Welcome to the EPA 2022 Interactive Programme 

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Human beings need social group identities. These may be based on age, sex, gender and gender identity, ethnicity, religious beliefs, language, nationality and etc. In fact, in-group identities, collaborations and reference systems have positive effects on health / mental health. But, the problematic issue is the process of Othering and Dehumanization of the group designated to be the Other. Othering, rising from imagined or the expectation of generalized differences and used to distinguish groups of people as separate from the norm reinforces and maintains discrimination.

Social power relations determine the stratification of ‘them’ and ‘us’. Whether a group is to be designated as the Other and labelled with prejudice will depend on the zeitgeist of the current dominant social power. Dehumanization created many tragedies via genocide, slavery, racism, sexism, and other intolerant forms of violence. Theories, generally termed as scientific racism of late 19th. & early 20th. centuries, times of colonialism, assumed that some races are inferior to others, and that differential treatment of races is consequently justified. Such approaches led to movements of unification / purification practices which cannot be legitimate and caused vast individual and institutional racial discrimination, human rights violations and violence.

As a social determinant of health, racial discrimination and ethnocentrism, a powerful force that weakens human relations, continue to afflict the health and mental health conditions of people. Albeit racial discrimination, peoples of the world also have a history of effective praxis of inclusive ways of solving conflicts of interests between in-groups and out-groups.

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Background: Many patients suffering from schizophrenia spectrum disorders continue having distressing auditory hallucinations and paranoid ideations despite receiving current treatment. Virtual reality assisted treatment offers the potential of advancing current psychotherapies for psychotic symptoms by creating virtual environments that can elicit responses (e.g. thoughts, feelings, behaviours) mirroring real-world settings. In two large-scale randomised clinical trials, we are investigating whether targeted virtual reality assisted psychotherapy can reduce psychotic symptoms and increase daily life functioning and quality of life. The CHALLENGE trial examines whether nine sessions of virtual reality-assisted psychotherapy is superior to nine sessions of standard treatments in reducing the severity, frequency, and distress of auditory hallucinations in patients with psychosis. In the Face your Fears trial we are investigating whether virtual reality assisted cognitive behavioral therapy (CBT) is superior to standard CBT in reducing levels of paranoid ideation in patients with psychosis spectrum disorders.

Methods: The CHALLENGE and Face your Fears trials are randomised, assessor-blinded parallel-groups superiority clinical trials, allocating a total of 266 and 256 patients, respectively to either the experimental intervention or a control condition. The trials are currently enrolling patients; thus, no quantitative data is available yet. The main objective of this presentation is to give a qualitative account of this new psychotherapeutic methods as it is applied in both trials.

Results: Qualitative data comprising case descriptions and video material will be presented at the conference.

Discussion: The preliminary findings indicate great potential for these innovative treatments albeit important concerns regarding implementation will be raised.

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Gender equality leads to better health and mental health for women and girls as well as to better public health and mental health for all. Inequality, discrimination and social exclusion are both cause and consequence of mental health problems for all and affecting women and girls in specific and substantial ways. Equality through the realization of non-discrimination, respect and enablement of autonomy as well as full inclusion in all spheres of life are demands of gender equality legislation as well as human rights obligations for persons with mental health problems. Essentials of non-discrimination laws concern key areas, including health, family planning, marriage and parenthood, employment, housing, education, standards of living and social, political and cultural participation, along with the right to be free from exploitation, violence and abuse. Gender-specific attention to the risks, rights and needs of women and girls and their families are legal obligations as well as clinical and scientific responsibilities. Because of the cumulative and interacting gender-based and other forms of discrimination, regulations such as those following the adoption of the UN-Convention on the Rights of Persons with Disabilities include specific provisions for women with psychosocial disabilities. Other examples for the urgent necessity of a gender-sensitive approach are – among many others - safety and gender-responsiveness of community and hospital settings, humanitarian crisis response, working with family carers, and of course, mental health teaching and research, including efforts towards gender parity in academic psychiatry.

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Violence against women is widely recognised as a violation of human rights and a public health problem. The most common forms of violence against women are domestic abuse and sexual violence, and victimisation is associated with an increased risk of mental disorders. It is reported that a three times increase in the likelihood of depressive disorders, a four times increase in the likelihood of anxiety disorders, and a seven times increase in the likelihood of post-traumatic disorder (PTSD) for women who have experienced domestic violence and abuse. Significant associations between intimate partner violence and symptoms of psychosis, substance misuse, and eating disorders have also been reported. Furthermore, systematic reviews of predominantly cross-sectional studies report consistent relationships between being a victim of domestic violence and abuse and having mental disorders across the diagnostic spectrum for men and women, but since women are more likely to be victims, the population attributable fractions are higher for women. In this presentation, the focus will also be on 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. After a literature review, we will present and discuss current data from parental consultation and a survey on violence during the Covid-19 pandemic in Berlin.

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Suicidal behavior is a complex human behavior expressed in a spectrum of various acts. From a suicidal gesture to a completed suicide, all reflect a cry for help and need clinical and scientific attention. The process ending up with suicidal act is shaped by multi-factors, including the socio-cultural ones.

Suicide is indeed related to a deep feeling of hopelessness; not to have any control over their lives and circumstances except than deciding to stay alive or dead, and so related to serious psychopathologies, as depressive and substance use disorders. Hence, it is frequently seen as a personal act or as a question of individual decision. But since Durkheim‘s ground breaking work, which still inspires suicide researchers, the cultural factors behind this socially determined phenomenon have been widely discussed.

Suicide is totally a personal act and a fully socio-cultural phenomenon. The cultural factors of suicidality are among the social determinants of health/ill health. Epidemiological evidence and cross-cultural comparisons show huge differences in suicide rates across countries and even between regions of same countries, and these are constant differences. Furthermore, even the definition of suicide is effected by the social circumstances. Certain socio-cultural patterns shape how and when people commit suicide; i.e., these patterns have decreasing or increasing effect on suicide rates, which provides basis for suicide prevention. Likewise, social solidarity, high group integration and collective sensitivity may have preventive effects. This brings us to the discussion of the effects of big social turmoil or wars or pandemics on suicidal behavior.

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Aging persons can become involved in the criminal justice system, more commonly as victims but also as offenders. They are a growing group of interest in forensic psychiatry, due to the ageing of the population. Moreover, they are overrepresented in long-stay facilities. Forensic psychiatrists may be asked to evaluate elderly individuals whose behaviour has become problematic to their families, caregivers, or third parties. We will focus here on problematic behaviors in eldery people, particularly disinhibition, agitation and aggression, and criminal behaviour and the incarcerated eldery. Forensic psychiatric assessment with new-onset criminal behaviour require special inquiries regarding criminal responsibility or competency to stand trial. Little research is available regarding criminal behaviour in eldery persons in correctional settings.

In this paper a forensic-psychiatric expert report will illustrate these topics.

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Old age population is growing steadily during last decades (WHO 2017). Old population suffer from more morbidity including mental disorders (De Lorito,2018). This fact also applies for prison population (Yortons 2006) and in the lasts years has been an increasing interest for this topicThe aging of the world population is reflected in the penitentiary setting, with a progressive increase of elderly inmates. These prisoners present complex clinical processes with multiple comorbidities, requiring a specialized approach. In the 2020, the old age population in prison (considered over 60 years old) is around 5% in Catalonia (377 inmates,), same proportion (5%) in Spain.If we consider the cut-off point 50 y.o. (as other research) the proportion is 12%

Our aims are to describe sociodemographical and clinical characteristics of old age inmates (over 50 y. o.) who required to be admitted to psychiatric unit in Catalan prisons between 2016 and 2020. The asample of this study will be around 150 inmates admitted in our unit.

Elderly inmates present a high prevalence of substance abuse (especially alcohol), affective symptoms (depression) and cognitive deterioration. Likewise, is observed a significant presence of personality disorders, anxiety, post-traumatic disorders, psychotic disorders, and physical comorbidities.

Prisoners over 50 have a different profile from the rest of the prison population. They suffer more physical and mental illnesses, so they require specific health and social approach. It would be advisable to adapt clinical care by optimizing resources, developing prison psychogeriatrics and establishing specific evaluation and treatment method