Depression is the mental disorder with the largest disease burden impact. That is due to its high prevalence, chronicty, early onset but also due to its impact on various aging-related somatic morbidities and mortality. This talk will describes to what extent depression characteristics are related to chronologial and biological aging patterns.

Data will be shown from the Netherlands Study of Depression and Anxiety (NESDA, www.nesda.nl). In this study, a large cohort of over 3000 individuals (18-65 years), among which over 1200 with a DSM-based major depressive disorder (MDD), are now followed for 9 years. The association between depression characteristics and chronological and biological age will be described. Biological age was determined at various biological system-levels, including telomere length, epigenetics, transcriptomics, metabolomics and proteomics.

Older persons with a current MDD do not differ in overall disease severity as compared to younger persons with a current MDD. However, older depressed persons do differ in the types of symptoms they experience (more neurovegetative, somatic symptoms and less mood symptoms) and in their chronic course (with twice more chronicity in the oldest depressed persons compare to the younges depressed persons). At all biological system-levels, there was evidence for more advaned biological aging among persons with depression. This was not differential across chronological age groups. Discussion: Findings suggest that depression characteristics are linked to both chronological and biological age. It will be discussed what this could mean for clinical practice and intervention.

No significant relationships.

No significant relationships.

No significant relationships.

No significant relationships.

The diagnosis of intellectual disability (ID) alone does not predict the level of required care, functional outcomes or limitations in social and occupational participation. The International Classification of Functioning, Disability and Health (ICF) is a taxonomy of health and health-related domains. It provides a common language and framework for describing the level of functioning of a person within their unique environment. Furthermore, it helps to describe health problems of a person in line with the International Classification of Diseases (ICD-10).

Introducing the ICF taxonomy exemplary in the care of individuals with ID and mental health problems in Germany.

Comparison of the ICF’s comprehensive multidisciplinary approach to assess an individual’s level of functioning and care in relation to assessing the needs of persons with ID based on clinical experience.

The ICF provides a standardised assessment instrument to determine individual functional needs for the care, rehabilitation and societal integration of individuals with disabilities, which is a statutory requirement in many European countries.

Using the ICF for the assessment and management of patients with chronic health conditions, mental disorders and ID can help to accurately define individual therapeutic goals and monitor functional outcomes. A comprehensive narrative description of the patient’s functional status and clinical needs is comparatively time-consuming, requires greater effort by the assessing clinician and carries a higher risk of omission of pertinent functional domains; furthermore, a single ICF item confers little additional benefit to the patient in terms of the treatment or care they subsequently receive.

No significant relationships.

The International Classification of Functioning, Disability and Health (ICF) provides a framework rooted in patient-centered care and the biopsychosocial model that facilitates a comprehensive description of a person’s health and their level of societal participation. The importance of the ICF for assessing the needs of individuals with mental health problems (MHP) and intellectual disabilities (ID) is growing, especially in the social medicine.

To describe the benefits and limitations of the ICF in clinical practice, pertaining to the assessment of healthcare needs and societal participation in persons with MHP and ID.

Comprehensive literature search in medical databases using the Keywords: ICF, mental health, intellectual disabilities, social and occupational participation.

ICF-based instruments such as the Mini-ICF-APP, with which impairments and competencies in social and occupational participation can be described, are playing an increasingly important role in healthcare and rehabilitation. In Germany, for example, in accordance with the Federal Participation Act, the entitlement to disability support benefits is assessed using ICF-based instruments, which therefore play a decisive role in social medical care.

The functional descriptions of the ICF provide the opportunity for a standardized, yet individualized assessment of medical needs, general health and societal participation, thus facilitating the provision of a comprehensive package of care and support for people with disabilities. ICF-Core Sets and the Mini-ICF-APP are effective tools to describe level of function. It would be clinically valuable to further develop these instruments for use in persons with ID and MHP in the field of social medicine.

No significant relationships.

No significant relationships.

Bulgaria has undergone a number of very significant political and social changes over the past 150 years that has also impacted on the delivery of mental health care. There has been a 40% reduction in the number of inpatient psychiatric beds in Bulgaria within the past 20 years leading to the current state of approximately European average bed numbers per 100 000 population. This does not appear to have been accompanied by an increased investment in ambulatory / outpatient mental health services.

Description of the advantages and disadvantages of mental health services in Bulgaria, available staff and distribution in the country. The project RECOVER-E and its activities in Bulgaria are described.

Sources of health statistics of Bulgaria are used and analyzed. Maps and tables were used for visualization.

Taking into account the situation described in this way and the EPA guidelines for change in the system, a mental health strategy has been proposed.

It has a long and significant legacy of underfunding of mental health services, which has undoubtedly caused significant economic damage to Bulgaria through surmountable results increasing health and social care costs, and surmountable loss of economic productivity. A significant increase in the budget allocated to mental health and related social care services.

No significant relationships.

The risk of mothers to develop a severe mental illness is dramatically increased in the first three months after giving birth. Childbirth has the strongest relationship with postpartum affective psychosis, a condition that is characterized by an acute onset of florid symptoms, usually within 2 weeks of delivery, and atypical features, such as rapidly fluctuating psychotic symptoms, florid motor symptoms, perplexity and high risks to the mother and her baby. Follow up data of women with a first episode suggest that some women only become ill in the context of childbirth whereas in others it is an expression of a lifelong bipolar disorder. Whether this reflects two distinct forms of the disorder or different degrees of vulnerability requires future study. The profound hormonal and metabolic as well as psychosocial changes in the perinatal period give rise to a number of hypotheses that seek to explain the pathogenesis of postpartum psychosis. Current research findings on biological and psychosocial risk factors will be discussed as well as what is currently known about responses to treatment.

No significant relationships.

In the perinatal period, about 15-20 % of women will present a mental health disorder. These disorders, as with all sources of psychological and physical stress in early childhood, especially the poor quality of parent-child relationships, are widely involved in predicting poor mental health in adulthood. The economic cost of perinatal mental health, corollary of this human cost, evaluated in 2014 would amount to £GBP 8.1 billion per annual birth cohort according to a UK report. This report highlights another fundamental element: 3/4 of the costs are associated with the deleterious consequences of parental psychological disorders on child development. The mechanisms involved in the relationship between parental psychiatric disorders and child development are complex. On the other hand, the influence of parental characteristics on the future of children can vary depending on social determinants such as familial income level. During the perinatal period, parental mental health represents one of the keys to the infant development. Perinatal psychiatry allows a dual approach essential to deal with the complexity of perinatal psychiatry care, combining a curative aim (care of the parent) and a preventive one (preventing the risk of dysfunction in the process of becoming parents, in parent-child relationships and of impaired child developement). This intervention wil discuss how this interactive circle must be supported by perinatal mental health policies, of which the joint care of parents and infants (from parent-child psychotherapy to joint mother-baby hospitalisation) in perinatal psychiatry is a pivotal element.

No significant relationships.

Mental health support for parents, infants and children as an interdisciplinary, cross-sectoral task has existed for decades in many European countries. A highlighted goal of integrated services (medical, social and educational) is to support competent parenting and the positive parent-child relationship, for the optimal development including mental health of infants and children. In clinical practice, the role of psychiatrists is often linked to healing and rehabilitation, even though we also have an important role in prevention. The mental support, treatment and prevention of psychiatric disorders during the pre-, peri- and postnatal period are often not considered being preventive measures. The perinatal period is the most sensitive and at the same time one of the most important stages of our lives. The traumas suffered during this period affect both the mother and the newborn, in fact it affects the family as a whole. Models for the prevention of early trauma appear at the level of social community and, inter alia, health and social care. Traumas are closely linked to social determinants of health. Gene environment interactions also allow for the transgenerational transmission of trauma. The presentation introduces individual and family levels of interdisciplinary care, good practices and programs the knowledge of which may be important to psychiatrists. How the practicing psychiatrist can contribute to trauma prevention and how to understand the development of resilience. The presenter will detail good practices, and highlight the possibilities for all clinicians on ways to work in their respective field with a trauma preventive approach.

No significant relationships.

Forensic psychiatry is a specialty of psychiatry primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders(MDOs) are often cared for in secure psychiatric environments or prisons. However, the organisation of these services differs greatly between countries due to different traditions and legal frameworks. Some countries, e. g., require absent or reduced criminal responsibility (at the time of the index offence) in order to enter forensic services while others determine access on the basis of current need for treatment. Numbers detained in forensic services also vary significantly as does length of stay, raising significant economic and ethical challenges. This talk will present different legal concepts determining admission to forensic-psychiatric services, data on length of stay as well as approaches to risk assessment and treatment in Europe.

No significant relationships.

Early Career Psychiatrists (ECPs) are routinely at the front line of clinical practice worldwide, including the use of compulsory measures in psychiatry. However, ECPs practice in this aspect is understudied.

The aims of the study were (i) to clarify whether ECPs experience any difficulties in the process of compulsory psychiatric care; and (ii) to find out how ECPs consider compulsory measures in psychiatry.

An online anonymous survey of ECPs around the world was conducted in July-August 2019. The final sample had 142 psychiatrists (53% female; mean age 32.3±3.1) from 43 countries. Results. 96% of the Early Career Psychiatrists who responded to this survey agree with the continued use of the current legal framework for compulsory psychiatric treatment in their country, either with or without amendments. More than half of the respondents (57%) reported difficulties in providing compulsory psychiatric care due to either challenging interactions with the courts, documentation issues or moral concerns. Over half of the participants (53%) were keen to reform the legal procedures for compulsory psychiatric care in their countries.

The study has shown that there is an agreement among ECPs around the world that legal compulsory psychiatric care procedures are relevant and useful in clinical practice under certain circumstances. As stakeholders, ECPs could be encouraged and involved in adding their own experience and opinions to the debate on the employment of coercion in psychiatry as an ethical and legal issue.

No significant relationships.

Digital mental health, before, during and after the COVID-19 pandemic Over the last two decades the digital landscape of mental health care research and service innovation has gained momentum. This period is characterized by many successes’ stories but brilliant failures as well. Today, e-mental health is like a two-headed Janus. One side of his face illustrates the birth of innovative technologies that entered mental health service provision. In parallel, the evidence-base for the application of these new technologies, such as internet-based treatments for depression, has been established with effect sizes comparable to those of face-to-face treatments. The other side of his face shows, however, that eMental-health has not yet lived up to its’ full potential as its actual delivery, evaluation and implementation in routine care has proven to be a much longer and bumpier road than expected. The question addressed in this presentation will be ‘what does the future hold’? Acknowledging that futures are difficult to predict Heleen Riper nevertheless provides insights into how we may overcome some of these bumps by combining the best of two worlds, i.e. blending digital and face-to-face components into one integrated treatment approach. She will illustrate these new developments by virtue of the results of the H2020 European Comparative Effectiveness Study for Major Depression and current experiences with especially videoconferencing during the Covid-19 pandemic.

No significant relationships.

People with psychosis are commonly socially isolated, both due to their condition, and the stigma towards them. Remote volunteering over smart-phone can be a way to overcome social isolation and physical distance, promoting social inclusion. This talk will present the qualitative findings from a feasibility study – the Phone Pal – which connected in the United Kingdom patients with psychosis with community volunteers, to communicate with each other for up to 12 weeks via smart-phone (through texts, WhatsApp messages, e-mails, audio or video calls). Participants described at the end of the study their experiences of communicating with their match over the smart-phone in terms of frequency, duration and timing of communication, their communication method, content and style, and the changes of communication over time. Several participants reported a positive impact of being connected with someone, meeting a new person, feeling supported and feeling better, and a few described challenges, such as disappointment, guilt and burden. These interview findings show that some matches were able to develop a positive and friendly relationship, and were willing to continue to be in contact with each other beyond the study duration. It is hoped that this talk will generate a lively discussion, gathering further understanding about the potential benefits and challenges of remote volunteering over smart-phone for patients and volunteers, and its potential usefulness in the current pandemic times.

No significant relationships.

Carl Jung used the term, ‘The Wounded Healer’ as an archetypal dynamic to describe a phenomenon which may take place in the relationship between analyst and analysand. Jung discovered the Wounded Healer archetype in relation to himself. For Jung, ‘It is our own hurt that gives the measure of our power to heal‘. Indeed, recurrent themes in the autobiographical narratives of Wounded Healers is that their experiences living with trauma inspired them to become more empathetic, driven and insightful. Many report that debilitating though the symptoms of mental illness are, the stigma is far worse. In this paper we describe the inception of an innovative anti-stigma programme, ‘The Wounded Healer’ that blends the power of storytelling and the performing arts with psychiatry and how The Wounded Healer helps to heal the wounds that were afflicted by the trauma of stigma.

No significant relationships.

The COVID-19 pandemic with the related containment measures is having a negative impact on the mental health of the general population worldwide. This event has been described as a new form of trauma, which is influencing not only physical and mental health, but also the society as a whole. Among Western countries, Italy has been one of the first severely hit by the pandemic in terms of number of cases and mortality rates. In March, 2020, strictly restrictive measures has been issued in order to contain the spread of the disease. This period has been known as “Phase one” of the national health emergency, where all not necessary activities were closed, almost 30,000 people died and almost 100,000 people were home-isolated. In this context, the COvid Mental hEalth Trial (COMET) network, including ten university Italian sites and the National Institute of Health, has been established in order to promote a national online survey for assessing the impact of lockdown measures on the mental health of the Italian general population. In the COMET survey, it has been included a specific focus on young people, which are expected to be the most vulnerable to the consequences of the pandemic and of the strict containment measures. Findings from this study can be useful to inform national and international associations on the importance to provide adequate support to the mental health of the young people.

No significant relationships.

Early life trauma (ELT) refers to various types of adversity that occur during the early years (usually defined as the first 5 years) of a person’s life. It is a key determinant of mental health and well-being throughout the life course. A series of three workshops on early life trauma and mental health care were conducted in Belarus and Ukraine in 2018-2019 to support stakeholders and service providers to better understand and respond to ELT, and to support the development of a network of ELT specialists dedicated to finding common goals, pooling cross-disciplinary data and sharing experiences and good practice across countries. The workshops found that different attitudes, expectations and experiences amongst stakeholders and service providers could hinder the development of consistent, effective and empowering care in Belarus and Ukraine. However, opportunities for more protective and health-enhancing responses were also identified, including the need for: evidence-based education and training; clear roles and communication pathways across sectors; and inter-sectoral partnerships and networks to leverage resources, mitigate practitioner burnout, and build a continuum of support within communities. Findings have been disseminated through a directory of resources in Belarus, a project webpage (www.earlylifetrauma.info) and a report on ELT in Belarus and Ukraine published by WHO Europe.

No significant relationships.

1 in 4 women in Europe will experience domestic violence and abuse (DVA) in their lifetime. Abuse can take many forms, including, psychological, physical, sexual, financial, and emotional abuse. There is growing recognition of the health consequences of DVA in public policy and academic research across Europe and the globe. These include but are not limited to: a negative impact on mental health; increased substance misuse; increased presentation in emergency departments; increased rates of abortion or miscarriage; and increased presence of any sexual health problem. International and national policy guidance indicates that healthcare professionals have important roles in responding to patients experiencing DVA, usually with regard to identifying abuse and referring for specialist support. Barriers to engaging in DVA relate to lack of confidence in recognising abuse or initiating conversations about it, stigma surrounding DVA, fears of exacerbating violence, limited awareness of the resources available to support patients, and limited training in providing trauma-informed medical care. This session will give insight into efforts to improve the healthcare response to DVA. It will draw together examples of healthcare DVA programmes from across the globe and bring together lessons learnt about what works and what does not work in addressing DVA in clinical settings, with specific insights for professionals working in mental health services.

No significant relationships.

No significant relationships.