Welcome to the EPA 2022 Interactive Programme 

Organised by the EPA Section on Cultural Psychiatry. Racism and racial discrimination are one of many factors which can have a significant, negative impact on a person’s life chances and mental health. There is a particularly disproportionate impact on people from Black, Asian and minority ethnic communities, notably those of Black African and Caribbean heritage. Racism is pervasive and can manifest in several often-overlapping forms (including personal, cultural, structural and institutional racism). Like other types of discrimination, it can lead to a profound feeling of pain, harm and humiliation among members of the target group, often leading to despair and exclusion. This symposium will adress racism in the context of migration, the neurobiological underpinnings of racism as well as it’s impact on mental health, and racism and psychiatry. Efforts to tackle this should be urgently prioritised by health policies and professional bodies. Implications for mental health care and mental health care systems will be discussed.

Issues: 1. BPD is a common mental disorder (1 to 2% of general population), as severe as schizophrenia or diabetes in terms of loss of years of life (10 to 25 years). 2. Psychotherapy is the first line treatment recommended, but availability and acceptability are limited. 3. General psychiatrists express difficulties treating BPD patients. Description: Guidelines emphasize on psychotherapeutic treatment as they are the most studied and successful type of treatment. However, a large proportion of BPD patients do not have access to psychotherapy for different reasons (i.e.: this kind of treatment does not exist in their area, patient is not motivated). In this course, we will review clinically useful strategies to improve the outcome for these patients, which can be used whether the patient has access to psychotherapy or not. First, we will present ways to review diagnosis and efficient ways to offer psychoeducation to the client. Then we will consider treating clinical comorbidities such as addiction, PTSD, depressive disorder, ADHD. Furthermore, we will present the common medical disorders in this population and some tools to improve their medical management (screening, follow-up). We will highlight the potential of lifestyle medicine (improving nutrition, sleep, physical activity). We will discuss the strengths and weaknesses of psychiatric hospitalization and emergency services and offer guidelines for efficient case management. Considerations related to the usefulness of psychometric tools (screening and outcome measures) will be discussed. Lastly, we will introduce some new kinds of treatments and discuss prevention.

Organised by the EPA Section on Eating Disorders. Eating disorders (EDs) are severe psychiatric conditions with potential life-threatening complications. Although, the overvaluation of shape and weight are believed to be the central core of ED psychopathology, recent studies also demonstrated the centrality of general psychiatric symptoms (anxiety and depressive symptoms, post-traumatic stress symptoms, autism spectrum disorder symptoms, interpersonal problems and ineffectiveness) together with ED core symptoms (drive to thinness and interoceptive awareness) in patients suffering from anorexia nervosa, bulimia nervosa or binge-eating disorder. Therefore, there is a need for clinicians and researchers to provide a detailed characterization of the patient’s psychopathology in order to identify possible treatment targets, characterize new pathophysiological mechanisms and propose more accurate therapeutic and prevention interventions. The aim of this symposium is to illustrate new advances in psychopathology and treatment of EDs, which may provide a more comprehensive clinical evaluation of people suffering from these conditions in order to suggest new perspectives for research, prevention and/or treatment of EDs. To this purpose, Prof. Kate Tchanturia (London, UK) will discuss the relationships between EDs and autism spectrum disorders. Prof. Alessio Maria Monteleone (Naples, Italy,) will present the impact of the recent COVID-19 pandemic on the psychopathology and treatment of people suffering from an ED. Prof. Ashish Kumar (London, UK) will illustrate new advances in the treatment of children with EDs. Prof. Fernando Fernandez-Aranda (Barcelona, Spain) will analyze factors that predict the outcome of treatments in person with EDs.

Organised by the EPA Section on Schizophrenia. Cognitive dysfunctions represent a core feature of schizophrenia, are present at any stage of the disease and in subjects at high risk for psychosis (UHR), and have a significant impact on patient psychosocial functioning. Pharmacological treatment is modestly effective on cognitive dimension while there is considerable evidence of the efficacy of cognitive remediation interventions on cognition and functioning. The Workshop, proposed within the activities of the Section on Schizophrenia, has the aim of updating knowledge and discussing about the definition of cognitive impairment in schizophrenia, the impact of cognitive dysfunctions on the patients' real life functioning and quality of life, the available assessment instruments, the detection of impairment in early intervention settings, and the possible treatments, both pharmacological and non-pharmacological, with a special focus on cognitive remediation techniques. All these topics will be debated by the panel of experts involved in the preparation of the EPA guidance paper on the assessment and treatment of cognitive impairment in schizophrenia.

“There Are things patients Want to Say But clinicians Do Not Ask”. The patient-centred perspective on treatment outcomes is an effective way to provide care that really matters to patients. Assessing users' outcomes and experiences of treatements will help to understand whether the care provided contributes to better results – in terms of symptoms, functioning and quality of life... -, to a better experience of care, and is more tailored to their needs. Clinicians will learn how integrating the patient perspective and Patient-Reported Measures into their practice can improve care outcomes and how these findings could be included in routine care for optimal treatment outcome. The different talks will then be devoted to: (1) developing and implementing indicators that measure the outcomes and experiences of mental health care that matter most to patients (K. Debienassis), (2) how to integrate patient reported measures in routine care: lessons learned from experiences in 6 European countries (Pr Puschner), (3) the value and challenges of implementing patient centered measures in a psychiatric hospital setting (E. Scanferla, PhD), (4) how to optimise the collection of patient-reported outcomes in the context of a specific disease such as eating disorders (Pr Schmdt).

Organised by the EPA Section on TeleMental Health. Telepsychiatry, an aspect of digital psychiatry, is rapidly being adopted throughout the world as a solution for disparities in access to mental health care. Its spread has been significantly accelerated a consequence of measures taken to combat the COVID-19 pandemic. Whilst the evidence supports the use of telepsychiatry in clinical practice, clinicians have often started from a base with little or no specific training. The skills required for effective telepsychiatric care are distinct from our practices in the traditional clinic, face-to-face; adaptation of our usual practices are required to achieve optimal outcomes. The current situation may pose new risks, and there are controversies. The workshop aims to provide the audience with up-to-date techniques and information on the more important issues in telepsychiatric care, delivered by European experts in managing psychosis, suicide risk, substance misuse, transition psychiatry, care of the elderly, and forensic issues.

Organised by the EPA Section on Prevention of Mental Disorders. Early intervention in psychosis has an already established role in reducing the duration of untreated psychosis, preventing or at least delaying psychosis onset, and relieving clinical high-risk (CHR) patients them from their presenting symptoms. However, as a thorough diagnosis is always the prerequisite of a good intervention, the accurate early detection of psychoses by their CHR states is a prerequisite for an early tailored intervention in psychosis. In this course we will therefore focus on the early detection. The course participants will learn and discuss: - the concept of early detection, the rationale for the clinical approach, and the existing evidence-base - to recognize potential early signs of psychosis and learn the basics of diagnosing CHR states using different instruments for their assessment - to discuss potential ethical dilemmas, - the main theoretical challenges and - common obstacles in early detection. The course is practical and interactive, and suitable for mental health professional of all levels of experience. The participants will be able to present cases and problems from their daily work. The knowledge and experience acquired in this course are relevant as basis for the EPA course on Early Intervention and applicable to all areas of mental health. After the course the participants shall be able to detect patients possibly at clinical high-risk for psychosis.

Organised by the EPA Sections on Old Age Psychiatry and Suicidology and Suicide Prevention. Suicide rates are highest in old age, especially in elderly men. The symposium will discuss the evidence on risk factors for suicidal behaviour, showing (again), that the recognition and treatment of depressive disorders and (related) social dysfunction is crucial. Since our societies are in the process of digitalization we want to discuss e-mental-health and give a focus on the attitude to such approaches in older people as well as to the relationship between age and antidepressant outcome when using the iFightDepression-tool of the European Alliance against Depression. We will also discuss the potential influence of ageism – in the media and the society - on suicidality, a potentially underresearched area. Dying with dignity is a subject that has come up regularly in the news in Europe in recent years and applies especially to the older population. One presentation will focus on the ethical debates in various countries and especially France to allow assisted suicide and/or euthanasia. The other presentation will grasp the newest trends concerning assisted suicide during the pandemia, especially in Switzerland.

Organised by the EPA Sections on Old Age Psychiatry and Psychopharmacology. Patients with mental disorders are frequently treated for other comorbidities, including psychiatric and somatic comorbidities. While often underreported and undertreated, somatic comorbidities represent a high burden in patients with mental disorders and represent the most important cause of death. The most prevalent somatic comorbidities are cerebral- and cardiovascular diseases, different infections, and metabolic diseases. Insomnia and pain also frequently occur in multimorbid elderly patients. Despite a high burden of somatic comorbidities in this population, different studies have shown their inadequate treatment, low screening, and low treatment rates have been described. Medication selection in this population is mainly based on possible drug-drug interactions and irrational polypharmacy minimizing, often presented in this population. There are some tools available to help in pharmacotherapy selection in clinical practice, including different medication lists (e.g., Beers criteria, STOPP/START, and general guidelines). Although most important evidence-based papers and treatment guidelines describe the treatment of psychiatric disorders by often excluding somatic and non-somatic comorbidities. In this context, pharmacotherapy of comorbidities is complicated, and well-designed treatment guidelines are urgently needed. This proposed joint workshop of the Section of Old Age Psychiatry and the Section of Psychopharmacology will address a neglected topic: how to treat somatic and non-somatic comorbidities in elderly patients with mental disorders. Experts in psychiatry and psychopharmacology will address pharmacotherapy in this vulnerable population. The participants will learn how to treat these patients supported by the evidence-based data and real clinical pharmacological tools useful for daily practice.

Organised by the EPA Section on Neuroimaging. Functional Near Infrared Spectroscopy (fNIRS) is an optical technique that, using light at specific wavelengths, allows to probe changes in oxygenated and deoxygenated hemoglobin cortical concentration over time. In the last two decades, fNIRS has been widely used in the study of neuro cortical correlates of cognition and emotional processing, due to several advantages it offers over other neuroimaging modalities. In particular, fNIRS is harmless, tolerant to body movements, and highly portable, which makes it particularly suitable for subjects with different psychiatric disorders that present difficulty staying still. In the light of these premises, in this symposium the speakers will discuss present and future prospects of fNIRS for assessing cerebral cortex function in several typical and atypical conditions, from childhood to adulthood, providing examples of applications using different cognitive and emotional tasks.

The transdiagnostic approach is gaining momentum in psychiatry, probing the appropriateness of the categorical classification of mental diseases by diagnostic manuals, such as the ICD-10 or the DSM-5. The proposed symposium examines the transdiagnostic approach and provides an overview of its key components. The first lecture starts with the introduction of the transdiagnostic concept itself, and then diving into more details, the second presentation introduces psychiatric disorders’ polygenic and multifactorial architecture, as well as their shared genetic aetiology. The third lecture focuses on the impact of phenotypic overlap on intra- and inter-disease considerations and the fluidity of diagnostic criteria. Finally, in light of the presented notions, the last lecture discusses the therapeutic opportunities in transdiagnostic psychiatry with a special focus on antipsychotic treatment and the significance of partial agonists.

Organised by the EPA Section on Old Age Psychiatry. Depression is the most frequent mental disorder also in the elderly population and it is soften unrecognized and untreated. Compared to other age groups, there are differences in risk factors, symptomatology, comorbidity, differential diagnosis and management. In the course epidemiology and risk factors will be presented. Diagnosis will be discussed with special focus on the differential diagnosis to grief, dementia and anxiety disorders. Sleep problems and suicidality will deserve special attention. Regarding therapy relevant modifications of drug therapy and psychological therapies will be presented. The different types of psychotherapy for elderly (schema based therapy, psychodynamic psychotherapy, cognitive behavioral therapy) will be discussed. We also discuss neuromodulation therapies, ECT, and exercise. The management in the presence of physical disability or in special settings requires tailored interventions. Case vignettes regarding diagnosis and therapy are discussed.