The therapeutic working alliance (TA) between clinicians and their patients is considered an important factor as to the course and outcome of any therapy aiming to improve mental problems. Psychotherapy research has focused mainly on the individual personal relationship between patient and therapist as a source of this working alliance. Factors other therapist skills that determine the building up of the TA are sparsely investigated in particular in community mental health settings.

Data from a randomized controlled study (ISRCTN16971059) aiming at the improvement of outcome in community treatment by providing therapists with clues to the individual needs of their patients were used to assess determinants of the TA within this framework

The evolvement of the TA in the work with severe and persistent mentally ill people appears to be a dynamic process that is essentially driven by the individual patients service needs. As to individual outcomes the ability to repair ruptures in this working alliance seems to be more important than keeping TA high during the course of therapy.

Past research has shown that nonverbal behavior plays an important role in the development and maintenance of a therapeutic relationship. However, the exact nature of specific nonverbal behaviors that help promoting a therapeutic relationship have remained elusive.

Nonverbal synchrony - the coordination of patient's and therapist's body movement - was analyzed in a sample of N = 104 therapy sessions randomly drawn from an archive of routinely recorded ambulatory psychotherapies.

Motion energy analysis (MEA) was used to automatically and objectively quantify nonverbal synchrony in video-recorded therapy sessions. Using a bootstrap approach, it was first ascertained that the phenomenon actually exists: Nonverbal synchrony was compared to the amount of synchrony one would expect to occur by chance. Subsequently, patient's post-session questionnaires and post-therapy outcome assessments were associated with the amount of nonverbal synchrony.

Nonverbal synchrony occurs at a level that is significantly higher than expected by chance. Patient-therapist dyads that showed higher synchrony also reported higher relationship quality and better outcome at the end of therapy.

The coordination of nonverbal behavior is a hitherto neglected facet of the therapeutic relationship. Nonverbal synchrony embodies relevant aspects of both short-term outcome (post-session reports) as well as long-term outcome (post-therapy assessments). Given the fact that the therapeutic relationship is an important change factor, these data indicate that paying more attention to nonverbal aspects of the therapeutic relationship may maintaining the therapeutic relationship and thus increase the chance of patient's improvement.

This study was examination e-consalting by Telepsychiatry of war related Posttraumatic stress disorder(PTSD) and the Enduring personality change after catastrophic experiense (EPCACE).

The author's objective is to analize component of symptoms in PTSD and EPCACE. The subjects were 200 male psychiatric patients by Telepsychiatry and e-consulting with war related PTSD by videoconferencing via broadband ADSL by 2 Mbps. Posttraumatic stress syndrome-PTSS-10 scale, HAMD and 20-item Zung self-rating scale was used to assess state measures of symptom severity. The study tested the equivalence of the two forms of service (clinical psychiatric consultation “face to face” and telepsychiatry with interactive videoconferencing psychiatric services) delivery with Client Satisfaction Questionnaire (CSQ-8).

The symptoms of prolonged PTSS(posttraumatic stress syndrome) with duration between six moths and two years had been founded at 154 (77%) and 46 (23%) of patients had no PTSS: symptoms of depression had been found at 165 (82,5%) patients. The enduring personality exchange after catastrophic experiense (F62.0), had been found at 26(13%) patients (P < 0.01); symptoms of depression had been found at 66 (33%) patients after two years. Index of the CSQ-8 in groups Face to face 21.8±2.5(M±SD) and in telepsychiatric group 22.1 ± 2.7(M±SD).

Evolution of PTSD symptoms and continued examination and follow-up by Telepsychiatry service and e-consalting may be important in predicting the eventual development of depressive symptoms and precipitation of EPCACE(F62.0) enduring personality exchange after catastrophic experience in the war related PTSD.

The results demonstrated equivalent levels of satisfaction in both face-to-face and telepsychiatry groups.

Opioid dependence has increased greater that 150% from 1965–2008. Almost 2 Million Americans are currently opioid dependent. Approximately 4.4 million teenagers and adults have used opioid prescription painkillers for nonmedical purposes. Greater than 75% of opioid dependent patients in the U.S. go untreated. Greater than 60% of opioid dependent patients don’t seek treatment due to lack of accessibility of treatment centers or programs.

100 opioid dependent patients (illicit street and iatrogenic) volunteered and entered a “TELE-PSYCIATRY MODEL” for treatment of their dependence (age range 19, - 61. 58 males, 42 females). Utilizing the Bupernorphen protocol, all patients were interviewed, examined, induced, and regularly followed, ALL utilizing SECURE VIDEOCONFERENCNG interactive treatment methodologies. No in-person contact was made with any patients.

2 patients dropped out, 98 remain in treatment, and opioid free after a 7 month average. All patients found the Tele Psychiatry model to be acceptable, effective and preferable.

Cancer is a leading cause of death world-wide. Many patients spend the end of their lives at home while being cared for by family members. Consequently, the caring relatives face high burden and are prone to psychiatric symptoms. At the same time they are often reluctant to communicate their needs or seek help in professional palliative care settings.

This talk presents the baseline results of an ongoing study investigating caregivers’ distress due to their caring role together with their needs and perceived burden, and its relation to hope and psychiatric symptoms with a specific focus on the caregivers’ gender.

We report a cross-sectional investigation using structured questionnaires to assess caregiver burden and needs, distress, hope, psychiatric symptoms, and quality of life.

Female caregivers who were willing to participate in the study clearly outnumbered male caregivers. Results in terms of specific needs and perceived burden were similar for genders. Results for distress, hope and psychiatric symptoms were mixed.

Caregivers of terminally ill patients are a high risk group for the development of psychiatric disorders. Paying due regard to their burden and needs should be a central issue in palliative care and gender specific differences should be taken into account.

390 patients living at home with mild to moderate dementia and their family caregivers were recruited by 129 general practitioners (GPs) for a three-arm cluster-randomized longitudinal study. The IDA-Study (Initiative for dementia care in general practice, www.projekt-ida.de) was performed between 2005 and 2010 in Germany. Data were recorded by the GPs and the caregivers at baseline and after 12 and 24 months. 357 caregivers could be interviewed at baseline. The predictors for institutionalization were determined by means of binary logistic regression analysis.

The mean age of the dementia patients was 80.3 years (SD = 6.8). 65% suffered mild dementia, 35% had moderate dementia at baseline. 68% of the patients were women. The mean age of the family caregivers was 59.4 years (SD = 13.4); 73% were women.

Of the 250 evaluable cases who did not die at home during the first two years after baseline, 60 (24%) were institutionalized during this period. Neither the gender of the dementia patients (p = 0.78) nor that of the caregivers (p = 0.12) was a significant predictor for institutionalization in the regression analysis. Admission to a nursing home was significantly more frequent when the caregiver was older, in a city, when more use had been made of relief offers at baseline, and when the caregivers felt more burdened.

Institutionalization of a dementia patient does not depend on the gender of the dementia patient or on the gender of the caregiver. Factors of the care situation are decisive, especially whether relief offers are used or not.

Filial maturity has been discussed as important part of a successful development. In two studies we investigated, whether it is related to the subjective burden of care for demented parents and whether there are correlations to the early relationship between the caring child and their parents.

N = 61 adult children, who took care for a demented mother and/or father were recruited fort his study. We used the following scales and tests: The Louvain Filial Maturity Scale, the Freiburger Persönlichkeitsinventar for the personality profile, the Symptom Check List (SCL-90) for general psychopathology, the Nurses Observation Geriatric Scale (NOSGER) for the caregiver-rated symptom profile of the demented parent, the Zarit Burden Interview for caregiver burden. The demented parent were investigated by experts using a standardised interview for the diagnosis of dementia (SIDAM) and the MMSE for dementia severity. In the second study we interviewed N = 47 children also N = 27 of their non-caring siblings. In addition to the above mentioned instruments, we applied the Parental Bonding Scale.

Overall filial maturity was not related to the subjective caregiver burden as measured in this study. However, higher “parental consideration” was related to lower burden. And higher “filial obligation” was related to later nursing home admission. In contrast to their non-caring brothers and sisters, the caregivers rated their “early parents” as significantly less controlling and more caring. Both groups differed also with regard to filial maturity. Further research should clarify the role of parental bonding for the development of filial maturity.

The World Health Organization Department of Mental Health and Substance Abuse has been conducting an active program of field studies and international surveys as a part of developing the ICD-11 classification of mental and behavioural disorders.

A key priority for WHO is that the ICD-11 serve as a more effective tool for reducing the global disease burden of mental and behavioural disorders.

In support of this objective, a major goal of the revision is to improve the classification's clinical utility. To provide relevant information on clinical utility, WHO has worked to assess the perspectives of practicing clinicians throughout the world.

Two global field studies have been conducted regarding how clinicians conceptualize the relationships among mental disorders based on their clinical experience. The first study included 1371 psychiatrists and psychologists from 64 countries, and used a paired comparisons methodology. The second study used a ‘folk taxonomy’ method, and was administered with 480 psychiatrists and psychologists in Brazil, China, India, Japan, Mexico, Nigeria, Spain, and the USA.

Highly similar results were obtained across two large international studies using different methodologies. Clinicians’ conceptualizations are rational and highly stable, regardless of country, language, profession, and country income level. Differences between clinicians’ judgments and classification system are not due to idiosyncratic clinician error, but rather to systematic differences.

The presentation will discuss how empirical data on clinician judgments are contributing to the development of a new and more clinically useful classification of mental disorders, without sacrificing validity.

The divide between child and adult disorders disrupts the continuity of clinical care and is untenable in the face of evidence for continuity of psychopathology across ages.

The ICD-11 Working Group on Classification of Mental and Behavioural Disorders in Children and Adolescents has set out to integrate the categories previously grouped as “Disorders with onset usually occurring in childhood and adolescence” in the main classification.

The primary aim is to provide a classification that will facilitate efficient clinical care and will be easy to use for a range of medical and non-medical professionals across the World.

The recommendations are based on literature reviews, group discussions and consultations with leading professionals. Clinical utility is the primary criterion.

The principal proposals are: (1) A grouping of neurodevelopmental disorders will include autism, learning disorders, attention-deficit/hyperactivity disorder and other categories open to individuals irrespective of age; (2) Conduct disorder and Antisocial Personality disorder can be merged into a single category ‘Conduct/dissocial disorder’ diagnosed based on aggressive and deceptive behaviors in children and in adults; (3) Feeding and eating disorders can be merged into a single grouping with the same categories available to all age groups; (4) Categories that appear clinically useful but have insufficient evidence will be included in the main classification, but marked as ‘requiring further testing’; these may include disruptive mood dysregulation with dysphoria disorder, psychopathy, catatonia and avoidant-restrictive food intake disorder.

The proposals are subject to further consultation and field testing.

As a part of the development of ICD-11, a globally representative and multidisciplinary group has been appointed by WHO to consider critical questions regarding mental and behavioural disorders categories related to trauma and severe stress or adversity.

The ICD-11 Working Group on the Classification of Stress-Related Disorders seeks to improve the clinical utility of the current classification of mental and behavioural disorders.

To develop a clinically useful globally applicable and classification system, with particular consideration to implementation in low-and middle-income countries and in primary care settings.

Recommendations are based on literature reviews, group discussions and consultations with leading professionals. Key questions include: (1) How should the stressor or trauma criterion for Post-Traumatic Stress Disorder and Acute Stress Reaction be revised? (2) Should other proposed syndromes (Complex PTSD and Prolonged Grief) be included? (3) Can Adjustment Disorder be conceptualized as a stress-response syndrome based on positive symptoms? (4) Should the diagnosis‚ “Enduring Personality Changes after Catastrophic Experience” (EPCACE) be preserved?

Proposals for the candidate disorder entities related to trauma and severe stress or adversity have been developed, including Post-Traumatic Stress Disorders, Prolonged Grief Disorder, Adjustment Disorders, and Complex PTSD/EPCACE. The main features of these proposals will be presented.

The current discussion on these drafts would allow us to view these diagnoses as expressions of a stress- and trauma-reaction continuum. Future timelines and prospects of the working group will be discussed. Proposals are subject to further consultation and field testing.

The current revision of ICD-10 also involves the group of schizophrenia and other non-organic psychotic disorders.

To describe the current status of the development of the revised diagnostic criteria by the working group on psychotic disorders for ICD-11.

This presentation will describe the development of the work group on psychotic disorders and its current activities.

Report of the current activities of the WHO ICD-11 working group on psychotic disorders.

The workgroup was formed in 2010 and had its first in person meeting in January 2010. Several conceptual issues were evident and are currently being reviewed, including the use of dimensional assessments, the role of functional outcome assessments, the definition of course and severity specifiers, and the reorganisation of the psychotic disorders in the chapter. Also, the group has started to review the specific diagnostic criteria for schizophrenia, acute and transient psychotic disorders, schizoaffective disorder, delusional and brief psychotic disorders, and schizotypal disorders. While the revision proposals should be mainly evidence-based, initial review results indicate that in many cases expert consensus decisions will be necessary due to a lack of studies.

The workgroup on the classification of psychotic disorders is currenly reviewing the scientific evidence for specific diagnostic criteria and more general issues pertaining to the classification of psychotic disorders. Both expert consensus and evidence-guided criteriology will be necessary and the lack of suitable studies in some areas of psychosis research may prompt research suggestions for the upcoming ICD-11 field trials.