Proposed by the EPA Section on Old Age PsychiatryObjectives: The goals of this course are to: 1) Review recent noninvasive brain stimulation approaches (rTMS and tDCS) for the treatment of psychiatric symptoms and question their relevance in late-life psychiatric disorders 2) Practice with available brain stimulation devices approved as medical device by health authorities. 3) Discuss the strengths, weaknesses and gaps of the various approaches in each indication Description: Despite advance in psychopharmacology, up to 30% of patients with psychiatric condition continue to experience disabling symptoms despite being on medication. Thanks to their ability to modulate cerebral networks, noninvasive brain stimulation methods have been proposed as an alternative method to alleviate treatment resistant symptoms in patients with psychiatric conditions, especially depression, schizophrenia and substance use disorders. Noninvasive brain stimulation methods cover a broad range of approaches including electroconvulsivotherapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial electrical stimulation (tES: tDCS, tRNS, tACS, tSOS,...). The course will have four sections: 1. Overview of rTMS and tDCS methods 2. Brief presentations of their main indications in psychiatry (depression, schizophrenia and substance use disorders) and their place in the treatment algorithm, with a focus on the elderly 3. Practice exercises with the devices 4. General Discussion about strengths, weaknesses and gaps in adult as well as elderly population Chairs : Dr S.Bulteau; Dr D.Szekely; Pr C.Baeken. The presence of Pr Baeken is justified by the fact that he already had an experience in conducting such a workshop for the EPA in 2018, and because he will afford additional expertise for rTMS and tDCS use in clinical and research setting.

Proposed by the EPA Section on Old Age Psychiatry.Neuropsychiatry is a discipline that sits at the interface of both neurology and psychiatry and deals with the psychiatric manifestations of psychiatric disorders. Due to the division of psychiatry and neurology in the past century and the complexity in the management of neuropsychiatric disorders, psychiatrists often lack consistent experience in this field. The course will address neurodegenerative diseases, epilepsy and non-epileptic seizures, head injury and movement disorders. The first part of the course will provide participants with an overview of the general approach to neuropsychiatric diagnosis, examination and management. It will begin with an overview of the basics of interpreting key investigations in neuropsychiatry (magnetic resonance imaging and cognitive testing). Case studies will illustrate the cardinal neuropsychiatric presentations based on cortical and subcortical injury. The second part of the course will focus on the neuropsychiatry of seizure and movement disorders and Parkinson’s disease and their practical management. The final part of the course will be an interactive discussion based on cases from our daily practice illustrating the challenges faced by psychiatrists managing patients with primary neurological conditions. Course co-directors: Dr Ivan Koychev is a Clinical Lecturer in Old Age Psychiatry at the University of Oxford and Honorary Registrar in Neuropsychiatry at Oxford University Hospitals NHS Foundation Trust. He has completed a PhD on the neurobiological features of the schizophrenia spectrum. Dr Cecile Hanon is an old age psychiatrist working in the Resource Regional Center of Old age Psychiatry in Paris, France.

Symposium describing pros and cons, possibilities and difficulties of conducting high quality research, such as RCTs in psychiatry.

The dichotomous Kraepelinian classification of dementia praecox, later renamed schizophrenia, and manic-depressive psychosis has, since the late 19th century, caused difficulties for the identification and understanding of “intermediate” categories, mainly for those short-lived psychotic disorders that do not display prominent affective features. The proposed symposium will deal with the clinical, nosological and socio-cultural aspects of short-lived psychotic disorders as currently classified under “Acute and transient psychotic disorders” (ATPD) in ICD-10, and “Brief psychotic disorder” in DSM-5, pointing out differences and similarities vis a vis schizophrenia, substance-induced psychosis and affective disorders. Implications for psychiatric practice, research and classification will be discussed, particularly the newly proposed ATPD category for the forthcoming ICD-11 revision (i.e. acute polymorphic psychotic disorder), and operational definitions such as “Brief limited intermittent psychotic symptoms” subsumed under DSM-5 “Attenuated psychosis syndrome”. Existing studies suggest that the above conditions are rare and more often affect women in early-middle adulthood. They also are neither associated with premorbid dysfunctions nor high family risk, while there seems to be greater evidence of environmental factors mainly in developing countries and migrant populations. Although follow-up studies reported a favourable clinical and functional outcome, case identification proved difficult owing to the lack of clearly defining features and high rates of transition either to schizophrenia and related disorders or, to a lesser extent, affective disorders. The speakers are experienced researchers of international standing and among the most productive scholars in the field, both from developed and developing countries.

Proposed by the EPA Section on Cultural Psychiatry.Millions of migrants, refugees and asylum seekers live elsewhere than their regions of origin. More than 68 million people are fleeing their homes due to a global increase in social and political instability as well as socio-economic conflicts. This is a challenge for mental health care systems in Europe with respect to provision of adequate and need adapted care since there is increasing evidence of a high psychiatric morbidity in this population. The symposium aims to highlight the current situation of intercultural opening of mental health care systems for migrants and refugees across Europe. The EPA guidance on mental health care of migrants across Europe will be revisited in terms of lessons learnt and what still needs to be done. Data from an analysis of needs and barriers of a regular mental health care system will be presented. Insights from the EPA task force on mental health needs of refugees and asylum seekers will be discussed with regards to the question of whether or not this population needs need specialized services. Data from a stepped care need adapted pilot project in Germany will be presented showing the results of an effort for integration of asylum seekers and refugees in regular menatl health care services. This symposium aims to discuss recent evidence on the status quo of intercultural opening of regular menatl health care services and increase awareness and knowledge of possible treatment gaps in vulnerable subpopulations with respect to adequate and need adapted provision of mental health care.

Proposed by the EPA Section on Schizophrenia.A mild to severe cognitive impairment is present in the large majority of subjects with schizophrenia and is frequent in subjects with other psychotic disorders. It has a negative impact on real-life functioning and quality of life across the disorders. Cognitive dysfunctions are present since the first manifestations of the disease and in subjects at ultra-high risk for psychosis (UHR) and have a significant impact on their level of functioning, greater than symptom severity. Despite the functional consequences of cognitive impairment, its assessment and treatment represent, to date, unmet needs of most people with psychotic disorders. There is considerable evidence that cognitive remediation (CR) is effective in subjects with schizophrenia and other severe mental disorders. However, a limited number of studies reported beneficial effects also in UHR subjects. This symposium will provide data on cognitive assessment instruments, their diffusion and applicability in both clinical and research settings, and availability of multinational and multicultural validation for each instrument. In this symposium we will also delineate the state of the art of the therapeutic effects of cognitive remediation programs in subjects with first-episode and chronic schizophrenia, mood disorders, and in UHR people. Data relevant to generalization of cognitive improvement to real-world functioning, personalization of CR, integration with other treatments and dissemination in clinical practice settings will also be presented.

One of the most pressing issues in psychiatry and neuroscience is the investigation of the drivers and of the functional significance of variation in the human brain. This symposium harnesses the power of large datasets to examine human brain variation across the entire lifespan. Dr. Wierenga analysed data from the ENIGMA consortium and showed that males have greater variability than females in both cortical and subcortical brain structure. This effect appeared to be mostly stable across the lifespan. These findings may provide important clues for our understanding of male biased neurodevelopmental disorders. Prof. Frangou will present data from 11,000 children aged 9-10 years and show the profound effect of environmental enrichment and disadvantage on subcortical volume and cortical thickness. Dr Ruigrok will present data on the variation in childhood and adolescent brain development that is driven by prenatal testosterone. Dr. Sibley will present analysis of longitudinal measures of depressive symptoms and white matter microstructure , along with the investigating the strength of associations between depression-polygenic risk and behavioural, cognitive and neuroimaging traits in UK Biobank.

Suicidal behaviors are the most faithful risk marker for future death by suicide and entail substantial clinical and economic costs. This symposium will focus on current clinical-level prevention efforts for suicidal behaviors aimed at high-risk subjects and suicide attempters. Dr. Gramaglia will present the use of early rehabilitation strategies as a secondary prevention tool for suicide attempters admitted to the Psychiatry Ward in Novara, Italy. The involvement of the whole therapeutic team (including psychiatrists and nurses) in the approach to these patients will be described, as well as the psychometric assessment employed, and clinical implications will be discussed. Dr. López Castroman will present new data on the activation syndrome induced by antidepressants in a large cohort of depressed patients, identifying the clinical variables that can be used to detect the emergence of suicidal ideation. Recommendations about antidepressant prescription in suicide attempters will also be discussed. Dr. Martínez-Alés will talk about a real-world study comparing the effectiveness and cost-effectiveness of three differente post-discharge suicide prevention programs (a brief contact intervention, an enhanced contact intervention and a psychotherapeutic program) including 1,492 suicide attempters in Madrid, Spain. Dr. Jardon will provide an overview of VigilanS, a health care program designed for people with recent suicide attempts. Built on an algorithm that dynamically adapts the monitoring and case management to each individual’s suicide risk, recent assessments suggest that inclusion to this program, currently in use in northern France, is associated with a subsequent decrease in suicidal behaviors.