The protection of human rights and the dignity of persons with mental disorders has not a relatively short history in Romania. We have a short review of legislation and of conditions of hospitalization concerning involuntary commitment of the mentally ill people during our history before and after 1989, having more than 30 years experience in the field. Since 1989 it has been necessary to create committees to investigate abuse during involuntary commitment. On the other hand, before 1989 some persons with (or even without) mental disorders were committed to a psychiatry department to protect them. Generally, Romania's legislation is in keeping with principles set out by the World Health Organisation, United Nations and so on, concerning the protection of people with mental illnesses. The legislation calls for adequate treatment and respect for the human rights of the persons with mental disorders.

Standards and practice regarding involuntary commitment in a psychiatric department and also involuntary ambulatory treatment of person with mental disorders have been improved since the introduction of the new mental health law in 2002. We discuss about the assessment of competence in the elderly and ethical aspect of care and research, and about involuntary commitment of incompetent elderly patients. We also refer to the complications and difficulties when trying to apply the civil commitments compulsive hospital admission measure. Involuntary commitment of incompetent patients took in the consideration the best interest of the patient, but also the well-being of the family and the potential risk for others.

Germany and Switzerland are neighbour countries and have a long history of exchanging cultural and scientific issues especially - because of the common language - with the German speaking part of Switzerland (about 66% of the population). Both are federal states and laws for psychiatric patients are mainly task of the member cantons / states. However, large differences regarding the “liberal” history between both countries may be the reason for differing attitudes and regulations to involuntary admissions and guardianships. Examples will be given, especially concerning demented patients.

The Czech law related to compulsory hospitalization dates back to 1966, but it has been revised several times. Besides having mental illness as a criterion for compulsory admission, the law requires the criterion that the patient may only be committed to the hospital, if he is an acute danger to himself and/or others. The Czech law does not accept the criterion that patient may be committed, if there is a danger to his health or if his behavior is not accepted to the community. The law does not specify the type of psychiatric illness required for a person to be committed. A patient admitted voluntarily to a psychiatric ward can be subsequently detained if he fulfilled the criteria of the law. The psychiatrist must examine the patient, decide and apply for commitment. The court has to be notified of compulsory admission in period of 24 hours. The detention is decided by judge in seven days. The detention could last up to 3 months then should be reevaluated by court. Appeals or complaints regarding compulsory acts are referred to the court by guardian or patient himself. A competence proceeding and the appointment of a guardian is considered in the case of demented, retarded, and in some cases of psychotic people. At issue is whether such people are capable of managing their own affairs, to make sound judgment-to weigh, to reason, and to make reasonable decision. Incompetence is decided by judge. Expert psychiatric witnesses play a role in determining the level of incompetence. The court appoints a guardian.

The European Alliance Against Depression (EAAD) is a 4-level, community-based intervention programme to improve the care of depressed patients and prevent suicidality in Europe (1).

In 2001, a pilot project, the ‘Nuremberg Alliance Against Depression’, was initiated. This community based intervention program comprised a 4-level action programme, implemented in the city of Nuremberg (500,000 inhabitants) (2). Careful evaluation has provided evidence that this program is effective: the number of suicidal acts was reduced by 24% during the two year intervention compared to a baseline year and a control region (2).

Based on these positive results 18 international partners representing 16 different European countries established the ‘European Alliance Against Depression’ in 2004. The EAAD partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international level.

The European Commission listed EAAD as a ‘best practice’ model in its Green Paper (European Commission 2005).

Youth suicide is a significant public health issue that requires effective evidence based interventions. School based suicide prevention programs are popular in many jurisdictions and there is a perception that they are effective in reducing youth suicide rates. This presentation will apply a comprehensive evaluation framework to determine the effectiveness of school suicide prevention programs as described in the literature and will identify those conceptual and research issues that need to be addressed to develop and deliver effective school based suicide interventions.

Firstly, recent data on depressive disorders and suicidality burden in Portugal is presented and treatment gap is stressed as well as the insufficient information until recent years (1).

At the national level, the first epidemiological study on psychiatric disorders embedded within the World Mental Initiative Survey is ongoing and prevalence and needs for care data will be presented.

Implementation process of the EAAD 4-level intervention in Portugal is ongoing along with restructuring of both liaison and specialized mental health care on a regional sector of 350.000 inhabitants with a mental health specialised care department and four large primary care health centres, where liaison between 4 mental health teams and 200 GP was taking place accordingly with varying models (substitute care in most) and different clinical criteria for admission and follow-up.

The restructuring of mental health teams and their missions implied that while a set of sub-teams stood responsible for severe mental disorders, another subgroup was deemed to comply exclusively with common mental disorders and primary care liaison aided by standardisation of clinical criteria for referrals evaluation and reply, specialised therapeutic interventions, as well as collaborative stepped care.

Baseline and some outcome data on suicide and depression will be presented such as rates, psychopharmacological prescriptions, general population knowledge and beliefs, media reporting, and pre and post training evaluation of primary care professionals.

This presentation will give an overview of the aims and progress of the DEMoBinc study. The project aims to develop a toolkit for assessing the living conditions, care and human rights of people with long term mental illness in psychiatric and social care institutions in European countries. The study has been funded for 36 months by the European Commission and started in March 2007. It involves eleven centres across ten countries: UK; Germany; Spain; Czech Republic; Bulgaria; Italy; Netherlands; Poland; Greece; Portugal.

The toolkit will assess domains considered most important for service users’ recovery and is designed for use in a face to face interview with the institution manager. The domains have been identified through an international literature review and Delphi exercises in each country with mental health professionals, clients, carers and advocates and agreed by the research partners and an international panel of experts in rehabilitation and recovery. The toolkit will be refined through the course of the study to maximise:

1. a. its reliability;

2. b. its usability;

3. c. its ability

The DEMoBinc study's main objective is to develop an instrument for assessing the living conditions, the quality of care, and the human rights of long-term mentally ill patients in psychiatric and social residential care. It started on March 2007, with 11 centres and 10 countries participating.

The Portuguese centre has carried out a national literature review of mental health legislation, standards of care related with residential care for mental patients, and mandatory procedures for physical restraint and seclusion.

A three-round Delphi exercise with four groups of experts - advocates, mental health professionals, service users, and carers - was also developed. In the first round the participants were asked to state the ten more important components of care helping recovery in institutional care for the long-term mentally ill. The results were sent back to be rated for their importance on a 5-point scale. Finally, the participants were asked to confirm or change their own scores in comparison with the calculated group median. Between twelve and 18 participants by group were contacted, and the overall rate of participation was 73%.

A pilot study using the first draft of the DEMoBinc instrument was done, and refinement of the instrument is being carried out in twenty institutions and will be completed during the next months.

The results of the Portuguese centre on the national literature review, the Delphi exercise, and the first phase refinement of the DEMoBinc instrument will be presented and discussed.

Recent brain imaging studies indicate subtle functional and also structural brain changes in affective disorders. We report specific neurotransmitter receptor findings in vivo in major depression testing directly the ‘old’ monoamine and also newer peptide neurotransmitter hypotheses of unipolar major depression.

Positron Emission tomography imaging demonstrates relatively consistently a widespread reduction of brain serotonin 5-HT-1A receptors in drug-free or never-treated patients with clinical depression. The reduction of 5-HT-1A receptors is not confined to frontal or temporal cortex but seem to be widespread including multiple brain regions. Our data shows that the 5-HT-1A receptor finding seems to be robust even in primary care patients with mild/moderate depression. Pilot findings in our laboratory suggest that this alteration can be ‘normalized’ with a psychotherapeutic intervention. Substance P NK1 receptors appear not to be altered in never-medicated MDD patients. However, HAM-D total scores correlated positively with NK1 receptor binding in neocortical as well as limbic brain areas suggesting a modulatory role for NK1 receptors in major depression.

Our results indicate specific neurotransmitter changes in clinical depression that could also represent therapeutic targets but the specificity of these findings e.g. in relation to anxiety disorders (or comorbid conditions) needs to be explored further.

Current models for mood disorders and particularly bipolar disorder focus on increaesed activation within the limbic system coupled with reduced inhibitory control from the prefrontal cortex. This presentation will focus on functional magnetic resonance imaging studies that highlight limbic-prefrontal interactions in Mood Disorders and on the potential effect of antidepressants and mood stablisers on these neural networks.

We will present a comparison of serum antineuronal antibody profiles in children with OCD-only (n=13), PANDAS + OCD (n=20), CTD + OCD (n=23), and age-matched controls (n=29). Detection methods used to evaluate anti-brain antibodies included immunohistochemistry (striatum), ELISA (BA 9/10, BA 11, caudate, and cingulate gyrus), and Western immunoblotting (BA 9/10, BA 11, caudate, and cingulate gyrus).

Immunublotting was further used to assess the presence and concentration of putative antigens identified in post-streptococcal patients, i.e., *- and *-enolase, aldolase C, pyruvate kinase M1 and tubulin. Anti-lysoganglioside GM1 activity was measured by competitive inhibition.

New findings on serum antibodies against pyruvate kinase and lysogangliosides plus cytokine data in children with tic disorders compared to helathy control children are presented. Also blood-based gene expression data related to autoimmunity in children with tic disorders are discussed.

The clinical phenotype of pediatric OCD and tic disorders in relation to streptococcal antibody patterns will be discussed. Also, cellular and other immune findings will be presented on a group of children with OCD and tic disorders taking into account clinical phenotype data.

The objective of our study was to test the autoimmune hypothesis of OCD and TS as disorders related with PANDAS, and find clinical features or specific immunological markers related with them. Child onset OCD in adults has been associated with higher mean ASLO titers, higher frequencies of history of tic disorders, tonsillitis in childhood and compulsive symptoms. Also, two proteins, with molecular weights of 86kDa and 55kDa, have shown antibody binding in sera from 7 patients.The fact that some clinical and biological features related with PANDAS are found in adults and that antineuronal antibodies exist in patients with OCD or TS diagnosis that don't meet PANDAS criteria, lends further evidence that autoimmunity related with OCD is wider than PANDAS.

The internet makes it possible to search in an endless variety of information. However, not all information is valid and reliable. Googling the term schizophrenia gives over 10 million hits. Among these hits there are some high quality websites, but also many sites with useless or even misleading or false information. With this workshop the editors-in-chief of the website www.psychiatrynet.eu will present search strategies for the participants, which they can apply in their daily practice. In June 2008 the English version of www.psychiatrynet.eu has been launched modelled after the Dutch website www.psychiatrienet.nl (launched in 2001). The lead of the website is ‘An independent selection of high quality links by your colleagues’. Independency is a basic value and the financial support comes from the Foundation of the Netherlands and Flemish Journal of Psychiatry. The current editorial board consists of over 50 mainly Dutch and Flemish psychiatrists, who select links and provide a short description of the links. In the forthcoming years members from different European countries will be selected to join the European editorial board. The goal is to become a key website for psychiatrists in Europe.

The European portal www.psychiatrynet.eu offers a selection of high quality links for the practising psychiatrist, but also for researchers in psychiatry. The editorial board has selected websites for 16 categories of psychiatric disorders, following the DSM system. There are also links related to treatment, specific areas of interest and more general categories.

For example, if your are looking for guidelines for the treatment of schizophrenia, you will find a brief (3-6 lines) description of the NICE and APA guidelines and a link to these guidelines (in PDF) in the category psychotic disorders. You can search on a wide variety of relevant and checked information, like what are the international organisations on eating disorders or on specific substance abuse. If you want to know the names of the members of the DSM-V workgroups or the journal impact factors 2007, you can find it under general categories or by using the search function of www.psychiatrynet.eu.