The debates on euthanasia and assisted suicide (EAS) are topical in Europe. The extension of EAS for psychiatric reasons, already legalized in some countries, raises ethical and clinical issues, given the proximity between suicidal patients and patients who request or have accessed EAS. How can ESA be reconciled with the promotion of suicide prevention, which kills nearly 10,000 people per year in France? We will raise here several key questions that deserve a clear answer before considering going further in the social debates: how to ensure the irreversibility of psychological suffering? how to ensure that patients requesting EAS have full decision-making capacity? how to judge therapeutic futility? It seems crucial to protect the most vulnerable patients by ensuring that psychiatry benefits from scientific progress and can offer new solutions to suffering patients.

Thes issues will be discussed viewing the proposed law on EAS in France, which is supposed to come in February 2024…

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Switzerland is a country in which the liberal tradition is cultivated and every citizen’s free decision is honoured. Associations such as EXIT or Dignitas, which advocate the right to self-determined death, were formed here early on. They see themselves as completing the Age of Enlightenment, where the end result is an individually self-determined death. The Swiss federal government is therefore reluctant to define criminal offences. However, it is regulated that active euthanasia is prohibited. The organisations mentioned are also not allowed to act for their own benefit.

Meanwhile, the number of assisted suicides is higher than the number of suicides. The extent to which the one phenomenon is related to the other is open to debate.

The topic is controversial among the general public and the medical profession. Nevertheless, the Swiss Academy of Medical Science has published guidelines on dealing with dying and death, which also deal with physician-assisted suicide.

Various associations, including the umbrella organisation for suicide prevention in Switzerland, Ipsilon, are in favour of special protection for vulnerable groups. Some of them also recommend that civil law provisions be made for the process of assisted suicide.

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Affective and non-affective psychoses are characterized by deficits in neuro and social cognition, which strongly impact the patient’s psychosocial functioning and health and social system. Recent literature suggests that such deficits could benefit from the innovative combination of evidence-based interventions.

This lecture aims to describe an Italian multisite (Verona, Milano, Pavia), longitudinal randomized controlled trial funded by the Italian Ministry of Health investigating the impact of Cognitive Remediation (CR) alone or combined with other approaches (namely, Mindfulness and Social Skills Training (SST)) on clinical, neuropsychological, social and brain-related outcomes in patients with a DSM5 diagnosis of affective or non-affective psychosis.

In our study, patients underwent clinical and neuropsychological evaluation at baseline (T0), end of treatment (T1), and six months post-treatment (T2), which consisted of nearly four months of CR, CR+ Mindfulness, or CR + SST. The cognitive assessment included the Brief Assessment of Cognition for Schizophrenia (BAC-S) or Affective Disorders (BAC-A) and the Executive and Social Cognition Battery (ESCB), specifically designed to identify impairments in social cognition and executive functions in patients’ real life. Participants underwent a 3T multimodal MRI, including structural and functional sequences at T0 and T1. We also recruited healthy controls for comparative brain mapping at T0.

The present lecture will provide an overview of the research project, along with some preliminary findings on the effect of CR alone or combined with other interventions on clinical and social functioning and brain plasticity, with a focus on the degree of durability and generalization of CR effects to patients’ real life. The study’s outcomes have the potential to inform clinical and rehabilitative settings and tailor combined therapeutic interventions.

C. Perlini Grant / Research support from: Italian Ministry of Health GR-2016-02361283

Over the past decade (2010-2019), the number of people admitting to using cannabis in the European Union (including the United Kingdom, Norway, and Turkey) increased by 27%, from 3.1% to 3.9%. Notably, Portugal, Spain, and Luxembourg topped the list with the highest percentages of daily cannabis users among those who had consumed the substance in the last month.

With the relaxation of recreational cannabis laws in various European countries, such as Germany, Malta, and Luxembourg, there is a growing need for a public health-oriented and preventative approach. Drawing parallels with alcohol-related strategies, this session aims to explore this evolving landscape from a clinical perspective.

The focus will be on the World Health Organization’s definition of risky substance use, aiming to make it practical and applicable. Two existing proposals from Canada and Spain will be reviewed, with an emphasis on the role of standardized cannabis units in defining risk and the quest for consensus in this regard.

Additionally, the session will examine the similarities between alcohol and cannabis consumption, looking at the effectiveness of the Standard Drink Unit in early intervention and prevention of alcohol-related problems. Insights from the alcohol domain will be discussed, offering valuable lessons for preventing cannabis-related harm.

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Current metrics of cannabis use are inconsistent. This issue prevents the integration of the literature to date and to robustly measure the health risks and benefits associated with specific levels of cannabis consumption. This talk will overview a number of international initiatives to improve the current metrics of cannabis use.

The Standard THC Unit was created to objectively measure cannabis potency across all products, mode of administration, jurisdictions, contexts and over time.

To build upon the notion of the Standard THC Unit, addional multidisciplinary, international consensus based frameworks have been created.

One such ongoing initiatives, seeks to reach expert consensus on how cannabis potency should be reported in cannabis products in order to clearly and effectively inform consumers. The talk will overview preliminary results of the Delphi.

A similar Delphi methodology was used to establish internationally agreed-upon minimum standards to measure cannabis consumption in research (iCannToolkit), the results of which will be outlined.

Overall, it is imperative for cannabis researchers to join forces with multidisciplinary experts in order to improve metrics of use to inform consumers, general practitioners, researchers and public health experts on the harms and benefits associated with cannabis use.

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The Department of Social Rights of the Generalitat de Catalunya considered using a unique tool to identify people with complex social needs at Social Services centres and to support the diagnosis processes. After conducting a thorough search and selection process for various tools, the self-sufficiency matrix (SSM), a Dutch tool, was ultimately chosen.

The tool was adapted to the Catalan context through a transcultural translation process, which included a pilot and validation process. This resulted in the creation of the Catalan matrix (SSM-CAT).

A comprehensive implementation program was defined to start the adoption of the tool at basic social services. This program included training trainers and providing online training with practical cases. The implementation process was accompanied by support and monitoring to ensure success.

Through this process, over 3,468 professionals (including 334 trainers) received training on the self-sufficiency matrix, and 31,354 individuals who received basic social services in Catalonia were evaluated. In Barcelona, a more thorough monitoring of the implementation was conducted, assessing a representative sample of the care provided (6,916 individuals attended) generating a more accurate description of the situation of the people attended by social services in the city of Barcelona.

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Opioid use disorder is still the main presenting illicit substance use disorder that patients present within Addiction and Mental Health Services even though the majority of the patients are polysubstance users. Innovation in the field will allow providers to understand better how systems work to support a population with physical and psychological morbidities

We will present novel narratives in describing:

1. 1. Standards and principles

2. 2. Pharmacology

3. 3. Delivery systems

4. 4. Neuroscience based interventions

5. 5. Systems and implementation

The above desscriptors will allow a landscape that is less stigmatising and better in responding to the needs of the people who are highly stigmatised and multidisdvantaged.

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In February 2023, a series of earthquakes with high magnitudes affected 11 cities in Türkiye, a region with a population of over 13 million. With more than 50000 recorded deaths and more than 3 million survivors replaced, rescue and recovery efforts were challenging. The Psychiatric Association of Türkiye (PAT) immediately launched a “Disaster and Crisis Management,” which urgently formed and installed a program for psychosocial support and psychiatric care. The program included immediate, medium, and long-term actions. Hundreds of recruitments followed a call for volunteers for on-site and online support. An online “Earthquake and Mental Health” library was launched immediately, and a series of webinars on psychological first aid and disaster psychiatry were organized in the first two weeks. Furthermore, in three major cities, separate interactive meetings where question and answer sessions with trauma experts have been possible were held weekly with smaller groups. Almost a hundred volunteer PAT members served in the region in the first few months after the earthquake. All colleagues in the field, including those who survived the earthquakes, benefited from the resources of the PAT for their needs in housing, food, and mobilization. Starting from the first days, the PAT organized regional centers for coordination, which required financial resources and staff. The demand was high and could only be met with close collaboration with the Turkish Medical Association and the financial support obtained from international agencies, WPA, and other national psychiatric associations. The PAT started an online support system with technical support from a professional company, targeting healthcare professionals and first responders in the earthquake area. Volunteering psychiatrists provided appointment slots, rendering the system available 12 hours a day, seven days a week. With time, as the national healthcare delivery recovered, the PAT activities transformed into coordination, education, and supervision. Furthermore, the psychiatry residency training, which was interrupted due to the disaster, has been supported through a nationwide mentorship program launched by the PAT. The experience of the Psychiatric Association of Türkiye with disasters paved the way for an organized response, which was made possible through national and international solidarity.

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Natural disasters are and will continue to represent a great challenge in addressing mental health issues globally. The most devastating recent (earthquakes on 6th February 2023 in Turkey and Syria) caused death of more than 55,000 people, injury of about 100,000 people and loss of property, overall affecting millions of people. Moreover, in the last several years in Europe, they came in a form of double disasters (for example coupled with the COVID-19 pandemic) and pointed out the unpreparedness of the health (including mental health) sectors for the emergency situations.

However, in going through these experiences, we also learnt some of the practices that proved effective – including the fast creation of collaborative networks on a larger scale that also allowed fast spread of good practices and practical organisation of help. As a practical example of it - verbalized by the mental health professionals from Turkey through the Council of National Psychiatric Associations of the European Psychiatric Association, we organized a webinar delivered by experienced clincians, trauma experts and experts with lived experince in the earthquake zones. However, structural -implementation of mental health policies that focus on prevention and improving crisis response in care delivery are important to support populations affected by natural disasters to prevent the trauma sequel.

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The predominant association of attention deficit and hyperactivity disorder (ADHD) with males, often leads to underdiagnosis or misdiagnosis in females. Recent studies have highlighted marked differences between genders in the manifestation, symptoms, and outcomes of ADHD. Understanding these differences is essential for accurate identification, diagnosis, and tailored interventions for affected individuals, particularly females. TThe multifaceted nature of ADHD demands a nuanced examination of its impact on females, considering how societal expectations, hormonal influences, and a range of symptom presentations may contribute to the variation in the manifestation of this disorder across genders. This presentation aims to contribute to a more comprehensive understanding of ADHD, fostering improved recognition and tailored strategies to support both males and females who suffer from this condition.

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Attention-Deficit/Hyperactivity Disorder (ADHD) is commonly associated with childhood, yet its prevalence and impact extend into adulthood. The diagnosis of ADHD in adults poses unique challenges due to the subtlety of symptoms and the presence of comorbidities.

The workshop aims to provide early career psychiatrists with a comprehensive understanding of the unique challenges associated with adult ADHD, emphasizing evidence-based approaches to diagnosis and effective management.

The management of adult ADHD involves a multimodal approach encompassing psychoeducation, pharmacotherapy, and psychosocial interventions. The integration of cognitive-behavioral therapy (CBT) and coaching strategies proves beneficial in addressing executive function deficits and enhancing adaptive skills.

Pharmacological interventions are a key component in the management of ADHD. These interventions aim to alleviate symptoms, improve cognitive functioning, and enhance overall functioning. The two main classes of medications commonly used for ADHD treatment are stimulants and non-stimulants.

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Sleep disorders are the commonest comorbid conditions in adult ADHD. This presentation will begin with an overview of the relationship between ADHD and sleep as well as the impact of disturbed sleep on concentration, impulvity and hyperactivity. Next, we will discuss the clinical characteristics of the sleep disorders, how to screen for them and their pharmacological and non pharmacological management. By the end of the session, participants will have a clear idea of how to investigate the various sleep disorders, to distringuish and treat them.

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My PhD research critically examines the contemporary U.K politics of mental health and Illness and mental illness amongst young adults via social media.

This presentation examines the way in which social media, like Instagram and Tiktok allows young adults to explore, express and share their selfhood and identity around ideas of mental health and illness through videos, posts and online interactions. I will briefly explore how young adults use social media content to learn, experience and criticise their lived experiences, care for and treatment of mental health and illness. Arguing that these new developments in language and social practices around mental health and illness via social media need to be further explored, acknowledged and addressed in social science and this can be supported by work in the field of psychiatry.

To illustrate this, I will share empirical data from interviews conducted in 2021 and 2022 with young adults who speak about their mental health and illness online and have engaged with psychiatric services, for example, in-patient settings. Instagram and Tiktok have become important arenas for young adults because of the informative role they play in young adults’ understanding of what a healthy person looks like, or their ideas of the mentally healthy self. A concept I introduce in my research of which I will explain and explore through the presentation. In young adults’ understandings of mental health and illness there is a movement towards social practices that are intended to achieve (an idea of) mental health and this is created in a powerful digital environment that is affected by capitalism, neoliberal discourse and exists in a context of multiple political and health crises in the U.K and globally. Overall, the presentation argues that these mental health and illness social practices have transformed young adults’s experiences by responsibilisation in self-care that both isolates and empowers their experiences.

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This presentation provides an overview of the impact of information technologies on contemporary psychiatric practice, focusing on resources and strategies beneficial for early career psychiatrists. Considering the increasing role of digital technologies in diagnosing and treating mental disorders, the presentation emphasizes the practical applications of artificial intelligence (AI) and machine learning. These technologies offer novel approaches for analyzing large volumes of clinical data, enhancing diagnostic accuracy, and personalizing treatment.

The presentation further examines ethical and legal issues associated with using digital technologies in psychiatry, including ensuring data confidentiality and complying with patient rights. The importance of developing competencies in information security and ethical principles when using digital tools is highlighted.

The talk concludes with an overview of the current and future trends in the use of digital technologies in psychiatry, including the development of virtual therapeutic environments and mobile applications for monitoring and supporting mental health. Examples of successful integration of these technologies into clinical practice are presented, emphasizing their potential to improve the quality of patient care.

Overall, the presentation underscores the importance for early career psychiatrists of mastering information technologies, highlighting their role in enhancing diagnosis, treatment, and patient care, as well as discussing the challenges and opportunities they present.

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In recent years, there has been a growing recognition of the importance of involving people with lived experience of mental health issues in psychiatric research. User involvement in research goes beyond being merely instrumental and is deeply intertwined with ethical and political considerations. Shifting from traditional research paradigms to collaborative partnerships with users is seen as a crucial step in ensuring that research is more relevant, meaningful, and respectful of the diverse perspectives within the mental health community. While there is a growing interest and responsibility regarding this matter, there is still a need to better understand the differences between participation, engagement, and user-led research alongside a respectful integration of user perspectives.

In this presentation, the state-of-the-art regarding user involvement in psychiatric research will be reviewed and possible ways to practically implement such practice will be discussed.

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Patients and the research community need better and more cost-effective randomised trials. These are the ‘gold standard’ way of seeing if a new treatment works or not, and take years of effort involving lots of patients and funding. However, around half of trials fail to show that the new treatment is better than what it is being compared with. In cancer, this problem has been recognised. They use trial designs which test multiple treatments, and find out quicker answers to more questions. These ‘efficient trials’ are able to involve patients at a faster rate and to improve the chances of patients receiving a treatment that works. In mental health, the whole toolbox of trial designs is not being used. Sometimes there are valid reasons for this, but sometimes it is simply that researchers do not know about them – this talk will expand on the concept of ‘efficient trials’ in mental health, and present the opportunities and challenges to using these.

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Psychotic experiences show a dynamic pattern over time, often in interaction with the environment. In my talk, I will discuss how Ecological Momentary Assessment (EMA) or Experience Sampling Methodology can be used to assess psychotic symptoms in the flow of daily life. I will focus on the assessment of both positive and negative symptoms, where I will discuss both how we can measure such symptoms as well as what the dynamic patterns look like in everyday life. Furthermore, I will also focus on how ESM can be used to transfer psychological treatment to daily life using an app. I will discuss the INTERACT trial, a trial in people at the early stages of psychosis, where we investigated the effect of Acceptance And Commitment Therapy in Daily Life, compared to Treatment As Usual.

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Increasing volumes of information are being collected via electronic health records and there is growing multi-site expertise in utlising these for research. This emerging field of healthcare data science is not only concerned with the technical challenges associated with complex data, but also with the need for effective security and governance in the use of sensitive information with robust structures for stakeholder input and guidance. To date, most of the focus has been on supporting observational cohort studies nested within clinical records data - particularly investigating research questions around treatment response and course/prognosis. It is likely that electronic health records will become increasingly integrated with clinical trials, providing opportunities for pre-study feasibility scoping, targeted recruitment, and enhanced and extended follow-up. In addition, there is interest in emulated trials using routine data. For mental health data science, key challenges lie in the quality and quantity of data made accessible, with a particular need for natural language processing to derive structured data from extensive clinical text. Many of the challenges have been addressed for observational research, creating exciting prospects for a transformed trials landscape.

R. Stewart Grant / Research support from: Janssen, GSK, Takeda

To contribute to this debate I offer perspectives from my PhD research which critically examines the contemporary U.K politics of mental health and illness amongst young adults via social media. My work examines the way in which social media, like Instagram and Tiktok allows young adults to explore, express and share their selfhood and identity around ideas of mental health and illness through videos, posts and online interactions. Through this work I have engaged with digital services, psychologists and medical professionals on the subject of using technology for the treatment, engagement of and knowledge of mental health and illness. I have additionally engaged with some work on the role of the Metaverse for treating mental illness, and how this could work, but also the limitations of virtual spaces. Exploring debates in digital sociology adds evidence to these arguments and can support the understanding of the political ramifications of using technologies in the clinical space. Arguing that these new developments in language and social practices around mental health and illness via social media need to be further explored, acknowledged and addressed in social science and this can be supported by work in the field of psychiatry. Overall, my contribution to the debate will be to offer political and digital social perspectives on the use of technology and highlight some of the biases and drawbacks of utilising AI to treat mental health and illness.

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The metaverse, a term first employed in Neal Stephenson’s 1992 novel “Snow Crash”, is a digital environment delivered via artificial intelligence in which multiple users can use avatars to engage in social, economic and cultural activities. Broadly speaking, metaverse encompasses technologies as diverse as augmented reality (AR), “lifelogging” (smart watches, smart phones and other wearables), “mirror” worlds (e.g. Google Earth, Waze, …) and virtual reality (VR). There is a pressing need to understand the potential of metaverse for medicine in general and psychiatry in particular. The therapeutic use of VR technologies is already a reality in clinical practice, particularly in terms of online treatments and exposure and response prevention for anxiety disorders, obsessive-compulsive and related disorders, and trauma-related disorders. Avatar integrated therapies may increase treatment seeking via anonymity, decrease in physical and communication barriers, and facilitation of expression. In terms of research, the metaverse allows manipulation of the therapeutic environment in order to answer specific questions.

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