Proposed by the EPA section on Eating Disorders -Anorexia nervosa (AN) and bulimia nervosa (BN) are severe eating disorders (ED) with potential life threatening complications. Although the efficacy of treatments varies among studies, a recovery average of 30% of ED patients is acknowledged. In addition, high rates of drop-out and relapse contribute to a low efficiency of available treatments. Therefore, there is a need to improve the knowledge of the pathophysiology of these disorders in order to identify possible treatment targets and propose more accurate therapeutic interventions. The aim of this symposium is to illustrate new advances in the pathophysiology of EDs, which might provide a theoretical pathogenetic link between alterations in specific brain and/or peripheral systems and ED psychopathology in order to suggest new perspectives for prevention and/or treatment of AN and BN. To this purpose, Prof. F. Fernandez-Aranda (Barcelona, Spain) will discuss personality, cognitive and neurobiological markers associated with therapy response in EDs. Prof. Valdo Ricca (Florence, Italy,) will present the role of the reward system in EDs. Prof. Milos Gabriella (Zurich, Switzerland) will illustrate the role of hypoleptinemia in anorexia nervosa and will present the first experiences with off-label treatment with metreleptin, a leptin analogue. Dr. Philibert Duriez (Paris, France) will analyze factors that drives the increase of insight of patients treated for EDs.

The methodology of scientific method can be sometimes difficult to understand and implement in psychiatry. Different tools exist to help this process by collecting and interpreting data but they can sometimes be quite expensive. Here we will present free and open source softwares that help to communicate but also randomize, collect, interpret and publish data. These tools can be easily reused and shared. That could improve validity and reproducibility of scientific research. In order to be interactive, we will involve the participants in the collection of the data of a prototypical scientific study, an international cake testing database! (http://bit.ly/cakereport) We will see a study protocol and how we can pregister this protocol defining the primary outcome. Here what is the best cookie from 2 different brands? We will discuss the issue of sample selection. Who will taste the cookies? Randomizer.org will help us to attribute a condition (cookie A or B) to each subject. Limesurvey helps to run easy online surveys. What did you think about each characteristic of your cookie? R helps to analyse and plot the data. What the mean score? How to plot the results? Is the difference significant? GitHub helps to publish publicly or not our data and analysis script. ArXiv systems helps to publish early works and manuscripts before publication. Equator-network.org can give guidelines that could help to write scientific articles. We can promote our work then on wikipedia and discuss what are the advantages and issues to promote your own work on wikipedia.

Proposed by the EPA Section on Addictive Behaviours - Motivational interviewing is defined as a patient-centered and collaborative approach that guides people to initiate and maintain a strategy of behaviour change through the resolution of their ambivalence. This approach has become in the last decades the golden standard to manage addictions as opposed to classic confrontational models. Different meta-analysis, have demonstrated its moderate but robust effect in improving both adherence to treatment and addictive behaviours. Brief interventions have proven its efficacy in primary health settings, to help patients reduce their drug use, specially concerning alcohol and tobacco. Motivational adaptations of those brief counselling interventions have been developed and tested in recent years. In this course, attendees will receive training on how to use brief motivational interventions (BMI) with patients suffering addictive disorders in the Emergency Room. The course will address the following topics: •How to identify which clinical situations are, and are not, suitable for a brief intervention •Key elements of a successful brief motivational intervention •Barriers (and how to overcome them) to deliver BMI in the Emergency Room •Elements that influence adherence to treatment and successful referral •Review of the existing scientific evidence The course will be very interactive. Videos, group dynamics, and role playing techniques will be used. At the end of the course, trainees should be able to: •Identify when a BMI is suitable •Know the theoretical principles of BMI •Be able to deliver consistent BMI to patients in need •Understand key elements for a successful referral

Ethics (from the Greek ‘εiks: the best way to behave”) is, according to the Oxford dictionary “the branch of knowledge that deals with moral principals”. Moral principles govern a person’s behaviour. Aristotle held “virtues” as the guiding principal, Kant “duty”, whereas utilitarianism stipulates that the “guiding principal” should be “the greatest happiness or benefit of the greatest number”. In medicine ethics are based on the Hippocratic oath, nowadays expressed in the “Declaration of Geneva” (2017). Two moral principles in this medical oath are crucial: - respect for the autonomy of the patient and their safety (in a broad sense: both physical and intellectual (privacy). In clinical practice, medical doctors struggle, on daily basis, with dilemmas around these themes. What to do, if there are appropriate treatments but the patient declines them or cannot express his will? When a patient expresses a wish to die or asks their doctor to refrain from treatment this is particularly challenging. In cases of cancer, few will doubt that the doctor should abide by the patient’s wishes. In psychiatry the doctor will struggle with the dilemma of whether the patient understands what they ask for and its consequences, particularly if it appears to be suicidal ideation? In other words, does the patient have capacity to oversee the consequences of his ideas, are they an autonomous agent? These themes will be explored and discussed in the groups or subgroups, using case vignettes.

Borderline personality disorder (BPD) is very common, with an estimated community prevalence of 1-3%, rising to 25% in psychiatric inpatients. Nevertheless, diagnostic assessment and disclosure in patients suspected to suffer from BPD can be difficult and even uncomfortable to many clinicians. In a survey among psychiatrists, 57% indicated they had failed to disclose a diagnosis of BPD at some point in their careers, citing diagnostic uncertainty and concerns about stigma as key issues (Sisti et al. 2016). This workshop will engage the audience in an intensive discussion of the challenges clinicians face when diagnosing borderline personality disorder (BPD). We will first review when and how to disclose a suspected diagnosis of BPD to a patient, and how to involve the patient in the diagnostic process. Secondly, we will work through some common difficulties during BPD diagnostic assessment, including the differential diagnosis with other personality disorders, trauma-related disorders and developmental disorders, as well as how to deal with comorbid psychiatric and somatic conditions. Furthermore, we will address how the new dimensional approach to the classification of personality disorders adopted by ICD-11 (WHO, 2018) diverges from the classical categorical case definitions used in the ICD-10 and DSM-IV/DSM-5 diagnostic frameworks, thereby significantly altering the concept of personality disorders. We will demonstrate how to diagnose BPD according to the new classification models, using the DSM-5 checklist and PID-5 diagnostic interview. Finally, we will illustrate some of the complexities of ICD-11 versus DSM-5 diagnostic perspectives with reference to a real-life court case.

Proposed by the EPA section on Women, Gender and Mental Health -The first speaker will outline key areas where progress in women’s mental health has been made in recent years. They include an increasing recognition of the important role that maternal mental health in the perinatal period has for the developmental trajectory of children and family function, and an increasing awareness of the links between women’s physical and mental health and social determinants, including violence in the home and community. Effective mental health and other services that target affected women and their families are increasingly supported by policy makers. Intimate partner violence is widespread globally and the main burden is borne by women with a range of poor outcomes. The second speaker will present data of a recent population study that examines the strength of it’s association with mental disorders in in male perpetrators and will discuss implications for risk reduction. It is now well established that there are significant differences in the suicidality of men and women. The third speaker will examine what we have learnt so far about factors that may explain the higher risk of suicide attempts and lower risk of suicide in women and the implication for prevention strategies. Human trafficking affects an estimated 20 million people worldwide. The last speaker will present data on the prevalence of mental disorders in female victims. At least some women will come into contact with mental health services who have a key role in responding to their needs. The presenter will discuss appropriate assessment, interventions and training.

Ironically, our beloved globalization brought us a new dystopia, in which the fight against the COVID-19 epidemic led to place half of humanity in quarantine. It is well known that psychosocial stressors and protective factors are linked in a multitude of ways to longevity: risk of suicide and psychosocial stress/social support, psychopathologies such as depression, post-traumatic stress disorder and others that impact the body, and the lifestyle that may modify social connectivity. Patients with psychiatric disorders are particularly vulnerable to the negative consequences of the outbreak. Dominik Moser will discuss the mechanisms and quantifications of the social distancing in term of adverse consequences on health. Pilar Saiz will present data on the prevalence and risk factors of suicidal ideation in the Spanish general population early in the COVID-19 pandemic. Emilie Olié will characterize the psychological impact of the French lockdown in a cohort of patients suffering from mood disorders followed up 6 months. Danuta Wasserman will present a Swedish perspective (Sweden being an exception in the collective management of the pandemic) and ethical issues raised by not protecting sufficiently the elderly population. These presentations will help to better monitor psychosocial needs and to deliver support to patients in the age of COVID-19.

Major depression is a serious, disabling, often chronic or recurrent mental disorder affecting over 350 million people worldwide. Treatment of major depression is now conceptualized as proceeding through three phases: the acute phase, the continuation phase, and the remission phase. Patients not achieving remission after several treatment trials are defined treatment-resistant, but a debate is ongoing regarding how many trials must fail before a patient can be defined as “treatment-resistant”. A new concept of “difficult to treat depression” has been recently proposed, based on the model of other medical disciplines. According to this concept, when a complete control of the disorder is not feasible, the treatment should aim at minimizing the impact of symptoms and the side effects of treatments on patients’ daily lives. Moreover, the concept of difficult to treat depression includes the presence of co-occurring problems/behaviours/disorders/situations, which can worsen the course or management of depression. The management of difficult to treat depression include the optimization of disease management, in terms of symptom control, improvement of daily functioning and of quality of life, rather than aiming to achieve sustained remission. In this symposium, the model of difficult to treat depression will be described and the possible therapeutic implications for clinical practice will be discussed. The dimensional treatment model of depression will be introduced and atypical presentations of major depression will be highlighted in order to increase clinicians’ opportunities to manage major depression.

Proposed by the EPA section on Schizophrenia -The goal of schizophrenia treatment has shifted from symptom reduction and prevention of relapses to functional recovery. However, recovery rates remain very low. Early intervention and identification of predictors of clinical and functional outcome is essential to implement personalized and integrated treatment programs to prevent disability and promote recovery. Stratification of subjects with high-risk status, first-episode and chronic schizophrenia using several predictors of clinical and functional outcome might contribute to early recognition, treatment, rehabilitation and personalized care, promoting prevention of disability, independent leaving, social inclusion and user satisfaction. The symposium will present data in chronic and first-episode patients on predictors of clinical and functional outcome, along with perspectives on personalized and integrated management programs in subjects with schizophrenia and high-risk status.

Scientific research is essential in improving care of patients with mental health problems. European Psychiatry is the official journal of the European Psychiatric Association and is published since 1986 with the aim to improve the lives of patients with psychiatric disorders and to promote professional excellence through education and research. The course will provide essential information on how to write and successfully publish a paper in European Psychiatry. The teachers of the course are the two editors of the journal who will actively interact with participants in order to improve their writing skills. In particular, during the course, participants will be invited to discuss their experience with scientific journals and will be provided with practical suggestions on how to write good papers. Participants will be guided through the journey of publication from the hypothesis-based approach to Editor’s expectations until acceptance of manuscripts.

Proposed by the EPA section on Psychopharmacology -Psychopharmacology during Infections, including COVID-19 Infectious diseases are more frequent among people with psychiatric disorders as compared to the general population and they significantly contribute to the higher mortality rates observed in psychiatric disorders, e.g. schizophrenia, depression, bipolar disorders. Psychiatric residency training and continuing medical education for psychiatrists provide very limited or no information about the management of psychiatric patients with infectious diseases. The COVID-19 pandemic confronted the health care systems with enormous challenges, including the treatment of psychiatric patients suffering from coronavirus infection. The main objectives of this symposium are: 1. to provide data about the importance of infections for patients with psychiatric disorders; 2. to provide state of the art information about the management of patients with comorbid psychiatric disorders and infectious diseases; 3. to help integrating the lessons learned from COVID-19 pandemic into psychiatric practice. The following specific topics will be addressed: 1. The prevalence of comorbidity and mortality associated with infectious diseases in patients with psychiatric disorders (presenter: Istvan Bitter, Hungary); 2. The challenges of psychopharmacological treatment during the COVID-19 pandemic in Lombardy* (presenter: Antonio Vita, Italy); 3. The interactions between Covid-19 drugs and psychotropic agents (presenter: Christoph Hiemke, Germany); 4. The pharmacotherapy of infections in patients with mental disorders receiving psychotropic drugs: focus on good practices (presenter: Matej Stuhec, Slovenia). * Lombardy is one of the regions in the world hardest hit by the COVID-19 pandemic.

Proposed by the EPA Section on Child and Adolescent Psychiatry and Neurodevelopmental Disorders Across the Lifespan (NDAL) -Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a high prevalence, i.e. Centers for Disease Control and Prevention reported that 1 in every 54 (1.9%) 8-year-old children had been identified as having ASD in 2016. The symptoms of ASD – which are associated with significant impairment in family, social and/or educational, occupational, or other important areas of functioning - typically present in early childhood, and always persist into adulthood. Therefore proper assessment and comprehensive management of ASD is necessary across the lifespan. Moreover, individuals with ASD often present with comorbid disorders, i.e. altogether 70% of people with ASD have at least one co-occurring psychiatric disorder. The most common comorbidities next to ASD are mood disorders, anxiety disorders, and attention deficit hyperactivity disorder. All these can often lead to challenges in the assessment and management of ASD. The lectures of the symposium aim to help clinicians’ work in the field of ASD across the lifespan. The speakers are professionals from child to adult mental health services as well. The topics of the presentations include: 1) the introduction of a new semi-structured clinical interview designed to support healthcare practitioners in assessing ASD in children, young people, and adults (Susan Young). 2) the demonstration of challenges in the treatment of patients with ASD and comorbid ADHD through clinical cases (Judit Balazs). 3) Pharmacological treatment of adult Autism Spectrum Disorder (Josep Antoni Ramos-Quiroga), 4) Psychological management of adult Autism Spectrum Disorder (Kobus van Rensburg).