First demonstrated in 1976, the robust association between smoking and suicide mortality has been established and is dose-dependent, with an estimated increase in suicidal deaths risk of 24% for each increment of 10 cigarettes smoked per day. The statistical association has been shown to exist very soon after smoking initiation, during adolescence, and to withstand adjustments for confounding factors, such as demographics, socio-economic status, somatic and psychiatric comorbidity, and substance use. As the underlying mechanism of the greater suicide risk in smokers is not currently elucidated, we will briefly recapitulate the main hypotheses proposed to date: the toxic effects of nicotine, hypoxemia, monoamine oxidase activity inhibition, the high prevalence of psychiatric comorbidity and consequent suicide risk, and smoking-induced serious physical illness with pain and disability resulting in negative mood response. Smoking could also be an inadequate self-medication for psychological symptoms, themselves causing suicide, and finally the association could be due to a third underlying factor associated with both smoking and suicide.

Despite the proven association between smoking and high rates of medical morbidity and reduced life expectancy in people with severe mental disorders (SMD), their smoking rates do not decline as they do in the general population. We carried out a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to investigate the clinical efficacy, safety and tolerability of a smoking cessation programme designed for the treatment of patients with SMD in the community under real-world clinical conditions. A total of 82 patients were enrolled. Short-term efficacy: The 12-week 7-day smoking cessation (self-reported cigarettes per day =0 and breath CO levels ≤9 ppm) prevalence was 49.3%, with no statistically significant differences between medications (transdermal nicotine patches 50.0% vs. varenicline 48.6%, chi-square =0.015, P = 1.000). Long-term efficacy: At weeks, 24 and 36, 41.3 and 37.3% of patients were abstinent, with no statistically significant differences between treatments. Safety and tolerability: No patients made suicide attempts or required hospitalization. There was no worsening of the scores on the psychometric scales. In both groups, patients significantly increased weight, without significant changes in vital signs or laboratory results, with the exception of significant decreases in ALP y LDL-cholesterol levels in the varenicline group. Patients under varenicline more frequently presented nausea/vomiting (P < 0.0005), patients under TNP experienced skin reactions more frequently (P = 0.002). Three patients under varenicline had elevated liver enzymes. In conclusion, we have demonstrated that in real-world clinical settings it is feasible and safe to help patients with stabilized severe mental disorders to quit smoking.

Attention Deficit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences over the lifespan. Given this background, there is a need for an effective treatment of ADHD patients.

In the lecture, evidence-based psychosocial interventions for ADHD will be presented.

Transcranial electrical stimulation (tES) is a non-invasive brain stimulation method that has evoked increasing interest during the past years. The most common form of tES, transcranial direct current stimulation (tDCS), is considered to modulate neuronal resting potentials. For example, anodal stimulation over motor cortex appears to lead to increased neuronal excitability under the stimulation electrodes. However, some recent findings suggest that the effects of tDCS extend beyond the cortical areas under the electrodes, to deeper brain structures such as the midbrain. The brain also actively regulates peripheral physiology. Thus, changes in brain activity following tES may lead to modulation of peripheral physiology. For example, tDCS targeting primary motor cortex has been observed to induce changes in peripheral glucose metabolism. Furthermore, stimulation of dorsolateral prefrontal cortex has been shown to lead to alterations in cortisol secretion and the activity of the autonomic nervous system. Unpublished findings from our group corroborate with the above observations. Nevertheless, the evidence regarding peripheral effects of tES remains limited. Investigating such possible effects may be relevant especially from the point of view of tES safety and potential therapeutic discoveries.

Transcranial direct current stimulation (tDCS) of the prefrontal cortex (PFC) is currently investigated as therapeutic non-invasive brain stimulation (NIBS) approach in major depressive (MDD) and other neuropsychiatric disorders. In both conditions, different sub regions of the PFC (e.g. the dorsolateral prefrontal cortex, the dorsomedial prefrontal cortex and others) are critically involved in their respective pathophysiology. Although the neurophysiological properties of tDCS have been extensively investigated at the motor cortex level, the action of PFC tDCS on resting state and functional MRI connectivity of neural networks is largely unexplored. Beyond motor cortex paradigms, we aim to establish a model for PFC tDCS modulating functional connectivity in different conditions to provide tailored tDCS protocols for clinical efficacy studies in major psychiatric disorders such as MDD and schizophrenia. One major obstacle in brain research is that patients represent themselves as individuals not as groups. Recent research has shown that the individual human brain functional MRI connectivity shows different within-variability than the variability found between subjects. Several neuroimaging methods may be useful to find a classifier that can be reliable used to predict NIBS effects. These neuroimaging methods include individual brain properties as well as the evaluation of state-dependency. Anatomical targeted analyses of rTMS and tDCS in neuropsychiatric patients and healthy subjects have found promising results.

By combining neuroimaging and NIBS new functional models can be developed and compared in different health and pathology states, e.g. in the development of any given psychiatric disorder.

Transcranial electrical stimulation (tES) is being widely investigated to understand and modulate human brain function. The interest in using tES to enhance cognitive abilities not only in patient populations but also in healthy individuals has grown in recent years. Specifically in combination with cognitive training tES has shown success in enhancing cognition. However, to date, we still know little about the impact of interindividual differences on intervention outcomes. A variety of tES techniques and their effects in combination with cognitive training, interactive effects of tES with baseline cognitive abilities and neurophysiological traits will be presented and following ramifications with regards to the development of individualised stimulation protocols will be discussed.

Repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) is a treatment option for patients with medication-resistant major depressive disorder (MDD). However, antidepressant response is variable and there are currently no response predictors with sufficient accuracy for clinical use. Here we report on results of an observational open-label study to determine whether the modulatory effect of 10 Hz motor cortex (MC) rTMS is predictive of the antidepressant effect of 10 Hz DLPFC rTMS. Fifty-one medication-resistant MDD patients were enrolled for a 10-day treatment course of DLPFC rTMS and antidepressant response was assessed according to post-treatment reduction of the 17-item Hamilton Rating Scale for Depression score. Prior to treatment, we assessed the modulation of motor evoked potential (MEP) amplitude by MC rTMS. We measured MEP's to single pulse TMS using surface electromyography, before and after MC rTMS, and calculated MEP modulation as the change of mean MEP amplitude after MC rTMS. MEP modulation proved to be a robust predictor of reduction of clinician-rated depression severity following the course of DLPFC rTMS: larger MC rTMS-induced increase of corticospinal excitability anticipated a better antidepressant response. These findings suggest that MC rTMS-induced modulation of corticospinal excitability warrants further evaluation as a potential predictive biomarker of antidepressant response to left DLPFC 10 Hz rTMS, and could inform future developments of rTMS to treat depression.

In the field of bipolar disorder, some proposals of a staging model have been suggested considering the progressive features of the disorder. The staging model regards special features of the patients and further draws a route to define the prognosis and treatment as well as the neurobiological background of the disorder. The aim of this model is to identify rational therapeutic targets and provide the most effective and less toxic intervention in a time-sensitive manner. Advocating for a model of staging in bipolar disorder that can group the patients according to quantitative cut-offs of common practice clinical variables as well as defining a biochemical correlation seems to be a further step towards an operative and valid model of staging in bipolar disorder.

Addictive behaviours are highly common (prevalence worldwide about 10%), with major impact on the individual and society (contributing to 5% of overall DALYs and mortality) [1,2]. Though a number of evidence-based treatments are available, relapse rates remain high, up to 50% within one year of treatment [3,4]. Staging of addictive behaviors might contribute to improve this prognosis by indicating which patient could benefit most from which treatment modality.

In DSM-5 clinical staging of addictive disorders is limited to grading the severity of the disorder, based on criterion counts [5]. However, addictive disorders are highly heterogeneous, with distinct clinical profiles and neurobiological underpinnings of the disorder. Reward-processing deficits are considered a hallmark of addiction. Several additional neurobiological deficits have been identified in addicted individuals, such as dysfunction of brain stress systems, anterior cingulate cortex and habenula.

These neurobiological deficits may identify clinical subgroups of patients with distinct pathophysiology (profiling), or be related to progression of the disorder (staging). This presentation will focus on clinical staging and profiling of addictive behaviors combining neurobiological findings and clinical practice [6].

The clinical staging model is an approach used in medicine to define the extent of disease. In psychiatry, this model has recently been applied to psychotic disorders to distinguish the earlier, non-specific features of illness (e.g. ultra-high risk [UHR]; at-risk mental state [ARMS]), from later, more severe features associated with chronic illness. A key element of the staging model is to identify and classify the neurobiological processes underlying the disorder and to define potential interventions in the different stages. With the premise that dysfunctional neural mechanisms underlie symptomatology, the integration of categorical phenotypic classifications (class of disorder) with dimensional criteria (domains of dysfunction) becomes crucial. This approach aims to better classify trans-diagnostic dimensions of disease and discrete symptom-specific subgroup populations within biological frameworks, which may lead to the detection of new biomarkers and the development of more effective treatment and prevention strategies.

With growing globalisation and an increasing number of people on the move across boundaries, it has become vital that service providers, policy makers and mental health professionals are aware of the different needs of the patients they are responsible. One of the most fundamental barriers for migrants, refugees and asylum seekers in accessing health services are inadequate legal entitlement and, mechanisms for ensuring that they are well known and respected in practice. Access to the healthcare system is impeded by language and cultural communication problems. Qualified language and cultural mediators are not widely available, and moreover, are not regularly asked to attend. This can lead to misunderstandings, misdiagnosis and incorrect treatment, with serious consequences for the afflicted. The language barrier represents one of the main barriers to access to the healthcare system for people who do not speak the local language; indeed, language is the main working tool of psychiatry and psychotherapy, without which successful communication is impossible. Additionally, the lack of health literacy among the staff of institutions, which provide care for refugees and asylum seekers means that there is a lack of knowledge about the main symptoms of common mental health problems among these groups. The healthcare services, which are currently available, are not well prepared for these increasing specific groups. In dealing with ethnic minorities, including asylum seekers and refugees, mental healthcare professionals need to be culturally competent.

In this talk, main models for providing mental health care for migrants and refugees will be presented and discussed.

Recent mass movement of human beings in various parts of the world has brought several challenges. Not only refugees from Syria and Libya to Europe but also refugees, migrants and asylum seekers in Latin America bring specific set of issues with them. It is critical that clinicians are aware of both the vulnerability of individuals to mental ill health as a result of migratory experiences but equally importantly their resilience. The impact on the mental health of those who may be involved directly or indirectly in delivering care along with those new communities who receive these groups need to be taken into account when planning and delivering psychiatric services. It is essential to recognise that experiences of being a refugee or asylum seeker are heterogeneous. Being an asylum seeker carries with it legal definitions and legal imperatives agreed at international levels.

Policymakers and clinicians need to be aware of differential rates of psychiatric disorders in these vulnerable individuals and specific needs related to language, religious values and other cultural factors. Mental health problems may be related to experiencing cultural bereavement where individuals feel that they have lost their cultures, relationships and cultural values. Judicious and careful use of trained culture brokers and mediators should be encouraged as these individuals can inform the team about community needs and inform the community about the team functioning and its principles so that community expectations can be managed appropriately. Such approaches may also help reduce stigma against mental illness.

Increasing numbers of individuals forced to leave their home countries in areas of war, conflict, human rights violations and persecution pose a challenge for host countries to meet the mental-health care needs of these individuals. Refugees and asylum-seekers may face unique risk factors for mental disorder before, during, and after their migration leading to suicidality. Experiences of family withdrawal, integration difficulties, and perceived lack of care may contribute to suicide within the refugee populations. Identifying effective treatments and support to minimize the risk especially once the individuals arrive in their new country is key to providing appropriate care. Barriers to mental-health care including lack of knowledge about available resources, communication or language barriers, cultural beliefs about origins and treatment of mental disease, as well as a lack of trust in authority, pose a challenge for health care providers and policy makers.

Research has been inconsistent in the findings for the prevalence of mental disorders, suicidal behaviours, and suicide ideation among refugees and asylum seekers. Thus far, research has been limited to small scale, non-randomised, often qualitative analysis. Several studies have found higher rates of mental disorder, whereas others have found a similar prevalence as in the general population, although, Post-Traumatic Stress Disorder has more consistently been found to have a higher prevalence among migrants. The lack of early and thorough exploration of suicidal intent in this population requires large-scale quantitative studies to evaluate the effectiveness and feasibility of current practices in mental-health care and suicide prevention.

Obesity (OB) and eating disorders (ED) are two complex weight/eating conditions that share phenotypic traits, including psychopathological variables, specific environmental risk factors and biological vulnerabilities. Both OB and ED are associated with maladaptive eating styles that may be relevant to their development and maintenance. In abnormal/excessive eating behavior, a complex interplay among physiological, sensorial, psychological, social and genetic factors influence appetite, meal timing, and the quantity of food intake and food preferences. Neurobiological functioning has also been found to be altered in extreme weight conditions, namely with regards to reward processing, emotion regulation and decision making. In this presentation we will discuss the relevance of such components as well their interaction using findings from cross-sectional and longitudinal studies conducted in extreme eating/weight conditions, when compared with healthy controls. The development of innovative treatments considering neurobiological factors will also be covered.

During more than half a century, Psychiatry has extensively accepted a biomedical model studying mental disorders (including schizophrenia, affective disorders and the large group of stress-related disorders, including anxiety disorder. Thus, the classical dichotomy between functional and organic psychiatric disorders is obsolete and from a theoretical point of view there should be no obstacle for Psychiatry to deal with the study of dementias from gene to clinical levels using empirical methods, including neurotransmitters and scanning techniques. However, in many European countries, the dementias have been claimed as belonging primarily to Neurology, leaving the role of psychiatrists to treat psychotic symptoms and bizarre behavioral disturbances.

However, psychiatrists have a long tradition of detailed psychopathological description and great skill in coping with the many psychological, ethical and social problems that are such important features of mental disorders and particularly the dementias, and so, the specific skills of psychiatrists will certainly be warranted in managing the many significant psychological and social problems of the patient both within the family and in society. The discussion must overcome the sterile debate between specialties to focus on the skills needed to adequately address the needs of patients with dementia and their caregivers.

Memory clinics (MCs) are multidisciplinary teams involved with early diagnosis and treatment of people with dementia. In this presentation, we will discuss several trends of the role of psychiatrists over the last twenty years, on the basis of five questionnaires that were sent to MCs every 5 years in the Netherlands.

MCs have developed in Europe using a range of service models but providing similar functions, which include assessment, information, treatment monitoring, education, training and research. MCs may vary among each other, and across countries. Psychiatrists used to play a coordinating role in most MCs, but there is now a tendency that MCs are more frequently led by other specialists, notably neurologists. In 1998 in the Netherlands, only a small minority of the MCs had a structural cooperation with local service providers, but 10 years later, most of them were collaborating with other regional care organizations. In most cases, the collaborating partner was a community mental health team or a long-term care facility.