Proposed by the EPA Section on TeleMental Health -The 21st century has witnessed a fast-paced revolution in information technologies, that in turn contributed to the spread of new complementary diagnostic and clinical tools for mental health, which are likely to become a standard of practice in the near future, especially for younger generations of psychiatrists. The symposium will provide an introduction on the main past and contemporary issues related to the diagnostic process in psychiatry and innovative digital approaches to psychiatric diagnosis will be presented. In detail, Neuroanalysis represents a novel integrative approach, based on a patient-interactive digital platform which couples EEG-based imaging data with machine-learning algorithms to measure brain network activity in psychiatric diseases. Digital Phenotyping takes advantage on biosensors and allows to analyze several digital parameters (individual level of activity, GPS location, use of voice/speech, use of social media and human-computer interactions) in real time. Its clinical potential in relation to monitoring the transition from at-risk conditions to initial stages of mental illnesses, in providing accounts of early signs of relapse, and in promoting recovery will be addressed. Finally, the use of automated technologies to perform innovative clinical assessments will be reviewed, with specific reference to the identification of subjects at high risk for neurodevelopmental disorders. Digital tools today represent potentially cost- and time-effective tools for clinical providers to help support early detection and diagnosis of psychiatric disorders and their potentials as well as their caveats for clinical practice will be thoroughly discussed.

Proposed by the EPA sections on Psychopharmacology and Old Age Psychiatry-According to the data, more than 50% of elderly patients with mental disorders are treated with multiple drugs (e.g. 5 or more medications), which can lead to medically unnecessary polypharmacy (i.e., irrational polypharmacy). Due to frequent comorbidities and treatments in the elderly, polypharmacy is the rule rather than the exception and can lead to several harms, treatment failures, and inappropriate prescribing. Elderly patients on polypharmacy (rational and irrational) are also excluded from many clinical trials and consequently, this age group is underrepresented in meta-analyses and clinical guidelines as well, which leads to a lack of evidence-based medicine supported results useful for daily practice. In this context, the prudent deprescribing process is a key step in irrational polypharmacy reduction. The purpose of deprescribing is to reduce inappropriate polypharmacy, medication burden and harm, and to improve patient health-related outcomes. There are some tools available that can help in the deprescribing process in clinical practice, including different medication lists (e.g. Beers criteria, STOPP/START, and guidelines). This proposed joint workshop of the Section of Old Age Psychiatry and the Section of Psychopharmacology will address a neglected topic: why and when to use the deprescribing process of psychotropics in elderly patients in real clinical settings. Experts in psychiatry and psychopharmacology will specifically address the use of the deprescribing process of antidepressants, antipsychotics, hypnotics, and other psychotropics in this population. The participants will learn why is important to use deprescribing processes supported by evidence-based data and real clinical pharmacological tools useful for daily practice.

Proposed by the EPA section on Addictive Behaviours -Patients with psychiatric disorders and co-occurring addictive disorders often pose a clinical challenge, both in the diagnostic process, as well as during treatment. Co-occurring substance use may interfere with clinical assessment and often requires adjustment of pharmacological and psychological treatment approaches. However, comorbidity between psychiatric disorders and addictive disorders is rather common with about 30% of cases also having a substance use disorder, depending on the type of psychiatric condition and treatment setting. As a result, every clinician working in psychiatry will encounter clinical dilemma’s as described above. In this symposium, experts in the field co-occurring addictive disorders in psychosis, bipolar disorder, suicidal behavior and ADHD will share clinical dilemma’s and scientific answers to these dilemma’s. With this symposium, the speakers intend to provide tools and advice to come to more personalized and integrated treatment for your patients. Speakers will share data, recent literature and their view on diagnosis and treatment in patients with psychosis, bipolar disorder, suicidal behavior and ADHD. All speakers are connected to the Network of Early Career Professionals working in the area of Addiction Medicine (NECPAM: http://necpam.co/).

Proposed by the EPA section on Neuroimaging -Brain subregional shrinkage is commonly reported in major affective and non -affective psychosis, but its role in the illness is still poorly understood. In particular, it is unclear how clinical and psychosocial variables relate to brain volumes across the life span.  In particular, longitudinal studies have reported a correlation between larger ventricles, decreased prefrontal volumes and worse outcome in psychoses. This would potentially allow to isolate subtypes of schizophrenia patients with a worse prognosis and more evident biological impairments, ultimately helping in designing specific cognitive rehabilitation. This symposium will focus on the correlations between environmental variables and psychotic and affective disorders. Four international recognised speakers in the field will represent countries from Europe, UK and USA. Prof. Kirkbride will describe whether environmental factors (e.g. urbanicity, migrancy, residential stability) may relate to increased risk of affective and non-affective psychosis. Prof. Fiorillo will delineate the impact of adversities during adolescence on the development of psychosocial disability and mental disorders, and how these can influence their long-term trajectory.  Prof. Brambilla will show the impact of disability and social functioning on brain anatomy in schizophrenia and bipolar disorder. Prof. Frangou will present data from a nationally representative  cohort of 10,000 children aged 9-10 years in the US, quantifying the effect of being raised in a psychosocially disadvantage environment and delineating the separate and cumulative effect of risk and protective factors. It has finally to be noted that this is an official proposal from the  EPA Neuroimaging Section.

Proposed by the EPA Section on Schizophrenia -Apathy as a negative symptom of schizophrenia is conceptualized in terms of reduction of goal directed behavior due to a lack of interest and motivation for goal-directed behavior initiation and persistence. The revised diagnostic criteria for apathy (DCA) have been proposed for trans-diagnostic use to better identify apathy across a number of neuropsychiatric disorders. The Section workshop aims to illustrate and discuss the overlap and specificity of apathy in schizophrenia with the trans-diagnostic construct identified by using the DCA. A European study on apathy in schizophrenia will be illustrated and preliminary findings reviewed to highlight the limitations of apathy as defined by the DCA in the context of schizophrenia. The relationships of apathy defined using DCA with the negative symptom domain of Avolition in schizophrenia and its overlap with functional impairment due to cognitive deficits/ depression/ extrapyramidal side effects will be discussed. Data in first-episode patients with schizophrenia will be reviewed to illustrate how the negative symptom domains and cognitive impairment are key factors in the prediction of long-term impairment in real-life functioning. Finally, the therapeutic perspectives for the treatment of apathy in schizophrenia, both when primary to the disorder process or secondary to other dimensions of schizophrenia will be reviewed and discussed.

Proposed by the EPA Section on Prevention of Mental Disorders. - Early intervention in Psychosis is one of the most dynamic and original areas in contemporary mental health for several interrelated reasons. Indeed, in the last two decades EIP has been a tremendous catalyzer for research, service-reform and concept-innovation in the broader field of psychiatry. However, as every innovative paradigm, EIP has entered a maturity phase in which reconceptualization of goals, strategies and opportunities to solve wide-scale, real-world problems are mandatory. This symposium will offer a critical, multilateral over-view of the EIP field, capitalizing on the contribution of leading international clinicians and researchers who have a direct, plurennial experience in the field. The symposium proposal is a collegial expression of the EPA Section of prevention of mental disorders.

Proposed by the EPA sections on Old Age Psychiatry and Suicidology and Suicide Prevention -At advanced age, rates of males diverge even more from those of females. A better understanding of these factors may reduce the toll of suicide at these extreme ages as Prof. de Leo is going to discuss. Prof. Zeppegno will focus on the even twofold rate of suicidal behaviours when there is a chronic or terminal illness. Psychiatrists and geriatricians will likely meet mentally competent older adults expressing a wish to die: sometimes entangled with e.g.chronic illness, sometimes in the absence of terminal illness, but due to the feeling that they have already lived a completed life. The possibility of a "rational suicide" will be discussed. Prof. Stek is going to discuss the problem that in late life depression the clinical management of suicidality is often complicated by the presence of physical and neuropsychiatric comorbidity. Moreover, in The Netherlands the position of euthanasia in end of life choices may interfere with available diagnostic and treatment options. The challenges of well substanciated decision making in these situations will be discussed. Although interventions for suicide prevention are known, their relative effect for the elderly in general have not been explored. Prof. van der Feltz-Cornelis will discuss in her lecture what could be aspects of relevance for interventions in this specific age group. And finally Prof. Hegerl will show – at the example of a recent increase in gassing suicides – which role the media and especially the internet plays for the methods of suicide and what it could mean for suicide prevention.