Personality disorders have high prevalence rates of approx. 8% in the general population and up to 40% among psychiatric patients. The increasing amount of empirical and experimental research within the last ten years challenges our concept of personality disorders (PDs) with the following most prominent findings:

• • Longitudinal studies indicate much less stability than expected.

• • The DSM classification system hypothesis of a fundamental difference between axis I and axis II disorders has not been empirically affirmed.

• • Some of the current categories of disorders cover highly heterogeneous individuals and have low therapeutic implications.

• • The detection of neurobiological underpinnings of personality dysfunctioning points to a close interaction between nature and nurture in etiology.

• • Psychotherapeutic approaches developed for specific disorders have been proven to be efficacious; they rather favour a limited focus on maladaptive behaviors and attitudes instead of targeting a fundamental change of personality structure.

• • There is no empirical basis for polypharmacy; classes of psychotropic agents act on a rather broad spectrum of symptoms with no convincing database to suggest the combination of several drugs with respect to different targets.

There has been considerable interest in recent years in the investigation of the role of gene x environment (G x E) interactions in aetiology of psychiatric disorders. While the fact that genetic effects may moderate the effects of environmental exposure is widely accepted, and supported by family and twin studies, there is controversy regarding the degree of evidence for specific G x E interactions reported in the literature. Here it is argued that examples of environmental interactions with genes identified at the molecular level are not as well established as widely believed.

A number of relevant factors influencing the weight of evidence for specific G x E interactions will be discussed, including the degree of stringency employed in the definition of “replication”, the impact of different statistical models used to test for interactions, and the statistical power of individual studies. It is concluded that in only a minority of studies is a replication reported that is qualitatively comparable to that in the original report. Given reasonable assumptions regarding likely genetic and environmental effects, simulations indicate that published studies are most likely underpowered, suggesting that positive results for widely reported G x E interactions may be compatible with chance findings.

The aim of this communication is to debate between two seemingly contradictory epistemological approaches in emergency psychiatry: Psychotherapy and Pharmacotherapy. Even if many international experts consider the interest of combining psychotherapy and pharmacotherapy in emergency, clinicians often find a conflict between psychotherapeutic and pharmacological skills. The question of the transference will be discussed in the emergency psychiatric settings. The newest literature data about the interest of the combining treatments (psychotherapy and pharmacology) in emergency psychiatry will be discussed by the experts from our international emergency network [1]. Then, the presentation of some preliminary research experiences of our group [2, 3], will be followed by the discussion of new unpublished data from around 10000 patients admitted consecutively in four emergency psychiatry rooms (Switzerland, Belgium, France, Romania). The clinical heterogeneity of the emergency psychiatry situations often stimulate clinicians to become creative and search for “symbiosis” between psychotherapeutic and pharmacologic treatments, as well as for clinical practice and evidence based medicine.

This communication focus on the critical points about the quality of care in emergency psychiatry: rapid diagnose, management of the psychotherapeutic and pharmacologic treatments effective in emergency. The interest of an international research network in emergency psychiatry is emphasized starting from several clinical experiences (United States, Switzerland, Belgium, France, Luxembourg, Romania).

Increasingly women with schizophrenia are becoming mothers. This can cause different problems for them, their partners, their relatives and other caregivers.

Traditionally women with schizophrenia suffered from infertility - partly due to the illness itself and its psychosocial impacts such as social isolation and lack of partnership, partly due to treatment with hyperprolactinaemia-/infertility-inducing neuroleptics. Recently this has changed dramatically, due to better community-based psychosocial treatments and also due to prolactin-sparing neuroleptics. Many women with schizophrenia now become pregnant - planned or unplanned. This, as well as motherhood, can be a considerable strain to the women concerned and her caregivers.

Counselling a women with schizophrenia therefore always has to include her fertility situation, her desire to become a mother or not, contraception or planning pregnancy and motherhood (considering the course of her illness, her medication, her psychosocial situation, partnership, social support etc.). Counselling in case of unwanted pregnancy is of utmost importance as well as addressing issues such as medication, prenatal care, etc. during pregnancy. Cooperation with the obstetrician, midwife, paediatrician and childcare agencies is necessary. After delivery, parenting assessment in mother-baby-units can be very helpful to evaluate the need for additional care. Long-time programmes for training parenting skills and “parenting rehabilitation” are urgently needed and should also support the relatives and others who care for the woman and her child.

In her talk, Sigrid Steffen will speak about the core aims of EUFAMI in respect to family members and carers. Sigrid will base a lot of her talk around her own personal experience as a carer of a son who was diagnosed with schizophrenia, and she will augment this with experiences of other members of EUFAMI from across Europe. She will elaborate on the stresses and strains under which family members (the carers) come under and will discuss the challenges which carers face on a daily basis.

Her talk will also include a description of a typical ‘journey’ which carers and families travel in the execution of their caring role in an attempt to describe the various feelings and pressures they experience. Sigrid will also discuss what she understands to be the critical needs of carers and the level of support required. In particular Sigrid will concentrate on the stigma which families feel and experience during their lifetime, a aspect which is little understood and appreciated by the wider public. In conclusion, Sigrid will detail some of the work which EUFAMI has been and is involved with and which is related to the subject of her talk.

This speaker will serve as chair ofthis workshop. Background informationabout schizophrenia will be presented, including how cultural variables impactvarious aspects of the illness. Ofparticular interest is the fact that patients from more traditional societiesappear to have a vastly better course of illness (World Health Organization, 1960, 1992). The speaker will present results fromnumerous studies, both from her own research and from colleagues, demonstratingthe possible reasons why patients from these cultures have better prognoses. Main ideas include attributions for thecause/controllability of the illness, use of religion/spirituality, greaterfamily cohesion, and less critical/hostile emotional climate of the family(commonly referred to as Expressed Emotion). Dr. Weisman de Mamani will describe how these studies have shaped a newfamily therapy for schizophrenia, titled Culturally Informed Therapy forSchizophrenia (CIT-S). This new therapyis being pilot tested at the University of Miami and incorporates elements frompreviously-established therapies as well as new, culturally-informedtechniques. CIT-S consists of 15sessions broken into five modules: Family Collectivism, Education, SpiritualCoping, Problem-Solving, and Communication Training. CIT-S is offered in English and in Spanish.

This speaker will discuss the relationship between therapist fidelity (competence/adherence) and outcome for family therapy for schizophrenia. Some of her research will be presented linking various aspects of therapist performance to dropout rates, consumer satisfaction, and a host of client variables. She will also address how Culturally Informed Therapy for Schizophrenia (CIT-S) is being evaluated at the University of Miami, including outcome measures and timeframes. Most importantly, she will present preliminary outcome data comparing CIT-S to a treatment as usual, psychoeducation-only condition. Implications, limitations, and future directions for research and treatment will also be discussed. An interactive format will be utilized to field a discussion with the audience on how techniques of CIT-S can be used in other contexts outside of work with families coping with schizophrenia. Depending on time and interest, additional role-plays will be conducted further demonstrating CIT-S techniques.

This speaker will describe literature regarding the adaptive uses of religion and spirituality, such as religious or spiritual coping and making meaning from stressful life events. She will cover the Spiritual Coping module of the Culturally-Informed Therapy for Schizophrenia (CIT-S). In this phase, therapists begin with a detailed spiritual history in order to gauge each family member's beliefs, involvement in spiritual or religious activities and other practices they may have. Therapists assign homework that encourages the family members to explore their religious or spiritual experience in a positive and adaptive light. For clients who do not identify as religious or who are experiencing religious delusions, therapists proceed with this phase of treatment with a more philosophical or existential approach to spirituality and morality. A demonstration of this module will be conducted using volunteers from the audience.

This speaker will also describe the final two modules of CIT-S, which are based on the work of Falloon etal. (1984) and Miklowitz and Goldstein (1997). The fourth phase of treatment, Communication Training, attempts to unite concepts and skills learned in the three previous phases through specific attention to communication skills. Family members learn to communicate with and support each other in effective ways. The fifth phase of treatment, Problem-Solving, allows the family to learn and practice problem-solving strategies using relevant examples.

The speaker will describe the first two modules of the culturally informed family therapy for schizophrenia, as well as some of her own research on insight in severe mental illness. The first module of the treatment is Family Collectivism. This module is based on strong research linking perceptions of family cohesion to decreased psychiatric symptoms and less general emotional distress (Weisman, Rosales, Kymalainen, & Armesto,2005). This module is aimed at fortifying a strong sense of family unity and helping members to view themselves as a team working towards a mutual goal with the objective of tapping into the protective effects of experiencing a cohesive family unit. A demonstration of this module will beconducted using volunteers from the audience.

The second module, Education, is based on earlier psycho-educational programs of Falloonet al. (1984) and Miklowitz and Goldstein (1997). The Education module discusses the known causes of schizophrenia, the exacerbating factors, and ways in which family might influence the patient's mood, thoughts, and behaviors. This speaker will discuss patients' insight into having a mental illness, which is an important variable when conducting psychoeducational programs. Many individuals suffering from schizophrenia have limited or no insight into the fact that they have a mental illness. This speaker will explore possible mediators and moderators of the relationship between insight and distress and discuss how these factors may be important during treatment, particularly in the psychoeducation module.

Empathy is a complex phenomenon. First of all empathy means the capacity to understand someone else’s state of mind or to identify with his emotional state. From this point of view, empathy plays a fundamental role in psychotherapy and has been studied as a fundamental therapeutic factor. It is true that an emphatic attitude can help other people and lead to a better understanding of their feelings. But empathy can also be used as a horrible instrument to manipulate and abuse the other. We can see this kind of malign empathy in perverted narcissistic relationships, in sadism or in torture, where the torturer can use empathy in order to figure out the most effective ways to make each of his victims suffer.

In psychiatry the interplay of sameness and otherness is of special interest and importance. Patients suffering from mental disorders are deeply affected by the experience of the otherness of oneself and the resulting marked changes in the surrounding world. Otherness is strongly connected with alienation, again a phenomenon which most of our patients with mental disorders suffer from. In this context we should not forget, however, that in former times medical doctors dealing professionally with mental disorders were called alienists indicating on the one hand that they are treating ‘aliens’ but on the other hand indicating the ‘alien role’ of psychiatrists. Alienation leads quite often to objections and hostile behaviour. For these reasons hospitality has to play a profound role in treatment programs for patients suffering from mental disorders and their aftermaths. J.Derrida rightly underlined the structural similarity of the words hostility and hospitality. Treatment settings are usually characterized by mutual and ambiguous relations between sameness and otherness, between acceptance and rejection, welcoming and refusal, integration and disintegration. This means that the problems resulting from the interplay of the sameness and otherness do not affect only patents but also treatment teams. One of the way-outs of the dilemma may be a profound change in treating persons with mental disorders - from the monologue of professionals to the mentally ill patients (no seldom leading to the experience of alienation) to a professional dialogue in a warm atmosphere of hospitality opening the chance for a concerted treatment approach based on reciprocity and confidence.

What are the aesthetic characteristics of badness? Is repulsion the only reaction to the wickedness, mess and disorderliness characterizing it? Or can it, depending on particular conditions, generate fascination? How does it challenge the clinical practice?

One of our analyses deals with the many meanings and uses of the term, in the moral as well as in the aesthetic sphere, referring to the breaking of the rules in both fields.

Besides an initial interpretation of badness, related to something which our mind cannot contain or make sense of, we also consider it as a legitimate aesthetic value. It is then the sublime and tragic categories that allow us to grasp the fascination and awe, the difficulty of judgment and the pleasure, due to the excessiveness, the disproportion, and the playing on the edge of the norms.

We examined the roles that the category of badness, as well as those of the sublime and tragic, play vis-à-vis the category of madness, on both the patient's and the therapist's side, on the diagnostic front and on the therapeutic one. To this purpose, we referred to some clinical and artistic, narrative and pictorial examples.