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.

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 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.

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.

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.

Organised by the EPA Section on Psychopharmachology. In 2019, the WHO has adopted the 11th revision of the International Classification of Diseases (ICD-11), with planned implementation from 2022 onwards. The chapter Mental, Behavioural or Neurodevelopmental Disorders in ICD-11 expands the number of categories, modifies terminology, and includes new diagnostic entities. Major change is a separation of Sleep-wake disorders and Sexual dysfunctions, Sexual pain disorders, and Gender incongruence into individual chapters. Although the impact of ICD-11 on clinical practice is yet to be examined, it is clear that treatment guidelines should be adjusted accordingly. Thus, it is urgent to determine the availability of approved treatments for new disorders, to look into the labels of psychotropic drugs based on classifications before ICD-11 and to determine how they fit into the new system. The symposium will focus on several clinically relevant groups of mental disorders that changed from the previous classification: psychotic disorders, neurodevelopmental disorders, eating disorders, and catatonia, which has been introduced into ICD-11 as an independent category. Available treatment options and therapeutic strategies for the updated classification will be discussed.

Organised by the EPA Sections on Neuroimaging and Child and Adolescent Psychiatry. Neurodevelopment represents a period of increased plasticity and vulnerability, during which a complex confluence of genetic and environmental factors influences brain growth trajectories, cognition, emotion regulation and mental health outcomes. In this symposium, we will focus on the link between genes, disease-related behaviour and the brain, using a multidisciplinary perspective bridging epidemiology, genetic, neuroimaging and psychopathology. Specifically, we will discuss how genetic and environmental risks for developmental disorders translate to brain function, structure and connectivity and how this in turn – ultimately- translates to emotion regulation and behavioural development. In addition, we will explore examples of the long-term psychological and behavioural sequelae in individuals with typical and atypical development, particularly focusing on clinical phenotypes associated with emotional dysregulation. Ultimately, we will discuss the key role of genetic and neurobiological markers to improve the early detection and treatment of developmental disorders.

Organised by the EPA Sections on Neuroimaging and Psychotherapy. Resilience is a multifactorial construct that shapes the adaptive individual’s response to trauma, preventing the development of stress-related mental illness in the face of adversity. In this symposium, we will describe molecular, neurobiological and psychological mechanisms associated with trauma and resilience and integrate them into a translational perspective. Evidence from both animal and human studies will be discussed for this purpose. Unbalanced approach-avoidance tendencies, a highly prevalent endophenotype of psychopathology, will be discussed as a live example suitable to bring clinic and basic research in molecular psychiatry closer. Indeed, neurobiological substrates of resilience-related behaviors and their relevance in clinics can only be investigated through a translational research based on comparable paradigms between humans and animal models. Lastly, we will focus on the role of resilience as a translational endpoint in the treatment of stress-related disorders. Particularly, we will discuss the putative role of the neurobiological mechanisms underlying resilience in the development of novel interventions for stress-induced disorders that specifically target neural circuitry and brain areas associated with resilience outcomes.

According to Kraepelinian distinction, bipolar disorders have a more favourable prognosis compared to Schizophrenia. This observation has been confirmed by more than a century of research and clinical studies. Nevertheless, it is not possible to identify a single type of outcome for bipolar disorders. Moreover, it is not uncommon for bipolar disorder to include high rate of recurrences, suicidal symptoms, persisting alterations of psychosocial functioning even during the euthymic phases. At last, despite the advances in pharmacological and non-pharmacological treatments, bipolar disorders often entail multiple relapses and impaired psychological recovery. The clinical prediction of the course and outcome of bipolar disorders continues to be challenging, despite the multiple research efforts. Specific diagnostic tests and biomarkers for bipolar disorders are still lacking, therefore psychiatric interview and examination provide the basis for outcome prediction. The clinical course of patients with bipolar disorders is influenced by many factors. Several clinical and preclinical factors have been specifically involved in the outcome prediction. The aim of this symposium is to summarize the main factors involved in predicting the course and outcome of bipolar disorder. Specifically, the role of temperament in modifying the clinical course and outcome is examined in this symposium. In addition, because child and adolescent onset may influence the long-term outcome of the disorder, this topic is also reviewed. Furthermore, the role of pharmacological treatment and its impact on clinical outcome is considered. Lastly, because neuropsychological deficits may have an impact of long-term outcome, implications for treatment strategies are discussed.