Since the beginning of the COVID-19 pandemic a mental health deterioration has been detected in the general population and especially in people affected by pre-existing psychiatric conditions, and mental health care has moved towards online treatment. Literature studies have been reviewed to gather evidence regarding the impact of the COVID-19 pandemic on people affected by eating disorders (EDs) exploring changes in ED-specific and general psychopathology; mechanisms of vulnerability and resilience; change in treatment delivery service; patients’ perception of online treatment and potential barriers and/or advantages of this method and its effectiveness. A wide variability characterized the response of people with EDs to the COVID-19 pandemic. A trend toward worsening of ED specific psychopathology with respect to the pre-pandemic period was observed as well as a deterioration in general psychiatric symptoms. Feelings of uncertainty and social isolation were the most common vulnerability mechanisms. Resilience factors such as heightened self-care and reduced social pressure also occurred. The treatment has largely switched to online delivering strategies which, despite considered the best alternative to the face-to-face approach, were suffering from some concerns about their quality. The exacerbation of specific and general psychopathology supports the hypothesis of an emotional and post-traumatic nature of EDs and outlines the importance of internalizing symptoms. In front of the great variability observed across ED patients during the pandemic, the identification of risk and resilience variables as well as of subjective factors affecting the perception of online treatment may inform clinicians and promote more targeted and individualized approaches.

Eating disorders are severe mental disorders, with high mortality rates and high incidence in adolescence and early adulthood, especially in women. The course of these disorders is uncertain and treatment outcomes are limited. Several factors such as duration of the disorder, dysfunctional personality traits and cognitive profiles, as well as genetic vulnerabilities, will influence adherence and response to treatment. In this presentation we will include recent results on prospective observational studies, analyzing personality and cognitive predictors of treatment response in eating disorders, as well as potential associated neurobiomarkers.

Anxiety disorders are common in pregnancy and in the post-natal period. This presentation will focus on how anxiety disorders may present in the perinatal period, the need for accurate and timely diagnosis, and barriers to diagnosis and barriers for women in accessing appropriate care and treatment.

• Diana discusses the terror of perinatal ocd undiagnosed with four small children ages six years and under

• Diana explains fearing seeking help and seeing a psychiatrist knowing she would have to disclose her thoughts and images she encountered daily

• She pinpoints what moved her forward and stresses the importance of revisiting ocd when it is not in your life

• She talks of hope and through successful CBT and Citalipram, has been free of the disorder for twenty years

Post-traumatic stress disorder (PTSD) occurs in 4% of all pregnancies during the postnatal period. This prevalence can increase in high-risk groups reaching a mean prevalence of 18%. Some risk factors are significantly associated with the development or exacerbation of postnatal PTSD, including prenatal depression and anxiety, pre-pregnancy history of psychiatric disorders, history of sexual trauma, intimate partner violence, emergency childbirth, distressing events during childbirth and psychosocial attributes. Maternal postnatal PTSD is highly associated with the difficulties in mother-infant bond and the postpartum depression. Evidence shows significant links between psychological, traumatic and birth-related risk factors as well as the perceived social support and PTSD following childbirth. The City Birth Trauma Scale can be recommended as a universal instrument for diagnosis of postnatal PTSD.

Molecular psychiatry research needs a deeper characterization of emotional and cognitive neural underpinnings, along with a broader recognition of trauma-related circuitries and their involvement in shared pathological endophenotypes. One such endophenotype is unbalanced approach avoidance conflict (AAC), a highly recurrent trait of psychopathology. A translationally validated rodent model of AAC is the elevated plus maze (EPM) test, recently shown to be pharmacologically controlled in human and rodents via homologous neural substrates. Thanks to this test, we identified the involvement of the epigenetic enzyme LSD1 as a molecular restrainer of anxiety. We identified LSD1 aberrant regulation within the hippocampus of suicidal victims, suggesting its broad functional involvement in maladaptive behaviors. Interestingly, thanks to the parallel employment of rodent models, we evaluated a stress-related LSD1 homeostatic regulation that transiently limits memory formation-instrumental gene expression in the hippocampus upon trauma. Our work shed new light on epigenetic processes devoted to trauma resiliency through a negative regulation of anxiety plasticity.

Adaptive responding to severe stress or trauma requires an optimized reconfiguration in the activity of large-scale neural networks. In vulnerable individuals, this response can go awry, inducing long-term consequences on mental health, such as posttraumatic stress disorder (PTSD). Improved understanding of the neurobiological mechanisms underlying this maladaptive neural response to trauma might benefit early intervention (i.e., secondary prevention) options in stress-related psychopathology. Yet, because of obvious ethical limitations these acute responses to trauma are inaccessible in humans. Therefore, we here used a mouse model for PTSD to investigate adaptive vs. maladaptive neural responding to trauma, the latter leading to long-term behavioral consequences mimicking symptoms observed in PTSD patients. By using transgenic mice, we were able to fluorescently label all activated neurons during trauma exposure, and relate these activation patterns to later PTSD-like symptomatology. We observed increased neuronal activity in sensory-processing and memory-related areas of mice vulnerable to the long-term consequences of trauma exposure, compared to resilient mice. Moreover, vulnerable mice displayed increased functional connectivity between the default mode network and lateral cortical network (a proxy for the central executive network in humans) during trauma processing relative to resilient mice. As such, these findings provide first insight in how a maladaptive neural response to trauma can result in later symptoms of psychopathology.

According to the social brain hypothesis, the human brain includes a network designed for the processing of social information. This network includes several brain regions that elaborate social cues, interactions and contexts, i.e. prefrontal paracingulate and parietal cortices, amygdala, temporal lobes and the posterior superior temporal sulcus. We will explore neuroimaging studies that investigated social isolation in healthy subjects.

Recently, many reports have been available related to neuropsychiatric complications in the course of COVID-19 infection, and its long-term consequences. Many of them are related to psychological factors, such as: isolation, change of existing habits, fear of getting sick and dying, fear of losing a job and fears related to the financial situation, which resulted in an increase in the occurrence of diseases and mental disorders such as adaptation and anxiety disorders, depression. t has been also reported that treatment in conditions of intensive care unit lead to high prevalence of psychiatric disorders like PTSD in discharged patients. In our own studies we observed that patients with new appearing psychiatric symptoms were mostly those, who were professionally active, but did not work remotely. The time the patients spent at home had a negative impact on their well-being, they generally felt worse, their family life suffered more frequently. The most common cognitive symptoms, which are reported embrace: problems with short- and long-term memory, lack of mental clarity, feeling eclipsed, lightheaded, poor concentration, mental fatigue. We also present here a series of post-acute COVID cases from the examined population and provide a concise comparison of observed symptomatology with previous reports.

Within the IT4Anxiety project, the World Health Organisation Collaborating Centre (WHOCC) for research and training in mental health of Lille, is the leader of the work package “identification of needs among the different actors in the mental health field”. The complexity of our object of study - the use of new technologies for people’s mental health - requires undertaking a multi-disciplinary approach, considering both the clinical and the socio-anthropological aspects. A mixed-methods research conducted with pepole people experiencing anxiety, carers and professionnals, aims to describe the use, acceptability and needs of the different categories of actors concerned by the use of new technologies. The quantitative part is a cross-sectional, descriptive, observational study. A anonymous self-administered questionnaire is distributed online and in hard copy in the 5 partner countries (Belgium, France, Germany, the Netherlands and the UK) to the three study populations. It consists of access to digital tools or technological solutions, experience related to these and the contribution and perceived effect of users to e-mental health related projects. The qualitative approach includes a detailed understanding of the potential therapeutic and socio-anthropological changes that these tools can bring. It explores : description of used technologies, the representations and emerging needs in relation to the management of anxiety and the improvement of mental health ; the clinical impact perceived by all stakeholders and the implementation of new ways of living with the tools. This international research will enable a comparative study to be carried out on the dynamics of appropriation of these e-(mental) health devices in different countries of the North-Western European region.

Technological innovations give new perspectives in many fields, including health. It was in this context that the IT4Anxiety project was born in 2019 bringing together mental health professionals and start-ups, but also universities, research centres, higher education establishments and public authorities from the North-West Region of Europe. The project is challenging our ability, as partners, to gather stakeholders from different background, medical and non-medical field, in order to support the implementation and co-conception of innovative solutions with the objective of reducing the anxiety of mental health service users. During the four years of project implementation (2019-2023), the stakeholders will have opportunities to work with the end-users, expecting to address the needs of around 3,000 mental health service users suffering from anxiety. The fifteen start-up involved in the project activities will be recruited through hackathons and calls based on identified needs. They will join the project in order to test and improve their solutions. This will create opportunities to connect the start-ups with the medical world, research codes and procedures and to give them a new perspective in the understanding of their targeted market segment. Furthermore, almost a thousand mental health professionals will be trained in e-mental health, benefiting from our training modules and an e-mental health job profile will be designed and implemented in our partner hospitals in Belgium and in Germany.

As the manager of a business incubator, I’m involved in the European project IT4Anxiety. It focuses on the creation and implementation of innovative solutions designed to reduce the anxiety of patients experiencing neurological disorders or PTSD. The IT4Anxiety project is a collaboration between mental health professionals, users and start-ups, but also universities, research centres and higher education establishments. There is growing evidence that technological solutions can expand and complement conventional medical protocols. Such “blended therapies” are central to the approach being developed through several work packages. In the framework of the IT4Anxiety project, I carry out actions to develop interactions between startups and mental health professionals.In this context, my speech will focus on 3 specific points: - Feedback on the process of testing and validation of innovative tools in hospitals, care homes… We developped a framework for testing and validating tools with patients and start-ups in order to guarantee the effective implementation of these innovative solutions, especially from an ethical point of view. Going before the ethics committee is often a new experience for start-up managers who have to answer complex questions - Feedback on co-creation processes, in particular through the organisation of hackathons bringing together start-ups, users and health professionals.The objective of the hackathons is to bring together stakeholders in the co-creation of innovative solutions and their integration thereafter into the mental health care sector - Examples of innovative tools in mental health developed by startups which have joined the IT4Anxiety project. These tools complement conventional medical protocols

The Interreg IT4Anxiety Project gives birth to training modules in digital health. The European Interreg IT4Anxiety project, led by the CNP St-Martin, is launching a new range of training modules in digital health awareness at the Haute Ecole de la Province de Namur, the University of Applied Sciences (HEPN). Electronic medical records, teleconsultation, mobile applications, virtual reality… Digital tools are already part of the daily life of workers in the health sector. However, until now, no curriculum has included appropriate training to enable caregivers to acquire the fundamental knowledge needed to use digital tools effectively in their professional practice. Thanks to the expertise and support of its various partners in the IT4Anxiety project, the Haute Ecole de la Province de Namur will provide digital health awareness training starting in 2022. These training modules will be provided as part of the in-situ training of caregivers and are already being tested in the academic training of future nurses. In addition to discovering the potential of new technologies in the health field, health professionals and future professionals will learn to identify the appropriate use of these tools, to deploy them and to use them in their profession, in a respectful and caring relationship with a critical eye. The structure of the courses, the assessment and the feedback from the HEPN will form the basis for an international deployment of this training by the German, French, Dutch and English partners of the IT4Anxiety project.

Suicidal behavior is a complex human behavior expressed in a spectrum of various acts. From a suicidal gesture to a completed suicide, all reflect a cry for help and need clinical and scientific attention. The process ending up with suicidal act is shaped by multi-factors, including the socio-cultural ones. Suicide is indeed related to a deep feeling of hopelessness; not to have any control over their lives and circumstances except than deciding to stay alive or dead, and so related to serious psychopathologies, as depressive and substance use disorders. Hence, it is frequently seen as a personal act or as a question of individual decision. But since Durkheim‘s ground breaking work, which still inspires suicide researchers, the cultural factors behind this socially determined phenomenon have been widely discussed. Suicide is totally a personal act and a fully socio-cultural phenomenon. The cultural factors of suicidality are among the social determinants of health/ill health. Epidemiological evidence and cross-cultural comparisons show huge differences in suicide rates across countries and even between regions of same countries, and these are constant differences. Furthermore, even the definition of suicide is effected by the social circumstances. Certain socio-cultural patterns shape how and when people commit suicide; i.e., these patterns have decreasing or increasing effect on suicide rates, which provides basis for suicide prevention. Likewise, social solidarity, high group integration and collective sensitivity may have preventive effects. This brings us to the discussion of the effects of big social turmoil or wars or pandemics on suicidal behavior.

Crises such as the corona pandemic, but also climate change associated events such as extreme weather events are major stressors for people on an individual, but also on a population level. Such crises often lead to highly burdened individuals with reduced quality of life, decreased well-being, mental health problems and an accumulation of psychiatric illnesses, especially in vulnerable population groups. These create a high demand and need for low intensive (psychosocial) support and primary and clinical care that can often no longer be adequately met by the existing infrastructure. However, good mental health and mental health care is a necessary prerequisite for people to lead fulfilling and productive lives and for communities and their settings (such as families, schools and workplaces, etc.) to function well. Therefore efficient supporting (public mental health) approaches are urgently needed. This presentation will introduce and discuss public mental health approaches and their effectiveness with a focus on mental health promotion and prevention. The implementation and dissemination of these approaches may help to further strengthen psychological resilience in communities to be better prepared for coping with acute crises and long-term stressors.

Crises such as the corona pandemic, but also climate change associated events such as extreme weather events are major stressors for people on an individual, but also on a population level. Such crises often lead to highly burdened individuals with reduced quality of life, decreased well-being, mental health problems and an accumulation of psychiatric illnesses, especially in vulnerable population groups. These create a high demand and need for low intensive (psychosocial) support and primary and clinical care that can often no longer be adequately met by the existing infrastructure. However, good mental health and mental health care is a necessary prerequisite for people to lead fulfilling and productive lives and for communities and their settings (such as families, schools and workplaces, etc.) to function well. Therefore efficient supporting (public mental health) approaches are urgently needed. This presentation will introduce and discuss public mental health approaches and their effectiveness with a focus on mental health promotion and prevention. The implementation and dissemination of these approaches may help to further strengthen psychological resilience in communities to be better prepared for coping with acute crises and long-term stressors.

Several observational studies investigated risk factors for suicide attempts/completed suicides in older age with contrasting evidence from ongoing population-based research. The risk factors most associated to suicide attempts than other variables were: depressive disorders, methods employed to self-harm (particularly poisoning), and psychotropic drug utilization followed by psychological factors and disability. Moreover, male sex, violent methods to self-harm, any psychiatric disorder (depression, anxiety and bipolar disorders), a poor medical condition, stressors/bereavement, and living alone appeared to be more significant for predicting completed suicides in late life. There is growing evidence of a role of environmental exposures in the pathogenesis and epigenetics of suicidal behavior in older age. Little is known about the possible relationship between suicidal ideation in older age and its biopsychosocial predictors, although psychiatric disorders (among which late-life depression, LLD), play a fundamental role. LLD, distinguished as late-onset depression (LOD) and early-onset depression (EOD). Suicidal ideators accounted for 2.32% of subjects, were female, smokers and obese affected by multimorbidity. After adjusting for age, gender, education and social dysfunction, suicidal ideation was associated to LLD (EOD>LOD:OR:21.71, 95% CI:9.22-51.14). In the full random forest model, asthma was the most important contributor to suicidal ideation. Among biomarkers, interleukin (IL)-6 followed by tumor necrosis factor (TNF)-a, Apolipoprotein E e4 allele-carriers, C-reactive protein contributed most to suicidal ideation. Although EOD is a strong determinant of suicidal ideation, other non-psychiatric factors, i.e., serum inflammation biomarkers, APOE e4 allele, and multimorbidity, should be taken into account when evaluating a suicidal ideation phenotype in older age.

E-Mental Health in older age Ulrich Hegerl, Caroline Oehler Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität Frankfurt/M, Germany European Alliance against Depression e.V. (www.EAAD.net) The implementation and uptake of digital tools for self management or psychotherapy for people suffering from depression or other mental disorders has gained momentum during the Covid-19 pandemia. While studies using waiting list or treatment as usual control groups are of limited value, meta-analyses of RCTs with face-to-face psychotherapy as control condition have found a comparable antidepressant effect, especially when the interventions were provided together with professional guidance. The iFightDepression-tool offered by the European Alliance against Depression (EAAD) is available in 10 different languages and is broadly used in several European countries. Data will be presented concerning the attitude of older people concerning iCBT and also concerning effects of age, guidance, and gender on both adherence to the iFightDepression-tool and antidepressant effects.

Suicide in old age is frequently considered the result of a rational decision. Accumulation of physical illnesses, frailty, dependence on others, loss of partner and loneliness are often seen as reasons that might justify suicidal acts. Depression is an important risk factor for suicidal behaviour even at very advanced age. However, ageistic views tend to consider depression as a normal feature of the aging process; it is possible that its presence can be overestimated or perhaps generalized more than necessary by making it the scapegoat of any situation related to suicide. In fact, adopting an attitude that involves excessive simplification of problems, where everything is attributable to ‘depression’, can induce a rigid prescriptive approach, often limited to the indication of an antidepressant drug. In this way, the appreciation of the multifactorial nature of an individual’s crisis becomes too narrow and the chances of counteracting the complexities of a dangerous suicide progression too modest. From a prospect of suicide prevention, approaching a patient carefully and prudently is always to be preferred to the disposition that considers life events as inevitable as well as all reactions related to them, including the most extreme, such as suicide. This attitude can lead to a poor involvement of the treating physicians, who might become too acceptant of the ‘unavoidability’ of the unfavourable progression of their patient. Such a passive approach may especially characterise the relationship with patients of very advanced age, where stressors of physical and non-physical nature easily aggregate, multiplying their impacting power.