A novel brief cognitive-behavioural SST addressing seven target behaviours proposed by Kopelowicz, Zarate, and Liberman (2006) was designed and tested in a sample of outpatients suffering from schizophrenia or schizoaffective disorder (Rus-Calafell et al., 2013). The proposed training was focused on the seven target behaviours: social perception, social information processing, responding and sending skills, affiliative skills, instrumental role skills, interactional skills, and behaviours governed by social norms. Furthermore, it was applied in a group format to provide the patients with opportunities to practice the newly learned skills with other subjects. Results at posttreatment showed an improvement in the self-statements during social interactions, negative symptomatology and psychopathology, and quality of life regarding mental health. Informants (most of them family) also reported a perceived positive change, in terms of social withdrawal and communication, for those patients who benefitted from SST. There was also a very positive effect of the treatment on the SST group regarding subjects’ emotional and social cognition. The authors assume that the treatment's content focused on social perception and social attribution resulted in a significant impact on these outcome measures, specifically in the emotional self-regulation statements during social interactions. In terms of subjective evaluation of the treatment, the qualitative assessment revealed a high treatment's acceptance and perceived benefit to subjects. Main application issues as well as clinical case examples will be discussed in the workshop.

In OECD countries with a national suicide prevention strategy there is a correlation with the reduction of suicides.

Most national strategies refer to common elements such as focus on depression and other mental health and addictive disorders diagnosis and treatment, attention on medical chronic patients, improvement of suicide risk assessment, suicide postvention, education of health professionals and the population, increased care accessibility, action on reducing access to lethal means, school programs, media intervention, etc.

These elements, for most European national suicide prevention strategies, fit the EAAD 4-level interventions, which tend to be evidence-based.

Portugal is considered to be a country with low suicide rates compared to other European countries though it also presents one of the worst ratios of suicide to undetermined violent deaths and evidence points towards a huge number of masked suicides amongst undetermined violent deaths making suicide much commoner than officially pointed out.

In April 2013, a ‘National suicide prevention plan’ was presented in Portugal listing most of the suitable actions that could be implemented. There might be strategic advantages to integrate these actions within a sustainable intervention comprehensive model and referring to clear measurable outcomes, in a given period of time.

There is a ten-year track record on the successful use of the EAAD 4-level model in three municipalities in Portugal and other possible examples on ‘how to’ disseminate at the national level are presented.

Object To know the treatment experiences of patients with depression in general hospital, and their suggestion on the present mental health services. To provides theoretical support for optimizing the mental health services model in general hospital. Methods Qualitative interviews were given to 10 patients diagnosed as depressive disorder from department of psychiatry, Renmin Hospital of Wuhan University. Questions were asked from following aspects: the process of seeking medical help before hospitalization in psychiatry department(when, where, who, referral), evaluation of drug treatment (efficacy, side effects, doctors) and psychotherapy, satisfaction and suggestions on medical services(including hospital environment, medical staff and etc.), social rehabilitation (stigma, social functional recovery, survival / quality of life etc.), socioeconomic factors (health insurance coverage, financial resources, social support resources). Answers referred to above factors were conducted to statistical analysis. Results showed departments of neurology, gastroenterology, endocrinology, Chinese traditional medicine, obstetrics and gynecology are the first medical choice of depressive patients; the average number of departments before they get psychiatric treatment is five, the average number of referral is 2. Medication side effects are the most concerned problems. Enough and reasonable information given from doctor about drug's name, efficacy, side effects, and length of treatment can improve patient's compliance, even can predict recurrence rate. Discrimination medical personnel can reduce compliance of patients: contempt, pessimism, avoidance, activity limitations, and impolite language and behavior. Psychotherapy can shorten the hospital stay. Health insurance coverage, job, social support can predict social functional recovery. Conclusions Doctors in general hospital should improve their ability in recognizing depression to ensure referral patients timely; Education of depression, medication-related knowledge should offered by psychiatrists to improve patients’ treatment compliance, and reduce relapse rate; psychological therapy should be incorporated into psychiatric conventional treatment; Medical personnel should be conscious of using positive affirmation, respectful words and actions; effective communication with families is necessary for promoting patients’ social rehabilitation.

Health is considered a right in the Spanish constitution and is financed through a very strict tax system. Health care covers 100% of the population and 100% of the needs, including even illegal immigrants.

The main problem of Spanish Health Care is that it has been transferred to the 17 different Autonomous Communities existing in Spain (regions with high administrative and political autonomy) which are the providers. In order to offer better services (and have more chances to be reelected) the autonomous communities have in the years before the crisis overspent circa 30% of their budget every year in health care, education and other services. The present economic crisis is forcing to better management and more standardization of the system having on the other hand significantly reduced the budget allocated to health care. There is more control on the expenses and no room for overspending via loans. At present there is no agreement on a common portfolio of services yet. There are also limitations such as charging for prescription and the reduction of the number of facilities and professionals.

Particularly for patients with mental disorders, the bioethical principles respect for the patient's autonomy and beneficence often come into conflict.

On the one hand, physicians have the legal and ethical duty to treat patients only with their informed consent. On the other hand, physicians have the duty to help patients. Many patients with severe mental or neurological disorders cannot give valid consent since their ability for autonomous decision making is temporarily reduced. In some cases, (compulsory) treatment might be the only way to restore the mental capabilities underlying autonomous decision making. To hold back treatment by referring solely to the autonomy principle runs the risk of acute or chronic health damage for patients. Furthermore, this position is based on a narrow understanding of respect for the patient's autonomy, which overlooks the duty to enhance or restore the disease-limited capability for autonomy, if possible.

An example for a narrow understanding of autonomy is the Special Report on Torture in Psychiatry by Juan Méndez (United Nations Special Rapporteur on Torture).

Positions which exclusively emphasize autonomy tend to overlook the right for adequate help.

Ethical dilemmas cannot simply be solved by prohibiting involuntary treatment in psychiatry without exception. Rather a solution has to consist of respect of the patient's autonomous will (possibly formulated in a psychiatric advance directive), effective help to restore reduced capabilities for autonomy, and beneficence.

Impaired episodic memory (EM) has been reported in schizophrenia. Intact EM requires that contextual features be bound to the content of the event, a mechanism called contextual binding (CB). It is proposed that binding errors during the encoding process are responsible for EM impairments in schizophrenia. The hippocampal formation is considered the central element for CB, it is hypothesized that the synaptic disorganization described in this condition results in such a deficit. The main goals of these studies were to investigate the neurofunctioning, neuroanatomy and neurofunctional connectivity of the hippocampus while performing a task that used CB mechanisms. Spatial relational processing is part of CB and is rooted in the hippocampal region. Visuospatial navigation (wayfinding task), was used as a probe to activate the hippocampus and its associated regions in a group of patients with schizophrenia (n=21) and matched healthy controls (n=23). During the wayfinding task individuals with schizophrenia found landmarks less frequently, made more errors and took more time to complete the task. fMRI result indicated that the patient group had a hypofunctioning of the posterior part of the hippocampus while performing the wayfinding task. VBM results indicated that controls had significantly more hippocampal GM than patients and poor performances at the wayfinding task was associated with decreased right hippocampal GM for the overall group. Connectivity results indicated that patient's hippocampus recruited alternate pathways and regions to guide and help them complete the wayfinding task. Structural and functional differences in the hippocampus might explain the connectivity differences and CB deficit in schizophrenia.

Digital health technologies may improve the management of individuals with mental health disorders by targeting important barriers to effective care. For patients with schizophrenia, for example, addressing:

• • The challenge of dealing with individual variation in treatment response. No specific tools are available to facilitate the delivery of truly patient-centric care. Predictors of an individual's side effects or treatment efficacy are not available, patients’ views on care are often not recorded, clinical state between appointments cannot be easily assessed, precise symptoms and side effects experiences are not captured in a reliable way and physical health is often neglected.

• • The challenge of effectively accessing and utilizing the vast amounts of evidence-based information to direct patient management at the point-of-care. Valuable evidence-based information, including guidelines and systematic reviews, is not used to guide care because there is too much information to assimilate, it is inaccessible at the point-of-care and it is difficult to personalize to any individual patient.

Optimal Medicine will present findings related to use of a web-based clinical decision support software system which enables clinicians to deliver individualised, evidence-based treatment at the point of care including:

• • Delivery of context-specific personalized decision support through a workflow driven interface

• • Interactive visualisation and monitoring of longitudinal status

• • Side effect risk profiling based on an individual's unique and evolving characteristics

• • Symptom and side effect rapid evaluation and monitoring using a hierarchical data selection

• • Integrated remote-monitoring technologies (iTunes app) for use between clinical contacts at times of particular vulnerability, such as discharge from hospital.

A neuroinflammatory process has been discussed in the literature in schizophrenia. Some immune-related genes have been reported to be increased in serum and post-mortem brain tissue of schizophrenia patients, whereas other studies cannot confirm these results. These controversies may be related to the selection of genes or the material under investigation as well as antipsychotic treatment.

In our genome-wide microarray study (Illumina) we have investigated the left superior temporal cortex and left anterior cingulate cortex in 10 patients with schizophrenia and 10 healthy controls. In a second Laser Capture Microdissection study we dissected pyramidal cells from hippocampus CA4 and performed genome-wide microarrays (Affymetrix).

In the superior temporal cortex and anterior cingulate cortex we found a downregulation of a large group of immune-related genes and could confirm these alterations by quantitative real-time PCR. In the pyramidal neurons of the hippocampus we also found immune-related genes to be downregulated, along with alterations in transcription factors and acetylcholine receptors.

Downregulation of immune-related genes in the brain of schizophrenia patients may occur in several brain regions and may be related to diagnosis or antipsychotic treatment. In contrast to findings in the blood, down-regulated immune-related genes in the brain are related to disturbances in synaptic transmission and plasticity, for example alterations of NMDA receptor mediated plasticity and free radicals.

The question of the cause of these findings, like an immune-deficiency or inflammation processes during neuronal development cannot be answered in post-mortem studies of elderly, chronic schizophrenia patients, which received antipsychotics for decades.

Increased incidence rates of psychotic disorder have been consistently observed in immigrants with significant variability across ethnic groups. These findings have been attributed to cross-cultural biases, i.e. misinterpretation of culturally appropriate ideas leading to an overestimation of these disorders among ethnic minorities. Another alternative explanation constitutes the selection hypothesis positing that the increased rate is due to selective migration of predisposed people. We will present two studies that aimed at testing these hypotheses by examining (a) whether risk factors for psychosis are more prevalent among future emigrants, and (b) whether psychotic symptoms differ in severity and nature according to ethnic group. The first study was conducted among a cohort of 50 087 conscripts who were assessed at age 18 on cannabis use, IQ, psychiatric diagnosis, social adjustment, history of trauma and urbanicity of place of upbringing. Through data linkage we examined whether these exposures predicted emigration out of Sweden. The second study included 301 first episode psychosis (FEP) patients within a defined catchment area in Montreal, Canada. Patients were administered scales for the assessment of positive and negative symptoms, as well as general psychopathology. Symptom scores of the reference group were compared to those of patients with different ethnic backgrounds. The results of these studies will be discussed in light of candidate explanations for the increased risk of psychotic disorder among immigrants. Future avenues using data from the EUropean Gene-Environment Interaction (EU-GEI) project will be proposed.

The Nordic countries are highly developed welfare states with a long tradition of egalitarian health and welfare policies. The Nordic welfare model is based on tax-funded public services and a high level of social protection. Improvements in mental health and mental health services have been on the agenda in these countries during recent decades. Mental health services have undergone a thorough reform, from an emphasis on psychiatric institutional care to the current emphasis on out-patient care and social participation. The reduction in numbers of hospital beds for psychiatric patients, especially for those with long-term disorders, has been met by an increase of psychiatric treatment in primary care and by growth in housing institutions provided by social care. In spite of the reforms, there is still a considerable life expectancy gap between people with mental disorders and the rest of the population.

A core element of Nordic mental health policies is a focus on mental health promotion, preventive actions and social inclusion. Acknowledging that determinants of mental health often lie in non-health domains such as social and family policies, labor policies and education policies, the Health in All Policies approach has been developed. Health in All Policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. In Europe, different models and best practices have been developed to secure that public policies across sectors systematically takes into account the mental health implications of decisions and avoids harmful mental health impacts. This includes effective safeguards to protect policies from distortion by commercial and vested interests and influence. Especially in times of economic hardship, nonhealth policies may have a decisive impact on populations’ health including mental health.

Accumulating evidence supports the view that deregulation of the immune system represents an important vulnerability factor for mood disorders and that this may be a common pathophysiological mechanism that underlies the development and progression of these disorders, at least in a subset of patients. Furthermore, mood disorders are also often accompanied by chronic medical conditions related to immune dysfunction such as autoimmune diseases, diabetes and atherosclerosis. The reviewed data suggest that if immune biomarkers exist for such immune abnormality they may be found in raised macrophage/monocyte inflammatory activation patterns (monocytosis, high inflammatory gene expression, raised GRβ/GRα ratio, and high levels of pro- and anti-inflammatory monocyte/macrophage derived cytokines in serum/plasma). This activation of the inflammatory response system may be suggestive for microglia activation as these cells are the macrophages of the brain, although evidence from human studies is still lacking. However, animal models of mood disorders suggest that such monocyte/microglia activation could be seen as the result of a combination of genetic predisposition and environmental factors. It has been proposed that the abnormal immune activation state of these cells is reached after an aberrant development/maturation from precursors. In the case of microglia, this in turn may lead to impaired neuronal development. This developmental/maturation abnormality may render the cells more vulnerable to subsequent stressors such as inflammatory stimuli thereby leading to increased incidence of mood disorders.