There is a wealth of data to tell us that, when it comes to illness, not all is as it seems. Research into hidden agendas of patients [1]drives home the point that a substantial portion of patients (up to 42%) have covert motives for obtaining secondary gains associated with their patient status (e.g., financial support, help or attention from others, stimulant medication, work or study related privileges, or evasion of responsibilities. Less than 10% shared their expectations with the psychiatrist. The Accident Compensation Scheme in New Zealand, , reported a prevalence of symptom exaggeration of 20-50%. In 2017 a disorder struck in Sweden. It struck whose families had failed their last appeal for asylum. The previously unknown ’catatonia’ has many of the characteristics of a culture bound syndrome – giving voice to the voiceless/powerless. Researchers from Ireland studied the motivations of people with factitious disorder. A desire for affection was the most commonly mentioned reason for fabricating illness and as a coping mechanism for threatening life events. The analysis showed that motivation was conscious. Bianchini et al have reported on the Financial Incentive Effect. Perhaps counterintuitively one of the most important points they make is that the presence of a financial incentive is associated with worse outcomes. They found that factors othere than the injury itself control for the probabilities of return to work. How can we determine what is real? [1] Van Egmond, J., Kummeling, I., & Balkom, T. A. (2005). Secondary gain as hidden motive for getting psychiatric treatment. European Psychiatry, 20(5-6), 416-421.

Some patients present symptoms in an exaggerated manner [1,2]. This behavior can be assessed with specialized tests: Symptom validity tests (SVTs) to measure overreporting of symptoms, and performance validity tests (PVTs) to measure underperformance on cognitive tests. But what does it mean when patients fail on multiple SVTs and/or PVTs? Does it reflect malingering; i.e. grossly exaggerating or feigning symptoms to gain an external benefit? Could it be seen as a plea for help in some cases? Or could pain, fatigue or cognitive impairment be underlying reasons for the validity test failures? In this presentation some credible and non-credible explanations for failing on validity tests will be discussed. A tentative framework that might aid in conceptualizing poor symptom validity will be presented. References [1] Dandachi-FitzGerald, B., Merckelbach, H., Bošković, I., & Jelicic, M. (2020). Do you know people who feign? Proxy respondents about feigned symptoms. Psychological Injury and Law, 13, 225–234. [2] Merckelbach, H., Dandachi-FitzGerald, B., van Helvoort, D., Jelicic, M., & Otgaar, H. (2019). When patients overreport symptoms: More than just malingering. Current Directions in Psychological Science, 28, 321–326.

This presentation provides an overview of factors that can cause symptom exaggeration and/or fabrication in chronic pain. It will explore how symptom and performance validity tests can be applied to chronic pain in the context of a malingering framework and the problems of implementing this in the UK through a case example.

Major depression has become one of the most frequent diagnoses in Germany. It is also quite prominent in cases referred for medicolegal assessment in insurance, compensation or disability claims. This report evaluates the validity of clinicians’ diagnoses of major depression in a sample of claimants. In 2015, n = 127 consecutive cases were examined for medicolegal assessment. All had been diagnosed with major depression by clinicians. All testees underwent a psychiatric interview, a physical examination, they answered questionnaires for depressive symptoms according to DSM-5, embitterment disorder, post-concussion syndrome (PCS) and unspecific somatic complaints. Performance and symptom validity tests were administered. Only 31% of the sample fulfilled the diagnostic criteria for DSM-5 major depression according to self-report, while none did so according to psychiatric assessment. Negative response bias was found in 64% of cases, feigned neurologic symptoms in 22%. Symptom exaggeration was indiscriminate rather than depression-specific. By self-report (i.e. symptom endorsement in questionnaires), 64% of the participants qualified for embitterment disorder and 93% for PCS. In conclusion, clinicians’ diagnoses of depression seem frequently erroneous. The reasons are improper assessment of the diagnostic criteria, confusion of depression with bereavement or embitterment and a failure to assess for response bias.

Since 1999, more than 100 “Maisons des Adolescents” (MDAs) - “House of Adolescents” - have been developed in France. These integrated youth-friendly facilities enabled young persons to gain access to specific care. The various medical programs of MDAs depend on the priorities of local communities rather than on official regulations. Most MDAs offer the following essential services: a “Health and Prevention Space” open daily; multidisciplinary consultations; consult liaison for youths hospitalized in medical units; a home visiting service; outpatient clinic including art workshops; refresher courses for school work; peer and parent support groups. The MDAs from the start addressed an age group (young people aged 11-21 years) rather than an illness. They thus provide primary prevention for young persons according to the World Health Organization definition of health as “a state of complete physical, mental and social well-being.” The success of the MDA network is already widely acknowledged by users, professionals, and policymakers.

Understanding the factors that play a role in the initiation of alcohol use and the subsequent transition to later alcohol abuse adolescence is of paramount importance from the context of developing better-targeted types of secondary (“pro-active”) prevention interventions (Hendriks VM, Dom G., 2021). Peer and family influences together with temperament traits have been suggested to be of cardinal importance regarding the initiation of alcohol use. In addition to these factors neurobiological and genetic factors play a major role in the risk of developing alcohol abuse upon initiation. The presentation will highlight the different psychological, neurobiological, and social factors underlying the risk of the transition to abuse and dependence in adolescence. In addition, examples of targeted prevention interventions will be highlighted.

Cognitive and social cognitive impairments are a central feature of schizophrenia and are known to significantly affect real-life functioning [1]. These impairments include deficits in memory, language function and executive function, as well as in processing speed and attention. In the domains of social cognition, face perception [2], voice perception, mentalizing and emotion regulation have been described to be affected. All deficits, cognitive and social-cognitive, can persist during symptomatic remission. Social cognition is a partial mediator between neurocognition and functional outcome. Recent research has demonstrated that neurocognition affects functional capacity and that social cognition affects community functioning [3]. The impact of cognition on quality of life (QOL) was shown in a large meta-analytic study, in which a moderate correlation of verbal ability and processing speed with subjective quality of life was found [4]. A network analysis showed that functional capacity and everyday life skills were the most central and highly interconnected nodes in the network. Functional capacity bridged cognition with everyday life skills, the everyday life skills node was linked to disorganization and expressive deficits [5]. Deficits in neurocognition and social cognition play a pivotal role as enduring impairment after clinical remission and as a critical rate-limiting factor in functional recovery. [1] Green et al. Schizophr Bull. 2000; 26(1): 119-136 [2] Sachs et al. Schizophr Res. 2004; 68(1):27-35 [3] Bechi et al. Psychiatry Res. 2017; 251:118-124 [4] Tolman & Kurtz Schizophr Bull. 2012; 272:419-424 [5] Galderisi et al. JAMA Psychiatry. 2018; 75(4):396-404

A renewal of interest in the cognitive assessment of people with schizophrenia was related to the increasing acknowledgement of the strong relationships of cognitive deficits with functional outcome. In the early 2000’s, research focused on those aspects of cognition that demonstrated a strong correlation with a variety of functional outcome measures (community functioning, functional capacity, social skills acquisition). Later on, social cognition, which was not included in neuropsychological batteries, became also a focus as it represents a mediator of the impact of neurocognition on functioning. The renewed interest and the association with functional outcome stimulated the development of batteries specifically devoted to the cognitive assessment of subjects with schizophrenia. The MATRICS Consensus Cognitive Battery (MCCB) is the instruments with the largest evidence of good psychometric properties and strong relationship with functional outcome. The MCCB has been proposed as the gold standard in assessing cognitive impairment in subjects with schizophrenia and has been translated into 24 languages and validated in many different countries. Different instruments are also available to assess emotional processing and theory of mind which should complement MCCB and similar batteries. The long administration time limits the use of batteries in everyday clinical routine and short-administered instruments were developed as screening tools. A brief, interview-based assessment of cognitive functioning, the Cognitive Assessment Interview, has also been developed and validated for use in clinical settings or as a co-primary measure in clinical trials. The development of a guidance paper might promote the routine assessment of cognition in subjects with schizophrenia.

Background. Cognitive impairment in schizophrneia is highly prevalent, the level of impairment range from moderate to severe. It has previously beed stated that cognitive impairment was stable through the course of illness, but newer finding from long-term studies indicate that some patient have improved cognitive function. Cognitive function is marginally reactive to antipsychotic medication, and it is highly predictive of poor social and vocational outcome. Also, it constitute a ‘glass ceiling’ for psychosocial and vocational rehabilitation. Several large batteries have been developed, and internationally, there is an attempt to agree on common measurements of core areas. There is a strong rationale for cognitive remediation, namly that it might improve the ability of patients to function in everyday life and that it has no side effects. Individuals at ultra-high risk (UHR) for psychosis have significant cognitive deficits that can impede functional recovery. Methods. In this randomised, clinical trial 146 individuals at UHR for psychosis were randomly assigned to treatment as usual (TAU) or TAU plus cognitive remediation. The CR targeted neurocognitive and social cognitive remediation. Results. A total of 73 UHR individuals were assigned to TAU and 73 assigned to TAU + cognitive remediation. Cognitive remediation did not result in significant improvement on the primary outcome; the Brief Assessment of Cognition in Schizophrenia composite score at 6-month follow-up (b=-0.125, 95%CI: -0.23 to 0.172, p=0.41). Conclusion. The 20-session treatment protocol was not well received in the UHR group. Possibly situations close to everyday life could be better received and be more motivating

Cognitive function in schizophrenia is one of the main elements significantly related to functional outcomes, accounting for approximately 25–50% of the variance in real-world functioning. Treatment approaches to cognitive dysfunctions include both pharmacological and psychosocial interventions. Second Generation Antipsychotics (SGAs) may partially improve cognitive dysfunction, due to their relatively high affinity for serotonin 5HT2A receptors. The effects of glutamatergic agents indicated benefits on cognition of a group of amino acids that act as glutamate agonists by binding to the glycine site on NMDA receptors. The administration of muscarinic antagonists potentiates cognitive impairments, while the α7 nicotinic acetylcholine receptors have been shown to play an important role in cognition with potential therapeutic applications in schizophrenia. Studies on drugs targeting neuroinflammation and oxidative stress emerged. Cognitive remediation has proved to be effective in improving cognitive dysfunctions and psychosocial functioning in people with schizophrenia, however there is still a limited understanding of how the putative active therapy ingredients contribute to changes in the brain and translate into improved real-world functioning. Cogrem exerts its maximal benefit when delivered in the context of other psychiatric rehabilitative interventions, but it is not yet clear what are the mechanisms of effectiveness of integrated treatment. It is important that future research shift from studies of group efficacy to individual efficacy of treatments, in the perspective of precision medicine. Issues related to individual predictors of effectiveness and of interactions between specific pharmacologic, specific cognitive remediation technique and individual patients’ characteristics should be furtherly addressed.

Cognitive impairment is conceptualised in different ways and the discussion will highlight differences and similarities. The importance of these cognitive impairments for choosing specific or generic cognitive remediation therapies will be highlighted as well as the need to consider social cognition and metacognition as potentially more important ingredients for improving recovery.

Women’s mental health deals with, but not limited to, various aspects of psychiatric disorders in women, across the lifespan. The differential influence of gender and gender related indirect factors on mental ill-health has been researched and established for at least three decades. However, this topic is seldomly considered to be included in the structured curricula of psychiatric training. Several institutions provide temporary, CME-linked courses and other training opportunities. Yet, in many countries it is not part of a core program, whereas in common mental disorders, it is women who predominate. In this talk, a special focus will put on the training needs of psychiatrists and other mental health professionals regarding women’s mental health, especially perinatal mental health and psychopharmacology during pregnancy and lactation. Another important aspect is the impact of intimate partner violence on the mental (and general) wellbeing of women, which despite being encountered by around 1 out of 3 women worldwide, is still poorly addressed and treated. Some other contemporary aspects such as the mental health of immigrant women, will also be discussed.

There will be two main foci to this presentation. Firstly, Designing and implementing a new educational program entitled “Women victims of domestic violence: Detection, clinic, help” – that is mainly based on the teaching of several modules, WPA International Curriculum for Mental Healthcare Providers on Violence Against Women. Our program is a follow-on to the one held during the COVID-19 pandemic restrictions, at which interest was expressed in sharing ideas and resources. Secondly, Informing on the recent trends in Russian perinatal psychiatry. This covers the psychiatric training in the assessment domain, case management, and service evaluation. We will introduce and review some resources for use in women’s mental health practicals, propose innovative pedagogical structures for practical teachings, such as Problem Based Learning, ’Vicarious Learning,’ and encourage discussion of how the practical aspects of women’s mental health teaching can be supported and enhanced. Teaching modules and training pathways will be delivered (“not too much; not too little and in the right order”), and dimensions of quality in continuing professional development in women’s mental health (i.e., Sophistication, Credibility, Timeliness, and Utility) will be outlined. This will be followed by a discussion exploring the different prioritization of the teaching modules across various organizations. We urge our audience to consider it is time for psychiatric training in women’s mental health to move from the margins to the center.

There will be two main foci to this presentation.

Firstly, Designing and implementing a new educational program entitled “Women victims of domestic violence: Detection, clinic, help” – that is mainly based on the teaching of several modules, WPA International Curriculum for Mental Healthcare Providers on Violence Against Women. Our program is a follow-on to the one held during the COVID-19 pandemic restrictions, at which interest was expressed in sharing ideas and resources.

Secondly, Informing on the recent trends in Russian perinatal psychiatry. This covers the psychiatric training in the assessment domain, case management, and service evaluation.

We will introduce and review some resources for use in women’s mental health practicals, propose innovative pedagogical structures for practical teachings, such as Problem Based Learning, ‘Vicarious Learning,’ and encourage discussion of how the practical aspects of women’s mental health teaching can be supported and enhanced.

Teaching modules and training pathways will be delivered (“not too much; not too little and in the right order”), and dimensions of quality in continuing professional development in women’s mental health (i.e., Sophistication, Credibility, Timeliness, and Utility) will be outlined.

This will be followed by a discussion exploring the different prioritization of the teaching modules across various organizations.

We urge our audience to consider it is time for psychiatric training in women’s mental health to move from the margins to the center.

A notable part of psychiatry is prevention. Our job, as psychiatrists, is not only to treat mental disorders, but also to prevent them. Treating mothers in postnatal period reducing the negative consequence of depression for child development, for example. General adult psychiatrists face the challenge of having patients, who receive psychiatric health care, while also planning to have a child. Many professionals may find themselves in a situation, when they feel clueless on what to advise regarding pharmacotherapy and realistic expectations on having a child. The presentation will focus on some crucial topics. What should counselling include when planning pregnancy, highlighting differences among first and second or further children. Potentials risks and harms on the fetus / new-born baby will be introduced with emphasis on pharmacological/chemical agents, infectious effects and social, relational and family stressors. What the guidelines are for Covid-19 vaccination and pregnancy. Relative and absolute contraindications of planned pregnancy will be discussed. The crucial question of artificial/therapeutic abortion; are there any psychiatric conditions, when a psychiatrist can/should suggest it? The advantage and knowledge of perinatal mental health guideline papers, bio-ethical aspects will be discussed, along with the consequences of untreated mental illness. Advantage of breastfeeding and an up-to-date view on what should be psychiatrists’ aim will be introduced. Why is it inevitable to cooperate with GPs, obstetric- and gynecology colleagues and further medical professionals? The essential aspect and advantages of involving fathers and extended family members in this approach also will be explained.

This presentataion outlines the development of a post-membership masterclass programme in Perinatal Psychiatry, funded by Health Education England and delivered through the Royal College of Psychiatrists. The masterclass programme renges from 5-15 days and there are separate programmes for consultants, SAS doctors and senior trainees in psychiatry. The course is delivered by experts in the area and contains a mix of didactic teaching and small group work. The programme was developed to meet the workforce needs of rapidly expanding perinatal mental services throughout England. The programme also helps facilitate the needs of perinatal psychiatrists from Ireland and from the devolved nations of the UK (Scotland, Wales and Northern Ireland).

Apart from other well-known psychological determinants of obesity, deficits in neuropsychological processes related to effortful control can be relevant predictors for weight problems and difficulties in weight loss. Deficits in top-down inhibition as well as in other processes such as strong bottom-up reactivity, like external eating, hinder resisting food temptations in an obesogenic environment, thus determining the risk for the development of overweight and obesity. Furthermore, these deficits are associated with less positive outcomes in weight loss interventions for subgroups of children and adolescents with severe obesity. Targeting those effortful control mechanisms underlying childhood obesity via cognitive behavioral techniques can facilitate behavioural change necessary to induce sustainable weight loss and weight control. In this presentation, I will present data on effortful control collected in a large sample of youngsters (n=572 participants, 51% boys, aged 7–19) with moderate to severe obesity. Results suggest that top-down inhibition and bottom-up external eating play a complex role in weight problems in certain subgroups of youngsters with obesity, stressing the importance of identifying subgroups for tailoring interventions. I will demonstrate a few science-based intervention techniques that have the potential to ameliorate effortful control capacities, and thus optimize treatment outcomes for those youngsters low in effortful control.

Background and aim: Temperament and personality traits are important factors underlying the vulnerability for both initiation and continuation of addictive behaviors. In SUDs there is a high comorbidity with mood and anxiety disorders and personality disorders. As there is a growing interest in the possible transdiagnostic role of Effortful Control in both SUDs as in their comorbid disorders the current study therefore investigates the influence of reactive (Behavioral Inhibition System and Behavioral Activation System, BIS/BAS) and regulative (Effortful Control, EC) temperament and their interaction in relation to clinical symptomatology and PDs in adult inpatients with SUD. Methods: The EC, BIS/BAS, SCL-90-R and ADP-IV questionnaires were administered to 841 patients (age between 17 y and 71 y) with a SUD admitted at the treatment unit for addiction of a psychiatric hospital. Results: Hierarchical regression analyses showed that both, clinical symptomatology and PDs were related to low levels of effortful control (EC). Furthermore, cluster C PDs were related to high levels of BIS and low levels of EC; whereas cluster B PDs were related to low levels of EC and high levels of BAS for the narcissistic and histrionic PD. An interaction effect (BIS*EC) was found for the Schizotypal PD, all other interactions (BIS*EC and BAS*EC) were not significant. Discussion: We found that low EC is involved in all clinical symptomatology and PDs in a sample of inpatients with SUDs. Therapeutic interventions aiming at strengthening effortful control can possibly result in better treatment outcomes for both the addiction as the comorbid psychopathology

In the first part of the talk I will show that using a computational approach, namely the Drift Diffusion Model, the efficiency of executive attention (EA) is associated with effortful control, the self-regulatory aspect of temperament in a sample of n=427 healthy subjects. Then I will demonstrate how, applying the same model, EA measured through the same conflict resolution task predicts longitudinally a sooner relapse in a sample of n=64 subjects with bipolar and depressive disorders. Lastly I will discuss how EA is associated with obsessive compulsive symptoms in the same clinical population and how they interact in predicting the course of illness. Altogether these results suggest that there is an association between self-reported effortful control and EA and that treatments targeting executive functions could be crucial in preventing relapses in subjects with mood disorders experiencing obsessive compulsive-symptoms.