The incidence of depressive symptoms among adolescents has been increasing in the last years and several risk factors have been associated with depression which has become a major public health issue.

Assess the prevalence and determinants of depression in a Portuguese sample of adolescents.

A cross-sectional study was designed with a sample of 447 adolescents aged 12 to 19 years old, attending a public school in S tao, Portugal. A self-administered questionnaire with questions about socio-economic status, risk behaviours and sleep disorders was answered by adolescents. Depressive symptoms were assessed by the Portuguese validated version of the Beck Depression Inventory, and the cut-off point for depression was 13 points. We considered the following global scores: 0-13:minimal depression; 14-19:mild depression; 20-28:moderate depression; and 29-63:severe depression. Prevalence was expressed in proportions and compared by the Chi-square test.

The prevalence of depressive symptoms was 13.2%. According to the severity of depressive symptomatology, the prevalence of minimum, slight and moderate depressive symptoms was 57.4%, 5.4% and 2.3%, respectively. Depression was associated with insomnia (yes, OR=7.9 95%CI=3.1-19.9), residence area (urban, OR=1.4 95%CI=1.1-2.1), father’s educational level (<9yrs, OR=3.4 95%CI=1.1-10.2), alcohol consumption (OR=1.6 95%CI=1.1-2.2), coffee consumption (OR=1.4 95%CI=1.0-1.9) and smoking habits (OR=1.5 95%CI=1.2-1.8).

Adolescents who develop depression are also likely to develop insomnia. Depressive symptoms are associated with sociodemographic variables and addictive habits. Mental health promotion should be considered in school programmes in order to decrease the risk of depression and associated diseases.

Our social environment can have important consequences for the development of emotional processes, mental health problems and/or wellbeing among individuals and communities. Recent research suggests that stigma and discrimination has been increasing, as measured by social distance of the general public. The context of public stigma in relation to people with mental health problems could have significant consequences in terms of exclusion and thus, impact the health and well-being of people with mental illness.

To describe new research in the field of social psychiatry which investigates the impact of the macro-social context on individuals, especially in terms of stigma and social exclusion.

This session will present recent research which looks at aggregate population data including structural policies or legislation in addition to public attitudes or beliefs and how this relates to individual outcomes of mental health and well-being including self-stigma, unemployment and suicide.

Initial research highlights the importance of macro-micro contexts for the social exclusion of people with mental health problems. Further research is needed to further delineate the mechanism of how individual internalize their social environment and how we might better intervene at the population level to improve the mental health and well-being of communities.

Further to the recent debate about the future and the identity of psychiatry, we argue that social psychiatry will play a major role in psychiatric research and practice in the future.

To report priority areas in mental health research according to different categories of European stakeholders and to analyze pitfalls in training in social psychiatry.

To review the current state of knowledge on social psychiatry and to propose future actions for research and practice in mental health.

In this presentation we will report data from the ROAMER stakeholders’ survey on priorities for mental health research in Europe according to the national associations of psychiatrists, other mental health professionals, users and/or carers, trainees in psychiatry, and the results from the activities of the European Psychiatric Association - Early Career Psychiatrists Committee (EPA-ECPC).

Social psychiatry is a priority in mental health research according to all categories of stakeholders. In particular, the most important research areas indicated by the 108 respondents are early detection and management of mental disorders, quality of mental health services, prevention of mental disorders, rehabilitation and social inclusion, and stigma and discrimination. According to the survey carried out by EPAECPC, social psychiatry, psychopathology and forensic psychiatry are the areas most neglected during training

Our results show the general tendency that social psychiatry is a priority in mental health research and training. Actions should be taken as soon as possible in order to: a) fight stigma; b) improve employment rates of mentally ill; c) develop strategies to manage migrants’ psychiatric problems; d) improve quality of mental health services; e) promote mental health in the population.

Antiparkinsonian drugs increase dopaminergic system activity in order to compensate dopamine neurons degeneration in corpus striatum.

To study antiparkinsonian drugs hallucinatory side effect

Our study included 28 geriatric patients enrolled in a private long-term care institution with mean age 84.93 ± 5.71 years old, weight mean 66.36 ± 2.83 kg with Parkinson’s disease.

Drugs administered to patients with Parkinson’s disease were studied.

The association of L-DOPA and DOPA descarboxylase inhibitor (benserazide) were administered to 53%(15) in doses between 2.0-19.0 mg/kg/day.

L-DOPA associated to catechol-O-methyltransferase inhibitor (entacapone)

3 mg/kg/day were given to 7.14% (2) patients.

Bromocriptine 0.04 mg/kg/day were given to 3.57% (1) patient.

39.29% (11) did not received any antiparkinsonian drug.

Mental confusion and hallucination side effect were observed in 53.33%(8) patients treated with L-DOPA associated to DOPA descarboxylase inhibitor (benserazide).

The increase of dopamine levels due to the administration L-DOPA, in corpus striatum improved Parkinson’s disease symptoms although undesirable effect related to dopamine activity at mesocortical pathway such as confusion and hallucination were observed.

• • Determine how the Resilience could understand itself as protective factor, which avoids the anxiety and depression symptoms development in adolescents, who are exposed to different big stress factors, such as, Immigration Vs. Armed Conflict.

• • Demonstrate probable consequences in Mental Health, during migratory process in Adolescents.

Resilience is the human capacity to face overcome and make stronger or transformed by experiences of adversity. We can identify resilience factors in 4thcategories: I have, I am, I feel, I can.

It is a research focus an ecological descriptive study, concentred on obtaining through 62 Semiestructural interviews, with application of four(4) individual test: STAIC(Anxiety),BDI(Depression),Family-APGAR(linkage),and Resilience-in-front-of Adversity(Resilience), with the reference population sample selected for the study; to verify the existence or not of the Anxiety and Depression Sintomatology, secondary stressor event, related to violence situation or immigration described; in the same age group, twelve to seventeen, in two gepgraphycal zones, and different social stressors, but of the high complexity (Armed Zone Vs. Immigration Zone). The population was in two zones in order to take the samples. Zone-1: Adolescents, residents in Colombian armed conflict-(Arauca-Department). Zone-2:Adolescents, residents of Barcelona province-(Catalunya, Spain), who were born and came from Latin-America.

• • Resilience is defined as a human capacity, present in different communities of adolescents, that allows to face the adversities of life -violencearmed conflict-immigration, both in communities migrants/immigrants and residents in war area present in the study.

• • The Immigration is cause of anxiety in adolescents, including states of rejection, vulnerability and change in their identity.

• • Resilience also means life experience, it is a building life experience.

In schizophrenia negative symptoms often persist and determine an unfavourable course. Reviews including studies with small sample sizes indicate improvement of negative symptoms in schizophrenia patients by repetitive transcranial magnetic stimulation (rTMS), but provide heterogenous results. To prove the clinical efficacy of rTMS on negative symptoms trials with larger samples of patients are needed.

In a multicentre randomized, sham-controlled, rater- and patient-blind clinical trial including 197 patients we investigated the efficacy and tolerability of a 3 week 10 Hertz (Hz) rTMS add-on to antipsychotic therapy (in total 15000 stimuli, stimulation intensity 110 % of the individual motor threshold) over the left dorso-lateral prefrontal cortex (LDLPFC) immediately after treatment and during a 12 weeks follow-up.

According to our primary outcome parameter we observed a significant decline in negative symptoms (negative sum score of the PANSS) in the verum and sham group (N = 124), but could not find a significant superior reduction in the verum group at day 21. At day 28 significant more patients in the verum compared to the sham group showed a clinical meaningful reduction of PANSS negative subscore (= 20 %) (N = 89; 57.5 % vs. 32.7 %, p = 0.033), however this effect did not persist at further follow-up.

High-frequency (10 Hz) rTMS of LDLPFC over 3 weeks provided only a small benefit in the reduction of negative symptoms, however HF-rTMS was well tolerated. We discuss our results in comparison to current meta-analyses and previous studies.

ClinicalTrials.gov NCT00783120.

Previous studies have reported that patient with schizophrenia have preserved hedonic capacity, but impaired ability to anticipate future reward (anticipatory anhedonia) that, according to some authors, may underlie other aspects of negative symptoms, such as avolition.

The aim of our study was to demonstrate an impairment of reward anticipation in patients with deficit schizophrenia (DS), characterized by primary and persistent negative symptoms, but not in those with non-deficit schizophrenia (NDS) with respect to healthy controls (HC), by means of functional magnetic resonance imaging (fMRI).

fMRI was recorded during the execution of the ’Monetary Incentive Delay’ task in 11 patients with DS, 23 patients with NDS and 23 HC, during the anticipation of five different outcomes, small (SR) or large (LR) reward, small (SP) or large (LP) punishment or no-outcome (NO).

The ventral striatum response to reward anticipation was preserved in subjects with schizophrenia. Only patients with DS, compared with HC, showed a significant reduction in the left caudate during the anticipation of reward. The reduced activity of the caudate correlated with the scores for avolition but not for anhedonia.

Our preliminary data suggest an involvement of the caudate in the abnormal processing of reward stimuli in patients with DS and show that avolition and anhedonia are subtended by different functional abnormalities.

Several factor analytic studies have shown than anhedonia and avolition are included in the same factor, suggesting that motivational deficits in schizophrenia are related to a reduced experience of pleasure; however other studies have not confirmed this hypothesis. More recently, it has been hypothesized that avolition is related to a difficulty in anticipating reward value and\or regulating behavior on the basis of the associations between value and action.

This study is aimed to verify an impairment of reward anticipation in patients with deficit schizophrenia (DS), but not in those with non-deficit schizophrenia (NDS) and its association with primary negative symptoms, using event-related potentials (ERPs).

ERPs were recorded in 11 patients with DS, 23 patients with NDS and 23 healthy controls (HC), during anticipation of five different outcomes, small (SR) or large (LR) reward, small (SP) or large (LP) punishment or no-outcome (NO), and during feedback processing.

Patients did not differ from HC on indices of anticipatory or consummatory anhedonia, but they showed reduced motivation. During reward anticipation, only patients with primary and persistent avolition showed ERPs abnormalities, with respect to HC, in the early processing stages and a reduced activity of cortical generators in the cingulate, in the temporal-occipital and fronto-parietal regions, that are involved in the attention modulation and visual perceptual processing.

Our data suggest that anhedonia and avolition are partially independent constructs and that avolition is related to the inability to modulate attention and amplify visual perceptual processing of reward stimuli.

Eating disorders, represented in the spanish adolescent population a prevalence of 3,5% to 5,5% (Labrador-and-Raich.2007), increasing day by day in our treatment centres. Multiple diseases are based on the pattern of Impulsivity, which must be studied in their overall comorbidity, because the general approach to their differents etiologies, could have a focus on a Unique Therapeutic Plan (UTP).

There is a high comorbidity between the Impulsivity seen in Eating Disorders(ED) such as Bulimia Nervosa, Obesity, Binge(ED), Pica, among others, and externalizing disorders, because of their low tolerance to frustraction and low awareness of delimit, and many times there is also the presence of disorders related to substance use.

Demostrate by reviewing a case, the diagnostic comorbidity between Bulimia Nervosa and one type to Attention Déficit Disorder with Hyperactivity, associated with a pattern of substance abuse, with the same effective psychoterapeutic and psychofarmacological treatment, and demostrading, the posible same Neurobiological root.

Adolescent with 16 years old, with four years ago of hyporexia, vomits and binge, with hyperactivity, inattention and impulsivity. (BMI=17), in the context of greater family dysfunction and school bullying. There was cannabis abuse. He had received treatment with antipsychotics, antidepressives and mood stabilizers. By age 14, he was diagnosticated of Bulimia Nervosa in comorbidity with Attention Deficit Disorder with Hyperactivity in the Eating Disorders Institute(ITA). The new psychopharmacological treatment was with Methylphenidate, but he had tachycardia, also it suspend, and started Atomoxetine, associated with psychotherapeutic management and family therapy. Now the evolution is excellent(CHIP-AE), and there is absence of substance use over 12 months.

The eating disorders, with impulse control deficits, keep high etiopathogenic relationship with externalizing disorders-ADHD-, and could be effective the same psychotherapeutic and psychopharmacological treatment.

World Health Assembly adopted in May 2013 the Comprehensive MH Action Plan 2013–2020. At the end of 2012 WHO published QualityRights Tool Kit for mental health field; at same time a European Expert Group published European Guidelines on the Transition from Institutional to Community Care. In 2010 WHO, ILO and UNESCO published the joint community-based CBR-guidelines which cover psychosocial rehabilitation. In 2007 WHO launched recommendation for Pyramid Framework to support MH policy change. These recommendations are built upon the UN Convention on Rights of People with Disabilities (UN 2006), it includes people with mental disorders, too.

To present the findings of a MH policy analysis of the above-mentioned and about 25 earlier MH policy recommendations approved by Inter- Governmental Organisations since 1990. Common denominators are shared with participants, and compared with the reality in Europe. Main message is a search for community-based, more comprehensive, human rights based rehabilitation services, coordinated across organisational boundaries. Some examples are described.

1. (1) Presentation of the Bavarian experiences about CBR-based Clubhouse model, originally Fountain House model since 1948, disseminated since 1980s in Europe. In 2013 there are about 90 Clubhouses serving their members in 22 European countries.

2. (2) Presentation of research findings which prove the Clubhouse model is an evidence-based rehabilitation practice.

Content analysis of about 30 international MH policy recommendations since 1990s and comparative analysis of some community-based rehabilitation approaches.

Summarising main research findings in different countries in Europe and worldwide.

Clubhouse model is fitting in with the MH policy recommendations and should be used more widely in Europe.

Within the efforts to revise the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the Work Group on the Classification of Psychotic Disorders appointed by the World Health Organization (WHO) has proposed several changes, which will be put to test in international field trials in spring 2014.

The objectives of the field trials are to test whether the proposed revisions lead to an increase of clinical utility, reliability and validity of the classification of psychotic disorders.

WHO field trials target the following questions: (a) do clinicians apply the ICD-11 psychotic disorder diagnostic guidelines and discriminate among the descriptions consistently, (b) do the ICD-11 symptom specifiers lead to an incremental improvement over ICD-10 subtypes concerning reliability and clinical description, and (c) which is the optimal scale for the ICD-11 symptom severity specifiers. In further field trials, the effects of training on reliability in the use of symptom severity scales will be examined.

Report of current developments.

Schizophrenia subtypes will be replaced by six symptom specifiers, including a specifier for cognitive impairment. First-rank symptoms schizophrenia will be de-emphasized, course specifiers have been reformulated. ICD-11 includes stricter criteria for schizoaffective disorder and major restructuring of ATPD and delusional disorders.

Moderate to pronounced changes will be made to chapters on psychotic disorders. Proposed changes are likely to have impact on treatment planning, prognostic decision making, research, which will be tested in the ICD-11 field trials.

Abstract topic: 31 Schizophrenia

The European Guidance project provides a series of guidance documents on topics related to quality of mental healthcare and prevention of mental disorders, for which evidence- and consensus-based guidelines are currently lacking.

To provide information on good clinical practice by using problem solving examples, guidelines and quality standards of care to national societies, health authorities and practitioners; to address healthcare gaps and give advice on developing research programs.

To describe the development of the European Guidance.

Review of the Guidance project and its future activities.

The ‘EPA Guidance on the quality of mental health services’ provides evidence- and consensus-based recommendations on optimal structures and processes of European mental health services. In a structured process, the retrieved evidence is used as a basis for formulating recommendations.

The EPA Guidance recommendations may be implemented in European countries as a tool for improving the quality of mental health services. For internationally valid recommendations, high-quality multinational research would be warranted.

Considering the multinational nature of the European Union and the increasing role of regional constituents, harmonization of the quality of mental healthcare may be advanced on a supranational level with the help of the European Guidance. Its recommendations may be adapted to national or regional conditions in order to suit the needs, priorities and legislation of the respective European constituents.