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.

Background and aim: Based upon a person-centred approach, there is a growing interest in neurobiological transdiagnostic factors, such as reactive temperament (Behavioral Inhibition (BIS) and Behavioral Activation Systems (BAS)) and regulatory processes (Effortful Control (EC)). Three temperament-based personality types (Resilient, Undercontrolled and Overcontrolled type (RUO)) have been replicated in adolescents and younger adults with several clinical problems; with the resilient type (highest scores on EC) consistently showing less psychological symptoms. However, these RUO types have not been studied yet in older adults with mental disorders. Therefore, the current study investigates (1) whether these RUO types can be replicated based on the aforementioned reactive and regulative temperamental factors in older inpatients and (2) whether a higher EC is related to the presence of less psychopathology. Methods: The EC, BIS/BAS, SCL-90-R and ADP-IV questionnaires were administered to 96 older patients (<= 60 years) admitted to a psychiatric hospital. Results: Cluster analysis resulted in a solution of three atypical types: a Resilient type (low BIS, mean BAS, high EC), a Dysregulated type (high BIS, high BAS, low EC) and an “Apathic” type (mean BIS, low BAS, mean EC). Comparison of means revealed that the Resilient type has the highest scores on EC and shows less clinical symptoms and maladaptive personality traits. Discussion: Of the 3 RUO types, only the Resilient type was fully replicated in older psychiatric patients. Strengthening EC might be useful as an additional therapy in order to reduce clinical symptoms, possibly leading to a better treatment outcome.

Intellectual disability is a mental disorder which appears during the developmental period in childhood and continues life-long. It is characterized by intellectual deficits on the one side and maladaptive social functioning on the other. The intellectual deficits include problems in abstract and logic thinking, problem solving, reasoning, learning from experience and judging. The deficits in adaptive functioning appear in problems in social communication and participation as well as in mental overload phenomena caused by daily life activities. This overload often results in psychopathological features and psychosocial reactions which are usually observed in Burn-out-Syndromes as e.g. general exhaustion (depletion of primarily reduced mental resources), additional reduced efficacy (accompanied by feelings of insufficiency and poor self-esteem), and most typically feelings alienation (towards intrinsically familiar situations, towards relatives and friends and at least also against oneself) typically accompanied by irritability and dysphoria. Treatment programs therefore should not only focus on intellectual deficits but should include also the multiple sufferings from psychopathological phenomena and psychosocial effects of such daily life overload syndromes.

Background: A review describing the mental health needs of adults with autism spectrum disorder (ASD) and intellectual disability (ID) published just over 10 years ago found that those with ID and ASD were more vulnerable to psychiatric disorders than adults with ID who did not have comorbid ASD (Underwood, Tsakanikos & McCarthy, 2010). Method: An overview of psychopathology presenting in adults with ID and autism including the relationship of challenging behaviours to psychiatric disorder will be summarised. A review of key papers published from 2009 to 2021 was also undertaken. The focus of the search was on assessment, diagnosis and management so as to be relevant to clinical practice. Findings: There was only one paper identified describing a new structured diagnostic tool for use with adults with ID and ASD. The majority of the new evidence focused on interventions both psychological and pharmacological. Two brief case vignettes will be presented to illustrate the diagnostic and treatment challenges. Conclusion: The past decade has produced a small increase in the evidence base on the mental health needs of adults with ID and ASD. However more evidence on effective interventions is required. Underwood L, Tsakanikos E & McCarthy J. (2010). Mental health of adults with autism spectrum disorders and intellectual disability. Current Opinion in Psychiatry, 23, 421-426.

It is possible to properly diagnose and treat a person with intellectual disability and mental health problems, but it requires a lot of work on the part of a doctor, nurse, professional medical care, proper rehabilitation and cooperation with a speech therapist, psychiatrist and many others. To improve the functional capacity of this person, it requires the help of a wide variety of professionals to meet their needs. One of the examples of interdisciplinary cooperation in this area is the “Circles of Support” program implemented by the Polish Association for People with Intellectual Disability in Poland. Support circles assume the creation of a group of supporters around a person with a disability, in accordance with their needs, combining formal (family doctor, psychiatrist, psychologist, personal assistant, social worker, therapist, lawyer) and informal support (family, friends, acquaintances, neighbors) , salesperson in your local store). The support is strictly focused on the needs of a person with a disability, and according to their individual preferences, it is fully inclusive. This goal can be achieved by preparing a person with a disability and the environment in a way that enables them to function safely in their local community based on the concept of supportive circles. The only way to build a system of care for of people with intellectual disabilities and their relatives is to rely on networks of connections - people and institutions, on their real commitment and on working out mechanisms supporting the empowerment of people with disabilities - in life, physical, financial matters.

A potential avenue of investigating the caregiver-infant relationship lies in caregiver-infant synchrony, which refers to the coordinated interplay of behavioural and physiological signals reflecting the bi-directional attunement of one individual to the other’s psychophysiological, cognitive, emotional and behavioural state. Here, we aim to study how early naturalistic caregiver-infant interactions give raise to caregiver-infant attachment, which influences physiological and psychological processes by modulating brain sensitivity. Furthermore, we aim to study how caregiver-infant bond shapes neural pathways involved in socio-emotional regulation in typical and atypical contexts. We present new evidence from fNIRS hyperscanning studies, where we measured simultaneous caregiver (mothers, N=30 and fathers N=38) and child brain activity (N=70). From the mother-child hyperscanning study (Azhari et al., 2019; 2020; 2021), we have found that higher levels of parenting stress are correlated to lower mother-child brain-to-brain synchrony, especially in the areas of the medial left prefrontal cortex. Additionally, maternal anxious attachment (Azhari et al., 2020a) also correlated in lower mother-child synchrony in the frontal and medial left prefrontal regions. These areas contain structures implicated in the inference of mental states and social cognition, highlighting the role of psychological factors such as parenting stress and attachment style in the influence of caregiver-infant bond formation during naturalistic interactions. From the combined mother- and father-child free play sessions (Azhari et al., 2020b), behavioural data revealed that parenting stress and caregivers’ recall of their past bonding experiences their own parents interact with each other to influence the eventual quality of dyadic interaction with their child.

The EPA Guidance on the Quality of eMental health interventions in the treatment of psychotic disorders (1), based on systematic literature review, found strong evidence that web- and mobile based interventions for people with schizophrenia and/or other psychotic disorders are feasible and acceptable both for patients and caregivers. There was moderate evidence that eMental health interventions may improve specific elements of mental healthcare processes, such as shared-decision-making, symptom monitoring, disease management, information provision, empowerment, and there was preliminary evidence that they may also improve outcomes by fostering symptom reduction and treatment adherence. E-mental health interventions hold promise to shape the future of mental healthcare delivery through increasing service accessibility, reducing stigma and self-stigma, and providing timely and flexible support to individuals with psychotic disorders and their caregivers. Nevertheless, it is important to also consider other aspects such as the lack of ethical guidelines and quality assurance mechanisms, and the need to analyse the legal frameworks about eMental health in different nations when developing and implementing eMental health interventions. We did not identify ethical guidelines or quality assurance systems specifically developed for eMental health interventions targeting people with psychotic disorders. E-mental health interventions are efficacious to increase mental health literacy. We also found preliminary evidence that eMental health interventions are efficacious to treat psychotic disorders. Recent overviews (2) are coming to similar conclusions. Future research needs to provide better controlled, sufficiently powered studies to provide definite answers to open questions. Gaebel et al., 2016, DOI 10.1007/s00406-016-0677-6 Donahue, Rodriguez, Shore, 2021, doi.org/10.1007/s11920-021-01242-y

Suicide prevention remains very difficult to achieve for many reasons, notably because we do not have any indicator of risk prediction, short-term risk factors being little explored, and evaluations being retrospective they are biased. Furthermore, patients at risk are not followed up, because of their lack of confidence in care, stigma, shame. On the other hand, the gap observed during the covid19 pandemic between distress and less occurrence of suicides could be linked to more virtual contacts. Then, the smartphone might be a good tool to stay connected to a protective network. We will discuss the opportunity offered by the smartphone to monitor patients with ecological momentary assessment, allowing to better characterize their acute states and detect an increased risk in real time, and thanks to the ecological momentary intervention 24/7 availability, improve access to care and better coordinate resources, and encourage self-care. These tools while offering new solutions for an efficient real time suicide prevention, may also raise some ethical issues that should be addressed.

Covid-19 has induced many changes to society, including some in the practice of medicine and psychiatry. Among them is increasing use of telecommunications. A previous editorial outlined the possible uses and dangers of telemedicine with prisoners (Gunn et al 2020). Forensic psychiatry is also concerned with providing expert evidence to courts and other arbitration bodies and, increasingly, these bodies too are relying on such technology. Further in addition to traditional paper-style records (many now held electronically rather than literally on paper) there is increasing use of video recording of interviews, of day to day behaviour on secure hospital units and by bodycams when intervening in a tense, potentially violent situation. To what extent are these being used in court? Is there a European framework for guiding us on how to proceed? How has this been interpreted to date in countries across Europe? In this paper these issues will be addressed.

For many old people with mental health problems, access to psychotherapeutic and psychiatric help is often difficult. This is partly because going to a psychiatrist is still stigmatised, especially among the older generation. On the other hand, therapists with an interest in and competence for older people are often not sufficiently available even in the well-supplied western countries. In this situation, digitalisation offers various opportunities. Basically, the internet is a good way to promote health literacy. Classic psychoeducation can certainly be offered on the internet. And psychotherapy can also be administered with the help of the internet. Especially in the COVID-19 pandemic, the possibilities of internet-based therapies, for example Zoom or other techniques, were practised. This means that people with limited mobility can also receive therapy over long distances. This technology also makes it possible, for example, for the migrant population to receive therapy in their national language. All these possibilities are under development, but may become routine in the future. With the help of the digital possibilities, it is possible to organise helper conference. The professional exchange between relatives, family doctors, psychiatrists and other people in the help system can be easily organised in this way. The method also saves travel time, which is often not reimbursed in the health systems.

The implementation of early intervention services (EIS) dedicated to first episode psychosis (FEP) remains a challenge in France. In 2016, the London School of Economics published a report in which France appeared as a poorly developed country in terms of early intervention services. Since the 1980s, the French psychiatric “sectorization” system offers access to general psychiatric care with a graduated intensity (outpatient consultations, day hospitalization, full time hospitalization) targeting territories (“sectors”) of approximately 70,000 inhabitants. While this system has advantages in terms of universal access to care, it leaves little room for specialized services. The Greater Lyon agglomeration (2.4 million inhabitants) is composed of several psychiatric sectors administered by 3 psychiatric hospitals and a psychiatric emergency system administered by a University Hospital. Since 2018, various hospital and university stakeholders, patient associations and international partners, have been working together to tailor, set up and organize a care system for FEP patients. We present here how we have federated workforce resources initially working within 11 general psychiatric “sectors” and covering a population of 850,000 inhabitants. A 3-step process of (1) field analysis, (2) the creation of a community of practice composed of healthcare workers, researchers and service users, and (3) confrontation of the already existing healthcare with the logic of “principal components” for FEP care, allowed the creation of the outpatient “PEPS” service, which now offers continuous case management, a functional recovery program and new pathways to care to more than 200 patients with a diagnosis of first episode psychosis.

During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams’ contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.1