessing long-term treatment options, consideration should be given from the outset to the available clinical evidence for preventing the recurrence of mood episodes, as well as the predominant polarity of the patient.3

Because patient polarity plays an important role in the success of pharmacotherapy, this presentation will review the concept of predominant polarity in clinical practice and discuss the potential value of considering a drug's polarity index in the development of individualised long-term treatment regimens.

Although population-level research between economic crises and specific mental disorders is considered scarce, yet there is some evidence arising from previous economic crises in the USA, Asia and the former Soviet Union as well as some evidence arising from the present economic crisis associating such crises with psychopathology and especially depression and suicide. A review of the existing evidence will be carried out in this presentation. The importance of poverty, unemployment and debt will be underlined and the trans-generational effect of economic crises on children will be stressed.

The conclusions are the following:

Depression, especially in its self-destructive clinical expression is one of the major psychopathological conditions that are linked with economic crises. However, it is important to differentiate between understandable sadness, a potentially productive response to economic crises and the dysfunctional response represented by depression.

Screening for depression and suicidal tendencies during periods of economic crises as a routine psychiatric prevention strategy is recommended.

In view of the association of suicidal potential with unemployment, active labor market and family support programs are necessary.

The cost/effectiveness of mental health provision programs (investing in mental health) especially during periods of economic crises should be demonstrated and highlighted.

Highlighting the above and advocating for the establishment of cost-effective active labor market programs, rehabilitation and family support programs are recommended.

The primary goals of maintenance treatment in schizophrenia are sustained symptomatic control, relapse prevention, and delaying functional and cognitive decline.1 Successful pharmacotherapy is dependent on several factors including efficacy, therapeutic alliance, availability of optimal dosages and formulations, treatment adherence, and a low side-effect burden. New long-acting injectable (LAI) formulations of atypical antipsychotics have been developed to address suboptimal therapy outcomes by enhancing drug delivery, assuring efficacy of treatment, reducing side effects, and improving compliance.2 Evidence differentiating the effectiveness of oral vs. long-acting antipsychotics is difficult to obtain in randomized controlled trials (RCTs) where adherence to both is optimized.

RCTs are designed to establish clinical efficacy in an “ideal” setting in which medication adherence is controlled and highly regulated.3 However, RCTs cannot by definition assess treatment effectiveness. Conversely, naturalistic studies that mimic clinical practice are more likely to uncover real-world effectiveness differences of different treatment options. Research has demonstrated major benefits of LAIs in naturalistic studies, including large, nationwide cohort studies and mirror-image studies where patients serve as their own controls. Results from these trials are likely to be underestimated in RCTs owing to stringent inclusion criteria, frequent clinic visits and direct provision of medications.4 Therefore, data from meta-analyses can be misleading if the trial design is not considered in the interpretation of the results.5 Furthermore, naturalistic studies can more accurately assess the consequences for patients with regards to relapse and rehospitalization rates. Therefore, clinicians have to be aware of the origin of data and its impact on the results before making treatment decisions.

The current presentation will critically review data from 3 meta-analyses comparing LAIs with oral antipsychotics, exploring how to interpret the data from different trial designs in the context of unmet patient needs, and how the results from differential designs may impact treatment outcomes.

Schizophrenia is a chronic psychiatric disorder with onset of symptoms typically occurring in early adulthood, and requires lifelong treatment. Treatment goals for the long-term management of this debilitating disorder include sustained symptom remission and control, maintaining or improving patient level of functioning and quality of life, prevention of relapse, and continued monitoring for adverse events, as well as sustained adherence to medication.1 Poor adherence to medication is multifactorial and presents a major challenge in the long-term management of schizophrenia. in fact, rates of non-adherence and of partial compliance to antipsychotic medication are high and are associated with a significantly increased risk of relapse, hospitalization, and the potential for progressive functional impairment, resulting in increased morbidity and high healthcare costs.2,3 Thus, recognizing and managing non-adherence with the latest treatment advances has the potential to benefit patients as well as their families.

One possible solution to the challenge of non-adherence is the availability of long-acting injectable (LAI) formulations of atypical antipsychotics. The use of LAI antipsychotics may help improve the management of adherence and enhance the therapeutic alliance through regular injection visits. in addition to pharmacotherapy, current clinical practice guidelines recommend the use of psychoeducation to improve treatment outcomes.4 Psychoeducation, along with other behavioral therapies, can facilitate the improvement of patient insight, prevention of relapse, promotion of adherence, and ultimately improve continuity of care.

This presentation will provide an overview of key unmet needs in the long-term management of schizophrenia, and evaluate factors leading to non-adherence. The use of non-pharmacological and pharmacological strategies for improving adherence in routine clinical practice will be discussed in the context of a strong therapeutic alliance.

The nature of schizophrenia gives rise to a number of unmet needs that go beyond proven efficacy and safety of pharmacotherapy in randomized clinical trials (RCTs). Long-acting injectable (LAI) formulations of new generation antipsychotics offer an alternative treatment choice, and the investigational formulation of aripiprazole once-monthly is under regulatory review in the both the US and EU for maintenance treatment of schizophrenia.

The efficacy of aripiprazole tablets in the treatment of schizophrenia has been well established, with consistently low relapse rates, good tolerability, and preservation of function. in the “ASPIRE US” (Aripiprazole-Intramuscular-Depot Program in Schizophrenia) trial, a 52-week, multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy, safety, and tolerability of aripiprazole once-monthly as maintenance treatment in patients with schizophrenia, aripiprazole oncemonthly significantly delayed the time to impending relapse compared with placebo in the long-term maintenance treatment for schizophrenia. At 52 weeks, 10% of patients in the aripiprazole once-monthly group had relapsed, compared with 39.9% of patients in the placebo group (Hazard ratio, 5.03, p < 0.0001).1 in a second study comparing aripiprazole once-monthly with oral aripiprazole,2 aripiprazole once-monthly was non-inferior to oral aripiprazole and significantly delayed time to exacerbation of psychotic symptoms/impending relapse compared with aripiprazole once-monthly at a sub-threshold therapeutic dose. The estimated relapse rates at Week 26 were 7.1% for aripiprazole once-monthly and 7.8% for oral aripiprazole. This presentation will review the available evidence from recent RCTs showing the efficacy and safety of aripiprazole once-monthly for the longterm management of schizophrenia, and to explore, the link between low relapse rates and functional preservation.

In medicine, prodromes can be identified with early signs and symptoms that differ from the acute clinical phase. Appraisal of prodromal symptoms has been of importance in clinical medicine for many progressive, dangerous and treatable diseases in which early detection and timely treatment (particularly of recurrences) are crucial. The prodromal phase of depression has a large inter-individual variability and lacks diagnostic specificity. However, within each patient there is striking consistency in the prodromal symptoms that precede each episode, even though the same initial symptoms of the acute disorder may occur and not be followed by another episode. Their interpretation requires clinical judgment. Research on clinical judgment has disclosed several innovative assessment strategies: the use of diagnostic transfer stations instead of diagnostic endpoints using repeated assessments, subtyping versus integration of different diagnostic categories, staging, macro-analysis, extension of clinical information beyond symptomatic features. Such strategies can be applied to clinical cases at risk for depressive relapse and may pave the way for more effective modalities of treatment and relapse prevention. Evidence-based medicine does not appear to provide an adequate scientific background for the challenges entailed by current treatment of depression and needs to be integrated with clinical judgment.

The revision of the DSM scheme has highlighted several difficulties with classification: adapting criteria to different ages and genders; multiplicity of diagnoses in individual children (leading to a mistaken impression of ‘comorbidity’); complexity of the scheme making problems for nonspecialist clinicians; the use of unvalidated categories; and the inclusion of functional impairment as a criterion for several disorders.

In this paper, DSM5's approaches to solving some of these difficulties are illustrated, with reference to specific conditions arising in childhood; although at the time of writing full criteria are not available. An overarching formulation of disorders has been introduced, and “disorders arising in childhood” no longer form a separate group in view of the extensive evidence for the early origins of many psychiatric disorders. “Pediatric bipolar disorder” has become overused, and a new category of “disruptive mood dysregulation” introduced. ADHD subtypes have not been validated and are downgraded to “presentations”; and “restrictive-inattentive” disorders have not (yet) earned their place. ADHD criteria in adult life have been relaxed a little. The “autism spectrum” has replaced subsyndromes, and proposes two dimensions for description. Callous-unemotional states in conduct disorder have received attention; as has the description of syndromes involving self-harm. The remaining challenges for clinicians and researchers will be described.

In discussions within and in communications directed to the recently re-established EPAs Ethical Committee a wide range of important ethical challenges has appeared, including e.g. the need for a forum to get advise for colleagues in ethical complicated situations, to underline and define ethical principles in clinical and research practice, to investigate ethical demands and boundaries regarding user involvement, to underline the need of not only evidence based but even value based practices.

In order to get guidance from our member states and their professional societies, the ethical committee has carried out an international European survey directed to national psychiatric asssociations and national ethical reference persons. The survey contained amongst others questions about the most frequent experienced ethical problems in the respective country.

By doing this, a significant diversity became apparent, seemingly influenced by the psychiatric professional development in the countries, but even showing differences in the sensitivity to cultural and societal - political factors.

Thus, with respect to the diversities in our European countries, it appears important to maintain a continous professional discussion on ethical issues, even considering the processes and changes ongoing due to the political and sociocultural development as well as psychiatric scientific improvements and research implications.

A need to put ethical issues and development on the EPAs agenda is evident as well as the need to continously improve and discuss international and national ethical guidelines and practical clinical strategies. Feasible ways regarding the future work of our ethical committee will be presented.

The objective of the Age of the Brain is change the way people think about their brains and the conditions which affect it forever, and for the better.

This will be achieved through our coordinated efforts as well as by stimulating thousands of other parties - governments, professional societies, patient groups, industry, pressure groups, trusts, individuals and a multitude of other organisations - to be part of this ongoing campaign.

The brain is the most important organ in the body.

Ignorance, epidemic across every level of society is having an impact on the health of our brains across the world. We believe it is time this stopped.

By launching the Age of the Brain, a programme to raise awareness and educate across the world we plan to make a significant impact. This is about changing the way the people think about their brains for good. The programmes will be stimulating, thought-provoking and effective. We aim to challenge current perceptions and re-align incorrect and ignorant thinking but most importantly get people to take personal responsibility for their brain health and well being.

Cuts on health care are necessary for different reasons. First the economical burden of health care should be proportional to the possibilities of the population. Yet in times when the population grows older and possibilities augment, containment is necessary. Governements and health insurance authorities will look closely into possibilites of reducing costs by a great efficacy, by shared descision making, by choices that are to be made. An other alternative is found by asking patients for an own contribution to their health expenses. in that regard it was appauling to witness the fact that in the Netherlands this own contribution was raised soley in patients with psychiatric disorders where individuals with so called somatic diseases were exempted.

With, among others a strong support from the national psychiatric associations, the own-contribution for psychiatric patients was banned.

Yet the new governement threatens to repeat this non-sense by stating that only psychosis are real disorders and all other mental disorders a matter of pulling yourself together. Stigma on Mental disorders is a very actual theme! Let us face it!

Mental disorders specifically associated with stress are exceptional in requiring external events as causes of psychiatric symptoms in order to arrive at a diagnosis. The field is characterised by lively debates, including about the extent to which human suffering should be medicalised and the purportedly inflationary expansion of post-traumatic stress disorder (PTSD) diagnoses. The ICD-11 Working Group on this topic was asked to review scientific evidence and other information on use, clinical utility, and experience with relevant ICD-10 diagnoses in various health care settings; to review proposals for the American Psychiatric Association's DSM-5 and consider how these may be suited for global applications; and to assemble proposals for ICD-11 with a focus on improving clinical utility. The Working Group has recommended a separate grouping of ‘Disorders Specifically Associated with Stress’ for ICD-11, rather than combining them with anxiety disorders as in ICD-10 or DSM-IV. Disorders Specifically Associated with Stress have two key characteristics: 1) they are identifiable based on psychopathology that differs from other mental disorders; and 2) they arise in specific association with a stressful event or series of events. For each disorder in the grouping, the stressor is a necessary, though not sufficient, causal factor. The stressor may range from negative life events within the normal range of experience (in the case of adjustment disorder) to traumatic stressors of exceptional severity (in the case of PTSD and Complex PTSD).