Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. Suicidal crisis: Acute intervention should start immediately in order to keep the patient alive.

An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. in order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.

Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Long-term treatment with lithium has shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment team: Multidisciplinary treatment team including psychiatrist and other health professionals are always preferable. Family: The suicidal person independently of age should always be motivated to involve family in the treatment. Social support: Psychosocial treatment is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack social networks.

Training of Personnel: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other health professionals.

Early clinical detection and intervention in schizophrenia has recently become a major objective of mental health services, while research on the early phases of the disorder may provide important clues to the pathophysiology underlying schizophrenia. Thus, the identification of a clinical syndrome that reflect a predisposition to schizophrenia is fundamental from a clinical and a research perspective. The onset of schizophrenia is usually preceded by a prodromal phase characterized by functional decline and subtle prodromal symptoms. However, clinical criteria currently employed to define a high-risk mental state for psychosis have relatively low validity and specificity. Consequently there is an urgent need of reliable biomarkers that underlie schizophrenia. Structural and functional neuroimaging methods have rapidly developed into a powerful tool in biological psychiatry as they provide an unprecedented opportunity for the investigation of brain structure and function. in this core-symposium it will be aimed to show that neuroimaging studies of the prodromal phases of psychosis have the potentials to identify core structural and functional markers of vulnerability to psychosis and to clarify the ongoing changes during the transition from high-risk to first episode psychosis.

To reduce the huge impact of mental disorders in the European society we need to increase our knowledge on their determinants, how to prevent them, and how to improve the efficacy and effectiveness of treatments. There are clear indicators that funding for mental health disorder research is much lower than the corresponding impact on health. in this context, the ROAMER project, funded under the European Commission FP7 program, aims to develop a comprehensive and integrated mental health research roadmap, orientated to translational research. To ensure an effective and widely accepted Roadmap, we want the process to be inclusive and participatory, incorporating a large diversity of research scientists from many disciplines and also incorporating the view of users, carers, professionals and policy makers and funding institutions. We have established six domains: i) infra-structures and capacity building, ii) biomedicine, iii) psychological treatments and processes, iv) social and economic aspects, v) public health, and vi) wellbeing. Within each of the domains, we will describe the state-ofthe- art of the research, will enumerate of gaps in current knowledge, as well as the advances needed in research in their field. Work groups have been established in each area. A much larger participation of scientists and stakeholders will be achieved through mail and web surveys. Documents will be available at the ROAMER web page (www.roamer-mh.org). Consensus in each of the stages will be achieved using an adapted Delphi method.

Derived from ancient Buddhist and Yoga practices, mindfulness is a mental state characterized by nonjudgmental awareness of the present moment experience while encouraging openness, curiosity, and acceptance. This skill can be learned through practice, and has be integrated in different clinical approaches.

Mindfulness-Based Stress Reduction (MBSR) is a structured group programme conceived to alleviate suffering associated with physical, psychosomatic and psychiatric disorders.

A systematic review of RCTs on MBSR supports that this approach improves mental health in non-clinical and clinical populations. in clinical populations with psychiatric disorders, MBSR has some benefit as it reduces symptoms of distress, anxiety and depression or teaches patients coping skills to handle these symptoms.

Mindfulness-Based Cognitive Therapy (MBCT), which is an adaptation of the MBSR programme, incorporates elements of cognitive therapy to prevent depressive relapse. Meta-analysis indicate that MBCT is an effective intervention for relapse prevention in patients with recurrent major depressive disorder in remission, at least in case of three or more previous episodes. Moreover, in two studies, MBCT was at least as effective as maintenance antidepressant medication.

While MBCT is a relapse prevention programme for patients in full remission, recent data suggest that it may be indicated also for people in partial remission, including those with quite significant residual depressive symptoms.

Recent focus on early detection and intervention in psychosis has renewed interest in the psychopathological delineation and assessment of psychotic phenomena.These phenomena express a fundamental qualitative change of the patient's mentality (consciousness, subjectivity) which often surfaces already during the prodromal/at risk mental states and is typically manifested across several psycho-behavioral domains (i.e. subjective experience, expression, cognition, affectivity, behavior, and willing). This interactive workshop will offer a clinical introduction into the basic semiology of psychosis, combining descriptive, clinical and structural-phenomenological approaches in psychopathology.

Schizophrenia severely affects mental and physical health. Although 20-50% of patients experience significant improvement at some point in life, schizophrenia is the 5th leading cause of disability in men and the 6th in women; patients with schizophrenia die 12-15 years before the average population, and relatively few of them are in work. It is increasingly acknowledged that much of the personal, social and economic burden of schizophrenia is due to impaired functioning in the real-life of those affected. As a matter of fact, the focus of schizophrenia management has gradually shifted from reduction of symptoms and prevention of relapse to improved functioning in the real-life. The presentation will address the following issues: a) definition and measurement of schizophrenia outcome; b) main variables directly or indirectly influencing functioning in the real-life; c) unmet needs in schizophrenia present management; d) recent treatment strategies and e) priorities for research investments.

Although placebos have long been considered a nuisance in clinical research, today they represent an active and productive field of research and, because of the involvement of many mechanisms, the study of the placebo effect can actually be viewed as a melting pot of concepts and ideas for neuroscience. Indeed, there exists not a single but many placebo effects, with different mechanisms and in different systems, medical conditions, and therapeutic interventions. For example, brain mechanisms of expectation, anxiety, and reward are all involved, as well as a variety of learning phenomena, such as Pavlovian conditioning, cognitive, and social learning. There is also some experimental evidence of different genetic variants in placebo responsiveness. The most productive models to better understand the neurobiology of the placebo effect are pain and Parkinson's disease. in these medical conditions, the neural networks that are involved have been identified: that is, opioid, cannabinoid, cholecystokinin, dopamine modulatory networks in pain and part of the basal ganglia circuitry in Parkinson's disease. Important clinical implications emerge from these recent advances in placebo research. First, as the placebo effect is basically a psychosocial context effect, these data indicate that different social stimuli, such as words and therapeutic rituals, may change the chemistry and circuitry of the patient's brain. Second, the mechanisms that are activated by placebos are the same as those activated by drugs, which suggests a cognitive/affective interference with drug action. Third, if prefrontal functioning is impaired, placebo responses are reduced, as occurs in dementia of the Alzheimer's type.

Mental health issues in the workplace have recently received considerable attention due to the industrial world's transformation to a service-based economy. Employers incur substantial costs that arise from mental disorders through lost productivity or absence from work. As such, mental disorders pose one of the largest challenges to social and labour-market policies in industrialized countries.

Within this occupational context, burnout has become a favoured concept. What has emerged from research is a conceptualization of job burnout as a psychological syndrome in response to chronic interpersonal stressors on the job.

Burnout has been associated with various forms of job withdrawal—absenteeism, intention to leave the job and job loss. For people who stay on the job, burnout leads to lower productivity and effectiveness at work. Consequently, burnout is associated with decreased job satisfaction and a reduced commitment to the job. People experiencing burnout also can have a negative impact on their colleagues. There is also evidence that burnout has a negative impact on people's private life and their social relationships.

Thus, the question is not if burnout is a myth or reality but rather why this concept receives so much opposition from mental health professionals. The concept of burnout complies with the public perception about the development of mental disorders and the role of environmental factors. We should take the chance to find a joint model with our patients how disorders arise and can be treated.

The term „illness” implies a medical disease model, namely that symptoms or syndromes indicate an underlying organic disease - in the case of psychiatry a disorder of the brain. But no brain markers could be identified until today, which would indicate a psychiatric illness or in particular a certain psychiatric illness. Furthermore organic causes of a mental disorder are an exclusion criterion for a diagnosis of a mental disorder. For all these reasons all international classifications systems use the term “disorder” instead of “illness”.

Beyond the question if mental disorders are disorders of the brain one might challenge the concept of psychiatric diagnoses at all. Most diagnostic thresholds are arbitrary or imposed on pragmatic grounds. For a categorical diagnosis to be scientifically valid, clear symptom boundaries should separate it from other conditions. But this is rarely the case concerning psychiatric diagnoses.

In many respects a dimensional approach would be much more appropriate than a categorical view. A dimensional approach would reflect the fact that mental problems are part of the human condition, which turn into psychiatric disorders when the affected individual cannot perform his or her social roles any longer.

The personal, social and environmental factors that determine mental health and mental illness may be clustered conceptually around themes like the development and maintenance of healthy communities and each person's ability to deal with the social world and manage his or her life. All this would be much more helpful than the conceptualisation of mental disorders as brain diseases.

In drug and alcohol dependence, detoxification is characterized by a significant reduction in drug-induced dopamine production and release, which has been shown to impair reward anticipation elicited by non-drug-associated stimuli. Drug-associated cues, on the other hand, appear to elicit increased functional activation in the medial prefrontal cortex (MPFC), which has been shown to be associated with impaired dopamine neurotransmission in the ventral striatum (VS). These findings suggest that dopamine dysfunction in alcohol dependence is associated with an attentional and motivational bias towards drug-associated at the expense of non-drug-associated stimuli. In schizophrenia, on the other hand, unmedicated patients show an increase in dopamine synthesis capacity and release in the associative striatum, which may extend into parts of the VS. Here, chaotic or stress-induced dopamine firing appears to interfere with the encoding of salient reward prediction errors, which may result in the attribution of salience towards otherwise irrelevant, neutral cues. In accordance with this hypothesis, functional impairments in the encoding of reward-associated cues were associated with motivational deficits in the VS, while a bias towards processing of negative feedback in the MPFC correlates with the severity of delusions. Computational approaches show that particularly in disorders as schizophrenia, where patients often fail to understand the underlying task structure, it is necessary to model a behavior in order to match patients and controls for the applied strategy - functional activation differences observed when subjects are matched for task strategy then point to a true neurobiological difference, i.e. VS-encoding of prediction errors in schizophrenia.

A main task of psychopathology is to gain a profound understanding of the basic starting points for the work of psychiatrists. Such a psychopathology of understanding depends to a great extent on where the “understanding” psychopathologist is coming from and on what his or her perspectives and concepts are. An understanding of the valency of psychopathological phenomena in the structure of an illness, as an indispensable basis for effective treatment of mental disorders, is impossible without knowledge and understanding of the philosophical roots in the theory of psychopathological research and psychiatric practice. The scientific work on that has found its way into psychiatric literature under headings like theoretical psychopathology, meta-psychiatry or philosophy of psychiatry. What theoretical psychopathology seeks to do is not to address issues of clinical practice per se, but rather using meta-analyses, analyses of the fundaments of psychopathological thinking and practice to contribute to a clarification of seminal and relevant problems of clinical practice and of empirical science. Since self-reflection always entails self-creation within an autopoietic system, theoretical psychopathology as a the self-reflecting sub-discipline of psychopathology plays a central role as a driving force in the development and creation of future psychiatry.

The European Commission funded the ROAMER project, which was launched in October 2011, to develop a roadmap to promote and integrate research on the biological, epidemiological, social and public health aspects of mental health. ROAMER has established six scientific domains (i.e. infrastructures and capacity building; biomedicine; psychological treatments and processes; social and economic aspects; public health; and wellbeing) that are being addressed in parallel. This process is developed in three different phases devoted to conducting an initial state-of-the-art analysis, enumerating gaps in current knowledge, and defining advances needed in research in each field. The project includes the participation of researchers, professionals, service users, families and other stakeholders.

The project is funded by the coordination and support action under the Seventh Framework Programme (FP7). This funding instrument is oriented towards non-research initiatives which require a wide participation of European institutions.

In the session, we will describe the role of coordinators and project managers in European Projects, as well as the current status of funding programs in the EC, the steps to apply to their calls, and the daily issues you should deal with when managing European projects profiting our ROAMER experience.

[ROAMER has received funding from the European Union Seventh Framework Program (FP7/2007-2013) under grant agreement n° 282586]

If Postpartum mood disorders are now considered a major issue both in public health and in psychiatry, the study of maternal Borderline personality disorder (BPD), most often or not associated with peripartum depressive disorder has attracted much less attention. We now know that BPD is common and highly associated with postpartum depression (Apter et al, 2012). This constitutes a high risk group where both mothers and infants are at relational and psychiatric risk; mothers do not acknowledge their mental health issues and therefore do not seek and receive care, whereas their emotional dysregulation negatively impacts interactions. Distorted interactive configurations organize as early as three months postpartum. Mothers show major difficulty in responding to infants and in turn, infants react with dysregulated and/or dismissive behaviors thus reinforcing the risk for an increase of intrusive and inappropriate response from the caregiver. Rapidly mothers and infants seem off beat. At one year, the infants are at high risk of presenting insecure attachment thus heightening their risk of developing future psychopathology. How to recognize, and intervene with these populations will be presented using videos as illustration and tailored management in a perinatal and infant/toddler unit.

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Moreover, research indicates that far from all who suffer from depression and suicidal ideation seek treatment and the determination of suicide risk and prevention of suicide attempts is traditionally difficult. In an era of empowered public and patients awareness, internet may be a more powerful determinant of health-seeking behavior than medical opinion. Suicide information is easily accessible over the web, as are special chat rooms for discussions with likeminded people. Internet can be considered as well as efficiently exploited to help people in severe emotional distress, including those contemplating suicide. Some websites advise acutely suicidal persons to seek help. Promotion and announcement of suicide are forbidden. Some websites offer a variety of professional help, including psychological and health-related information on various troubling issues, questions and answers and professional guidance intended to promote self-help in coping with numerous psychological problems. One promising treatment is activation, two kinds of which are behavioural activation, and one solely focused on physical exercise. These two kinds of activation therapy have the potential to be administered via the Internet, which would both lower the threshold for those seeking treatment, while also providing effective treatment to a low cost.

There is substantial evidence that cognitive behavioral therapy (CBT) works for child anxiety disorders, but this evidence-base mainly rests on efficacy trials with rigorous scientific control conducted in University-clinics. Are results transferable to ordinary clinics? To a large extent, the answer seems to be yes. This presentation will review the state-of-the-art of effectiveness trials for child anxiety disorders. Additionally, data will be presented from a large ongoing randomized controlled trial (RCT) for child anxiety disorders conducted in community child and adolescent mental health clinics in Norway. This is the child part of the Assessment and Treatment - Anxiety in Children and Adults (ATACA) trial, PI's Heiervang and Havik. Children aged 8 to 15 years (N = 182) with a primary diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder were included and randomized to group CBT (GCBT), individual CBT (ICBT) or a waitlist condition (WLC). The treatment program was Barrett's Friends for life manual. CBT outperformed WLC, with no major difference between GCBT and ICBT. Although overall symptom reduction was comparable to previous effectiveness trials, the full remission rates were somewhat lower than in previous trials. The possible reasons behind this will be discussed, and there will be an emphasis on how process factors such as pretreatment motivation, perceived treatment credibility, and the therapeutic alliance, which were all assessed in the RCT, may play a part to influence treatment results.

Mental disorders as a whole are the leading cause of disability worldwide. It is estimated that over 5 million people in Spain suffer from any of these disorders throughout his life. The importance of mental disorders in today's society is enormous. In fact, in the EU mental health spending ranges between 3% and 4% of GDP, mental disorders being the leading cause of early retirement and disability pensions. In addition, mental illness poses a heavy burden, not only economically, but also socially, in the form of personal and family cost. With a mission to improve clinical care and overall mental health of our society through an increasing of translational research generated knowledge in the field of Psychiatry and Neurosciences, on 1 January 2008 the Center for Biomedical Research Network on Mental Health Area (CIBERSAM) was established. Since then, a fruitful network has been created, and its organization and procedures will be shown in this presentation.