The European Psychiatric Association (EPA) created the European guidance project which will provide a series of guidance documents on topics related to the quality of mental healthcare service structures and the prevention of mental disorders, for which evidence- and consensus-based guidelines are currently lacking.

To provide information on good clinical practice, using problem solving examples, guidelines and quality standards of care for European providers of mental healthcare, national societies and health authorities, to address health care gaps, and to give advice on developing research programs.

The aim of the “EPA Guidance on the quality of mental health services” is the provision of recommendations for optimal structures of mental healthcare services by identifying and evaluating the current evidence and comparing the efficacy of different service structures wherever possible.

Recommendations, which were divided into structure recommendations and process recommendations, were developed on the basis of systematic literature researches and a peer review process within the EPA. Recommendations were supplemented by quality indicators and their evidence base was graded by a three-part evidence rating system.

In total, 30 evidence- and consensus-based recommendations were developed, which comprise ten general and six service-type-specific structure recommendations, and four general and ten specific process recommendations.

The initial panel of recommendations on European mental healthcare service structures needs to be tested in each European country with the aim to further develop the recommendations based on the feedback from users.

The risk of suicide attempt and death by suicide during an antidepressant drug treatment for a major depression episode (MDE) remains unclear. Furthermore, this risk can be influenced by genetic factors, especially those involved in the serotonine pathway.

We genotyped the variants of 6 candidate genes (including 5HTT/SLC6A4, TPH2, 5HTR1A, 1B & 2A) in 4000 outpatients treated with tianeptine for a MDE to search for an association with a suicide risk and the treatment response.

The goal of this study was to evaluate the pharmacogenetic role of the serotonin pathway in suicide risk during an antidepressant treatment.

A total of 4000 outpatients for a MDE were treated with tianeptine. The criteria for a MDE were examined by the clinicians according to the DSM-IV diagnosis and the duration of each symptom was recorded during the inclusion and at 4 to 8 weeks of treatment. The Hospital Anxiety and Depression Scale (HAD) was evaluated at the two visits. Suicide attempts, number and suicide idea of MADRS, before and during treatment, were recorded. DNA was extract from saliva sample and genotyping of 22 single nucleotide polymorphisms (SNPs) was performed by Taqman assay.

All clinical and genotyping data were collected for 3771 tianeptine-treated outpatients. A total of 450 subjects have reported suicide attemps before treatment and 24 during treatment.

The results of pharmacogenetic association for suicide risk during an antidepressant treatment will be presented during the workshop.

The Stigmatization of psychiatric patients has been observed across the world, and the family members who care for them are the first-hand witnesses of any discriminatory attitudes. Little is known about how the problem manifests differently across cultures.

Study the cultural differences of the experience of stigma in families of patients in Iran.

The qualitative data obtained was based on the responses of 20 families to 10 open-ended questions about stigma. The effect of stigma was rated by two coders with high inter-rater reliability. The rating ranged from “no effect” to “severe effect” of stigma.

In 40% of the interviews, family members reported that stigma had had a moderate effect on their lives. The content analysis of the data developed some various categories that showed the caregivers’ perceptions of stigma. Main categories included: concealment (unsupported network, blame for causing the illness, embarrassment); limitations (work, education, relation with other); genetic attribution (tainted other family members via genetic connection with patients); traditional beliefs in society about patient (patients seen as weak and unworthy people); God's wish, burden (burden because of covering and burden of caring) and the importance of gender differences in the stigma of the illness.

Patients with psychiatric disorder and their families suffer from stigma with a broad range of negative attributes which may interfere with various aspects of their lives. Concealment and limitations are common experiences in families. Gender differences and God's wish conception are specifically related to cultural factors.

Media reporting of suicide has repeatedly been shown to trigger suicidal behavior, with evidence being most consistent for reports on celebrity suicide. Very little is currently known about preventive ways of reporting on suicidality that allow for destigmatization of suicide without harm for those at highest risk.

This presentation will review what we currently know about the relationship of suicide and media reporting and underlying mechanisms. Public health interventions currently used to prevent copycat behavior will be reviewed, including interventions that restrict media reporting on suicide, and interventions that focus on changing the quality of reporting. Recent findings on a possible preventive effect of media reports on constructive coping in adverse circumstances will be presented and discussed with regard to implications for suicide prevention, in particular for suicide awareness campaigns and the prevention of copycat behavior.

The presentation will include a selective literature review of research on the relationship of media and suicide, intervention studies to prevent imitation effects, and studies at the interface with suicide awareness campaigns. Particularly experiences gained in the translation of the Austrian Suicide Prevention Plan will be presented and contextualized with international developments in the topic area.

To assess the mental health literacy of adolescents and young people in relation to depression, schizophrenia and alcohol abuse in the areas of recognition, intention of professional help-seeking and obstacles/barriers.

It was used a random cluster sample of 4938 adolescents and young, having been used QuALiSMental (Loureiro et al., 2012) during the year 2012. The average age is 16.75 years (SD = 1.62), being respectively 43.3% males and 56.7% females.

The recognition of disorders is reduced (27.23% in depression, 26.16% in schizophrenia and 45.27% in alcohol abuse). There is intention of professional and specialized help-seeking, with focus on psychiatrists, nurses and psychologists. As the biggest barriers to help-seeking fear and personal shame, non-recovery of symptoms and breach of confidentiality are referred.

The low mental health literacy is an indicator of the need for developing programs to promote health and prevent mental illness. Despite being valued the intention of help-seeking, fear of stigma and discrimination associated with these diseases is high. Nurses, psychologists and psychiatrists can play a relevant role in this regarding the role they occupy in the context of school health. Increase mental health literacy could reduce the delay between the first signs and symptoms and the professional help.

This study is part of a project [PTDC/CPE-CED/112546/2009] funded by The Portuguese Governement (FCT) and FEDER (EU).

Psoriasis is a multifactorial chronic infiammatory skin disease that often occurs in patients with overweight or obesity; obesity makes psoriasis less susceptible to therapy and a moderate weight loss improves drug response. Many studies shows connections between obesity and eating disorders, but few studies investigated the link between eating disorders and psoriasis.

To evaluate the presence of eating disorders and psychopathological traits in patients affected by psoriasis compared with a control population, and correlate this data with different features of cutaneous disease and BMI.

To suggest the importance of a psychological support that could reduce the occurrence of loss of control over food.

We enrolled 100 consecutive psoriatic outpatients and a control group of 100 selected non psoriatic outpatients, matched by BMI to the study group. The assessment battery was composed by the Psoriasis Area and Severity Index (PASI) score, the EDI and SCL-90R.

Most of EDI and SCL-90R subscales resulted more altered in psoriatic population compared to the controls (p < .001 for IA and ID, and p < .05 for GSI). Moreover, we noticed an association between the progressive weight gain and the impairment of most of EDI subscales, indicating the presence of an ED in only psoriasis group (p < .01).

Psoriasis is associated with psychopathological traits and symptoms commonly associated with eating disorders. A multidisciplinary approach could have an important role to reduce the loss of control over food, to loss weight and to improve the drug response.

Cognitive deficits may compromise patients’ utilization of rehabilitative information. There is an increasing attention on the opportunity to integrate a specific support to cognitive functions in alcohol detox programme and the first step to program the clinical intervention is to have a complete overview of cognitive deficits in alcoholics clinical sample.

62 patients who refer to alcoholism service were screened at admission time. Cognitive functions were assessed by trained psychologist with a specific neuropsychological battery. The impact of clinical features as age, gender, scholarship and concurrent polyabuse was evaluated for each function.

The 45,7% of our sample shows a generalized decline. Subtests shows impairment's different degrees (26,1% verbal memory; 32,6% working memory; 50,0% psychomotor speed and coordination; 30,4% verbal fluency; 58,7% selective attention; 13,0% tower of London task; 41,3% executive functions; 56,5% sustained attention). Clinical features have different impact on cognitive functions.

Alcoholics patients shows a diffuse range of cognitive impairment. For this reasons a cognitive remediation programme could be a useful adjunctive intervention for the treatment of alcohol dependence.

Several studies suggest that people with serious mental illness represent a higher risk of violent acting out than the general population.

To evaluate the prevalence of violent behavior in psychiatric patients and compare the group of patients who committed violent acts with nonviolent patients to identify risk factors for violence.

A retrospective-comparative study was conducted among 160 patients hospitalized in the psychiatric service D of the hospital Razi during the period between 1 July 2011 and 15 October 2011.

Among the patients in our sample 78.75% (N = 126) had submitted an act of violence during the month before hospitalization. The male gender was correlated with violence (OR = 2.7). History of violence and criminal history had significant correlations with violence with OR = 2.5. Schizophrenia diagnosis was the most represented among the mentally ill violent. Monitoring irregular and poor adherence to treatment were important risk factors with OR = 2.6. Addictive behavior was found among 49.2% of violent patients. Substance use was correlated with violence (OR = 4.5).

It is interesting to note that in recent years the interest of clinicians to the question of violence among the mentally ill has increased. There is also an evolution of psychiatric practice with dimensions of legal framework more rigorous. Clinicians and forensics must continue to work together in this area.

The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. The efficacy of antipsychotics in CBS is based on sketchy evidence. The use of serotonin selective re-uptake antidepressants (SSRI) for CBS is anecdotal.

To describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment.

Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after 8 weeks of treatment. All had undergone brain -CT and cognitive assessment.

There were 4 men and 4 women, mean age 81.7 ± 7.3 years. Brain-CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had MMSE scores ≥ 27/30. Previous antipsychotic treatment was mostly with risperidone 1.0 to 3.0 mgs/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p < 0.001) after 8 weeks of escitalopram treatment (mean dose: 11.8 mgs/daily). There were no side-effects nor adverse events reported.

This is the first case-series to show that SSRIs are an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in the CBS.

Relationships between physicians and pharmaceutical & other medically related industries have received considerable attention in recent years. We surveyed physicians all around Saudi Arabia (SA) to collect information about their knowledge, behaviors and attitudes regarding their relationships with the industry.

A cross-sectional survey that used a 47-item, anonymous, self-administered questionnaire, was sent to all accessible doctors in SA. The questionnaire was developed based on literature review, discussed between authors and reviewed by experts. The survey

600 doctors (physicians and surgeons), 15% of them were psychiatrists who filled in the survey. Preliminary results of only 15% of the total sample indicated that 40.9% (n = 38) of participants have encountered a pharmaceutical company representatives (PRs) at least once in their life. Psychiatrists were among the top specialties in accepting gifts and promotions presented to them by PRs. 4.3% (n = 4) of participants mentioned that PRs almost always offer a gift and promotion after every meeting. The most frequently mentioned gifts presented to participants by PRs are stationary such as pens or notepads (26.9%). Although 60.2% (n = 56) of participants had been educated about the ethics in physician industry relationships, 34.4% of participants accept gifts and promotions presented to them by PRs.

The final results of this study will be ready by Feb 2013. It will be presented fully in the EPA 2013.

The results of this survey indicate that relationships between physicians and industry are common and underscore the variation among such relationships according to specialty, practice type, and professional activities.

Forensic psychiatry is a branch of psychiatry which emphases on the interface between law and psychiatry. It may include psychiatric consultation in a wide variety of legal matters, as well as clinical work with perpetrators and victims.The objective of current study is to visualize the scientific activities in the field of Forensic psychiatry through 2006–2012.

The Science Citation Index Expanded (SCI-E) and Social Science Citation Index from the database of Web of Science were used to obtain all publication entitled as“Forensic psychiatry” through 2006–2012. Restriction of publication entitled into Forensic psychiatry cause to obtain the most relevant papers in the field of Forensic psychiatry.

Analysis of data showed that a total number of 248 papers entitled as Forensic Psychiatry were published in the journals which indexed in Web of Science during the period of study. The most majority of publication came from North America and west Europe. USA sharing 23% of global publication in the field is the most productive country followed by Germany (19%), England (14%), and Canada (7%). More than 63% of global publication came from these four prolific countries. A total number of 271 organization have contributed their works in the field of Forensic Psychiatry, the American private University of Yale was the most productive among them.

The aim of this study was to investigate the relationship between suicidal behavior and chronobiological thyroid axis activity in depressed patients.

The serum levels of TSH, were evaluated before and after 8 AM and 11 PM TRH challenges, on the same day, in 230 medication-free DSM-IV euthyroid major depressed inpatients and 50 healthy hospitalized controls.

Compared to controls: 1) patients with a recent suicide attempt (n = 71) showed lower TSH response to TRH (ΔTSH) at 11 PM, lower ΔΔTSH values (differences between 11PM-ΔTSH and 8AM-ΔTSH) (p < 0.03 and p < 0.00001, respectively), and lower free thyroxine (FT4) levels (p < 0.00001); 2) patients with a past suicide attempt (n = 52) showed no major alteration of the HPT axis activity; 3) patients without a suicide attempt history (n = 107) showed both lower 8 AM-ΔTSH and 11-PM ΔTSH (p < 0.04 and p < 0.000001), and lower ΔΔTSH values (p < 0.000001), but no alteration of circulating thyroid hormone levels.

Our results suggest that in patients without a suicide attempt history increased hypothalamic TRH stimulation (as evidenced by reduced TSH responses to TRH) might be a compensatory mechanism. in patients with a suicide history this compensatory mechanism is not effective. in patients with a recent suicide attempt the evening TSH blunting, associated with reduced FT4 levels, might be indicative of a decreased central TRH activity leading to a reduction in the TSH resynthesis in the thyrotrophs during the day after the morning challenge.

Attention deficit / hyperactivity disorder (ADHD) affects about 60% of adults who suffered from ADHD in childhood. Methylphenidate is a common off-label treatment.

The aim of this pilot study was to assess the neuropsychological effects of a single dose of methylphenidate (10 mg orally) on different attention components and executive functions by using the computerized attention assessment battery TAP 2.2 (Testbatterie zur Aufmerksamkeitsprüfung).

Fifteen DSM IV-ADHD adult patients were enrolled into this study. Neuropsychological evaluations were performed at baseline and after the methylphenidate test. Patients were subsequently treated with adequate dose of methylphenidate and followed over a period of 6 months.

Compared with baseline, a single dose of methylphenidate induced a significant improvement in working memory (p = 0.001), sustained attention (p = 0.0007) and visual scanning (p = 0.0007) in terms of omissions and mistakes. Reaction times also decreased in tonic arousal (p = 0.002), incompatibility (p = 0.008) and flexibility tasks (p < 0.00001). There was a significant correlation between working memory and sustained attention before and after methylphenidate (both p < 0.01). Among our patients, 12 who responded positively to the methylphenidate test, showed favorable long-term outcome with methylphenidate treatment.

Adults with ADHD showed neurocognitive improvements after a single 10 mg dose of methylphenidate. Our results suggest that the methylphenidate test would be useful in predicting subsequent response to methylphenidate treatment in ADHD adult patients. Controlled prospective studies are needed to confirm this hypothesis.