Although population-level research between economic crises and specific mental disorders is considered scarce, yet there is some evidence arising from previous economic crises in the USA, Asia and the former Soviet Union as well as some evidence arising from the present economic crisis associating such crises with psychopathology and especially depression and suicide. A review of the existing evidence will be carried out in this presentation. The importance of poverty, unemployment and debt will be underlined and the trans-generational effect of economic crises on children will be stressed.

The conclusions are the following:

Depression, especially in its self-destructive clinical expression is one of the major psychopathological conditions that are linked with economic crises. However, it is important to differentiate between understandable sadness, a potentially productive response to economic crises and the dysfunctional response represented by depression.

Screening for depression and suicidal tendencies during periods of economic crises as a routine psychiatric prevention strategy is recommended.

In view of the association of suicidal potential with unemployment, active labor market and family support programs are necessary.

The cost/effectiveness of mental health provision programs (investing in mental health) especially during periods of economic crises should be demonstrated and highlighted.

Highlighting the above and advocating for the establishment of cost-effective active labor market programs, rehabilitation and family support programs are recommended.

The primary goals of maintenance treatment in schizophrenia are sustained symptomatic control, relapse prevention, and delaying functional and cognitive decline.1 Successful pharmacotherapy is dependent on several factors including efficacy, therapeutic alliance, availability of optimal dosages and formulations, treatment adherence, and a low side-effect burden. New long-acting injectable (LAI) formulations of atypical antipsychotics have been developed to address suboptimal therapy outcomes by enhancing drug delivery, assuring efficacy of treatment, reducing side effects, and improving compliance.2 Evidence differentiating the effectiveness of oral vs. long-acting antipsychotics is difficult to obtain in randomized controlled trials (RCTs) where adherence to both is optimized.

RCTs are designed to establish clinical efficacy in an “ideal” setting in which medication adherence is controlled and highly regulated.3 However, RCTs cannot by definition assess treatment effectiveness. Conversely, naturalistic studies that mimic clinical practice are more likely to uncover real-world effectiveness differences of different treatment options. Research has demonstrated major benefits of LAIs in naturalistic studies, including large, nationwide cohort studies and mirror-image studies where patients serve as their own controls. Results from these trials are likely to be underestimated in RCTs owing to stringent inclusion criteria, frequent clinic visits and direct provision of medications.4 Therefore, data from meta-analyses can be misleading if the trial design is not considered in the interpretation of the results.5 Furthermore, naturalistic studies can more accurately assess the consequences for patients with regards to relapse and rehospitalization rates. Therefore, clinicians have to be aware of the origin of data and its impact on the results before making treatment decisions.

The current presentation will critically review data from 3 meta-analyses comparing LAIs with oral antipsychotics, exploring how to interpret the data from different trial designs in the context of unmet patient needs, and how the results from differential designs may impact treatment outcomes.

Schizophrenia is a chronic psychiatric disorder with onset of symptoms typically occurring in early adulthood, and requires lifelong treatment. Treatment goals for the long-term management of this debilitating disorder include sustained symptom remission and control, maintaining or improving patient level of functioning and quality of life, prevention of relapse, and continued monitoring for adverse events, as well as sustained adherence to medication.1 Poor adherence to medication is multifactorial and presents a major challenge in the long-term management of schizophrenia. in fact, rates of non-adherence and of partial compliance to antipsychotic medication are high and are associated with a significantly increased risk of relapse, hospitalization, and the potential for progressive functional impairment, resulting in increased morbidity and high healthcare costs.2,3 Thus, recognizing and managing non-adherence with the latest treatment advances has the potential to benefit patients as well as their families.

One possible solution to the challenge of non-adherence is the availability of long-acting injectable (LAI) formulations of atypical antipsychotics. The use of LAI antipsychotics may help improve the management of adherence and enhance the therapeutic alliance through regular injection visits. in addition to pharmacotherapy, current clinical practice guidelines recommend the use of psychoeducation to improve treatment outcomes.4 Psychoeducation, along with other behavioral therapies, can facilitate the improvement of patient insight, prevention of relapse, promotion of adherence, and ultimately improve continuity of care.

This presentation will provide an overview of key unmet needs in the long-term management of schizophrenia, and evaluate factors leading to non-adherence. The use of non-pharmacological and pharmacological strategies for improving adherence in routine clinical practice will be discussed in the context of a strong therapeutic alliance.

The nature of schizophrenia gives rise to a number of unmet needs that go beyond proven efficacy and safety of pharmacotherapy in randomized clinical trials (RCTs). Long-acting injectable (LAI) formulations of new generation antipsychotics offer an alternative treatment choice, and the investigational formulation of aripiprazole once-monthly is under regulatory review in the both the US and EU for maintenance treatment of schizophrenia.

The efficacy of aripiprazole tablets in the treatment of schizophrenia has been well established, with consistently low relapse rates, good tolerability, and preservation of function. in the “ASPIRE US” (Aripiprazole-Intramuscular-Depot Program in Schizophrenia) trial, a 52-week, multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy, safety, and tolerability of aripiprazole once-monthly as maintenance treatment in patients with schizophrenia, aripiprazole oncemonthly significantly delayed the time to impending relapse compared with placebo in the long-term maintenance treatment for schizophrenia. At 52 weeks, 10% of patients in the aripiprazole once-monthly group had relapsed, compared with 39.9% of patients in the placebo group (Hazard ratio, 5.03, p < 0.0001).1 in a second study comparing aripiprazole once-monthly with oral aripiprazole,2 aripiprazole once-monthly was non-inferior to oral aripiprazole and significantly delayed time to exacerbation of psychotic symptoms/impending relapse compared with aripiprazole once-monthly at a sub-threshold therapeutic dose. The estimated relapse rates at Week 26 were 7.1% for aripiprazole once-monthly and 7.8% for oral aripiprazole. This presentation will review the available evidence from recent RCTs showing the efficacy and safety of aripiprazole once-monthly for the longterm management of schizophrenia, and to explore, the link between low relapse rates and functional preservation.

In medicine, prodromes can be identified with early signs and symptoms that differ from the acute clinical phase. Appraisal of prodromal symptoms has been of importance in clinical medicine for many progressive, dangerous and treatable diseases in which early detection and timely treatment (particularly of recurrences) are crucial. The prodromal phase of depression has a large inter-individual variability and lacks diagnostic specificity. However, within each patient there is striking consistency in the prodromal symptoms that precede each episode, even though the same initial symptoms of the acute disorder may occur and not be followed by another episode. Their interpretation requires clinical judgment. Research on clinical judgment has disclosed several innovative assessment strategies: the use of diagnostic transfer stations instead of diagnostic endpoints using repeated assessments, subtyping versus integration of different diagnostic categories, staging, macro-analysis, extension of clinical information beyond symptomatic features. Such strategies can be applied to clinical cases at risk for depressive relapse and may pave the way for more effective modalities of treatment and relapse prevention. Evidence-based medicine does not appear to provide an adequate scientific background for the challenges entailed by current treatment of depression and needs to be integrated with clinical judgment.

The revision of the DSM scheme has highlighted several difficulties with classification: adapting criteria to different ages and genders; multiplicity of diagnoses in individual children (leading to a mistaken impression of ‘comorbidity’); complexity of the scheme making problems for nonspecialist clinicians; the use of unvalidated categories; and the inclusion of functional impairment as a criterion for several disorders.

In this paper, DSM5's approaches to solving some of these difficulties are illustrated, with reference to specific conditions arising in childhood; although at the time of writing full criteria are not available. An overarching formulation of disorders has been introduced, and “disorders arising in childhood” no longer form a separate group in view of the extensive evidence for the early origins of many psychiatric disorders. “Pediatric bipolar disorder” has become overused, and a new category of “disruptive mood dysregulation” introduced. ADHD subtypes have not been validated and are downgraded to “presentations”; and “restrictive-inattentive” disorders have not (yet) earned their place. ADHD criteria in adult life have been relaxed a little. The “autism spectrum” has replaced subsyndromes, and proposes two dimensions for description. Callous-unemotional states in conduct disorder have received attention; as has the description of syndromes involving self-harm. The remaining challenges for clinicians and researchers will be described.

In discussions within and in communications directed to the recently re-established EPAs Ethical Committee a wide range of important ethical challenges has appeared, including e.g. the need for a forum to get advise for colleagues in ethical complicated situations, to underline and define ethical principles in clinical and research practice, to investigate ethical demands and boundaries regarding user involvement, to underline the need of not only evidence based but even value based practices.

In order to get guidance from our member states and their professional societies, the ethical committee has carried out an international European survey directed to national psychiatric asssociations and national ethical reference persons. The survey contained amongst others questions about the most frequent experienced ethical problems in the respective country.

By doing this, a significant diversity became apparent, seemingly influenced by the psychiatric professional development in the countries, but even showing differences in the sensitivity to cultural and societal - political factors.

Thus, with respect to the diversities in our European countries, it appears important to maintain a continous professional discussion on ethical issues, even considering the processes and changes ongoing due to the political and sociocultural development as well as psychiatric scientific improvements and research implications.

A need to put ethical issues and development on the EPAs agenda is evident as well as the need to continously improve and discuss international and national ethical guidelines and practical clinical strategies. Feasible ways regarding the future work of our ethical committee will be presented.

The objective of the Age of the Brain is change the way people think about their brains and the conditions which affect it forever, and for the better.

This will be achieved through our coordinated efforts as well as by stimulating thousands of other parties - governments, professional societies, patient groups, industry, pressure groups, trusts, individuals and a multitude of other organisations - to be part of this ongoing campaign.

The brain is the most important organ in the body.

Ignorance, epidemic across every level of society is having an impact on the health of our brains across the world. We believe it is time this stopped.

By launching the Age of the Brain, a programme to raise awareness and educate across the world we plan to make a significant impact. This is about changing the way the people think about their brains for good. The programmes will be stimulating, thought-provoking and effective. We aim to challenge current perceptions and re-align incorrect and ignorant thinking but most importantly get people to take personal responsibility for their brain health and well being.

Cuts on health care are necessary for different reasons. First the economical burden of health care should be proportional to the possibilities of the population. Yet in times when the population grows older and possibilities augment, containment is necessary. Governements and health insurance authorities will look closely into possibilites of reducing costs by a great efficacy, by shared descision making, by choices that are to be made. An other alternative is found by asking patients for an own contribution to their health expenses. in that regard it was appauling to witness the fact that in the Netherlands this own contribution was raised soley in patients with psychiatric disorders where individuals with so called somatic diseases were exempted.

With, among others a strong support from the national psychiatric associations, the own-contribution for psychiatric patients was banned.

Yet the new governement threatens to repeat this non-sense by stating that only psychosis are real disorders and all other mental disorders a matter of pulling yourself together. Stigma on Mental disorders is a very actual theme! Let us face it!

Mental disorders specifically associated with stress are exceptional in requiring external events as causes of psychiatric symptoms in order to arrive at a diagnosis. The field is characterised by lively debates, including about the extent to which human suffering should be medicalised and the purportedly inflationary expansion of post-traumatic stress disorder (PTSD) diagnoses. The ICD-11 Working Group on this topic was asked to review scientific evidence and other information on use, clinical utility, and experience with relevant ICD-10 diagnoses in various health care settings; to review proposals for the American Psychiatric Association's DSM-5 and consider how these may be suited for global applications; and to assemble proposals for ICD-11 with a focus on improving clinical utility. The Working Group has recommended a separate grouping of ‘Disorders Specifically Associated with Stress’ for ICD-11, rather than combining them with anxiety disorders as in ICD-10 or DSM-IV. Disorders Specifically Associated with Stress have two key characteristics: 1) they are identifiable based on psychopathology that differs from other mental disorders; and 2) they arise in specific association with a stressful event or series of events. For each disorder in the grouping, the stressor is a necessary, though not sufficient, causal factor. The stressor may range from negative life events within the normal range of experience (in the case of adjustment disorder) to traumatic stressors of exceptional severity (in the case of PTSD and Complex PTSD).

Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. Suicidal crisis: Acute intervention should start immediately in order to keep the patient alive.

An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. in order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.

Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Long-term treatment with lithium has shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment team: Multidisciplinary treatment team including psychiatrist and other health professionals are always preferable. Family: The suicidal person independently of age should always be motivated to involve family in the treatment. Social support: Psychosocial treatment is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack social networks.

Training of Personnel: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other health professionals.

Early clinical detection and intervention in schizophrenia has recently become a major objective of mental health services, while research on the early phases of the disorder may provide important clues to the pathophysiology underlying schizophrenia. Thus, the identification of a clinical syndrome that reflect a predisposition to schizophrenia is fundamental from a clinical and a research perspective. The onset of schizophrenia is usually preceded by a prodromal phase characterized by functional decline and subtle prodromal symptoms. However, clinical criteria currently employed to define a high-risk mental state for psychosis have relatively low validity and specificity. Consequently there is an urgent need of reliable biomarkers that underlie schizophrenia. Structural and functional neuroimaging methods have rapidly developed into a powerful tool in biological psychiatry as they provide an unprecedented opportunity for the investigation of brain structure and function. in this core-symposium it will be aimed to show that neuroimaging studies of the prodromal phases of psychosis have the potentials to identify core structural and functional markers of vulnerability to psychosis and to clarify the ongoing changes during the transition from high-risk to first episode psychosis.

To reduce the huge impact of mental disorders in the European society we need to increase our knowledge on their determinants, how to prevent them, and how to improve the efficacy and effectiveness of treatments. There are clear indicators that funding for mental health disorder research is much lower than the corresponding impact on health. in this context, the ROAMER project, funded under the European Commission FP7 program, aims to develop a comprehensive and integrated mental health research roadmap, orientated to translational research. To ensure an effective and widely accepted Roadmap, we want the process to be inclusive and participatory, incorporating a large diversity of research scientists from many disciplines and also incorporating the view of users, carers, professionals and policy makers and funding institutions. We have established six domains: i) infra-structures and capacity building, ii) biomedicine, iii) psychological treatments and processes, iv) social and economic aspects, v) public health, and vi) wellbeing. Within each of the domains, we will describe the state-ofthe- art of the research, will enumerate of gaps in current knowledge, as well as the advances needed in research in their field. Work groups have been established in each area. A much larger participation of scientists and stakeholders will be achieved through mail and web surveys. Documents will be available at the ROAMER web page (www.roamer-mh.org). Consensus in each of the stages will be achieved using an adapted Delphi method.

Derived from ancient Buddhist and Yoga practices, mindfulness is a mental state characterized by nonjudgmental awareness of the present moment experience while encouraging openness, curiosity, and acceptance. This skill can be learned through practice, and has be integrated in different clinical approaches.

Mindfulness-Based Stress Reduction (MBSR) is a structured group programme conceived to alleviate suffering associated with physical, psychosomatic and psychiatric disorders.

A systematic review of RCTs on MBSR supports that this approach improves mental health in non-clinical and clinical populations. in clinical populations with psychiatric disorders, MBSR has some benefit as it reduces symptoms of distress, anxiety and depression or teaches patients coping skills to handle these symptoms.

Mindfulness-Based Cognitive Therapy (MBCT), which is an adaptation of the MBSR programme, incorporates elements of cognitive therapy to prevent depressive relapse. Meta-analysis indicate that MBCT is an effective intervention for relapse prevention in patients with recurrent major depressive disorder in remission, at least in case of three or more previous episodes. Moreover, in two studies, MBCT was at least as effective as maintenance antidepressant medication.

While MBCT is a relapse prevention programme for patients in full remission, recent data suggest that it may be indicated also for people in partial remission, including those with quite significant residual depressive symptoms.

Recent focus on early detection and intervention in psychosis has renewed interest in the psychopathological delineation and assessment of psychotic phenomena.These phenomena express a fundamental qualitative change of the patient's mentality (consciousness, subjectivity) which often surfaces already during the prodromal/at risk mental states and is typically manifested across several psycho-behavioral domains (i.e. subjective experience, expression, cognition, affectivity, behavior, and willing). This interactive workshop will offer a clinical introduction into the basic semiology of psychosis, combining descriptive, clinical and structural-phenomenological approaches in psychopathology.

Schizophrenia severely affects mental and physical health. Although 20-50% of patients experience significant improvement at some point in life, schizophrenia is the 5th leading cause of disability in men and the 6th in women; patients with schizophrenia die 12-15 years before the average population, and relatively few of them are in work. It is increasingly acknowledged that much of the personal, social and economic burden of schizophrenia is due to impaired functioning in the real-life of those affected. As a matter of fact, the focus of schizophrenia management has gradually shifted from reduction of symptoms and prevention of relapse to improved functioning in the real-life. The presentation will address the following issues: a) definition and measurement of schizophrenia outcome; b) main variables directly or indirectly influencing functioning in the real-life; c) unmet needs in schizophrenia present management; d) recent treatment strategies and e) priorities for research investments.

Although placebos have long been considered a nuisance in clinical research, today they represent an active and productive field of research and, because of the involvement of many mechanisms, the study of the placebo effect can actually be viewed as a melting pot of concepts and ideas for neuroscience. Indeed, there exists not a single but many placebo effects, with different mechanisms and in different systems, medical conditions, and therapeutic interventions. For example, brain mechanisms of expectation, anxiety, and reward are all involved, as well as a variety of learning phenomena, such as Pavlovian conditioning, cognitive, and social learning. There is also some experimental evidence of different genetic variants in placebo responsiveness. The most productive models to better understand the neurobiology of the placebo effect are pain and Parkinson's disease. in these medical conditions, the neural networks that are involved have been identified: that is, opioid, cannabinoid, cholecystokinin, dopamine modulatory networks in pain and part of the basal ganglia circuitry in Parkinson's disease. Important clinical implications emerge from these recent advances in placebo research. First, as the placebo effect is basically a psychosocial context effect, these data indicate that different social stimuli, such as words and therapeutic rituals, may change the chemistry and circuitry of the patient's brain. Second, the mechanisms that are activated by placebos are the same as those activated by drugs, which suggests a cognitive/affective interference with drug action. Third, if prefrontal functioning is impaired, placebo responses are reduced, as occurs in dementia of the Alzheimer's type.

Mental health issues in the workplace have recently received considerable attention due to the industrial world's transformation to a service-based economy. Employers incur substantial costs that arise from mental disorders through lost productivity or absence from work. As such, mental disorders pose one of the largest challenges to social and labour-market policies in industrialized countries.

Within this occupational context, burnout has become a favoured concept. What has emerged from research is a conceptualization of job burnout as a psychological syndrome in response to chronic interpersonal stressors on the job.

Burnout has been associated with various forms of job withdrawal—absenteeism, intention to leave the job and job loss. For people who stay on the job, burnout leads to lower productivity and effectiveness at work. Consequently, burnout is associated with decreased job satisfaction and a reduced commitment to the job. People experiencing burnout also can have a negative impact on their colleagues. There is also evidence that burnout has a negative impact on people's private life and their social relationships.

Thus, the question is not if burnout is a myth or reality but rather why this concept receives so much opposition from mental health professionals. The concept of burnout complies with the public perception about the development of mental disorders and the role of environmental factors. We should take the chance to find a joint model with our patients how disorders arise and can be treated.

The term „illness” implies a medical disease model, namely that symptoms or syndromes indicate an underlying organic disease - in the case of psychiatry a disorder of the brain. But no brain markers could be identified until today, which would indicate a psychiatric illness or in particular a certain psychiatric illness. Furthermore organic causes of a mental disorder are an exclusion criterion for a diagnosis of a mental disorder. For all these reasons all international classifications systems use the term “disorder” instead of “illness”.

Beyond the question if mental disorders are disorders of the brain one might challenge the concept of psychiatric diagnoses at all. Most diagnostic thresholds are arbitrary or imposed on pragmatic grounds. For a categorical diagnosis to be scientifically valid, clear symptom boundaries should separate it from other conditions. But this is rarely the case concerning psychiatric diagnoses.

In many respects a dimensional approach would be much more appropriate than a categorical view. A dimensional approach would reflect the fact that mental problems are part of the human condition, which turn into psychiatric disorders when the affected individual cannot perform his or her social roles any longer.

The personal, social and environmental factors that determine mental health and mental illness may be clustered conceptually around themes like the development and maintenance of healthy communities and each person's ability to deal with the social world and manage his or her life. All this would be much more helpful than the conceptualisation of mental disorders as brain diseases.