Reasoning biases, specifically jumping to conclusions and belief inflexibility, may play a causal role in persistent paranoia. SlowMo, a new digitally supported blended cognitive-behavioural therapy, targets these biases. Adopting the terms ‘fast’ and ‘slow thinking’ as a heuristic to support therapy, SlowMo encourages people to notice a tendency to fast thinking, and to slow down for a moment to reduce paranoia. SlowMo therapy is the first digital blended therapy for paranoia, employing face to face therapy sessions with interactive digital content, and using mobile technology to promote generalisation to daily life. We report a randomised controlled trial with N=362 participants with distressing and persistent (3+months) paranoia, comparing 8 sessions of SlowMo plus Treatment as Usual (TAU) with TAU alone. We examined SlowMo’s effectiveness in reducing paranoia and improving reasoning biases; its mechanisms of action; usability; and acceptability (Garety et al., 2021). Outcomes: SlowMo was beneficial for paranoia: 10 /11 paranoia measures at 12 weeks and 8/11 at 24 weeks demonstrated significant effects, and sustained moderate effects were observed on all observer-rated measures of persecutory delusions. Improvements in self-esteem, worry, wellbeing and quality of life were also reported. Mediation: Consistent with the theory-driven design and treatment rationale, improvements in slower thinking were found to mediate change in paranoia at 12- and 24-week follow-ups. However contrary to hypothesis, reduced fast thinking did not mediate change in paranoia, whereas worry did. These findings highlight the potential therapeutic mechanisms of action of SlowMo which which are discussed further. Garety P, Ward T, Emsley R, et al. Effects of SlowMo, a Blended Digital Therapy Targeting Reasoning, on Paranoia Among People With Psychosis: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(7):714–725. doi:10.1001/jamapsychiatry.2021.0326

Aim: To describe how a US-based psychiatric Mother-Baby Unit adopted a virtual platform during the pandemic. Objectives: When the Covid-19 pandemic descended, mental health clinicians world-wide were faced with maintaining access and care delivery. Pregnant and newly postpartum women experienced the pandemic and lockdown through the lens of impending parenthood and new parenthood--amplifying distress, isolation, and lack of social and family support. The lockdown prevented those with most acute illness from accessing daily treatment in our structured, supportive intensive treatment setting. We acknowledged the urgency of developing a method to continue to treat our patients in a group environment that offered psychotherapy, psychopharmacology, dyadic and family intervention, and social support. Methods: The hospital purchased “Zoom for Health” platform to ensure compliance with regulatory guidelines. Cameras for individual computers were purchased with philanthropy funds, obtaining them quickly, compared to waiting for hospital funding. The clinical team designed a schedule of groups and individual sessions, each with their own zoom link. Each morning, a team member, sent the daily schedule through the patient portal of the EMR. Conclusion: Before the pandemic, the census was 12 pts per day. The full-day program paused for 7-10 days although individual sessions and medication management were conducted by phone as the virtual platform was constructed. Once established, census resumed normal levels. Challenges to running the Day Hospital virtually included: technology glitches, family demands and distractions, and privacy concerns. Overall, the program was a success wherein women requiring intensive treatment were able to receive treatment and social support.

Eating Disorders are common psychiatric disorders, and their occurrence is not rare in pregnancy. The aim of this presentation will be to provide an overview of eating disorders in pregnancy. I will first cover prevalence and nature of eating disorders and their symptoms in pregnancy. I will present quantitative and qualitative data from my own research. I will then present research on the effects of eating disorders on pregnancy and obstetric outcomes. I will conclude discussing issues around identification of eating disorders in pregnancy; in particular research from my lab on gaps in identification, and how to improve identification of eating disorders in pregnancy.

There has been a significant increase in the incidence of depression in countries around the world during the COVID-19 pandemic. Identified concerns include: loss of family members, fear of gettin sick, finances, decreased social connections, deteriorating relationships at home and decreased ability to practise previously helpful coping skills. Family/couples intevrentions alone or in combination with individual therapy and/or pharmacotherapy have been shown to be helpful in diminishing symptoms of depression and in improving family functioning. This presentation will review evidence examining the effctiveness of family/couples therapy in treating adults with depression and outline therapy processes that have been shown to be effective.

Due to the nature of the perinatal period, it affects generations who are more at home in the electronic space, hence some form of telemedicine can be used in a number of areas. The “Together” Baby-Mother-Father Integrated Program has been running since 2004. Both the condition of those affected and the current epidemic makes it difficult for patients and their families to access adequate perinatal specialist care. At the beginning of the epidemic, the switch to telemedicinal psychiatric care has been rapid and focused mainly on the use of Phone, Skype, Viber and Email. To our findings the advantages include, easier access to care, and more frequent contacts. The home environment is accessible and the families are more involved. Also, care does not compete with the scarce resources of time and space. Some of the possible disadvantages are, that more work on intimacy is needed, and the treatability of certain diseases is questionable (e.g., psychoses). Care is less documentable with the current regulations, and funding has not yet been adapted to the changes. The telemedicinal care and support network in Hungary - among many - contains an online medical system (EESZT) including e-prescription. Online- psychotherapy, consultation, peer-group platforms. There is a non-stop hotline for patients, etc. In 2021 the total number of our cases increased by 34%, but realistically the visit number was also higher, due to the amount of shorter telephone and e-mail interactions. Depression and bipolar disorder were among the highest proportion by the patients present.

There are many reasons for people with (and without) severe mental illness to exercise regularly. In people with schizophrenia, major depression and bipolar disorder, it has already been shown that regular physical activity as an add-on therapy can improve quality of life and symptom severity. This is particularly important in domains that standard therapy is currently not able to treat sufficiently, such as cognitive deficits. Postulated underlying neurobiological effects include increased volume in hippocampal areas as demonstrated by data of a current clinical trial in people with schizophrenia.

Furthermore, regular exercise is essential to counteract the increased cardiovascular morbidity and mortality of people with severe mental illness. However, most people with severe mental illness do not achieve the recommended amount of physical activity and the potential of exercise as an add-on therapy is currently not even close to being fully realized. On the one hand, it is important that mental health staff also considers the physical condition of patients with mental illnesses and counsels them on their health behavior. On the other hand, there is a need for individually adapted training programs delivered by qualified exercise professionals that incorporate motivational and adherence strategies. Examples of barriers and facilitators for the implementation of exercise as an add-on therapy are discussed on the basis of current local projects.

Music therapy can be defined as the controlled use of music or musical elements by a qualified therapist with a client or a group of clients. The active or passive delivery of musical therapy may facilitate the development of individual potential and/or restore psychological functions of the individual, allowing to obtain better interpersonal, physical, and psychological functioning. Indeed, existing literature suggested that music therapy holds a significant therapeutic potential in a number of psychiatric disorders, including psychosomatic, anxiety and affective syndromes. More recently, evidence concerning the potential of music as a mean to increase group cohesion, acceptance, interpersonal relationships in psychiatric settings has highlighted the potential to improve the patient’s global functioning, social functioning, mental state, and positive/negative symptoms of psychoses. Traditionally, music therapy is delivered in controlled outpatient setting and few evidence point to a possible role in the treatment of acute psychoses, during their hospital stay. Recently, newer evidence has recently piled up and showed that music therapy can induce clinical (in particular, on affective symptoms), functional and quality of life improvement in patients with acute psychoses, even over a short period of time such as during emergency hospitalization. The reported effects might be related to complex neural modulation phenomena involving different interhemispheric, cortical and subcortical brain pathways. Practical clinical experiences, setting or implementation issues and quality standards in music therapy will also be discussed.

Background: Many patients suffering from schizophrenia spectrum disorders continue having distressing auditory hallucinations and paranoid ideations despite receiving current treatment. Virtual reality assisted treatment offers the potential of advancing current psychotherapies for psychotic symptoms by creating virtual environments that can elicit responses (e.g. thoughts, feelings, behaviours) mirroring real-world settings. In two large-scale randomised clinical trials, we are investigating whether targeted virtual reality assisted psychotherapy can reduce psychotic symptoms and increase daily life functioning and quality of life. The CHALLENGE trial examines whether nine sessions of virtual reality-assisted psychotherapy is superior to nine sessions of standard treatments in reducing the severity, frequency, and distress of auditory hallucinations in patients with psychosis. In the Face your Fears trial we are investigating whether virtual reality assisted cognitive behavioral therapy (CBT) is superior to standard CBT in reducing levels of paranoid ideation in patients with psychosis spectrum disorders. Methods: The CHALLENGE and Face your Fears trials are randomised, assessor-blinded parallel-groups superiority clinical trials, allocating a total of 266 and 256 patients, respectively to either the experimental intervention or a control condition. The trials are currently enrolling patients; thus, no quantitative data is available yet. The main objective of this presentation is to give a qualitative account of this new psychotherapeutic methods as it is applied in both trials. Results: Qualitative data comprising case descriptions and video material will be presented at the conference. Discussion: The preliminary findings indicate great potential for these innovative treatments albeit important concerns regarding implementation will be raised.

Background: Virtual Reality (VR) is increasingly used for treatment of psychiatric disorders. With immersive VR, people can be gradually exposed to situations they fear, they can practice new behaviour in a safe and controlled way. The threshold for engaging in therapy is lower in VR than in real life. VR applications for psychosis have been introduced fifteen years ago, and are rapidly expanding. Methods: In our VR mental health lab, several VR therapies for psychotic disorders have been developed and investigated. Results of recent randomized controlled trials (RCT) will be presented, and ongoing and future projects will be discussed, including VR cognitive behavioral therapy (VRcbt) for paranoid delusions, social cognition training, stress management and avatar therapy for auditory hallucinations Results: The RCT of VRcbt for paranoid delusions (N=116) had strong and statistically significant effects on paranoid ideations, anxiety and safety behavior. Facial emotion recognition was improved by VR social cognition training (RCT N=81), but other domains of social cognition proved more difficult to improve. A VR relaxation tool (RCT N=50) had strong immediate effects on perceived stress and emotional states. Ongoing VR intervention studies are a modular VR intervention aimed at improving social functioning (VR SOAP) and an empowering intervention for patients with auditory hallucinations (VR VOICES). Discussion: VR is a powerful tool for treatment of psychotic disorders, offering interventions for multiple symptom domains and functioning. Next generation VR studies hold the promise to expand and substantially improve psychosocial treatment of psychotic disorders.

First Episode Psychosis (FEP) treatment is a critical element of mental health-care systems, which has been shown to improve outcomes in this patient group. Due to divergent historical and political trajectories, countries of Central and Eastern Europe have taken a different course in the development of mental health-care. Among these differences is the less advanced level of present FEP treatment networks. Traditionally mental health-care is more inpatient based in these countries, with a lesser emphasis on specialized outpatient services, and early intervention programmes have been only launched during the last 15 years. Despite the lag of the development of FEP services, a variety of models has been already started in our countries. In my lecture I will review the literature about the Central and Esteran European region. I will also present good practices of how the existing early intervention programmes can be integrated into the traditional mental health-care systems.

Introduction First episode psychosis (FEP) programs target the first 3-5 years after the first manifestation of a psychotic episode. Although follow-up results after 10-15 years are mixed, reported results of the first 5-10 years are promising in improving relapse prevention, functional outcomes and reducing mental health care costs, compared to treatment as usual. Objectives Our objective was to develop the first complex FEP program in Hungary. Methods Male and female inpatients, (age:17-40years), hospitalized due to a first psychotic episode and consenting to participate, were included, since 2019 October. Drug induced psychosis and organic background in the etiology of the psychotic episode were excluded. Duration of the program is 2-3 years, based on the individual needs of the patients. The program provides detailed clinical and neuropsychological examinations, MRI, pharmacotherapy, various psychosocial interventions, and support group for relatives. Results Twenty-eight patients [15 male,13 female, mean age=22,4 (18-40)years] were included. The program has been repeatedly limited by COVID-19 pandemic. Psychiatric control, pharmacotherapy, psychoeducation and supportive therapy, however could be continously provided via telepsychiatry, even during the lockdown. During the first 2 years, 90% of the patients remained in treatment, showed good compliance with pharmacotherapy; 10% of the patients were rehospitalized due to relapse. In the presentation, besides clinical experiences, preliminary clinical outcome data will also be presented. Conclusions The first complex FEP program in Hungary, although limited repeatedly by the pandemic, show promising clinical results with low relapse rates and high level of adherence to therapy in the first 2 years after a first psychotic episode.

We have witnessed a significant push towards staging in medicine. That trend has not bypassed psychiatry, with realization that early phases of various disorders present the window for early intervention that is most likely to result in preserving every-day functionality and achieving favourable outcomes. First-episode psychosis programs have been developed in order to ensure adequate early interaction with psychiatric services, help achieve faster and quality remission, prevent relapses and ensure better long-term outcomes. There is still, however, no consensus on the format or the most appropriate intervention in the early-course psychosis. Patients in Zagreb, Croatia, are offered a number of first-episode psychosis programs, one of which is housed in the largest Croatian psychiatric institution, University Psychiatric Hospital Vrapce. Specialized early-course treatment model in Vrapce stemmed from first-episode inpatient unit established in 2004, and grew to present in its core integration of care across different organizational units, acuity levels, and specific patient needs. Recognizing that a significant number of first-episode patients first interact with psychiatric services through emergency units, Vrapce’s model fostered early interaction with specialized services staff starting with intensive and emergency care units, allowing for continuity of care and early recruitment into specialized services. Vertical integration meant inpatient acute and subacute units seamlessly linked with day hospital and outpatient services, creating the setting for earlier formation of therapeutic alliance and treatment plans, but also allowing for flexible entry points for users. COVID-19 pandemic, in addition to challenging the initial integrations of services, facilitated transfer of certain services into virtual space.

Previous studies have found relatively good physical health in doctors, whereas several studies now report relatively high levels of stress and burnout among them. With the exception of higher suicide rates, we have less evidence of poorer mental health among doctors than among other professionals. The elevated suicide rate may represent the tip of an iceberg of frustration and inadequate mental health care among medical doctors. There are very few longitudinal studies that can identify possible risk factors and causality. The Longitudinal Study of Norwegian Medical Students and Doctors (NORDOC) has since 1993/94 followed repeatedly two cohorts of medical students (N=1052) in seven waves during 25 years (Facebook: @docsinrush). Outcomes presented here are on mental health, burnout and problematic drinking. There are two main hypotheses with regard to possible risk factors. First, it may be due to individual factors such as personality traits, past mental health problems etc. Second, contextual stress may influence mental health among doctors, whether this be unhealthy working conditions or negative life events (i.e. stress outside of work). The presentation will give and overview of both individual and work-related predictors of stress and mental health problems among Norwegian physicians. Individual and organizational interventions to reduce stress and physician burnout will also be dealt with.

Background: Surveys assessing alcohol use among physicians most commonly employed the Alcohol Use Disorders Identification Test (AUDIT) or the AUDIT-C. As with other screeners, prevalence estimation is dependent on the accuracy of the test as well as choice of the cut-off value. The aim of the current study is to use samples from various countries derive more precise prevalence estimates of alcohol problems in physicians by correcting for false positive and false negative results using samples from various countries Method: At the Congress of the German Association of Psychiatry, Psychotherapy and Psychosomatics, 2005 in Berlin, 1800 questionnaires, which included the AUDIT-C were distributed among the attending participants. 936 questionnaires (52%) were returned. Also, the data are compared to a second study, performed in Salzburg, Austria to further elucidate the situation. The screening results will be presented and compared to the values when using a correction- formula using data from a general population sample on sensitivity and specificity of the AUDIT-C. Results: Based on the results of AUDIT-C and using a cut-off of 5 for both sexes, 24.1% of the sample of 887 physicians of the German sample are problematic drinkers (14.7% in female and 32 % in male physicians). Using a correction formula leads to markedly lower rates: 6.1% (all), 3.7% (female), 8.1% (male). Discussion: In this large sample, findings clearly confirm that uncorrected screening results lead to severe over-estimation of the prevalence of problematic drinking in physicians. The corrected prevalence rates are lower than in the general population.

The COVID-19 pandemic has raised several concerns regarding its mental health effect on patients and professionals. In the beginning, the absence of knowledge about the disease transmission or effective therapies, the quick spread among the population collapsing hospitals in combination with the lack of protection measures put healthcare professionals working in the frontline in a high stressful situation. The professionals had to face several unprecedented challenges: improvised hospitals, living in hotels to avoid infecting the family, deciding, as in wartime, which patients could be intubated and which could not, doubling shifts, and above all, the uncertainty about the disease, the high severity and the contagiousness that isolated the patients from their family, leaving the health professional with the responsibility of being a caregiver in the broad sense of the word. With this picture several studies have reported a high prevalence of mental disorders. A survey of 9138 Spanish professionals conducted during the first wave of the pandemic showed that 45.7% had a mental disorder (depression, generalized anxiety disorder, panic attacks, post-traumatic stress disorder and SUD), 14.5% had any disabling current mental disorder and 8.4% had suicidal thoughts. In Spain, managed by the Galatea Foundation, there is a special programme of confidential care for doctors with a mental illness or addiction. During the pandemic, a 30% increase of requests for help were registered, 70% of which came from primary health care professionals. The presentation provides also qualitative data with testimonies of professionals and anti-stress protection measures implemented by some health institutions.

Alcohol, psychoactive substance abuse, and burnout are areas of significant problems within health care professionals and medical doctors. In 2011 we did a survey (n = 1601) in Belgium among the medical specialists. Beginning of 2021, exactly 10 years after the first survey, we repeated the survey this time among both medical specialists, general practitioners, and pharmacists. The results of this survey (N = 4361) will be presented and tendencies compared with international findings. We discuss the findings from both the longitudinal perspective using our 2011 data and also from the perspective of the impact of the Covid19 pandemic on health professionals.

Authors: Klier CM, Amon S, Fernandez Arias P Introduction Denial of pregnancy the most important risk factor for neonaticide and is a frequent pregnancy associated disorders. It occurs more often than placenta previa or uterus rupture. Wessel found that 1 in 475 women deny pregnancy, but a new study by Simermann even found a higher prevalence of 1:300. We studied how women face their reproductive potential before the denied pregnancy occurs. Moreover pregnancy variables in this group were compared to Austrian population data. Methods In total, there were 69 neonaticide victims between 1995 and 2017. We analysed 55 neonaticide cases, committed by 48 perpetrators, whereas 4 of them were repeated perpetrator and responsible for 11 cases. We also included three cases of suspected neonaticides, whereas later the coroner identified a natural cause of death. The datasheet contains 553 variables, all cases were code by one rater SA. Specifically we looked at the following variables: method of contraception, partner’s interest in contraception, abortion, evidence of pregnancy, motives of pregnancy negation, pregnancy symptoms, prenatal care, awareness of environment, living situation during pregnancy and at birth, immediate reaction to birth Results We found a high percentage of women who did not use contraception (53%), specifically when compared to the percentages of the Austrian population data from a recent survey (26%). When the contraceptive methods were looked at, women in the neonaticide group did practically not use any method with a pearl index of <4, in comparison to 20% in the general population. A high adolescent birth rate (47%) could be shown in comparison to the population (3%). Conclusions It needs further research to find out how denial of pregnancy and reproductive potential are connected and if the reasons for denial of pregnancy are the precursors of the reproductive denial also.

This presentation will review the current state of knowledge about severe maternal perinatal mental illness. Severe disorders are associated with a higher prevalence of somatic difficulties during pregnancy, poorer quality of pregnancy follow-up and potential impairment of infant care. These children are therefore very vulnerable and require specific care. We will present how graduated care coordinated and above all integrated between psychiatry, obstetrics, neonatal pediatrics and child protection services allows for early and effective preventive interventions, both for the child’s development and maternal mental health. The concept of shared parenting will be particularly developed.

Up to one in four young children have been estimated to be exposed to parental mental illness. Although the majority of affected parents will not harm their children, is is now well established that parental mental illness places children at an increased risk of all types of injury. Both maternal and paternal mental illness are implicated. Children of parents with mental illness are at the greatest excess risk of being injured in their first year of life, and this applies particularly to violence related harm. Within the first year, the risk is highest during the first three months after birth. A number of parental and family background factors have been identified in the UK triannual serious case reviews of abuse related harm to children and in other publications that can increase or decrease the risk. These findings have significant implications for clinical practice. In order to mitigate the risks to young children, an early assessment of a parent with a mental illlness, close collaboration between mental health, social care and other involved professionals, and a comprehensive care package which aims to improve parental mental health health, reduce other risk factors and exploit parental strengths and protective social factors, are essential. Mental health professionals have an important role to play in achieving improved outcomes for children at risk and their families.