Various psychotherapeutic approaches could be used for the assessment, formulation, and treatment of the same case. It is of great importance to include cultural evaluation and empathetic reformulation in psychotherapy applications. This case presentation illustrates a female patient in her thirties who was consulted at the psychiatric outpatient clinic with depressive symptomatology, which presented after a psychosocially stressful life event. Following a detailed clinical evaluation, psychotherapeutic treatment was planned with the diagnosis of major depressive disorder. In this case presentation and subsequent discussion, the case-specific advantages, along with standard and differing aspects of different psychotherapeutic methods and treatments, will be evaluated.

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The first psychotic episode is often a moment of utmost importance for the patients and their families, as well as for the treating professionals who need to address several dilemmas. Findings suggest that Self-Disorders (SD) specifically aggregate within schizophrenia spectrum disorders, pointing to the possibility that they could be a central phenotypic marker of schizophrenia spectrum disorders across the different severity of their clinical manifestations. We will present and discuss a case report involving a patient’s first admission, where diagnostic uncertainties exist. The goal is to enhance our comprehension of the significance of contemporary clinical and phenomenological psychopathology, with a specific focus on SD, in order to achieve a more accurate and precise assessment of incipient schizophrenia.

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A case of misdiagnosis and mismanagement in forensic psychiatry Speaker: Farzaneh Saeedzadeh Sardahaee, MD, PhD, Consultant Psychiatrist, Trondheim, Norway

Timely diagnosis and treatment for psychiatric illnesses in first time offenders in forensic psychiatry remains a challenge. Presenting a young male first-time offender with recent onset psychosis, ADHD and anxiety disorder, the speaker reflects upon the complexities around making the right diagnosis in a prison with very limited resources for clinical observation. Minting the term “Psychosis Incognito”, the speaker goes on to explore a complex multiagency follow up process faced by this offender and his treating team, as well as many medical complications including malnutrition and Korsakoff syndrome.

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Geographical differences of the offender-patient pathways across Europe

In this part of the workshop,I will make an approach of of how will be treated an forensic psychiatric complex case from Spain point of view, and diffenneces with another countries.  . Differents pathways from detention to be admitedd in a psychiatric facility will be described . Also the approach from standard care to a more complex medical situacion ( from clinical, social and psychological viewa ) in a penitentiary (forensic) resources, including  rehablitaation. And finally, the follow-up / after care of a mentally ill offender, when discharge to the commnuity.

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Telepsychiatry has emerged as a transformative force in the field of mental health care, addressing disparities in service delivery and increasing access to care. This exploration focuses on the role of telepsychiatry in achieving equitable mental health care for individuals with intellectual disabilities (ID). Intellectual disabilities affect millions globally, posing significant public health challenges. This vulnerable population encounters numerous barriers in accessing quality mental health care, including geographical isolation, limited transportation options, and a shortage of specialized providers. Telepsychiatry offers a promising solution, leveraging technology to overcome these challenges. The presentation reviews the current landscape of mental health care for individuals with intellectual disabilities and the specific barriers they encounter. It highlights the potential benefits of telepsychiatry, including increased availability of specialized care, reduced geographical barriers, and enhanced caregiver support. Ethical considerations and best practices associated with implementing telepsychiatry in the context of intellectual disabilities are discussed. Case studies and success stories illustrate how telepsychiatry positively impacts individuals with intellectual disabilities and their families. In conclusion, telepsychiatry plays a promising role in promoting equitable mental health care for individuals with intellectual disabilities. Embracing technology and adopting best practices pave the way for a more inclusive and accessible mental health care system, leaving no one behind.

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After the introduction of all the speakers, the main aim of this workshop will be mentioned, which consists of identifying and highlighting those clinical, sociodemographic, environmental and other factors than might predict an increased risk of overall, depressive, manic or mixed relapses in bipolar disorder, which is crucial for the identification of high-risk individuals. Dr. Pacchiarotti will present main results from a systematic review performed recently by the work group aimed at collecting the available evidence regarding different factors that increase rates of mood recurrences or relapses for different polarities in bipolar disorder.

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In this section, the speaker will present the results from a recent longitudinal study performed by the work group, in which a cohort of 265 patients admitted with a manic episode were followed up during three years after hospital discharge to identify acute readmissions due to affective relapses. The study of different sociodemographic and clinical variables potentially implicated in a higher risk of readmission over three years is presented, including adherence to treatment, substance use, number of previous episodes, family history, predominant polarity, treatments used and number of visits to the Emergency Department.

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Based on the available literature and the studies presented by the previous speakers, Dr. Andreu will provide a summary of predictive and protective factors associated with mood relapse or recurrence in bipolar disorder, with a special focus on the distinction between modifiable and non-modifiable factors and on the identification of specific phenotypes at higher risk of relapse. The speaker will also mention the role of psychotherapeutic and pharmacological treatments, and will summarize the available evidence regarding lithium response.

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This section will be destinated to the presentation of specific cases of patients with bipolar disorder admitted to our acute psychiatric ward. For each case, sociodemographic, clinical and environmental characteristics will be described and pharmacological treatment discussed. In addition, predictive and protective factors for mood relapses will be identified, and then, prospective information regarding their clinical prognosis will be provided in order to discuss with the attendees the impact of the mentioned factors on clinical outcomes.

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Physician assisted dying is not new, neither historically, nor globally. What has changed in the UK however, is the perspective of society. In the UK, the British Medical Association is both a union and a professional organisation representing doctors and liaising with governments departments in matters of healthcare. As with various specialties within medicine, there are those in favour of change and those against. There are matters on which there is common ground, and a consensus of experts has identified principles, which, if legislation is to change, would be sensible to follow. A profession has united around the idea that if change is coming, it is better to inform the debate proactively and ensure that the interest of patients and doctors are promoted.  This session will look at how potential change in the UK has been approached and hopefully well managed.’

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The debates on euthanasia and assisted suicide (EAS) are topical in Europe. The extension of EAS for psychiatric reasons, already legalized in some countries, raises ethical and clinical issues, given the proximity between suicidal patients and patients who request or have accessed EAS. How can ESA be reconciled with the promotion of suicide prevention, which kills nearly 10,000 people per year in France? We will raise here several key questions that deserve a clear answer before considering going further in the social debates: how to ensure the irreversibility of psychological suffering? how to ensure that patients requesting EAS have full decision-making capacity? how to judge therapeutic futility? It seems crucial to protect the most vulnerable patients by ensuring that psychiatry benefits from scientific progress and can offer new solutions to suffering patients.

Thes issues will be discussed viewing the proposed law on EAS in France, which is supposed to come in February 2024…

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Switzerland is a country in which the liberal tradition is cultivated and every citizen’s free decision is honoured. Associations such as EXIT or Dignitas, which advocate the right to self-determined death, were formed here early on. They see themselves as completing the Age of Enlightenment, where the end result is an individually self-determined death. The Swiss federal government is therefore reluctant to define criminal offences. However, it is regulated that active euthanasia is prohibited. The organisations mentioned are also not allowed to act for their own benefit.

Meanwhile, the number of assisted suicides is higher than the number of suicides. The extent to which the one phenomenon is related to the other is open to debate.

The topic is controversial among the general public and the medical profession. Nevertheless, the Swiss Academy of Medical Science has published guidelines on dealing with dying and death, which also deal with physician-assisted suicide.

Various associations, including the umbrella organisation for suicide prevention in Switzerland, Ipsilon, are in favour of special protection for vulnerable groups. Some of them also recommend that civil law provisions be made for the process of assisted suicide.

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Affective and non-affective psychoses are characterized by deficits in neuro and social cognition, which strongly impact the patient’s psychosocial functioning and health and social system. Recent literature suggests that such deficits could benefit from the innovative combination of evidence-based interventions.

This lecture aims to describe an Italian multisite (Verona, Milano, Pavia), longitudinal randomized controlled trial funded by the Italian Ministry of Health investigating the impact of Cognitive Remediation (CR) alone or combined with other approaches (namely, Mindfulness and Social Skills Training (SST)) on clinical, neuropsychological, social and brain-related outcomes in patients with a DSM5 diagnosis of affective or non-affective psychosis.

In our study, patients underwent clinical and neuropsychological evaluation at baseline (T0), end of treatment (T1), and six months post-treatment (T2), which consisted of nearly four months of CR, CR+ Mindfulness, or CR + SST. The cognitive assessment included the Brief Assessment of Cognition for Schizophrenia (BAC-S) or Affective Disorders (BAC-A) and the Executive and Social Cognition Battery (ESCB), specifically designed to identify impairments in social cognition and executive functions in patients’ real life. Participants underwent a 3T multimodal MRI, including structural and functional sequences at T0 and T1. We also recruited healthy controls for comparative brain mapping at T0.

The present lecture will provide an overview of the research project, along with some preliminary findings on the effect of CR alone or combined with other interventions on clinical and social functioning and brain plasticity, with a focus on the degree of durability and generalization of CR effects to patients’ real life. The study’s outcomes have the potential to inform clinical and rehabilitative settings and tailor combined therapeutic interventions.

C. Perlini Grant / Research support from: Italian Ministry of Health GR-2016-02361283

Over the past decade (2010-2019), the number of people admitting to using cannabis in the European Union (including the United Kingdom, Norway, and Turkey) increased by 27%, from 3.1% to 3.9%. Notably, Portugal, Spain, and Luxembourg topped the list with the highest percentages of daily cannabis users among those who had consumed the substance in the last month.

With the relaxation of recreational cannabis laws in various European countries, such as Germany, Malta, and Luxembourg, there is a growing need for a public health-oriented and preventative approach. Drawing parallels with alcohol-related strategies, this session aims to explore this evolving landscape from a clinical perspective.

The focus will be on the World Health Organization’s definition of risky substance use, aiming to make it practical and applicable. Two existing proposals from Canada and Spain will be reviewed, with an emphasis on the role of standardized cannabis units in defining risk and the quest for consensus in this regard.

Additionally, the session will examine the similarities between alcohol and cannabis consumption, looking at the effectiveness of the Standard Drink Unit in early intervention and prevention of alcohol-related problems. Insights from the alcohol domain will be discussed, offering valuable lessons for preventing cannabis-related harm.

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Current metrics of cannabis use are inconsistent. This issue prevents the integration of the literature to date and to robustly measure the health risks and benefits associated with specific levels of cannabis consumption. This talk will overview a number of international initiatives to improve the current metrics of cannabis use.

The Standard THC Unit was created to objectively measure cannabis potency across all products, mode of administration, jurisdictions, contexts and over time.

To build upon the notion of the Standard THC Unit, addional multidisciplinary, international consensus based frameworks have been created.

One such ongoing initiatives, seeks to reach expert consensus on how cannabis potency should be reported in cannabis products in order to clearly and effectively inform consumers. The talk will overview preliminary results of the Delphi.

A similar Delphi methodology was used to establish internationally agreed-upon minimum standards to measure cannabis consumption in research (iCannToolkit), the results of which will be outlined.

Overall, it is imperative for cannabis researchers to join forces with multidisciplinary experts in order to improve metrics of use to inform consumers, general practitioners, researchers and public health experts on the harms and benefits associated with cannabis use.

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The Department of Social Rights of the Generalitat de Catalunya considered using a unique tool to identify people with complex social needs at Social Services centres and to support the diagnosis processes. After conducting a thorough search and selection process for various tools, the self-sufficiency matrix (SSM), a Dutch tool, was ultimately chosen.

The tool was adapted to the Catalan context through a transcultural translation process, which included a pilot and validation process. This resulted in the creation of the Catalan matrix (SSM-CAT).

A comprehensive implementation program was defined to start the adoption of the tool at basic social services. This program included training trainers and providing online training with practical cases. The implementation process was accompanied by support and monitoring to ensure success.

Through this process, over 3,468 professionals (including 334 trainers) received training on the self-sufficiency matrix, and 31,354 individuals who received basic social services in Catalonia were evaluated. In Barcelona, a more thorough monitoring of the implementation was conducted, assessing a representative sample of the care provided (6,916 individuals attended) generating a more accurate description of the situation of the people attended by social services in the city of Barcelona.

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Opioid use disorder is still the main presenting illicit substance use disorder that patients present within Addiction and Mental Health Services even though the majority of the patients are polysubstance users. Innovation in the field will allow providers to understand better how systems work to support a population with physical and psychological morbidities

We will present novel narratives in describing:

1. 1. Standards and principles

2. 2. Pharmacology

3. 3. Delivery systems

4. 4. Neuroscience based interventions

5. 5. Systems and implementation

The above desscriptors will allow a landscape that is less stigmatising and better in responding to the needs of the people who are highly stigmatised and multidisdvantaged.

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In February 2023, a series of earthquakes with high magnitudes affected 11 cities in Türkiye, a region with a population of over 13 million. With more than 50000 recorded deaths and more than 3 million survivors replaced, rescue and recovery efforts were challenging. The Psychiatric Association of Türkiye (PAT) immediately launched a “Disaster and Crisis Management,” which urgently formed and installed a program for psychosocial support and psychiatric care. The program included immediate, medium, and long-term actions. Hundreds of recruitments followed a call for volunteers for on-site and online support. An online “Earthquake and Mental Health” library was launched immediately, and a series of webinars on psychological first aid and disaster psychiatry were organized in the first two weeks. Furthermore, in three major cities, separate interactive meetings where question and answer sessions with trauma experts have been possible were held weekly with smaller groups. Almost a hundred volunteer PAT members served in the region in the first few months after the earthquake. All colleagues in the field, including those who survived the earthquakes, benefited from the resources of the PAT for their needs in housing, food, and mobilization. Starting from the first days, the PAT organized regional centers for coordination, which required financial resources and staff. The demand was high and could only be met with close collaboration with the Turkish Medical Association and the financial support obtained from international agencies, WPA, and other national psychiatric associations. The PAT started an online support system with technical support from a professional company, targeting healthcare professionals and first responders in the earthquake area. Volunteering psychiatrists provided appointment slots, rendering the system available 12 hours a day, seven days a week. With time, as the national healthcare delivery recovered, the PAT activities transformed into coordination, education, and supervision. Furthermore, the psychiatry residency training, which was interrupted due to the disaster, has been supported through a nationwide mentorship program launched by the PAT. The experience of the Psychiatric Association of Türkiye with disasters paved the way for an organized response, which was made possible through national and international solidarity.

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Natural disasters are and will continue to represent a great challenge in addressing mental health issues globally. The most devastating recent (earthquakes on 6th February 2023 in Turkey and Syria) caused death of more than 55,000 people, injury of about 100,000 people and loss of property, overall affecting millions of people. Moreover, in the last several years in Europe, they came in a form of double disasters (for example coupled with the COVID-19 pandemic) and pointed out the unpreparedness of the health (including mental health) sectors for the emergency situations.

However, in going through these experiences, we also learnt some of the practices that proved effective – including the fast creation of collaborative networks on a larger scale that also allowed fast spread of good practices and practical organisation of help. As a practical example of it - verbalized by the mental health professionals from Turkey through the Council of National Psychiatric Associations of the European Psychiatric Association, we organized a webinar delivered by experienced clincians, trauma experts and experts with lived experince in the earthquake zones. However, structural -implementation of mental health policies that focus on prevention and improving crisis response in care delivery are important to support populations affected by natural disasters to prevent the trauma sequel.

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The predominant association of attention deficit and hyperactivity disorder (ADHD) with males, often leads to underdiagnosis or misdiagnosis in females. Recent studies have highlighted marked differences between genders in the manifestation, symptoms, and outcomes of ADHD. Understanding these differences is essential for accurate identification, diagnosis, and tailored interventions for affected individuals, particularly females. TThe multifaceted nature of ADHD demands a nuanced examination of its impact on females, considering how societal expectations, hormonal influences, and a range of symptom presentations may contribute to the variation in the manifestation of this disorder across genders. This presentation aims to contribute to a more comprehensive understanding of ADHD, fostering improved recognition and tailored strategies to support both males and females who suffer from this condition.

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