In spite of the historically consolidated psychopathological perspective, neuroscientific research applied to schizophrenia has so far almost entirely neglected the first-person experiential dimension of this syndrome, mainly focusing on higher-order cognitive functions such as executive function, working memory, theory of mind, and the like. An alternative view posits that schizophrenia is a self-disorder characterized by anomalous self-experience and awareness. This view may not only shed new light on the psychopathological features of psychosis but also inspire empirical research targeting the bodily and neurobiological changes underpinning this disorder. Recent empirical evidence on the neurobiological basis of a minimal notion of the self, the bodily self, will be presented. The relationship between the body, its motor potentialities and the notion of minimal self will be illustrated. I will posit that this approach can shed new light on the self-disturbances and social deficits characterizing schizophrenia. I will propose that cognitive neuroscience can today address classic topics of psychopathology by adding a new level of description, finally enabling the correlation between the first-person experiential aspects of psychiatric diseases and their neurobiological roots. To this purpose, I’ll describe putative neural mechanisms underpinning the blurring of self-other distinction in schizophrenic patients. I will posit that brain function anomalies of multisensory integration, differential processing of self- and other-related bodily information, mediating self-experience, might be at the basis of the imbalance in the pre-reflective relationship of the embodied self to the social world observed in schizophrenia.

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The Covid-19 Pandemia is not a turning point for e-health It might seem meaningful that this e-health approach will also continue in mental health care after the Covid-19, given the obvious pragmatic advantages. But several issues could at least delimitate a future use of e-health technology in psychiatry/psychotherapy: Patient with severe depression and suicidality seem not to be the right target group Same with other serious mental disorders First contact patients (depending among others on their personality characteristics), often have problems to open themselves at phone or video contacts In Germany (and probably other European countries?) a relative high percentage of psychiatrists/psychotherapists are reluctant or at least ambivalent against video based interventions A quite high percentage of psychiatrists/psychotherapists in Germany believe that a relevant proportion of their patients might not accept this very technical approach of doctor-patient-interaction. Currently in Germany, probably also in some other European countries, complain that some legal and billing issues are not fully solved. Some of these problems could decrease in the future and insofar it is difficult to make a valid prediction of the place of e-health technology in psychiatry/psychotherapy. Beside this one point seems of great importance to me: the current e-health success, driven by the Covid-19 Pandemia, should not be the direction of more cost saving psychiatry/psychotherapy, generally neglecting the need for personal interaction between patients and therapists.

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Several changes to the classification of schizophrenia and other psychotic disorders have been made to increase the reliability, clinical use and validity of the diagnostic classification which are considered here. A diagnosis of schizoaffective disorder would only be made in ICD-11 when the definitional requirement of schizophrenia is met concurrently with mood symptoms that meet the definitional requirements of a moderate or severe depressive episode, a manic episode, or a mixed episode. This requirement is more restrictive compared to ICD-10, which just required the presence of symptoms of schizophrenia and mood disorder. The total duration requirement would be 4 weeks. A cross-sectional approach was maintained in the ICD-11 for schizoaffective disorders as there is no evidence on how a longitudinal “lifetime” criterion impacts cross-sectional inter-rater reliability, and the reliability of lifetime symptoms’ report by patients and retrospective assessment by clinicians remains unknown.

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There is a considerable overlap of psychotic and mood symptoms in patients with severe mental disorders, and a large proportion of patients meeting diagnostic criteria experience significant mood symptoms. The diagnosis of schizophrenia – schizoaffective type /schizoaffective disorder has been a part of the Diagnostic and statistical manual since the DSM-I. Even if the need for a diagnosis capturing this particular clinical picture obviously is needed, the agreement about when to use the diagnosis of schizoaffective disorder as well as the diagnostic reliability is low. There is an agreement that the diagnosis covers episodes with an overlap between a psychotic episode meeting the A criteria for schizophrenia and a major mood episode where the psychotic symptoms continue after the end of the mood symptoms. Given the prevalence of depression in schizophrenia, some episodes, however, meet the criteria for schizoaffective disorders while others do not. The DSM-5 thus argues that the pattern of overlapping symptoms should be present in the majority of episodes. Keeping the cross-sectional approach favoured by previous versions of the DSM and the ICD will here continue to spread diagnostic confusion.

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The discovery and development of drugs for treatment of brain disorders is an extremely challenging process requiring large resources, timelines, and associated costs. Positron Emission Tomography (PET) enables in vivo neuroimaging of various components of receptors, transporters, enzymatic activity and other types of proteins. PET also allows for studying the response to physiological or drug interventions in experimental medicine studies. Moreover, PET neuroimaging can assist to establish diagnoses in certain brain disorders and thereby improve patient selection and stratification for clinical trials. Over the past couple of decades, PET neuroimaging has thus become a central component of the evaluation of novel drugs for brain disorders, enabling decision-making in phase I studies, where early discharge of risk provides increased confidence to progress a candidate to a later phase testing at the right dose level or alternatively to kill a compound through failure to meet key criteria. The so called "3 pillars" of drug survival, namely; tissue exposure, target engagement, and pharmacologic activity, are particularly well suited for evaluation by PET imaging. Molecular neuroimaging has thus increasingly established itself as a unique tool that not only can demonstrate drug penetration and kinetics in the brain, but also identify pharmacodynamic effects, e.g., changes in glucose metabolism. It can also quantitate therapeutic action in vivo by determining, e.g., drug occupancy whereby the relevant dose ranges to be used in clinical efficacy trials can be determined.

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In depression (MDD) treatment there is a clear need for novel treatments, biomarkers and individualized treatment approaches. One of the most promising and most widely investigated biomarkers for antidepressant treatments is the EEG. Most EEG biomarkers however, still lack robustness and reproducibility and suffer significant publication bias as highlighted in a recent meta-analysis (Widge et al., 2018). Therefore, large controlled validation studies are needed with a focus on robustness, replication and clinical relevance. In this presentation results will be presented from the largest EEG Biomarker study to date, the international Study to Predict Optimized Treatment in Depression (iSPOT-D), where 1008 MDD patients were randomized to Escitalopram, Sertraline and Venlafaxine. Drug-class specific (Arns et al., 2016) and drug-specific (Arns, Gordon & Boutros, 2015) biomarkers will be highlighted as well as preliminary data from a prospective feasibility trial. Furthermore, data will be presented on repetitive Transcranial Magnetic Stimulation (rTMS) treatment in MDD on EEG and clinical predictors (Krepel et al., 2018; 2019) and a new method called Neuro-Cardiac-Guided TMS (NCG TMS), that exploits network connectivity in the frontal vagal pathway, as a target engagement approach (Iseger et al., 2019). Finally, clinical implications and implementations will be discussed from a ‘treatment stratification’ perspective, which might be a more realistic goal relative to ‘personalized medicine’ perspective.

MA is unpaid research director of the Brainclinics Foundation, a minority shareholder in neuroCare Group (Munich, Germany), and a co-inventor on 4 patent applications related to EEG, neuromodulation and psychophysiology, but receives no royalties related

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Psychologically, the question of profession-specific instruments and tools is not trivial. A profession is characterized by specific knowledge. Knowledge is regarded as part of professional competencies: What is done? How is something done? Why is something done? Knowledge and skills are acquired through specific training and continuing education.

Professional knowledge is represented in a specific language. In addition, standards and regulations apply to differentiate it from other professions. Different languages and special professional regulations make cooperation more difficult. These obstacles must be overcome.

Instruments stand for professional identity. Competence-based tools are subject to professional legal regulations (e.g. following standards defined by EuroPsy Certificate of EFPA), ethical guidelines of the profession (professional ethics according to EFPA Meta-Code of Ethics) and external guidelines for professional practice (e.g. national and EU regulations). This ensures patient safety through Europe-wide standards. The investigation of profession-specific profiles and their modification, also under the conditions of the pandemic, becomes important.

Professional instruments are protected by professional political boundaries. Profession-specific profiles are also an invitation to “coopetition”. While differentiation tends to lead to complementary mission fulfillment in practice, openness leads to a “spill-over of skills” in interdisciplinary practice. Alignment of competence profiles and cooperation are encouraged.

The future certainly lies in closer cooperation between the professions. The search for fundamental common ground (consilience), for effective and sustainable interventions (efficiency) and the demand for evidence-based practice (according to common ethical standards) place the well-founded benefit of an instrument for clients above any other interests.

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what did we learn in 2020? Every year several thousand scientific papers on alcohol, drugs, and nicotine are published. The picking of five papers must obviously be arbitrary and subjective. However, the scientific literature of 2020 cannot be regarded without acknowledging the many papers concerning the COVID-19 pandemic. Some studies on alcohol, drug, and nicotine show a small increase, some a small decrease, but many no change. The addiction consequences of the pandemic and the societal lockdowns may thus be less dramatic than feared. This is true even if many papers reported higher mental distress during the pandemic and there is a close relationship between mental distress and substance use, a relationship that has been further confirmed in studies from the past year. Furthermore, a review concerning the addictive potential of cannabis has further alarmed us of the current liberalization also affecting Europe. A new figure of “1 in 3” cannabis users getting hooked may possibly replace the old “1 in 10”. Furthermore, the year has brought even more solid knowledge of the transition from substance-induced psychosis (SIP) to schizophrenia, teaching psychiatrists in acute psychiatry an important lesson on how to view SIP. As many as 1 in 3 patients with SIP will eventually receive a diagnosis of schizophrenia, making SIP the most powerful risk factor for schizophrenia known. Lastly, the lecture will present a very novel and unexpected finding regarding alcohol elimination, that may change how we treat intoxications with different alcohols.

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Abstract: Biomarkers for diagnosis and treatment of Bipolar Disorder: hope or hype? Professor Allan Young, Centre for Affective Disorders, IoPPN, KCL London, SE5 8AF. allan.young@kcl.ac.uk The use of “biomarkers” (biological markers) in basic and clinical research as well as in clinical practice has become so commonplace in many areas of medicine that their presence as primary endpoints in clinical trials is now widely accepted. In clinical disciplines where specific biomarkers have been well characterized and repeatedly shown to correctly predict relevant clinical outcomes across a variety of treatments and populations, this use is entirely justified and appropriate. However, the validity of biomarkers in most psychiatric disorders continues to be evaluated. This lecture will review the current conceptual status of biomarkers as clinical and diagnostic tools for bipolar disorder and as surrogate endpoints in clinical research in bipolar disorder. The conceptual background in terms of current diagnostic categories and research domain criteria will be discussed and the various approaches with putative value (e.g., brain imaging, genetics, and neuroendocrinology) reviewed (1, 2). The lecture will end with a discussion of approaches to evaluating biomarkers of lithium response (3).

Wise et al, Mol Psychiatry. 2016 May 24. doi: 10.1038/mp.2016.72. [Epub ahead of print]; Young AH. Harv Rev Psychiatry. 2014 Nov-Dec;22(6):331–3 Bellivier F, Young AH, et al, Bipolar Disord. 2020 Oct 23. doi: 10.1111/bdi.13023. Online ahead of print.

Paid lectures and advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS Principal Inve

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Smart healthcare monitoring allows detecting health conditions using Big Data, namely aggregated data concerning physiological and behavioral parameters. The continuous collection of data from smart-devices performed by the Ecological Momentary Assessment approach represents a promising application of Big Data.

This preliminary study was aimed at developing a research protocol focused on the use of Big Data in evaluating the impact of urban environment, affected by a variety of potentially damaging anthropogenic actions, on illness relapses in Bipolar Disorders (BD).

This pilot study was designed by researchers from Departments of Psychiatry and Engineering (CIRIAF), University of Perugia. Environmental, physiological, and behavioral parameters and smart-devices aimed at collecting Big Data were identified. Subjects aged 18-65, affected by BD in current euthymic state referring to the University/General Hospital of Perugia will be recruited.

Subjects will undergo a baseline visit and three monitoring visits during one year. Wearable devices will be provided for collecting data about environmental and physiological parameters. Behavioral data will be collected through smartphone accelerometers, GPS, and overall smartphone use. Big data will be stored into an online platform that will provide real-time feedback concerning the recorded variables. Clinical information concerning BD relapses will be collected. Machine learning techniques, integrated to deterministic analysis of urban environmental conditions, will be used to create possible predictive models for BD relapses.

The present project could allow the creation of a new operative platform for a better health management system correlating real-time Big Data to specific clinical features of BD.

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