Welcome to the EPA 2022 Interactive Programme 

Organised by the EPA Sections on Consultation Liaison Psychiatry & Psychosomatics and Neuroimaging. The COVID pandemic has dramatically increased the need for help in mental health disorders, and has shown a specific effect of SARS-COV 2 in the brain, with effects that may persist longer than expected. In this joint symposium we will describe new-onset and pre-existing psychiatric disorders/syndromes after covid-19 infection. First, an overview concerning Delirium and covid 19 infection will be presented, including laboratorial and neuroimaging findings. Second the impact of Social isolation duo to pandemics and its brain correlations will be explored. Third, Pre existing and new onset cognitive impairment in patients with covid 19 will be explored. Finally, the evolution of pre-existing and new onset depression and anxiety disorders after covid 19 infection will be discussed in terms of their clinical and possible neuroimaging findings.

Mental health care for transitional age (16-24y) is a new hot topic, requiring adapted care, not child-, nor adult- psychiatric treatment. Flanders(Belgium) has 4 psychiatric wards for people in transition age. We look at specifics of this treatment program, merging the psychiatric and developmental perspective into useful tools. @ease is the Dutch variant of Australian Headspace, and opened its doors in 2018. At present 5 centres are operational and the first results on the youth attending the centres will be presented, as well as qualitative data on barriers and facilitators of accessing youth mental health services. Since 1999, the development of more than 100 “Maisons des Adolescents” (MDAs) has enabled young persons to gain access to specific care in integrated youth-friendly facilities in France. The various medical programmes of MDAs depend on the priorities of local teams rather and community needs as well as on official regulations. All MDAs offer essential services such as a “Health and Prevention Space” open daily and multidisciplinary consultations. The MDAs from the start addressed an age group in transition (young people aged 11-21 years) rather than a specific illness. The success of the MDA network is already widely acknowledged by users, professionals and policy makers. Findings on temperament, cognitive, genetic and functional imaging factors will be summarised in relevance towards both alcohol initiation and subsequent transition to heavy alcohol use in adolescence, offering important links in developing early proactive interventions targeting subgroups of adolescents at risk for future alcohol use disorder and addictive behaviours.

The pharmacological treatment of MDD in terms of response and remission is still unsatisfactory. The molecular factors involved remain poorly understood. Dr Baune will present an overview on new methods to advance pharmacogenomics in MDD with a focus on polygenic risk scores and multi-omics approaches. Secondly, he will present recent studies that use a functional genomic approach to predict treatment response in severe mental illness. Thirdly, his presentation will highlight novel genomic data from the PREDDICT study. Dr Dierssen will present an overview of new approaches to examine the molecular basis of neuropsychiatric disorders at single cell resolution that allow the understanding of expression levels of individual genes and how they influence biological pathways. Examples in MDD that highlight the importance of dissecting cell-type-specific contributions to the disease and offer opportunities to identify novel targets for treatment will be discussed. Dr Minelli will present a synthesis encompassing the state of the art about clinical methodologic features of the studies investigating the effectiveness of pharmacogenetic testing for antidepressant drugs in MDD and it will address commentaries regarding their limitations and potential future perspectives for an application to real world contexts. Dr Squassina will present findings of an ongoing study evaluating the clinical utility and cost-effectiveness of pharmacogenetic testing based on CYP2D6 and CYP2C19 profiling in antidepressants. The sample includes 150 MDD patients with deep clinical phenotypic characterization, and a large set of socio-economic variables that will be implemented in a pharmacoeconomic model useful to estimate the cost-effectiveness of pharmacogenetic testing.

Treatment resistant depression (TRD) is associated with severe impairment in cognitive functioning, increased risk of developing/being associated with comorbid illnesses, decreased workplace performance, increased risk of suicide, and increased cost of care TRD is becoming a major threat to public health because TRD prevalence represents at least 15–30% of MDD cases and MDD itself is one of the most commonly encountered mental disorders with a worldwide point prevalence rate of 4.7%. The speakers will present real life data from different European countries (Poland, Hungary – AS and ZF) and discuss possible new approaches to the TRD diagnosis and treatment (AH and JARQ).

Organised by the EPA Section on Addictive Behaviours. Mental health and substance use problems in medical doctors remain are a highly relevant topic in many European Countries. The pandemic has only sharpened these needs and problems. However, prevalence data and treatment interventions remain understudied. In this symposium, we present recent data and trends within four European countries. Spain was one of the European countries that suffered the highest impact of the COVID pandemic. Health professionals had to deal with very stressful personal and professional situations. A number of relevant sequelae have been described, including PTSD, burn-out, substance abuse, mood and anxiety disorders. This presentation will describe the data available, the actions taken, and the lessons learned. We present the results of prospective and longitudinal studies on individual and organizational factors that predict mental health, burnout, and problematic drinking in Norwegian doctors. In addition, findings are presented of the effects of counseling for burnout (Villa Sana) and mindfulness training (RCT with 6-year follow-up). Data will be presented from the study “Physician Health: Results and caveats from surveys in Austria, Switzerland, and Germany “. This presentation focuses on alcohol use disorders in physicians, highlights pitfalls in this context, and presents results on a survey on physician health in the canton fo thurgau; Switzerland, and the State of Salzburg, Austria. Finally, data will be presented from a recent (2021) large (n = 4000) survey in medical doctors on their substance use (alcohol, psychoactive medication, and illicit drugs), medication self-prescription, and burn-out in Belgium.

Organised by the EPA Sections on Mental Health and Intellectual Disability (MHID) and Psychopathology. Recognition of psychiatric symptoms in patients with intellectual disability (ID) requires from the examiner not only using information gained during the interview, because many of the patients may have difficulties to express their internal perceptual experiences with the use of spoken language. One way to gather this information is to observe details of a person’s behavior and compare these behaviors to those of persons with known psychotic symptoms. In this symposium specific problems in psychiatric examination regarding different groups will be presented. In the first presentation the specificity of the interviewing and observing adult patients with ID with psychotic, affective and other disorders will be discussed. The second one will be devoted to psychiatric problems superimposed upon ID in children, underlying and permeating mental development. In the next presentation the an analysis of psychopathological symptoms in patients with autism spectrum disorders will be done. Finally the need of cooperation of different specialists and carers: doctors, nurses, psychologists, teachers, parents in a common framework in order to collect and share all possible information about possible patients` psychopathology will be discussed. The examiner must not only make his or her own observations, but must also very intentionally gather the observational data from those who know the person well. It is also very important to interpret the observations in the context of the person’s other symptoms and life experiences. All the above elements of examining a patient with ID and comorbid psychiatric disorders a very important for their proper diagnosis and treatment.

Organised by the EPA Section on Old Age Psychiatry. The United Nations has proclaimed that “Mental health is a human right” a position supported by WHO. Globally, mental health systems have been in crisis, and in violation of basic human rights, segregated from the rest of health care, prompting calls by the UN Special Rapporteur on the Right to Health, for a sea change in mental health care systems to end decades of abuse, neglect and violence. This imperative is driven by global population ageing, with progressive rises in the proportion of the population aged over 65. Of these, approximately 20% will have mental health conditions such as dementia, depression, anxiety and substance use, often complicated by physical and psychosocial comorbidities culminating in disability. As such, older people may experience multiple jeopardies of discrimination and stigma conferred by age itself (ageism) and having a mental disorder (“mentalism”), with marginalized groups such as older women, LGTBI and indigenous elders faring worst. Older persons facing this level of stigma are often “invisible”, have no voice, nor support for autonomy, nor advocacy. Older people facing ageism and mentalism are often left behind and disproportionately excluded from social protection and survival support. This symposium intends to debate some special contexts where Human Rights are violated and to describe some actions to promote the Human Rights of this population. Ref.: Peisah C, de Mendonça Lima CA, Verbeek H, Rabheru K. IPA and WPA-SOAP joint statement on the rights of older persons with mental health conditions and psychosocial disabilities. International Psychogeriatrics. doi:10.1017/S1041610221000454.

There is a growing interest in a transdiagnostic approach to psychiatric disorders that cuts across traditional diagnostic boundaries to provide new insights in understanding mental health problems. A possible important transdiagnostic factor in psychopathology is Effortful Control. Effortful Control or executive/cognitive control refers to the ability to regulate behavior, emotion and cognition. It has been identified as a contributor to both adaptive and adverse outcomes in children, adolescents and adults. Clinical research points out that individuals with low levels of Effortful Control are at increased risk for multiple types of psychopathology like eating disorders, substance use disorders, anxiety and mood disorders, …. Early assessment of Effortful Control and early interventions to improve Effortful Control might help to prevent or decrease the risk on developing a broad spectrum of psychiatric disorders in children, adolescents and adults. This presentation includes recent research on the role of EC in psychopathology across the lifespan and therapeutic implications: 1) The role of effortful control and the Dual Pathway model in childhood obesity; 2) The role of effortful control in substance use disorders; 3) The role of effortful control and executive attention in mood disorders; 4) The role of effortful control in pyschopathology amongst older psychiatric patients.

Organised by the EPA Section on Addictive Behaviours. Treatment of addictive disorders is often aimed at reaching abstinence. However, the goal of full abstinence is not always achievable. There is a long tradition on opioid substitution treatment (OST) worldwide. However, also for other substances of abuse substitution approaches might be a viable option. Substitution treatment in patients with addictive disorders might contribute to increased quality of life, a more stable personal and health situation, including both physical and mental health, better treatment retention and a better life expectancy. In this symposium developments in the field of substitution treatment will be shared. More specifically, the following substitution treatments will be discussed: Sodium Oxybate for alcohol use disorders, Cannabinoids for cannabis use disorders, new developments in opioid substitution treatment, and baclofen as a substitute for Gamma Hydroxy Butyric-acid (GHB) and alcohol. Furthermore, also for stimulants substitution treatment with long-acting stimulants seems potentially advantageous. This will be touched upon briefly in the discussion with the audience. The aim of the current symposium is to provide a state-of-the-art overview of current practice and future outlook of substitution treatment for patients with addictive disorders. After attending this symposium, participants gain insight in the current evidence base for substitution treatment, and receive practical recommendations directly transferable to clinical practice.

Organised by the EPA Section on Addictive Behaviours. Motivational interviewing is defined as a patient-centered and collaborative approach that guides people to initiate and maintain a strategy of behaviour change through the resolution of their ambivalence. This approach has become in the last decades the golden standard to manage addictions as opposed to classic confrontational models. Different meta-analysis, have demonstrated its moderate but robust effect in improving both adherence to treatment and addictive behaviours. Brief interventions have proven its efficacy in primary health settings, to help patients reduce their drug use, specially concerning alcohol and tobacco. Motivational adaptations of those brief counselling interventions have been developed and tested in recent years. In this course, attendees will receive training on how to use brief motivational interventions (BMI) with patients suffering addictive disorders in the Emergency Room. The course will address the following topics: • How to identify which clinical situations are, and are not, suitable for a brief intervention • Key elements of a successful brief motivational intervention • Barriers (and how to overcome them) to deliver BMI in the Emergency Room • Elements that influence adherence to treatment and successful referral • Review of the existing scientific evidence

The low recovery rate in schizophrenia is correlated to the residual symptomatology developing in about 50% of patients in the course of the illness. A core feature of these residual symptoms consist of cognitive dysfunction which can well be determined but is very difficult to treat. P Garety summarizes the effect of psychotherapeutic interventions on cognitive deficits beyond cognitive remediation, F. Padberg researches the literature of NIBS to see wether there is an effect of this method on cognitive functioning in schizophrenia. A Yung will demonstrate that aerobic exercise improves cognitive dysturbance in psychotic illness significantly, but will search wether these effects endure. W. Fleischhacker will not only review current pharmacological options to treat cognitive dysfunction in schizophrenia, but will present data on a Glycin-Transporter Antagonist of Boehringer-Ingelheim showing a nice effect on cognition.

Mental health care improved significantly over the last decades. Precision and prevention in mental health hold the promise of further significant steps to better care. Therefore the state of the art in other medical disciplines are summarised to compare it with the situation in mental healt. I Horvath gives an overview where precision in medicine, e.g. in oncology, helped significantly to improve the outcome. E. Meisenzahl demonstrates the growing literature to show progress in diagnostic, prognostic and theranostic prediction in mental health holding promise for a successfull translation into clincial care in due course. E Rehfuess summarizes the prevention in cardiovascular risk factors which improved the outcome of related illnesses significantly. C Arrango will demonstrate how the knowledge of risk factors for psychoses helps to build up targeted prevention in this group of disorders.