The key features of CBT are collaborative empiricism, structuring techniques, a psychoeducational emphasis, pragmatic methods of work and homeworks. Comprehensive cognitive-behavioral-biological sociocultural models are used in the group cognitive behavioral therapy with patients suffering with anxiety disorders. Cognitive processes modulate the effects of the external environment like stressful life events, interpersonal conflicts, traumatic memories etc. on the central nervous system substrate for emotion and behavior. Dysfunctional cognitions can be produced by both psychological and biological influences and vice versa. Cognitive behavioral intervention can change the emotional, behavioral and also biological processes. Because environmental, cognitive, behavioral, emotional and biological processes should be conceptualized as a part of the same system, it is valuable to search for ways of integrating or combining cognitive and biological interventions to enhance treatment outcome. The CBT models of panic disorder, social phobia, GAD, agoraphobia, health anxiety, and depression are described and way how educate patients in groups about these models will be elaborate during the workshop.

Beyond the clinical efficiency argument, the efficacy of the group CBT approach has also been confirmed by carefully conducted research that started in the 1970s. Reviews and one meta-analysis suggest a high level of efficacy, event to the point of equivalence between group and individual CBT for depression. Considerable evidence for the efficacy and effectiveness of a group CBT approach in many different anxiety disorders was found. Our controlled studies in last 10 years showed the efficacy comparable to pharmacotherapy with SSRIs in specific group CBT of panic disorder and social phobia and higher efficacy than psychodynamic psychotherapy in mixed diagnostic group of anxiety disorders.

Data consistently show that around 90% of suicide victims and attempters have at least one Axis I major mental disorder (mostly major depression) at the time of their suicide event. As major mood disorder patients commit or attempt suicide mostly during major depression, treating acute mood episodes and stabilizing the remission period is crucial for suicide prevention.

In a Budapest psychological autopsy study more than 25 years ago, 63% of consecutive suicide victims had current depressive disorders (almost half of them bipolar depression). More than half of depressed suicide victims had medical contact during their last depressive episode, but less than 20% of them received antidepressants and/or mood stabilizers. In a recent case-control psychological autopsy we found that 49% of victims (and 6% of controls) had current major depression, 26% of victims (and 38% of controls) had medical contact and 18% of the suicide victims (and 8% of the controls) took antidepressants during the 4 weeks preceding the interview. Strong relationship between suicide attempts and agitated/mixed depression has been found both in population-based epidemiological and clinical samples.

In agreement with the Swedish Gotland Study findings, two major community-intervention suicide preventive projects in Hungary showed that education of doctors, healthcare professionals, and the public effectively reduces suicide mortality. Better recognition and more widespread treatment of depression seems to be a main contributing factor to markedly declined suicide rates of Hungary in the last 3 decades.

Suicide is a complex human behaviour challenging not only for medicine and psychiatry but the whole society as well. Although our knowledge is expanding concerning the underlying factors of suicidal behaviour, we still do not have sufficient knowledge concerning its biochemical, neuroanatomical and genetic background. Genetic determinants of suicidal behaviour may lead to the emergence of such personality traits and temperaments which may be long-time predictors of suicide. One of the most likely genetic candidates in the background of suicide is the 5-HTTLPR polymorphism of the serotonin transporter gene. Although there are contradicting results, several studies and metaanalyses support that the s allele plays a role in the background of violent suicide. However, in order to be able to delineate the genetic background of suicide, different types of suicidal behaviour should be distinguished, since studies indicate that these may have different genetic factors. Also, personality traits and temperaments should be identified which may play a modulating role between genetic factors and suicidal behaviour. So far, neuroticism, affective temperaments, and impulsive aggression have been found to be associated with both the s allele and suicidal behaviour. In order to gain deeper insight to the genetic determinants of suicidal behaviour we must determine intermedier endophenotypes modulating between genetic factors and manifested suicidal behaviour.

Functional remission is an important treatment goal in schizophrenia, as independent living and reintegration of patients into the community and the workplace is the ultimate goal of any treatment. Nevertheless, assessing functional remission in schizophrenia is problematic, as it is a multifactorial and complex entity reflecting various aspects such as symptoms severity, personal skills and socio-cultural expectancies.

The different instruments available for clinicians will be reviewed, with large differences regarding way of administration (self-report, clinican or informant rating, tests), strength (speed, easiness, accurency, capacity to involve patients, stardardized, objectivity), and limits (validity, biases, tto narrow, costly, time-consuming, culture specific). These will be detailed for GAF, PSP, UPSA, CAN, FSRS and FROGS.

A shorter (and quicker) version of the FROGS will also be presented, restricting the instrument on four items that are able to capture a large part of the variance of the functional impriovement which is associated wityh longer clinical remission (time and improvement sensitive).

The disruption of psychosocial functioning (PSF) is currently listed as one of the DSM IV diagnostic criteria for schizophrenia and PSF is increasingly recognized as an important determinant of successful treatment of the disease. Many factors influence patients psychosocial functioning; they can be grouped into illness related factors, context related factors and factors related to individual resources. Among illness related factors, negative symptoms and cognitive impairment are the most largely investigated domains. Evidence has been provided that negative symptoms are related to a poor psychosocial outcome; however, whether negative symptoms contribute to patients disability or represent its consequence is an open issue. Moreover, the study of relationships between negative symptoms and psychosocial functioning is further complicated by the overlap between the two domains in several assessment instruments and by the definition of negative symptoms as a unitary construct.

Cognitive impairment has also been reported in association with poor psychosocial functioning. It is debated whether a global impairment in cognition is relevant to poor functioning in the real life, or deficit of specific cognitive domains (including social cognition) play the most important role, or whether specific cognitive deficits are actually responsible for the impairment of specific aspect of psychosocial functioning.

The need for future treatments to target negative symptoms and cognitive impairment for their direct and indirect impact on psychosocial functioning will be highlighted.

The disruption of psychosocial functioning (PSF) is currently listed as one of the DSM-IV diagnostic criteria for schizophrenia and PSF is increasingly recognized as an important determinant of a successful treatment of the disease. However, despite the widespread use of the term, there is limited consensus about its definition and measurement. The workshop will provide a review of current definitions and measures of PSF in schizophrenia and an update of findings on PSF relationships with symptoms, cognitions and ICF. The inclusion of PSF in ICD-11 diagnostic criteria for schizophrenia will also be discussed.

The prevalence of both type 1 and type 2 diabetes mellitus (diabetes) is disproportionately high in people with clinically significant depression. Lifestyle programs are recommended for the management of diabetes, but are difficult to implement in practice, particularly for depressed people who are least likely to adhere to healthy lifestyle recommendations. In addition, interventions recommended for the management of depression have limited impact on diabetes outcomes and do not take into account lifestyle risk factors. The aim of this presentation is to inform policy and decision-making on the organization and delivery of effective multidisciplinary care for the management of co-morbid diabetes and depression.

This presentation will describe the results of a randomized trial that tested a multicondition collaborative care model versus usual primary care to treat patients with comorbid depression and poorly controlled diabetes and/or heart disease (HbA1c>8,5%, LDL>130, systolic blood pressure>140). This intervention used medically supervised nurse care managers who provided education, support for self care with motivational interviewing and problem solving,adherence monitoring, and carefully tracked disease outcomes. Physicians provided weekly caseload supervision and recommended changes in medication that the nurses communicated to the primary care physician. Intervention patients compared to usual care patients were found to have significant improvements in depression, HbA1c, LDL and systolic blood pressure over a one year period. Intervention patients also had significant improvements in functioning, quality of life and satisfaction with medical care compared to controls.

Violations of these fundamental rights will impair mental health and have negative consequences on social life, and interpersonal relations.

In recent years, we witness an upsurge in attention paid to ethical aspects of the psychiatric profession, and the civil rights of persons with mental illness.

Today the psychiatric profession is guided by a number of declarations. Some are common to all medical professionals e.g. WMA Tokyo Declaration, others reflect the psychiatric profession with the Madrid Declaration providing the key guidelines. Much attention is paid to alleged political abuse where e.g. psychiatric care and diagnoses have been used on non-mentally ill persons. To avoid this, a psychiatric diagnosis should be determined according to internationally accepted standards and difficulty in adapting to social values should not be considered mental illness.

Now focus is directed towards improving conditions and rights of marginalized groups and efforts to find the best local development and empowerment for people with mental illnes. International cooperation is needed to alleviate inferior conditions and support development.

The world is becoming more global.

With the focus on terrorism in recent years there is increasing concern that fundamental human rights may be violated in the interest to combat acts of terrorism. Knowledge about the mental health consequences of state perpetrated violence is thus of clear clinical relevance for psychiatrists worldwide as a significant proportion of e.g. refugees and migrants have experiences of war, persecution and a large proportion of the worlds population live in countries that condone such violations.

Prospective population based cohort studies in the field of psychiatry are crucial in order to study the etiology of complex and multi-factorial diseases such as psychiatric disorders. From the ethical point of view, however, the collection of longitudinal data poses several challenges to psychiatrists, mainly related to the processing of personal data. Respecting and protecting the confidentiality of data and the privacy of individuals regarding the information that they have given as participants in a research project is a corner stone of complying with accepted research standards. However, in longitudinal studies establishing and maintaining privacy is often challenging due to the necessity of repeated contact with participants. A novel internet-based solution is introduced here, maintaining privacy at the same time as it assures linkage of data to individual participants in a repeated measures design. Using the Anonymous Repeated Measurements via Email procedure (ARME), two separate one-way communication systems are established through ad hoc e-mail accounts and a secure study website. Strengths and limitations of the approach are discussed.

This presentation will use a number of anonymised real case examples to inform a discussion of ethical dilemmas in daily clinical practice. The context for discussion will be set by a brief review of the types of adverse behaviors and outcomes that doctors might experience.

Doctors often worry about ethical issues, and these can be a major source of stress. Even worse, poorly managed ethical dilemmas can lead to complaints, investigation, litigation and other potentially adverse outcomes.

Yet at the heart of such challenging situations sits a patient - a real person and their family.

Ethical dilemmas will be reviewed that deal with issues such as:

1. - Poorly performing doctors

2. - Exploitation and abuse

3. - Limited resources

4. - Confidentiality

Outgoing from an international european survey directed to national psychiatric asssociations and national ethical reference persons, we have collected data about the use of international regulations, the eventual existency of national guidelines and codices as well as the character of frequently experienced ethical problems in different parts of europa.

By doing this, a great diversity became appearant, guided by the psychiatric professional dcevelopment in the countries, but even showing significant sensitivity to cultural and societal - political influences.

Thus, 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 dcevelopment as well as psychiatric scietific improvements and research implications.

A need to put ethical issues and development on the EPAs agenda seems evident as well as the need to continously improve and discuss international and national ethical guidelines and practical clinical strategies.

Recent research shows that in first episode schizophrenia the chance of response to an antipsychotic trial decreases from 75% in the first trial to 17% in the second. A subsequent trial with clozapine has a response rate of 75% again. Studies show a significant higher response rate at clozapine plasma trough levels above a therapeutic threshold of 350–400 ng/ml. The absolute risk difference is about 40%. In children and adolescents with therapy-resistant early onset schizophrenia spectrum disorder clozapine appears to be superior to olanzapine and haloperidol. Clozapine has a superior effect on aggression in patients with psychotic disorders. Case series point to an anti-aggressive effect in non-psychotic disorders too. Comparison of patients on clozapine to patients on other antipsychotics shows decreased rates of suicide and suicide attempts. A randomised controlled trial in patients with schizophrenia or schizoaffective disorder and a high risk for suicidality shows an absolute risk difference of 2,9% of suicide attempts per year in the clozapine group versus the olanzapine group. In observational studies more patients on clozapine get into remission and maintain remission of alcohol and substance abuse or dependance than on other antipsychotics. Thus clozapine has a place beyond therapy resistance in schizophrenic patients with aggression, suicidality or alcohol and substance abuse/dependance.

Clozapine is uniquely effective in the management of treatment-refractory psychosis. However, many patients who are eligible to receive clozapine do not receive it, either because they have previously experienced adverse effects, or because of a reluctance to undergoing mandatory blood monitoring. At the National Psychosis Unit, a service designed for patients with treatment refractory psychosis, we specialise in helping patients to start to re-start clozapine under these circumstances. This presentation will combine research evidence and our own experience on the National Psychosis Unit to offer advice on improving the acceptability and tolerability of clozapine. I will cover common but troublesome problems such as hypersalivation and sedation, as well as the approach to re-challenging patients who have previously experienced suspected blood dyscrasias or cardiovascular complications of clozapine.