The last decade has witnessed major advances in psychiatric genetics and their publication have received wide media coverage. Psychiatrists are asked to answer questions and faced the growing awareness among patients and their family members. While genetic testing is not part of the routine clinical practice for the most common psychiatric disorders (schizophrenia, bipolar disorders, major depressive disorders), it can already be done in certain cases, particularly for the identification of pathogenic copy number variants that are associated with high risk for schizophrenia. Major efforts to promote such testing are now underway in Europe and the development of new tests looking for other variants is spreading. However, genetic testing and counseling are not harmonized yet and remain patchy across Europe. The socioeconomic and political heterogeneity of the countries leads to spatial disparities. Cultural and ethical differences leads to different representations of psychiatric care and genetics. Scientific research and funding is poorly distributed. In 2018, the European Union funded a COST Action to build a network called EnGagE: “Enhancing Psychiatric Genetic Counselling, Testing, and Training in Europe”. The objectives are to develop a framework to facilitate the implementation of genetic testing and genetic counseling into routine psychiatric care. EnGagE aims to develop standardized practice recommendations and research protocols, share scientific knowledge and data, and provide standardized training. This EnGagE’s workshop will focus on the four sides of genetic testing: laboratory update, medical impact, research point of view and new challenges.

The pharmacotherapy of patients with Schizophrenia is challenging for a variety of reasons. For some patients, a poor response to antipsychotic treatment or a high side effect burden raises the question whether to switch antipsychotics, including to clozapine, or whether to combine antipsychotics. Other patients experience persisting positive, negative as well as comorbid anxiety, depressive or obsessive-compulsive disorders that require the addition of medications to manage their residual symptoms or conditions. With the introduction of new pharmaceuticals, polypharmacy is becoming more and more common in real-world clinical settings and clinicians are confronted with an increasing number of complex treatment options. In this symposium, speakers will outline the conceptual basis for a rational, safe, and evidence-based polypharmacy for Schizophrenia. Four different scenarios for combining medications rationally will be presented. First, we will review combining antipsychotics for non-refractory psychotic patients, including combining olanzapine with amisulpride. Second, we will discuss clozapine augmentation strategies for refractory patients. Third, we will examine the value of adding antidepressants for depression, negative symptoms and obsessive-compulsive symptoms in the management of psychotic disorders. Finally, a talk will address medication strategies to manage antipsychotic-associated weight gain.

Bipolar disorder is highly related to increased risk of suicidal behaviour, and the identification of patients at risk is considered clinically meaningful. A variety of associated risk factors have been identified, but it is unclear whether they differ or take their origins with regard to patient age, thus leading to highlight some vulnerability windows. Dr Romero will discuss which factors are associated with suicidal behavior in adolescents with bipolar disorders, thus describing a specific window of vulnerability. Pr Etain will highlight that suicidal risk may take its origins very early, and especially in the case of exposure to childhood maltreatment. He will show that salient dimensions of emotional regulation and impulsivity mediate the link between early stressors and suicide attempt later in life. Based on a large cohort of bipolar disorder patients, Pr Courtet will then address the question whether depressed suicidal patients will have a similar course of bipolar disorder at a two-years follow up in comparison to depressed non-suicidal patients. Finally, Dr Lengvenyte will present clinical and cognitive risk factors for suicidal events in patients with late-onset bipolar disorder. This symposium will discuss suicidal risk in bipolar disorders through the lifespan including its origins in childhood, early and late windows of vulnerability and longitudinal course.

The concept of “biological ageing” or “premature senescence” in relation to psychiatric diseases originally arose from the evidence that severe mental diseases (such as Major Depressive Disorder, Schizophrenia, Bipolar Disorder, or Post-Traumatic Stress Disorder) are associated with early mortality and with increased risk of developing certain senescence-associated medical comorbidities. Over the last years the research on the field has been stimulated by studies exploring the role of molecular underpinnings of senescence, i.e. molecular pathways at the peripheral and central level which are thought to have a causal role in, or to reflect, the ageing processes, in mental diseases. In the present symposium recent developments on the topic emerging from clinical and preclinical data will be presented and critically discussed.

Proposed by the EPA section on Women, Gender and Mental Health - Gender can significantly impact on the course of infection during a pandemic, but also it’s longterm sequelae. In the case of COVID-19, current worldwide statistics show more men than women dying of acute infection, while women are projected to suffer more than men from the health, economic and social consequences of the pandemic. Up to date research findings will be presented by the first speaker. Several studies to date have reported an increase in common mental health problems during the acute phase of the Covid-19 pandemic in all population groups with a more pronounced rise in women. Longer-term effects on mental health in people who have suffered from Covid-19 are as yet unknown. The second speaker will focus on the incidence of post-traumatic stress disorder in this group, reviewing up-to-date literature and presenting data from her research group on men and women who were treated as inpatients or at home. The third speaker will discuss evidence that domestic violence and related deaths of women increased during the Covid-19 lockdown periods. The barriers that social restrictions create towards identifying and supporting victims will be discussed and recommendations given to overcome them. Particularly difficult challenges are also encountered during a pandemic by mental health services which care for women with severe mental illness who are pregnant or have recently given birth. The 4th and 5th speaker will discuss which strategies that were rapidly adopted during the Covid-19 pandemic to meet these challenges in the inpatient, community and liaison setting, were successful.

Forcibly displaced people across the world face social, psychological and economical challenges linked to their unsecure status, often involving racial discrimination. The cycle of racial discrimination, stigmatization and exclusion starts with the labeling of people with displacement background as a group and individually as `the Other` causing alienation and mobilizing mental stereotypes including ignorance and prejudices. Stigmatisation is a mixture of ignorance and stereotypes, prejudice and discrimination. While ignorance could be defined as the lack of knowledge and interest, and stereotypes reflect the cognitive aspect of social categorization of members of ‘ingroups’ and ‘outgroups’. Prejudices or negative attitudes towards outgroups reflect the emotional aspect of differentiation, and discrimination refers to the behavioral patterns directed to the well-being of outgroups, and harming them. Thus, stigmatization and discrimination is very close and negative related to the poor living conditions of these groups and their psychosocial status in the society. There is a large and growing body of evidence indicates that experiences of racial discrimination are an important type of stressor that can alter the health status and lead to behavioural patterns, which increase health risks. Furthermore, several studies has focused on the relationship between racial discrimination and poor health outcomes in these vulnerable groups. We will focus on the impact of racism and discrimination on mental health of forceíbly displaced people and discuss how to deal with growing racism and discrimination including recommendations. All presentations will be discussed with the plenum.

Psychiatry relies upon self-reports to access the patient's inner world, more than most specialties. In forensic psychiatry the risk of secondary gain distorting events is substantially higher than elsewhere. With estimates of exaggeration being between 15%-40% we need better tools than 'clinical impression' to assess the validity of claims and reports. Dr Torenc (Portugal) will take us through the twists and turns that prisoners take to persuade us of their illnesses, of why they may feign for benefit and how to manage them. Dr Wise (UK) will discuss some of the issues that medical personnel face when using these tests, including attacks on their credibility; examples from court cases will demonstrate possible solutions. On the other hand in recent years the introduction of peer support workers (PSW), individuals with personal experience of mental health problems who have recovered and support those with current mental health difficulties, has been recommended. Evidence suggests gains of such interventions, particularly in psychosocial outcomes. The introduction of PSW in mental health settings poses particular challenges. Dr. Drennan will talk about developments in governance for lived experience roles in forensic in-patient treatment programmes. Ms Walde will add a German perspective about the preparation and implementation of a peer support worker in a forensic hospital for offenders with substance use disorders.