The rapid urbanization characterizing the modern era determined a relevant impact on global health, acting through different pathways. Anthropogenic actions contributed to exacerbate climate change in urban areas, causing several phenomena influencing urban citizens’ wellbeing. Implications on mental health were established in most recent times, representing a growing field of research. Indeed, the exposure to urban environment has been associated to a higher risk of developing serious mental disorders. The effects of frequently uncontrolled urbanism on mental health are expected to be correlated with several factors, such as higher level of pollutants, light changes, inflammatory mechanisms, unhealthy lifestyle, psychosocial determinants. In this complex scenery, environmental resilience is crucial in order to minimize vulnerabilities and possible risks connected to critical changes. Further interest on urbanization and climate change was also raised by the recent Covid-19 pandemic, since it was demonstrated that pollution may lead to significantly higher rates of death in people infected by the virus spread. In consideration of the implications that the Covid-19 pandemic presented on mental health, the role of environmental resilience as a possible protective factor will be critically analyzed. In addition, a critical reappraisal of the specific effects of climate change and related factors on mental health will be provided. The contribution of recent approaches such as the Ecological Momentary Assesment and the use of Big Data in the analysis of the environmental determinants of mental health will be also overviewed, considering possible future developments of research in this field specifically involving climate change.

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.

Bipolar disorder is a severe mental disorder associated with high levels of personal and societal burden. Although several pharmacological and non-pharmacological interventions have been developed and are currently available in the routine the long-term treatment of bipolar patients, the rate of functional recovery is not very satisfying yet. Many unmet needs are still present in the optimal management of bipolar patients, including diagnostic, clinical and therapeutic challenges.  New perspectives are emerging for improving the clinical and functional outcomes of patients suffering from bipolar disorder. In particular, it has been recently argued that the optimal management of bipolar patients requires the evaluation of patient’s personal history according to a longitudinal perspective. In this conceptual framework, the construct of predominant polarity has been proposed by Colom for describing the predominant type of affective episodes according to a lifetime perspective. The predominant polarity has several therapeutic and prognostic implications for the long-term management of bipolar patients. Furthermore, neuroimaging correlates have recently confirmed the prognostic role of predominant polarity, highlighting the relevance of such index from a clinical perspective. In this symposium, the role of neuroimaging correlates of predominant polarity will be presented. Moreover, further new perspectives in the field of research in bipolar disorder are recently focusing on the role of childhood maltreatment and expression of symptoms during childhood as relevant predictors of long-term outcome. There is the need to translate the model of early interventions to the context of affective disorders, in order to significantly improve the long-term outcome of bipolar patients.

The symposium will present four scenarios for the future of psychiatry – seen by psychiatrists with predominantly national experience at the beginning, middle and  top of their career and by a psychiatrist with nearly fifty years of work on international mental health and psychiatry issues. The perspectives will differ and it is expected that taken jointly they will present a more realistic estimate of psychiatry in the future than those usually forecast. The presentations will address issues of diagnosis and treatment of mental disorders as well as those of training for psychiatry and its role in public health efforts. The presentations will also touch upon matters such as the impact of new digital technology and trends of telemedicine,  advances in the management of comorbidity of mental and physical disorders, and the role of psychiatry in future global crises such as those caused by pandemics and pollution and climate change.

The current diagnostic systems are subjected to continuing revision processes in order to adequately describe the complexity of mental disorders. During this process, some disorders have been progressively “forgotten” and are understudied by the younger generation of psychiatrists. Among the several reasons behind this process, there is the tendency of modern classification systems to improve the clinical utility of diagnostic categories, although reducing their validity. Furthermore, the reductionistic approach adopted by the modern classification systems has eliminated the capacity of detecting the subtle clinical differences among different patients, even when affected by the same disorder. However, the need for young generation of psychiatrists to re-discover the roots of psychopathology and the classical European tradition has been recently claimed. In this workshop, the speakers will discuss certain classical syndromes which are rarely addressed in the current educational curricula. In particular, de Clerambault, Cotard and Capgras syndromes will be presented, together with kleptomania and pyromania. The relevance of these syndromes for the clinical routine practice as well as the forensic implications will be extensively discussed.

Persons with severe mental disorders frequently experience discrimination and isolation due to the high levels of stigmatizing behaviours and attitudes held by the general population. Furthermore, stigma represents a significant obstacle not only for people suffering from mental disorders, but also for their relatives and their loved ones, who also experience stigma by association. Fighting stigma represents an “old unmet need” in the mental health field and several international and national organizations have promoted interventions for challenging stigma and improving mental health literacy in the general population. It has been clearly demonstrated that the specific cultural background can impact on the development of stigmatized belief, behaviours and attitudes about people with mental disorders. Therefore, in order to overcome stigma effectively it is needed a multicultural social perspective, even for adapting antistigma initiatives to the specific cultural context of each country or region. Although so many efforts have been put forward in fighting stigma and ending discrimination against disadvantaged people, stigma has not been overcome yet. There is the need to develop new effective, multimodal, integrated strategies in order to challenging effectively stigma. In this symposium, national experiences from different European countries will be discussed, with a specific focus on the future perspectives of research in the field of stigma and discrimination.

The COVID-19 pandemic represents a unique traumatic event which has had and is continuing to have an impact on the mental health of the general population worldwide. The pandemic is a new form of threat, different from previous mass disasters such as tsunami or earthquakes, where the threat is well defined and confined in time and space, while this virus can be everywhere and can be carried by everyone. Therefore, the pandemic and its related containment measures are associated with high levels of depressive, anxiety and stress symptoms in the general population, as well as by increasing levels of stigma and discrimination towards the infected people. However, the pandemic is expected to cause a global economic recession, with increasing rates of unemployment and poverty, which will in turn increase social disparities and suicide risk. Therefore, the most disadvantaged people, such as people living with disabilities, elderly people or migrants, are expected to be the most severely affected by the long-term consequences of the pandemic. In this workshop, international renowned speakers will discuss the impact of the COVID-19 pandemic from a social, economic and clinical perspectives, also including experiences from low-resource settings. Furthermore, a specific focus will be given on carers of patients with severe mental disorders, which have been overlooked during the initial phases of the pandemic.