Proposed by the EPA Section on Neuroimaging and Epidemiology and Social Psychiatry -Refining our understanding of developmental trajectories of mental disorders will allow us to identify early those patients most likely to develop persistence impairment in mental health as well as those patients which will benefit most from treatment. Because of the limited viability of treating all cases, it is particularly important to find out individual determinants predisposing to worst outcome or to a better response to treatment. The key role of social and environmental risk factors, within a gene-environment interplay framework, in precipitating and maintaining specific trajectories in mental disorders will be pointed out in different representative samples. In the same way, alterations in neurobiology and neuroimaging biomarkers which have been associated to developmental patterns leading to different mental health outcome will be critically revised in the light of recent evidence-based results.

Proposed by the EPA Section on Mental Health and Intellectual Disability -The International Classification of Functioning, Disability and Health (ICF) is a taxonomy of health and health-related domains. It provides a common language and framework for describing the level of functioning of a person within their unique environment. Furthermore, it helps to describe health problems of a person in line with the International Classification of Diseases (ICD-10). ICF aims to provide a patient-centred approach to the assessment and management of people with chronic health conditions, mental disorders and intellectual disabilities (ID) by defining individual therapeutic goals and monitoring functional outcomes. The ICF also plays an important role in psychiatric rehabilitation, describing health problems due to mental illnesses and neurodevelopmental disorders. ICF facilitates a comprehensive multidisciplinary approach to assess an individual’s level of functioning and care. Use of a standardised classification system to assess and document biopsychosocial function helps to further support provision of high-quality individualised health and social care. Furthermore, ICF provides a standardised assessment instrument to determine individual functional needs for the care, rehabilitation and societal integration of individuals with disabilities which is a statutory requirement in many European countries. For example, in Germany, the revision of the Federal Participation Act (BTHG) requires the use of ICF as a standardised assessment instrument for determining individual functional needs of individuals with ID. Main objective of the workshop is to introduce the ICF and discuss its advantages and limitations in clinical practice, research, psychiatric treatment and care of individuals with ID and mental health problems.

The shortage of child and adolescent psychiatrists is a global crisis. Much attention has been given to solutions to the unmet need for child mental health services. One of the four priorities for the next decade of child psychiatry outlined in 2019 by a workgroup of psychiatric leaders of international groups is to expand the workforce beyond the direct training of child psychiatrists to other healthcare professionals. (Skokauskas 2019). Project ECHO (Extension for Community Health Care Outcomes) has been a promising model of workforce expansion. It uses the approaches of high quality CME and integration by combining collaborative cased based consultation with didactic instruction delivered virtually. The initial success of this model has led to its global expansion.(VanCleave 2017) This workshop will demonstrate the efficacy of ECHO as a workforce multiplier by describing its use to address child psychiatry shortages in four different countries. An opportunity for general questions and discussion of developing ECHO programs will follow brief presentations. Dr. Pajer will describe Project ECHO Ontario(CYMH) which has trained 500 primary care and mental health providers. Dr. Leppert will discuss KKI-NECT(US) which addresses early childhood mental health and development. Dr. Newcomb will describe ECHOs targeting general practitioners and non-medical staff in Queensland Australia. Dr. Dharmadhikari will discuss using ECHO to train general psychiatrists in rural India. Dr. Gardner’s presentation of operational outcomes will open the discussion about developing of ECHO programs (funding, operationalization, evaluation). All of the presenters will describe adaptations to their programs to address COVID-19 related concerns.

The molecular factors involved in the pathophysiology of major depressive disorder (MDD) and related endophenotypes remain poorly understood. The complexity of the MDD phenotype may contribute to inconsistent results. Dr Mara Dierssen will do an overview concerning transcriptional factor mechanisms underpinning of neurodevelopmental disorders. One recent approach to examine the molecular basis of MDD is co-expression network analysis, which facilitates the examination of complex interactions between expression levels of individual genes and how they influence biological pathways that could be affected in MDD. Dr Bernhard Baune will present recent findings supporting dysregulated immune response and protein processing in the endoplasmic reticulum in MDD, thus providing novel insights into the pathophysiology of depression. Genome-wide transcriptome analysis of MDD patients clinically well characterize as well as of relevant risk phenotypes such as childhood traumatic experiences could represent an advance in this field. Dr Alessandra Minelli will present results from a transcriptomic study on the effect of childhood traumas. Moreover, she will show the role of environmental and genetic factors on the identified dysregulations. Based on the hypothesis that MDD could be characterized by accelerated aging, Dr Alessio Squassina investigated the role of telomere length and inflammation in this disorder. Findings showed that MDD patients have shorter telomeres compared to controls, and that treatment-resistant patients have higher levels of TNFα than non-TRD and controls, suggesting that TR might be associated with increased inflammation.

The novel coronavirus pandemic 2019 (COVID-19) is posing new critical challenges in many areas of mental health worldwice, such as: 1) widespread social alarm, with an overall increase of anxiety states, somatic concerns, and mood sensitivity; 2) long-lasting physical distancing due to both the response to public health protection rules and also voluntary conduct. The interaction of such conditions sharply increases the risk of inducing or reinforcing some features of conduct disorders, such as behavioural addictions. To go in-depth into the psychosocial meaning of these conducts is quite timely and potentially urgent from a clinical point of view. Addictive conducts born or reinforced in a long-lasting self-distancing condition may grow over time and root themselves also in a future normalized situation. Some behavioural risks must be considered: a) increased time spent using Internet, with very frequent development of mild to severe forms of addiction, including a compulsive need to be in touch with other people, increased/addicted use of social media., anxiety reaction when not online, etc.) onset/increase of specific Internet-use profiles with high addictive risk, such as online gambling, gaming, shopping; most common forms of internet use may become problematic in distressed self-distancing conditions; c) increased time of physical exercise at home with compulsive features, in people with a previous profile of exercise addiction and also the lack of access to a specific sports addiction; d) possible influence on course and shaping of previously existent or newly induced features of mental disorders.

Transgender people represent a broad spectrum of individuals that transiently or persistently identify with a gender different from the one assigned at birth (APA, 2013). Transgender healthcare issues have become an increased matter of interest over the last years, as shown by the growth of publications on the subject and by the increase of referrals reported worldwide in all age groups. However, transgender people report encountering numerous obstacles in accessing and receiving appropriate health care with professionals being described as not properly trained on specific gender issues. Considering the diversity and complexity of the gender spectrum in the different age groups, and in light of the recent changes in the formal psychiatric classification, mental health providers play a critical role in meeting the needs of gender non-conforming children, adolescents and adults, according to individualized paths. This course has the following aims: (1) learn the principles of assessment of gender incongruence in childhood, adolescence and adulthood; (2) address co-occurring psychopathology; (3) identify different treatment paths according to age and individualized psychological and/or medical needs; (4) work in a multidisciplinary team in line with an integrated model. Each area will be considered in the four presentations of the course. Then, video of cases will be presented, and small groups of discussion will be organized. In particular, two of the speakers are actively involved in the revision committee for the Standards of Care of the World Professional Association for Transgender Health (SOC 8); thus they will provide recent updates on this topic.

Recently, the discussion on physician aid-in-dying (PAD) extended to the context of mental disorders. Supporters of that view mainly argue based on patient autonomy. In Switzerland the Swiss Academy of Medical Sciences (SAMW) updated their recommendation, replacing the requirement of terminality with the criteria of unbearable suffering. This would allow people suffering from mental illness to access PAD. However, the Swiss Medical Association (FMH) decided not to adopt this recommendation and to restrict PAD to cases of terminal illness. In Germany, in 2020 the Federal Constitutional Court ruled that the right to self-determined death, including the freedom to seek assistance for suicide, if available, is a civil right. The implications of these decisions for legislation and practice on PAD in general and mental disorders in particular are not fully conceivable yet. The discourse about defining severe suffering and terminal illness in psychiatry is complex and challenges legal, ethical and professional positions on both an individual and a collective level. Suffering is a necessary but insufficient condition for PAD in psychiatry, the other criteria being decision-making capacity and refractoriness of the suffering. Additionally it has to be taken into account that suffering is a subjective experience that can only be quantified by the patient. The symposium aims to focus on the discussion of conditions under which severe mental illness might lead to such a pronounced and unbearable state of suffering, with no prospect of therapeutic improvement that - after a conscientious assessment - PAD can be considered.

Psychiatrists are often expected to be experts on suicide prevention however, curriculum contents on the management of suicidal persons and suicide prevention might vary between universities during medical education. ELLIPSE (E-Lifelong Learning In Prevention of Suicide In Europe), an innovative project co-funded by the Erasmus+ programme of the European Union, with 8 partners from 5 countries (Sweden, Austria, Hungary, Norway, Poland) will be presented. Its aim is to develop a European online training program in suicide prevention for the higher education sector; to increase knowledge and to professionalize attitudes and skills of students in suicide prevention. Workshop participants will have an opportunity to follow the different stages in the development of the European e-learning program ELLIPSE, as well as to learn about French experiences with MOOCs, online courses on suicidal behaviour. They will be invited to share ideas on the future European guidelines in the education on suicide prevention, which may become an important complement to ongoing efforts in the transformation of mental health services in Europe.

The coronavirus disease (COVID-19) pandemic is causing a global health crisis of unprecedented proportions in modern times. Importantly, the pandemic is expected to have negative health consequences beyond those caused by the coronavirus per se – including significant psychological distress. This symposium will focus on the mental health consequences of the COVID-19 pandemic. First, Dr. Christoph U. Correll will provide an overview of the design of the “Collaborative Outcomes study on Health and Functioning during Infection Times” (COH-FIT), putting it in the context of available evidence when the study started. He will present also global results from over 100 countries across 6 continents, focusing on the subgroup of >15,000 minors, in whom their caregivers rated the impact of COVID-19 on their physical and mental well-being. Second, Dr. Marco Solmi will present global results of COH-FIT study in adults from over 100 countries and >50,000 participants across 6 continents, with a specific focus on Italian sample (over 7,000 respondents, including a nationally representative sample). Third, Dr. Karolina Skonieczna-Żydecka will present results of the COH-FIT study in Poland with >1500 participants, with a specific focus on health workers. Fourth, Dr. Søren D. Østergaard will present the results of a survey in which 6000 randomly drawn patients with mental disorders undergoing treatment in the psychiatric services of the Central Denmark Region (catchment area of 1.3 million people) will be involved. The survey, which will be conducted in June 2020, will focus on well-being and symptom levels of the participants during the COVID-19 pandemic.

Proposed by the EPA Section on Psychotherapy -This symposium will present current knowledge, development and clinical experiences on internet-based cognitive behavioural therapy (ICBT) developed in various settings and countries. Presentations include a description of the journey towards national implementation of ICBT and its outcomes in Sweden (MK), of individually tailored ICBT with different modes of delivery and different degrees of therapist support. Moreover, a presentation by VK include Adaptive Treatment Strategies, where a wide range of data before and during treatment are processed by an AI-driven clinical decision support tool guiding the adaption of therapist-guided ICBT at the individual level. Another presentation (KM) will describe the implementation of a national ICBT clinic in Denmark, from the first initial steps through to becoming a national service. Current evidence of effectiveness and implementation efforts conducted at the clinic. JB will report on a pilot study comparing online versus face-to-face transdiagnostic therapy in Arabic-speaking refugees. She will describe the different aspects of tailoring treatment contents in these two settings and discuss potential advantages of a tailored approach for the specific patient population.

Developed over 80 years ago, ECT continues to be the most powerful and acutely effective treatment available for severe, often treatment-resistant, depression. Its use is supported by data from randomised trials and meta-analyses. However, there is still a need to develop better strategies to optimise ECT practice, by identifying both patient-level and treatment-level characteristics that predict therapeutic benefit and minimise side effects. This symposium will be informed by our on-going, or recently completed, clinical studies and trials. We will discuss whether we should focus our attention on the ‘average’ ECT treatment technique that suits the majority of our patients (i.e. “one size fits all”) or tailor the treatment to the needs of individual patients. Pascal Sienaert will discuss the available evidence to guide clinicians in personalising electrode position, dosing strategies and parameter selection, and to make individualised adjustments during the ECT course. Linda van Diermen will identify key clinical elements that predispose to beneficial treatment effects, distinguishing between primary and secondary predictors, and formulate recommendations to aid in patient-treatment matching. Esmee Verwijk will address why outcome measures at the group level do not always fit individual patients and how patients can be helped by preventing and/or treating cognitive side effects. The relatively neglected issue of optimising speed of response to ECT and the role of electrode placement and other clinical factors will be discussed by Declan McLoughlin. Together, the sessions in this symposium will help participants to apply evidence-based methods to personalising ECT practice for their patients.

The work of psychiatrists has been profoundly disrupted by the COVID-19 pandemic (e.g., redeployment, shifting institutional priorities, sudden massive use of telehealth services). At the same time, mental health concerns in the population have been exacerbated by the pandemic (e.g., due to isolation, anxiety, substance use), resulting in increased need for services at a time when accessing services is more difficult. This symposium will present the results of two large longitudinal studies that speak to these issues. The first is a global, multilingual study of the impact of the COVID-19 pandemic on clinical practice and well-being of psychiatrists and other mental health professionals. Results will be presented from two waves of data collection with members of the World Health Organization's Global Clinical Practice Network (GCPN), comprising 15,500 clinicians from 159 countries. The first speaker will focus on predictors of distress, occupational burnout, and practice disruption over time and the use of distance technologies for evaluation and treatment. The second and third speakers will focus on China and Russia, examining impact on GCPN members as a function of the course of the pandemic in those countries. The fourth speaker will focus on the mental health impact of the COVID-19 pandemic among a representative sample of the general population of Madrid (n = 900), interviewed by telephone at two time points. The symposium will consider the implications of the results for the delivery of mental health services and for programs and policies that protect well-being and reduce occupational burnout among psychiatrists.