Social psychiatry starts from the position that as social animals, the cause, course and response to treatment of mental health problems are powerfully determined by the social environment. For example, childhood trauma within the home and bullying at school is associated with both internalizing and externalizing disorders and exerts its influence through life-long impacts on the individual's ability to form supportive relationships with others, their self-esteem and their resilience in the face of future adversity. Difficulties forming and sustaining personal relationships are intensified by the emergence of illness, consequent social exclusion and discrimination that in turn intensifies damaging beliefs of low self-worth and rejection. In contrast, we have considerable evidence for the “therapeutic” value of good relationships, notably the role of family and social support in the remarkable resilience shown by those who have come through the most appalling environmental and personal crises. It is therefore surprising that the balance of psychiatric therapeutic effort is stubbornly focused on the individual patient as the problem with less attention paid to developing and implementing social interventions targeted at the family and wider social network to prevent and alleviate mental illness. In this presentation I will argue that psychiatrists should be more active in developing and leading interventions that focus on the social and interpersonal networks of their patients with illustrations from past and ongoing efforts to this end.

The European Federation of Psychiatric Trainees (EFPT) represents the consensus of psychiatry trainees associations across more than 30 European countries, advocating for the improvement and harmonization of psychiatry training across Europe. This federation has as priority to get direct feedback from psychiatry trainees, analyzing the concerns related to psychiatry and training in Europe, collaborating with other national and international partners to translate trainees’ views into action, while offering trainees several opportunities.

Surveys of psychiatry trainees show that the main concerns around Europe revolve around differences of duration of training in the different countries, the discrepancies between the European training standards, the national programmes and the real experience of trainees. Likewise, levels of recruitment into psychiatry and inadequate working conditions also concern trainees, especially at the current times of economic challenge, where the choice to migrate abroad is quite frequent. Nevertheless, the involvement of psychiatry trainees in the development of national programmes and in the quality assurance of training varies significantly around Europe.

This presentation will highlight the current differences observed in the structure, content and duration of psychiatry training programs in Europe, reporting trainees’ views on a European curriculum of psychiatry, and exploring mechanisms to evaluate and harmonize the postgraduate training in Europe.

Psychological treatments aimed at symptoms or behaviours that impede recovery now have a relatively strong database but it is not clear which treatments are more effective and when they should be applied. For large-scale roll out we need to consider which are the most helpful and cost-effective at which stage of the illness and to which individuals. This requires knowledge of how service users ascribe value to different outcomes and treatments as well as which individuals are likely to benefit the most from different treatments to produce a coherent mental health recovery programme. Tailoring treatment requires an understanding of adherence requirements as well as therapeutic interactions to explain how therapy fits with the service users’ personal goals. Not all information for making these clinical decisions is embedded in any database so the burden on research is to provide enough information to signal to health professionals the best course of action. More research on dissemination of treatment approaches as well as training and supervision requirements is needed in the form of dissemination science if patients with a diagnosis of schizophrenia are to receive the best intervention programme.

Until recently nutrition and various other lifestyle factors were predominantly in the focus of medical disciplines like cardiology, endocrinology or gastroenterology. As mental disorders are multifactorial diseases and as such are complex, emerging evidence suggests that nutrition, exercise and sleep also play an important role in the aetiology, progression and treatment of mental disorders. In this regard research has mostly focused on depression and anxiety, but there is also evidence for other mental disorders like schizophrenia or autism. Some details concerning the relationship between diet and sleep on neuro-transmitter processes, immune-inflammatory pathways or oxidative stress will be demonstrated.

Modifications of life style factors and diet are increasingly recognized as potential therapeutic options. Mostly used are nutrient-based supplements and essential elements in combination. But also healthy diet patterns with a high intake of vegetable, fruits and fish have proven beneficial in the treatment. If we better understand the microbiota-gut-brain axis and its impact on behavior, mood and cognitive processes, diet and lifestyle factors can not only contribute to the treatment but also to the prevention of mental disorders.

Psychiatry is based on values and scientific evidence. The presentation will argue that both bases come with a social and political mission.

The values require a commitment to help those in need of support, which cannot be fully achieved without social and political action. The scientific evidence points to the central role of societal factors, such as inequality and poverty, for the development of mental disorders. Influencing these factors requires political decisions.

It will be concluded that taking up the social and political mission is a moral imperative for both psychiatrists as a professional group and individual psychiatrists, and may make the profession more relevant in society, more attractive to medical students, and more effective in helping patients with mental distress.

The discussion will address the challenges and practical options for such a mission.

Contemporary approaches to medical education emphasize the importance of doctors in training demonstrating the acquisition of competencies. This approach to educating doctors has been criticized on a number of grounds, not least because a solely behavioural focus risks trivializing medical professionalism. An alternative approach is to look at the formation of professional identity as a legitimate goal of training.

In this presentation, I will describe the behavioural and constructionist approaches to medical education and their implications for psychiatry training. I will make a plea for psychiatry training to renegotiate the balance between the two approaches.

Psychiatrists have a unique place in the spectrum of mental health services, as being able to integrate psychotherapy and pharmacotherapy in clinical practice. It is through psychotherapy training that a trainee gains optimal communicative skills and competence in establishing therapeutic alliance with a patient. It helps developing empathic understanding, which is very important for a good collaboration and enable understanding, diagnostic and treatment. It improves trainees’ own insight. All are these fundamental aspects of a biopsychosocial approach of psychiatry.

In many countries psychiatry trainees have a positive attitude towards psychotherapy during their training. Moreover, patients often prefer and adhere to combined psychotherapy and medication than split-care treatments. Research in psychotherapy provides ample evidence that these treatments are effective. The UEMS considers psychotherapy education as mandatory. EFPT advocates that all trainees must gain competence in at least one recognized form of psychotherapy and have a basic knowledge for other forms. Altogether, there is a consensus among all actors of mental health services that psychotherapy training is essential and should be improved. Yet, it is still far from being a priority in psychiatric training and is subdued by biological training and research, which is easier, faster and prevailing in training institutions. Also, psychotherapy training is found less affordable by trainees.

With collaboration from other organizations, EFPT aims to improve standards of psychiatry training, including psychotherapy. We present some initiatives led by UEMS, EPA, WPA and ECNP. Today's technology allows trainees to reach various psychotherapeutic training availabilities, including online tools (Webinar, MOOCs, online guidebooks) and international courses. It is advisable that training institutions devote more time on psychotherapy training and supervision, associations provide costly training availabilities or scholarships, encourage more scientific research on psychotherapeutics and take into account the progress of research in psychology and neuroscience [1–5].

Addiction medicine/psychiatry, a medical subspecialty founded on October 1991 by the American Board of Psychiatry and Neurology, was granted as subspecialty within psychiatry. It mainly deals with medical assessment, diagnosis and treatment of subjects who suffer from an addiction (i.e. drug and/or alcohol addiction; gambling; sexual addiction; game addiction; and so on). Addiction psychiatry also deals with subjects in dual diagnosis, i.e. individuals with addiction issues along with co-occurring psychiatric disorders. However, despite its well established “dignity” to be part of psychiatry, most mental health's professionals believe that it is not a primarily psychiatric field due to the frequent co-occurrence of internistic/medical issues. In addition, the situation of psychiatric training specifically addressed to addiction is widely diversified across the European countries. Therefore, most psychiatrists do not possess specific qualifications and formation on this increasing field of psychiatry. The present lecture aims at providing an insight into the issues related to the diatribe between psychiatry and medicine on addiction medicine/psychiatry, specifically focusing on differences across European countries.

Psychiatrists have a unique place in the spectrum of mental health services, as being able to integrate psychotherapy and pharmacotherapy in clinical practice. It is through psychotherapy training that a trainee gains optimal communicative skills and competence in establishing therapeutic alliance with a patient. It helps developing empathic understanding, which is very important for a good collaboration and enable understanding, diagnostic and treatment. It improves trainees’ own insight. All are these fundamental aspects of a biopsychosocial approach of psychiatry.

In many countries psychiatry trainees have a positive attitude towards psychotherapy during their training. Moreover, patients often prefer and adhere to combined psychotherapy and medication than split-care treatments. Research in psychotherapy provides ample evidence that these treatments are effective. The UEMS considers psychotherapy education as mandatory. EFPT advocates that all trainees must gain competence in at least one recognised form of psychotherapy and have a basic knowledge for other forms. Altogether, there is a consensus among all actors of mental health services that psychotherapy training is essential and should be improved. Yet, it is still far from being a priority in psychiatric training and is subdued by biological training and research, which is easier, faster and prevailing in training institutions. Also, psychotherapy training is found less affordable by trainees.

With collaboration from other organizations, EFPT aims to improve standards of psychiatry training, including psychotherapy. We present some initiatives led by UEMS, EPA, WPA and ECNP. Today's technology allows trainees to reach various psychotherapeutic training availabilities, including online tools (Webinar, MOOCs, online guidebooks) and international courses. It is advisable that training institutions devote more time on psychotherapy training and supervision, associations provide costly training availabilities or scholarships, encourage more scientific research on psychotherapeutics and take into account the progress of research in psychology and neuroscience [1–5].

The concept of “dissociation” covers a rather wide array of psychopathological conditions, ranging from dissociation of consciousness (e.g., post-traumatic conditions), to dissociation of personality, (i.e., multiple personality disorder) and dissociation of the basic structures of the pre-reflexive self (as it is the case with schizophrenic abnormal experiences). I will focus on this last issue and describe the dissociation of time experiences in people with schizophrenia as a characterizing feature of this condition.

Schizophrenic persons often describe their sense of temporal reality as: “things to a standstill”, “immobility, but not calm”, “time going back to same moment over and over”, “people like statues”, “frozen moment”, “out of time”, “marmoreal”, “unreal stillness”. Time is fragmented, there is a breakdown in time Gestalt, and an itemization of now-moments. The mere succession of conscious moments as such cannot establish the experience of continuity. Another typical phenomenon is that a revelation is on the verge to happen, the world is on the verge of ending, a new world is coming, one's own life is on the point of undergoing a radical change. The schizophrenic mood can be characterized as the dawn of a new reality, an eternally pregnant now in which what is most important is not present, what is really relevant is not already there, but is forever about to happen. Time in the schizophrenic mood is “a state of suspense”, “pregnant now”, “being is hanging”, “something imminent”, “something… I didn’t know what … was going to happen … between inspiration and expiration”. The main feature of abnormal time experience in schizophrenia is disarticulation – a breakdown of the synthesis of past, present and future. This includes four subcategories: disruption of time flowing, “déjà vu/vécu”, premonitions about oneself and the external world. The integrity of time consciousness is the condition of possibility of the identity through time of an object of perception as well as of the person who perceives it. Abnormal time experience may be related to the manifold of other schizophrenic subjective abnormal experiences and symptoms, including anomalies of phenomenal consciousness (e.g., disintegration of the appearance of external objects and itemization of external world experience), selfhood (e.g., disruption of the implicit sense of being a unified, bounded and incarnated entity), and sociality (e.g., breakdown of one's sense of being naturally immersed in a meaningful flow of social interactions with others).

Disarticulation of time experience includes four subcategories. Disruption of time flowing: Patients live time as fragmented. Past, present and future are experienced as disarticulated. The intentional unification of consciousness is disrupted. The present moment has no reference to either past or future. The external world appears as a series of snapshots. Déjà vu/vécu: Patients experience places, people and situations as already seen and the news as already heard. This abnormal time experience entails a disarticulation of time structure as the past is no more distinguishable from the present moment. The already-happened prevails. Premonitions about oneself: patients feel that something is going to happen to them or that they are going to do something. This abnormal time experience entails a disarticulation of time structure as the immediate future intrudes into the present moment. The about-to-happen prevails. Premonitions about the external world: patients feel that something is going to happen in the external world. As the previous one, this abnormal time experience entails a disarticulation of time structure as the immediate future intrudes into the present moment. The about-to-happen prevails.

Established in 2008, the Research Working Group of the European Federation of Psychiatric Trainees (EFPT) creates a platform for trainee-led collaborative studies. Several large-scale transnational studies on training-related subjects have been initiated and carried out, driven by psychiatry trainees. Examples of recent and ongoing projects are the Brain Drain study, which investigated migratory experiences and attitudes among trainees in Europe, and the TEO-PC project, which aims to raise awareness on UEMS Psychiatric competencies as well as to compile data on trainees’ experiences and satisfaction with their national training programs.

Earlier projects leading to publications have looked into drug prescription habits of trainees [1,2] and the interactions trainees with pharmaceutical industry [3]. Besides these projects, EFPT yearly gathers reports from the representatives of the national trainees associations on the structure, content and conditions of psychiatry training in all member countries. The information obtained through these channels is used actively to guide and influence policy related to psychiatry training, through collaboration with relevant organizations involved in the creation of guidelines, and through the EFPT statements, which serve to empower trainees themselves.

Despite the ongoing reality of workforce migration, information on medical migration is missing, with lack of detailed evidence of transnational migrations within Europe, obscuring the extent of how migration occurs amongst the different medical specialties.

The European Federation of Psychiatric Trainees (EFPT) has been pioneer in researching workforce migration in junior doctors, conducting the EFPT Brain Drain study, which explored the reasons and patterns of mobility and migration in 33 European countries among junior doctors training in psychiatry.

The intention has been to better understand the migration phenomena, its reasoning and effects in order to give practical proposals to improve education, training and work conditions and ultimately the health care itself in both donor and host countries.

Migration among medical professionals can take place throughout the career: before, during or after training. Exploring attitudes towards migration among junior doctors can help to understand the factors that shape the decision-making processes related to migration in future specialists.

These findings provide objective data that can assist policy makers, providing instruments to address the critical conditions leading to migration from at-risk countries, adjusting the pull factors and improving the standards of education, work and salaries.

Future studies should explore whether the presented results differ for junior doctors in other medical disciplines, as well as physicians in general and psychiatric consultants in Europe and in other areas of the world. Furthermore, the follow up of the respondents from this study could assess to what extent the migratory tendency and intention predicts the future migration itself.

The presentation intends to examine a new kind of clinical psychiatric syndrome, called by the author “synthetic psychosis”, which can occur in people who abuse novel psychoactive substances (NPS). This syndrome will be considered from both a psychopathological and a phenomenological perspective. The contemporary trend of poly-abuse of NPS in young people can lead to a sort of very intense paraphrenic state characterised by continuous hallucinations and formed by a mental automatism syndrome and by secondary (interpretative) delusions. The clinical case of G., discussed in this paper, is an exemplary case of this synthetic psychosis. The psychopathological understanding of the core symptomatology of the patient examined has been fundamental for the successive therapeutic approach. If this attempt at understanding is ineffective, the frequent consequences include: the worsening of the psychopathology and addiction; the patient's admission into a psychiatric hospital; his/her arrest for crimes related to antisocial behaviour; a diffusion of infective diseases commonly found in addicts; more frequent overdoses; aggressive behaviour; an increase in the costs of public health system and, finally, the suicide of the patient [1].

There is considerable interest in identifying biomarkers of antipsychotic response in schizophrenia. Glutamate is one key candidate. The development of brain imaging techniques for measuring brain glutamate levels has allowed this hypothesis to be tested directly in patients. This talk will present our ongoing research examining the relationship between brain glutamate levels and antipsychotic response in first-episode psychosis and in treatment-resistant schizophrenia. I will summarise our results from both our completed and ongoing studies, to consider whether glutamate imaging might be useful in the future to identify patients who would benefit from non-dopaminergic antipsychotic drugs and inform novel, glutamate-based, treatment strategies.