Detection of dementia is usually a two-step procedure, consisting of screening and application of diagnostic instruments. Screening has to be done on the background of fears for stigma and loss of autonomy.

There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed. We present results of a study in primary care, where we tested which elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…) would be best for this age group. All available screenings showed a good effect size of >0.70.

For the application of further diagnostic tools an update of the current guidelines is given and compared to the available evidence regarding guideline implementation. As far as possible, results of an ongoing study in Switzerland will be presented.

The term social cognition comprises of the perception and cognitive processing of stimuli of the social environment that is necessary to understand one's own behaviour and that of others. Social cognition is important for conscious and unconscious behaviour in social interactions and is composed of the recognition and interpretation of emotions in faces, body language and speech, reflection of one's own mental state and intentions as well as the realization of others’ intentions, thoughts and feelings. The mirror neuron system is involved in empathetic processes. Several aspects of the neural correlates of social interaction, embodiment and the mirror neuron system in schizophrenia and autism will be reported.

According to the neural exploitation hypothesis (Gallese, 2008; see also Glenberg, 2008) the linguistic system re-uses the structures and the organization characterizing the motor system. It follows that language comprehension is grounded in the perception, action and emotional systems. I will focus on two aspects which characterize action organization and the relationship between words and action. A major aspect of action organization is its goal derived structure and its hierarchical structuring in motor chains (Fogassi et al., 2005). I will discuss recent evidence on language comprehension showing that language shares with action the goal-directed structure and the motor chain organization. In addition, I will present results showing that the social context in which words are embedded influences the way in which these aspects are encoded. I will conclude that language re-uses and reflects action characteristics, but also modulates and constrains them.

The ability to understand intentions of actions performed by others is one of the prerequisites for social interaction. This ability has been attributed to our capacity to mentalize others’ behaviour, by simulating or predicting their mental states that would cause that behaviour and make it comprehensible. Brain imaging studies revealed the so called “mentalizng network” including the pSTS/TPJ, the temporal poles and the medial prefrontal cortex. This network gets constantly activated anytime we try to take the perspective of others or try to simulate their state of mind. On the other hand the discovery of mirror neurons has provided an additional explanation for understanding of the content of actions. The functional properties of these neurons point out that action understanding is primarily based on a mechanism that directly matches the sensory representation of perceived actions with one's own motor representation of the same actions. We provide evidence that both systems interact closely during the processing of intentionality of actions. Thus mentalizing is not the only form of intentional understanding and motor and intentional components of action are closely interwoven. Both systems play an important role in the pathophysiology of schizophrenia.

Drug dependence is defined as a chronic relapsing brain disorder that is defined by a compulsion to seek and use drugs despite negative consequences. Drug-related cues and stress are known to be key factors for drug use. It has been argued that drug use could be seen as self-medication in patients with drug dependence and co-occurring personality disorders. However, the relevance of co-occurring personality disorders for stress reactivity after drug use is not clear.

Thirty drug-dependent patients on stable opioid maintenance treatment with and without personality disorders were examined in a randomized placebo-controlled crossover study to investigate the effects of diacetylmorphine (DAM = heroin) on stress reactivity. They were compared with 20 healthy volunteers receiving saline. The drug-dependent patients administered either their individual prescribed DAM dose or saline. Afterwards they completed four emotional tasks while brain responses were measured with functional magnetic resonance imaging (fMRI). Before and after the fMRI investigation, adrenocorticotropic hormone (ACTH), cortisol, DAM blood levels, and psychological stress parameters, such as anxiety, anger, and craving were measured.

The findings of DAM effects on stress reactivity in patients with drug dependence and co-occurring personality disorders will be reported and clinical implications regarding specific psychosocial interventions will be discussed.

Over the past decade, the importance of co-occurring posttraumatic disorders in patients with substance dependence has become increasingly apparent. In clinical populations of addicted patients, about 25 to 50 percent receive a lifetime diagnosis of Posttraumatic Stress Disorder (PTSD). The talk will give an overview of the prevalence of PTSD and other trauma related disorders in European samples of patients with substance dependence. Moreover, data on experiences with the German version of an integrated treatment program for PTSD and substance abuse („Seeking Safety”, Najavits 2002) in N = 38 female outpatients with alcohol dependence will be reported. The results suggest that participants’ satisfaction with the content of the treatment, its structure and the session handouts was high. “Seeking Safety” therefore seems to be a promising treatment also for European patients with the dual diagnosis of PTSD and substance abuse.

In the last decades a large number of co-morbidity studies were published indicating a strong relationship between affective disorders and alcohol addiction. Patients with affective disorders suffer also from dependence disorders at about 6 times more often than the rest of the population. In 30 to 60 percent of patients with alcohol addiction also affective disorders are present. In this context authors emphasized that depressive states observed in the course of alcohol addiction may be reactions to problems occurring in the frame of dependence disorders. In contrast to that depressive mood disorders in general (and above all states of anxiety and increased tension often connected with depressive states) can also be considered as starting points of addictive behaviour. Furthermore alcohol itself may induce and catalyze depressive mood. Less attention has been paid to the role of manic or hypomanic states in dependence disorders. The few studies indicate an increased co-morbidity rate between bipolar II disorders and alcohol addiction. In a psychopathological study carried out on 200 alcohol addicts in the Anton Proksch Institute Vienna we focused on the co-morbidity with bipolar II as well as on the pathogenetic role of hypomanic states in the frame of constellations of conditions of alcohol dependence using among other scales and a standardized interview, the Hypomania Self Rating Scale (HSRS, Angst). Preliminary results underline a strong relationship between Bipolar II Disorders and Alcohol Addiction: hypomanic states induce high risk behaviours which may become responsible for relapse and increased alcohol consumption.

Big cities in Europe are characterised by social factors that can influence mental health and impact on the provision of mental health care. These factors include social inequalities, social marginalisation and fragmentation, large scale immigration, and a high proportion of mobile populations. Big cities tend to have higher levels of morbidity and higher costs of service provision than other parts of the same country. This leads to specific challenges, particularly in inner city areas. The paper summarises how mh services in London approach these challenges, how they are organised and how they have changed over the last 10 years. Services are provided by the NHS with an emphasis on care in the community. Whilst there have been large investments in mental health care and the establishment of a range of new teams with specialised functions over the last 10 years, recently funding has come under pressure and service provision may need to be reduced. There has also been a stronger focus on risk issues and the introduction of compulsory treatment in the community.

Taking the example of East London as the most deprived area in London, the paper will illustrate how traditional principles of sectorisation, catchment area responsibility and continuity of care have been put into question with potentially new solutions to old problems. The paper will also briefly describe how mental health care for socially marginalised groups is provided and compare the situation in London against that in other European capitals as investigated in the EC funded PROMO Study.

The Paris population covered, in 2007 2.181.000 inhabitants. This covers the city itself. When adding the surrounding towns, the total figure reaches 6.507.000, more than half the total Ile de France region.

A recent study (LAPORTE, 2010) gives an estimate of 21.000 persons being homeless in the Paris megapole. A third of these individuals suffer from severe mental illness, with a prevalence of 13, 2% for psychotic disorders, 6,7% for affective disorders, 12,2% for anxiety and 21% for personality disorders.

Psychoactive substances are to of concern for 29% of the homeless population.

The author will present data from a two consecutive studies carried out in the Paris megapole concerning the homeless population. (KOVESS, 2001; LAPORTE, 2010).

The author will present data from a two consecutive studies carried out in the Paris megapole concerning the homeless population. (KOVESS, 2001; LAPORTE, 2010).

Berlin is a capital characterized by migration; about 40% of all adolescents have a migratory background. In recent years, mental health care for migrants has received increasing attention, although costs e.g. for translation in hospitals are still not covered by the insurances, and problems of inpatient care for migrants without a legal status remain. In Berlin, psychiatric hospital care is sectorized, and in each sector, a central conference tries to organize outpatient care and facilities. In spite of these efforts, transition between in- and outpatient care often remains complicated, and outpatient psychotherapy care offered by psychologists frequently does not reach the most severely affected patients. Patients suffering from addiction face additional problems, as detoxification is financed by health care insurances, while treatment of the addictive disorder itself is mainly financed by retirement funds, with pervasive problems characterizing the individual patient's shift from one system to the other. So-called “integrated” approaches that link specialized outpatient and inpatient care are currently established by different health care insurances and may help to bridge such gaps. However, the multitude of different offers from competing insurances threatens to fractionize health care, and multimorbid patients may have to select e.g. an insurance with an excellent program for schizophrenia but a badly structured offer for cancer treatment. Multimorbid patients will thus be forced to decide which of their health care problems is most pressing and to neglect other diseases. Research on the impact of these “integrated” health care programs therefore is urgently warranted.

Over the 50% of the world's population now is living in the cities and particularly in the large metropolitan areas. Empirical evidence again and again confirms that some features of the context of a large city can influence the mental health of citizens. Faris and Dunham in 1939 were the first to show that the environmental and social disorganization in neighborhoods of Chicago was one of the most important factors to undermine the mental health of residents. This evidence was confirmed by a study carried out in midtown Manhattan, New York City. It suggests that the urban characteristics, such as social and environmental disorganization, could affect the mental health of the residents. Substantial evidence links structural inequalities to health and mental health and the researchers suggest that the disproportionate concentration of recent immigrants in urban neighborhoods contributes to racial and ethnic health disparities. While most part of the studies has examined the relationships between neighbourhood characteristics (e.g. socio-demographic characteristics, stability and mobility of the residents, ethnic composition, public transport, availability of green areas and parks, meeting places for social and cultural events, sport and leisure facilities, shopping centres, health and social services, etc.) and mental health, few studies have examined the factors that contribute to increase the incidence and the prevalence of the depressive disorders. Our research in Milan, Italy, is carrying out at the neighborhoods level, in analysis of intercity comparison, typically focused on the evaluation between environmental characteristics, neighbourhood-specific, and the incidence and prevalence of depression in residents.

Latent infection with the common intracellular protozoan parasite Toxoplasma gondii has been shown to result in altered behaviour of its host. This behaviour manipulation has been proposed to increase predation of the intermediate host (e.g. rodents and birds) enhancing parasite transmission. Other psychologicalsequalae have also been associated with latent toxoplasmosis including human affective disorders, as human are accidental hosts for Toxoplasma. During cyst stages of the life cycle found in the brain and other tissues, there is a complex interaction between the parasite and the host. Our research is concerned with the possibility that the parasite-induced behavioural changes are mediated by neurotransmitters. Potential factors in neurotransmitter levels include the location of the cyst, the host immune response, and direct parasite products. The cyst is found in many brain regions but elevated numbers have been reported in the hippocampus, amygdala, and nucleus accumbens. The host response involves interferon gamma suppressing growth through tryptophan degradation that could decrease serotonin levels. The parasite could directly manipulate the host brain through altering dopamine levels. We have found a change in dopamine associated with infection. Indeed, the parasite itself encodes the rate-limiting enzyme in dopamine synthesis, tyrosine hydroxylase. Dopamine's role is also supported by finding haloperidol, a dopamine antagonist, blocks manipulation of rodents by Toxoplasma. Our current investigations of alterations in neurotransmitter levels during chronic infection and association with brain cysts will be presented. Our data presents an interesting interplay with the ‘dopamine hypothesis’ that has postulated a link between elevated dopamine and schizophrenia.

Toxoplasma is considered as one of the most promising candidates of infectious agent that might trigger psychotic disorder in predisposed subjects or modulate the course of the disease. A clinical pattern has not been established yet in Toxoplasma infected schizophrenia patients. Psychopathological, cognitive and treatment response features of Toxoplasma seropositive and seronegative individuals suffering from schizophrenia spectrum disorder has been studied in China, Czech Republic, Ethiopia, Germany, Turkey, United States and other countries to determine whether schizophrenia and Toxoplasma infection co-morbidity modifies clinical presentation and illness course. Prague Psychiatric Centre project consisted of 251 patients with schizophrenia spectrum disorder consecutively admitted to between 2000 and 2010. Toxoplasma-infected patients spent more days in hospital during their last admission compared to Toxoplasma-free patients (p = 0.003; mean difference 32.9 days). Schizophrenia started approximately one year earlier in Toxoplasma-infected men and about 3 years later in Toxoplasma-infected women than in Toxoplasma-free patients, which corresponds to gender related toxoplasmosis incidence curves in the Czech Republic. All infected patients scored higher in the Positive Subscale of Positive and Negative Symptom Scale (PANSS). The PANSS scores and composite PANSS scores also correlated negatively with the concentration of anti-Toxoplasma antibodies indicating the increase of psychopathology with infection duration. Our findings support the hypothesis that toxoplasmosis may represent a risk factor for schizophrenia spectrum disorders.

Our seemingly effortless capacity of conceiving of the acting bodies inhabiting our social world as goal-oriented individuals like us depends on the constitution of a shared “we-centric” space. I have proposed that this shared manifold space can be characterized at the functional level as embodied simulation, a basic functional mechanism by means of which our brain/body system models its interactions with the world.

The mirroring mechanism for action and other mirroring mechanisms in our brain represent sub-personal instantiations of embodied simulation. Embodied simulation provides a new empirically based notion of intersubjectivity, viewed first and foremost as intercorporeity. Embodied simulation challenges the notion that Folk-psychology is the sole account of interpersonal understanding. Before and below mind reading is intercorporeity as the main source of knowledge we directly gather about others.

By means of embodied simulation we can map others’ actions onto our own motor representations, as well as others’ emotions and sensations onto our own viscero-motor and somatosensory representations. “Representation”, as used here, refers to a particular type of content, generated by the relations that our situated and inter-acting brain-body system instantiates with the world. Such content is pre-linguistic and pre-theoretical, but nevertheless has attributes normally and uniquely attributed to conceptual content.Social cognition is not only explicitly reasoning about the contents of someone else's mind. Embodied simulation, gives us a direct insight of other minds thus enabling our capacity to empathize with others.

This proposal opens new perspectives on our understanding of autism and other psychopathological states such as schizophrenia.

Values-based Practice is a new approach to working with complex and conflicting values in medicine. The approach is derived from work in analytic philosophy on the logic of values. As a practical approach, it is based primarily on learnable clinical skills. Values-based Practice has been developed particularly in mental health, through a number of programmes involving both voluntary sector and government organisations in the UK and internationally. Two examples of these programmes will be presented: one related to the use of involuntary treatment in psychiatry; the other arising from a government-sponsored programme on diagnosis and assessment in mental health. Values-based Practice is currently being extended into other areas of medicine as a potential partner to evidence-based practice in clinical decision making