Welcome to the EPA 2021 Interactive Programme
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Fully Live with Live Q&A On Demand with Live Q&A ECP Session Section Session EPA Course (Pre-Registration Required) Product Theatre
Sessions with Voting Ask the Expert Live TV
Browsing Over 53 Sessions
- Pre-Recorded with Live Q&A
- Pre-Recorded with Live Q&A
Key processes in human neurodevelopment take place within the biological environment of pregnancy and birth. Insults within this biological context can have long-term consequences on brain function, ranging from learning disabilities to complex psychiatric disorders such as schizophrenia. Birth asphyxia is the failure to start regular respiration within a minute of birth and is a neonatal emergency that may cause hypoxia (insufficient supply of oxygen to the brain and tissues) and possible brain damage or death, if left untreated. The perinatal period is associated with high risks and represents one of the first developmental milestones of brain development. During childbirth, there are cellular processes in place that increase the resistance of neurons to hypoxia and ischemic damage. These cellular processes are resilience factors that should protect against hypoxic insult. Previous reports have found alterations in genes regulated by hypoxia in schizophrenia and the lack of hypoxia related resilience factors in the presence of birth asphyxia might increase the risk for schizophrenia development. Therapeutic interventions for birth asphyxia, typically before the onset of clear neurological and behavioral symptoms, might prevent or ameliorate the development of schizophrenia later in life.
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.
Depression, anxiety, mental suffering, sexual violence, domestic violence and escalating substance use affect women more than men worldwide. The high prevalence of sexual violence suffered by women and the correspondingly high rate of post-traumatic stress disorder (PTSD) makes women the largest single group of people affected by this disorder. Thus, gender-specific risk factors for common mental disorders that disproportionately affect women include socio-economic disadvantage, low or subordinate social status and rank, dependence on men and hugh responsibility for caring for others. e.g. children. The effects of long-term, cumulative psychosocial adversity on mental health have still not been sufficiently taken into account and studied. Despite clinical guidance on the role of mental health professionals in identifying violence against women and responding appropriately, poor identification persists and can lead to non-engagement with services and poor response to treatment. Knowledge should be gathered on the prevalence and causes of mental health problems in women and on the factors that mediate and protect them. The symposium aims to contribute to improving the mental health of women. The first speaker will talk on „Mental health and human rights of women“, the second speaker will focus on „Mentally ill mothers: How to improve their mental health“. The third speaker´s presentation will be on „Mental health of women with immigrant, refugee and asylum seeker background - how can they be engaged and supported?", while the last speaker will highlight "Gender Inequity in Health: How can it be changed?". All presentations will be discussed with the plenum.
Proposed by the EPA section on Neuroimaging -One of the major limitations of current therapeutic management of psychoses is the lack of predictive, personalised medicine tools that could inform clinicians’ as choice of treatment for individual patients, aiming to improve functional outcomes while preventing adverse metabolic side effects (e.g., weight gain, metabolic syndrome, diabetes). In current clinical practice, poor efficacy or adverse side effects of treatments can present months after commencement of treatment. Even if therapy is adjusted, it might already be too late for the patient to fully recover from such comorbidity. Therefore, prompt identification of a patient’s risk profile is essential for selecting an optimal preventative therapeutic strategy. In a personalised medicine approach to disease treatment and prevention of comorbidities, a patient would first undergo a comprehensive screening by a range of diagnostic tools, which would predict the patient’s mental, functional and somatic outcomes given various lines of treatment, and thus help identify the optimal treatment strategy. Recent research using molecular profiling approaches (such as metabolomics) and neuroimaging suggests that such prediction of patient outcomes, even in individuals at clinical high risk for psychosis, may be feasible. The aim of this Symposium is to cover recent advances in the domain of outcome prediction, with specific focus on use of high-dimensional and multi-modal data such as from ‘omics’ and neuroimaging.
This symposium will discuss a) novel mechanisms of CNS and peripheral metabolic function (insulin resistance, the mitochondrial pathway of epigenetic regulation of neuroplasticity, neuropeptides) in cross-species models; b) the crosstalk between glial cells and neurons in the regulation of neuroplasticity and c) the need for integrated system-level strategies to identify and more effectively treat biologically based subtypes of depressive disorders and block the progression to dementia. New data of brain-enriched exosomes will also be presented as a new frontier to study in-vivo CNS molecular mechanisms in humans. Pierre Magistretti will present new data on the role of neuron-glia metabolic coupling in neuronal plasticity and neuropsychiatric disorders pointing to a novel action of L-lactate as a signaling molecule in addition to its role as an energy substrate. Carla Nasca (presenter) will present new data on the role of exosomes in psychiatric disorders and the emerging role of mitochondria as regulators of epigenetic programming of neuroplasticity in depressive disorders and rodent models. Aleksander Mathe will discuss the impact of targeting neuropeptide Y pathways in depressive disorders and post-traumatic stress disorder and present both preclinical and clinical data. Natalie Rasgon (chair and presenter) will describe conceptual model of the panel as a unique translational platform for studies of metabolic phenotypes in the progression from depressive disorders to dementia.
Proposed by the EPA Section on Neuroimaging -Converging evidence suggests that patients with major psychoses such as schizophrenia, bipolar disorder or major depression suffer from deficits in brain anatomy and neurocognitive functioning. Also, enhancing neuroprotective mechanisms and anti-inflammation mediators has recently been shown to be beneficial in these disorders. In this context we will present findings from proof of concept studies with aspirin and N-acetyl aspartate in the treatment of depression in bipolar disorder patients. The potential neuroprotective role of long-term antipsychotic therapy on brain anatomy and myelination in psychotic patients will also be debated. Moreover, we will show distinct and shared contributions of diagnosis and symptoms to neurocognition in severe mental illness in the Paisa population in Colombia. In particular, Bipolar-I and schizophrenia displayed nearly identical impairments in accuracy and speed, across cognitive domains, whereas bipolar-II and major depressive disorder performed similarly to controls, with subtle deficits in executive and social cognition. Finally, we will describe the impact of specific hippocampal subfields on negative symptoms and verbal learning in first-episode and drug-naïve schizophrenia patients. This symposium will be extremely innovative, trying to disentangle the complex inter-relationships between treatment, neuroanatomy, psychopathology and cognition in major psychoses, with the long-term goal of improving response in this patient group along with their quality of life. Finally, the data presented in this symposium we will also be crucial for testing novel interventions in this important area of drug development for the treatment of schizophrenia bipolar disorders, and major depression.