Research in interventions in schizophrenia spectrum disorders in Denmark has taken place in a loose network, which during the years have grown in size and had become increasingly organised. The randomised clinical trial: OPUS: Early Intervention in First Episode Psychosis was the first large two-site trial which took place in Copenhagen and Aarhus. Thereafter came the randomised clinical trial: NEUROCOM, Neurocognition and competence in schizophrenia which is also a two-site project. Evaluation of the effect of assertive community treatment in a quasi-experimental design in three cities is another example.

Parallel to this activity the Danish Schizophrenia Guidelines was developed and endorsed in Danish National Board of Health and the Danish National Indicator Project evaluated the quality of schizophrenia treatment in Denmark.

All first episode psychosis programmes meet once a year to discuss results of projects and future plans. A Danish Psychiatric Research Programme was formed to host the training.

The main requirement of diagnostics is the improvement of communication in daily practice on the one hand and the clinical relevance of diagnostic entities with respect to treatment and prognosis on the other hand. A main problem of the classical psychodermatological classifications is that the assignment to classes is based on more or less unproven assumptions and postulations concerning pathogenesis and nosology. This unsatisfactory diagnostic situation was the incentive to develop the Vienna Diagnoses Schedule for Psychodermatological Disorders, which was created on the basis of clinical experience in psychodermatological treatment units and includes four main diagnostic categories: 1. mental disorders without dermatological symptoms; 2. Mental disorders combined with dermatological disorders, e.g.classical psychosomatic disorders and stress-related disorders, secondary dermatological disorders due to mental disorders, secondary mental disorders due to primary dermatological disorders, mental disorders due to dermatological treatment, dermatological disorders due to psychiatric treatment, dermatological disorders often associated with mental disorders, and dermatological and mental disorders occurring simultaneously but independently from each other; 3. Dermatological disorders without mental disorders (troublesome patients, misdiagnosed patients, etc.); and 4. dermatological and/or mental problems not reaching the level of a disorder. Such a categorical classification has to be enlarged in clinical practice by a dimensional diagnostic approach, including not only deficiencies but also the resources of the patient in order to provide effective treatment strategies focusing not only on the disorder itself but on the suffering human being in its entirety.

Italian Reform Law 180/1978 established the closing down of mental hospitals and brought back psychiatry into medicine, the general hospital and primary care; this was the starting point of many relevant events in the history of psychiatry in Italy, one of which was the establishment of Consultation-Liaison Psychiatry (CLP). Since then, development of Italian CLP has been continuous, though heterogeneous over the national territory.

The Modena CL Service is based within a general hospital in the town area and is one of the services of the local hospital psychiatric department, also including a psychiatric ward, a day-hospital and an outpatient clinic. The CL Service provides about 1200 first consultations a year (3% of patients admitted to the hospital). It also provides an out-patient clinic for the follow-up after discharge of patients suffering from medically unexplained symptoms. Through the experience developed in Modena, one of the peculiar features of CLP in Italy is the strong background of integration between general psychiatry, CLP and psychosomatic medicine, which are neither formally nor theoretically separated in Italy. Integration is supported structurally by the existence of the Department of Mental Health, that organises psychiatric care at all levels in a certain geographical area: CLP care is coordinated to the other fields of psychiatry and to other medical Departments through this organisation. Weak points of CLP care in Italy are its very heterogeneous distribution; poor funding availability; need to improve standards of clinical practice, clinical management, training and research quality levels.

C-L psychiatry was born in the USA in the 1920s and began to become integrated into the core of psychiatric resident training by the late 1960s. In 2004, formal subspecialty status within psychiatry was granted to it, under the designation of ‘psychosomatic medicine’. The discipline evolved not only in the USA, but also in Australia, New Zealand, Canada, and in several European countries, which have developed C-L-relevant guidelines for training.

In Europe, since the creation of the European C-L Workgroup (ECLW) in 1987, the first Europe-wide C-L network, the discipline as a whole has evolved considerably. Nevertheless, there are still large discrepancies in the training standards across European countries. During postgraduate training, rotation to a C–L service is mandatory or recommended only in a small number of countries. A similar situation is present with respect to national guidelines for training in this psychiatric subspecialty. C-L psychiatry has been officially recognized as a subspecialty only in two European countries. Current C-L training requirements ranging from residency training to subspecialty additional education are presented. The effect that international training guidelines and recommendations (WPA, UEMS, EACLPP) have had on European developments is considered.

We conclude by suggesting possible measures that can be taken to support C-L psychiatry by means of training standards and of implementation of supplementary certification.

An understanding of the epidemiology of alcohol and drug use in young women is important to appreciate the considerable morbidity and mortality associated with it and to understand the impact of such use on offspring. Although abstention rates are consistently higher among women than men in general substance misuse is increasing in young women. Differences in definitions, measurement techniques, availability, social acceptability and affordability partly explain the great variability in reported prevalence rates. Alcohol exposure among pregnant women varies from 0.2% to 14.8%. An Australian national survey revealed that nearly half of pregnant and / or breast-feeding women up to 6 months postpartum were using alcohol. A Swedish study reported risky use of alcohol during the first 6 weeks of pregnancy, at 15%. Cannabis use among pregnant women varies from 1.8% to 15%. The reported prevalence of opiate use during pregnancy ranges from 1.65% to 8.5%. Cocaine use among pregnant women is reported to be between 0.3% and 9.5%. Most pregnant women stop or reduce their substance use during pregnancy and this might be an opportune moment for detection and treatment. Substance use tends to increase sharply in the postpartum period with adverse consequences for mother and baby. Perinatal substance misuse interventions can reduce adverse neonatal outcomes. On the basis of the relatively high rate of substance use disorders during pregnancy and postpartum period, effective screening and intervention strategies should be implemented.

Antenatal alcohol use is the leading preventable cause of birth defects, growth restriction and neurodevelopmental disorders, yet half of all pregnant women report drinking during pregnancy FAS and alcohol-related birth defects combined are estimated to be 10 per 1000 births or 1% of all births in some studies. The main objectives are a safe pregnancy with a healthy baby and mother. - the welfare of the unborn child and the mother is paramount. Promotion of engagement with substance misuse treatment and antenatal care within a coordinated multidisciplinary team is key. This session will cover the use of assessment, psychological and pharmacological interventions.

The use of assessment instruments (T-ACE, AUDIT and TWEAK) and biomarkers will be discussed. Brief interventions have been recommended as the first step in approaching people with mild-to-moderate alcohol problems. Since here is no research data available specifically on the impact of and pharmacological treatments for stabilisation, detoxification, reduction, maintenance and relapse prevention during pregnancy, good practice will be outlined. This includes psychological support and the psychosocial context. These complex clinical decisions depend on degree of dependence, polysubstance misuse, social stability and support network, and stage of pregnancy and must be individualised to the patient's needs. Some appreciation as to how to weigh the benefits against the potential risks with no obvious medical or social contraindication to the therapies will be discussed.

The treatment of pregnant women suffering from a disorder of misuse or dependence to illicit drugs (opiates, cannabinoids, psychostimulants, benzodiazepines) means an interdisciplinary challenge with a high responsibility.

Because of the specific characteristic of these women to play things down often the pregnancy is diagnosed very late. In addition the misuse of these substances is usually accompanied by severe smoking and drinking of alcohol. Therefore the toxic harmful consequences for mother and especially for the fetus, neonate or child are often difficult to differentiate from those of heavy smoking and of drinking alcohol.

Based on these facts, data describing the effects of the different illicit drugs on congenital complications and on the status of the fetus, neonate or child will be presented as well as different treatment procedures during pregnany. The indication or contraindication of withdrawal treatments of the different illicit drugs during pregnany will be presented. Special consideration of opioid maintenance treatment of pregnant women will be given.The value of treatment interventions within a multidisciplinary (social, psychological, pharmacological, obstetrics specialists, addiction psychiatry) package of care will be discussed. Depending on the available time an example of an interview with a pregnant woman who is dependent on illegal drugs will be given.

Interpersonal Psychotherapy (IPT) proved to be effective for the treatment of acute depressive episodes for which it was originally developed. However, for chronic depression (dysthymia), IPT with or without pharmacotherapy did not show a benefit over pharmacotherapy alone in terms of symptom reduction (Browne et al., 2002; Markowitz et al., 2005). In the study of Markowitz et al. (2005) it was not even superior to the control condition. However, the investigations using IPT with dysthymic patients had some shortcomings such as the use of a non-modified version of IPT (Browne et al., 2002) or insufficient statistical power (De Mello et al., 2001; Markowitz et al., 2005).

Data reanalysis from a larger study (Schramm et al., 2007) with 45 inpatients suffering from chronic Major Depressive Disorder that were randomized to 5 weeks of either combined treatment with IPT (15 individual and 8 group sessions) plus pharmacotherapy or to standard treatment (pharmacotherapy plus Clinical Management). The study included a prospective naturalistic follow-up, 3- and 12-months after discharge.

The brief, but intensive combined treatment program had significant acute and long-term benefits over medication monotherapy in chronically depressed inpatients. In summary, while limited by some factors, the results of this study provide hope that with intensive treatment chronically depressed patients have a good chance of getting well relatively quickly and with lasting effects.

There are a few studies available about cognitive behavioural treatment of mild chronic depressive disorders (dysthymia). These studies adapted only classical elements of shortterm cbt to this special group of patients. There are only clinical impressions and some case reports for cbt with more severely chronic depressed cases. I plan to present some general ideas about chronic depression and implications for cbt intervention. Our model of an intensive form of outpatient psychotherapy with chronic major depression has ten moduls over 45 to 60 individual sessions. We only have first experiences on single case level. More sophisticated and controlled studies are planned but will not start before we have more data to evaluate effect sizes and decide about appropriate outcome measures. The presentation will lay out the few available results of published studies, describe out treatment rationale and elements (moduls), and hopes to stimulate interest in more engagement to work and to investigate chronic depression.

After great anticipation and with high expectations the initial results of the CATIE (Schizophrenia) and the Star*D (Depression) studies have been published. Many results have been inconclusive, but more importantly, most significant outcomes have been highly controversial - from the inclusion criteria, patients selection, outcome measures used for evaluating efficacy, to the lack of full randomization and the doses used.

This presentation will present a review of both studies' results, covering the data that have been published thus far, and address some of the controversies.

The questions remains: Should these major studies results have an impact on treatment options in psychiatry?

The purpose of the study was to assess prevalence rates of pathological, problem and at-risk gambling in German- and Italian-speaking Switzerland in 2007, employing a DSM-IV-based instrument. A random sample of 4997 individuals participated in a computer-assisted telephone interview and 1388 of the individuals who refused to participate on the telephone interview completed a paper questionnaire. The total sample included 6385 participants; the return rate was 52.2%. Among the general population over 18 years of age, 2% engaged in lifetime at-risk gambling, 0.5% in problematic and 0.3% in pathological gambling. We found past-year prevalence rates of 0.7% of at-risk gambling, 0.1% for problematic and 0.02% for pathological gambling. These rates are lower than rates in previous Swiss studies. This may be due to measures to reduce false positive diagnoses such as employing the National Opinion Research Center DSM Screen for Gambling Problems (NODS) instead of the previously used SOGS, an instrument which was found to overestimate prevalence rates in general population up to 50%.

This survey aimed to evaluate the prevalence of pathological gambling in the Swiss adult population in 2005 and the link between pathological gambling and alcohol abuse. This replication study made it possible to compare the prevalence rates of pathological gambling measured before and after the introduction of casinos and new preventive legislation in Switzerland.