The challenges of providing mental health care to a culturally diverse patient population include having sufficient knowledge about cross-cultural issues in generally and especially knowledge about cultural background of the specified ethnic groups. Asylum seekers are certainly individuals with specific needs that are combination of potential traumatic experiences, current political situation in home country and asylum policy in third country where they seek the asylum. Language barriers, a mistrust of authority, and fears about confidentiality are well documented obstacles to the effective care of asylum seekers. Therefore, the language abilities and cross-cultural background of the therapist are not negligible. Current assessment and/treatment of asylum seekers in Denmark raises several controversial but important ethical dilemmas:

Sufficiency and satisfaction by the assessment and/or treatment provided via interpreters seen by the patient and the therapist

The impact of psychiatric statement on the process of asylum determination (used and/or abused by authorities and asylum seekers)

This paper describes clinical cases related to mentioned issues and give potential useful hints for future development within assessment and/or treatment of asylum seekers.

A growing body of research links the experience of racism to a variety of health and mental problems, with stress as the most direct link. The understanding of racism has become more complex in recent years, wherein investigators have shifted the focus away from overt forms of racism such as that associated with white supremacy to unintentional or "aversive" racism. Racism in mental health care is an ethical issue for psychiatrists and psychologists because it represents a very damaging force that is associated with mental health problems, and as such requires effective response. Racism and race related issues may enter the consulting room indirectly through the experiences of patients in the outside world, or, indeed, directly through the clinician's implicit and unintentional behavior. Both cases clinicians demand the awareness and responsiveness necessary to ensure that patients are not harmed. Conventional therapeutic approaches situate the locus of change in the individual yet racism is not a psychological problem as such. Recent work on racial microaggressions indicates that mental health professionals are prone to low level acts of racism that are of relevance only to the racially different patient; the clinician is unaware of such an act and as such not inclined to take corrective action. The Racial Identity Interaction model will be presented as a basis from which to understand the ethical impact of racism in the clinical context.

Suicide has a profound effect on the family, friends, and associates of the victim that transcends the immediate loss. Health professionals as well family members are usually unaware of immediate suicide risk and often present disbelief. The event is totally unexpected. This is a key issue in suicide prevention as underestimation of suicide risk and

As those close to the victim suffer through bereavement, a variety of reactions and coping mechanisms are engaged as each individual sorts through individual reactions to the difficult loss. Literature suggest that health professional in general and mental health professionals in particular are often unprepared and uneasy when it comes to deal with suicide risk. Communication of suicide intent has been reported as a common feature among suicide victims, yet some patients barely let other people know their intention to commit suicide or clinicians are not trained to notice warning signs. So it is of paramount important to integrate such communications with tactics to better identify suicidal patients. Managment of these patients is therefore a great issue and a difficult task which can be accomplish with the help of GPs, family members, psychiatrists and community members. Substance abuse disorder comorbid with other psychiatric disorders impairs positve outcome and dramatically increase suicide risk. Combined treatment is not always provided for such patients and proper management of suicidality is generally reduced. This symposium addresses some of the key issues in suicide prevention related to the role of health professionals in the assessment of suicide risk.

From psychological autopsy studies emerged that suicide victims do communicate their intent to end their life; nevertheless health professionals are often stricken by surprise when a suicide occurs. On average, 45% of suicide victims had contact with primary care providers within 1 month of suicide. Two third of the suicide victims communicated their suicidal intent over a period of weeks prior to their death, usually several different persons, 40% communicated their suicidal intent in very clear and specific terms. About 90% of suicide victims had received some kind of health care attention in the year prior to death, but this care was not provided by a mental health professional. Half of the persons dying by suicide had never been in contact with a mental health professional in their lifetime, not even once.

There are various elements that impair recognition of suicide risk by treatment professional and that are associated with stigmatization such as: Lack of knowledge and skills in relation to treatment of self-destructiveness; Professional's loss or absence of concern; Acceptance of patient's suicide as a solution to problems; Wishes that patient would commit suicide as a solution to his or problems; Degree of familiarity with patients; Unfounded optimism in relation to treatment; Fear of patient; Defects or problems associated with treatment system. This presentation explores possible educational interventions for health professional in general and mental health professionals in particular. Reactions after patient's suicide are also discussed.

Suicide attempt and particularly committed suicide are relatively rare events in the community, but they are quite common among psychiatric (mostly depressive and schizophrenic) patients who contact different levels of healthcare some weeks or months before the suicide. The most common current psychiatric illness among consecutive suicide victims is major depressive episode (56-87%), which, in the majority of cases, is unrecognized or untreated. The current prevalence of patients with major depressive episode in the primary care practice is around 8-12%, and earlier studies, performed 15-20 years ago, found that less than 20% of them were recognized by their GPs, and the rate of adequate antidepressant pharmacotherapy was under 10%. More recent papers reported much higher rates (62-85%) of recognition and treatment of depression in primary care indicating that the situation shows improving tendency. Since succesfull acute and long-term pharmacotherapy of depression significantly reduces the risk of both attempted and committed suicides, and 34-66% of suicide victims (two-thirds of them should have current depression) contact their GPs 4 weeks before their death, GPs play a priority role in suicide prevention. Although prior suicide attempt (particularly in the presence of major depression or schizophrenia) is the best single predictor of future suicidal behaviour, two-thirds of suicide victims die by their first attempt. Therefore the prediction of the first suicidal act is particularly important for the prevention. Followed the pioneering Swedish Gotland Study, several large-scale community studies demonstrated that education of the GPs on the diagnosis and treatment of depression.

During the eigthies an educational project on the recognition and treatment of depressive disorders was carried out in the swedish island of gotland, an island and Swedish count of dramatic societal transition and afflicted by the highest suicidality in sweden at that time. The educational intervention resulted in a decrease of suicides to the lowest figures in sweden, however mainly in females.

After a psychological authopsy of all persisting male suicides, that could not be reached due to their not -helpseeking behaviour and their lack of contact with the health care system, new educational efforts on gotland were completed with a focus on males suicidality, using the ad hoc constructed "Gotland male depression scale" as a main tool in an approach directed even to other societal structures on gotland than the health care system. During the nineties, consequently,even male suicidality decreased on Gotland for the first time. Since than, the "Gotland Study" of educating GPs as a suicide preventive effort in suitable endemic suicide regions has been widely spread and replicated in many countries, regions, and populations of societal transition, often with positive results. Educating GPs according to the Gotland Model is today considered to be one of the essential measures that should be offered in comprehensive,multimodal and multisectorial national programs of suicide prevention.

The literature suggests that nearly 50% of patients with schizophrenia have a co-occurring substance use disorder (SUD), most frequently alcohol and/or cannabis (at a rate about three times as high as that of the general population). Outcomes associated with Comorbid SUD and Schizophrenia are earlier onset of schizophrenia, increased relapses, treatment noncompliance/more side effects, poorer response to antipsychotic medication, more hospitalizations, increased risk for violence, increased medical costs, more affective disturbance. These conditions are also associated with increased suicide risk. The increased suicide risk of substance abusing schizophrenic patients could be the result of a cumulative effect of many factors or events, such as the loss of remaining social control through the consumption of psychotropic substances, noncompliance with antipsychotic medication, presence of paranoia and depression.

Abuse substances worsen both symptoms and prognosis of the illness and are related to higherrelapse rates.

Studies suggest that some of the second-generation (atypical) agents may be helpful for these patients. Some researchers have suggested that the lower incidence of neurologic side effects produced by the atypical antipsychotics, along with the possibility that these agents may be more likely to decrease negative symptoms, make them a logical choice for patients with co-occurring substance use disorder (even though parameters of the metabolic syndrome must be monitored while using these agents).

As medicine and magic began to slowly part ways in the Enlightment era, scientific evidence became the driving force and currency of medicine. As scientific evidence was being defined, the newly established medical schools imparted this knowledge to their students. Those who mastered the evidence, and committed to adhere to it, became physicians who enjoyed public trust and the statutory position that came with it. With some exceptions, the idea that scientific evidence should constitute the only foundation for medical practice has withstood the test of time and the occasional attacks, by well-meaning but naïve individuals as well as charismatic charlatans.

The principal stakeholders of clinical practice - consumers, practitioners, and providers of services and products - are all trying to influence the stream of evidence. The current debate on EBM focuses on what constitutes true scientific evidence, and how best to translate this evidence into clinical practice. The evidence available to the practitioner varies widely in terms of source, quality, and potential for bias, while the relevance of evidence, derived from statistical analyses of data from mega-trials, to the treatment of individual patients is sometimes difficult to grasp.

This presentation will discuss the gap between EBM and clinical practice and ways to bridge the two.

This contribution will explore UK-based research developments in substance misuse and mental illness over the last 20 years. The main body of work revolves around research largely, but not only, funded by the Department of Health from the late 1990s. Early research revolved around alcohol, especially alcoholic hallucinosis: the relationship with schizophrenia-like illness was examined and the conclusion at that time on the basis of twin, family and clinical studies, was that very few cases did develop into schizophrenia. More recently, large general population epidemiological, and medium or small scale clinical studies, have been undertaken on the relationship between substance misuse (sometime specifically on cannabis) and the later development of mental illness especially psychosis. The presentation will aim to draw parallels with the current debate around the link between cannabis and psychosis and urges caution in too rapid an assertion that cannabis is necessarily ‘causal’ and the clinical and policy implications of the misinterpretation of evidence. A proposal will be put forward that the genesis of psychotic illness in alcohol misuse is revisited using more sophisticated research methodologies. Given the changing landscape of substance use in the UK, particularly the fashion of polysubstance use and the recognition that this may be associated with psychotic illness, other drugs that are associated with psychotic illness should be similarly investigated to determine whether there is a common mechanism that might throw light on understanding the relationship between substance use and psychotic illness or schizophrenia.

In order to create hypotheses about the relationship between the effects of cocaine and the development of psychotic symptoms we conducted a pilot study with 55 patients. All patients were personally investigated on their current psychopathology. The 55 patients (more than 80% were males) were distributed in 5 diagnostic subgroups:

1. 1) Addiction without a further AS I diagnosis (n=10)

2. 2) Addiction and psychotic disorder related to cocaine (n=8)

3. 3) Addiction, psychotic disorder related to cocaine and another AS I disorder (n=10)

4. 4) Addiction and a schizophrenic spectrum disorder (not schizophrenia) (n=10)

5. 5) Addiction and schizophrenia (n=17)

We investigated if psychotic symptoms occurred during cocaine use, if these symptoms depended on the dosage of cocaine and if similar symptoms also occurred without cocaine but during stress.

Attention Deficit Disorder is a well recognized developmental disorder in children. The disorder has been found to persist in adulthood in about 50% of the cases with an estimated adult prevalence of about 3.5%. ADD in adulthood is characterized by high rates of one or more concurrent psychiatric disorders like mood disorders, anxiety disorders and personality disorders.

In the last decade interest has increased in the co-occurrence of ADD and substance use disorders (SUD). Approximately 15-25 % of ADD patients have a lifetime diagnosis of SUD involving a wide range of legal and illegal substances. Given the different spectrum of ADD symptomatology as compared to the childhood clinical picture, the high rates of psychiatric co-morbidity and the interference of substances with ADD symptoms and course, diagnosis and treatment of these patients constitute a real challenge.

Recent clinical research is directed at unravelling specific risk factors for developing SUD during the course of ADD in later life. Early diagnosis and adequate treatment seem to diminish this risk. Childhood conduct disorder and increased impulsivity are considered to imply an increased risk for developing not only SUD but also criminality in (early) adulthood. Clinical implications of these findings will be discussed during this presentation.

This presentation describes current knowledge about the treatment of patients with the dual diagnosis of post-traumatic stress disorder and substance misuse, a population that is typically considered “difficult to treat”. We will cover background on PTSD and substance misuse (including rates, the typical client, models and stages of treatment, and clinical dilemmas). Clinical interventions will also be addressed, with a focus on "Seeking Safety", an evidence-based model for PTSD and substance misuse.

Per definition adults with antisocial personality disorder have met the diagnostic criteria of conduct disorder since adolescence at least. Those who have started to show antisocial behavior before the age of ten tend to exhibit even more severe aggressive behavior throughout early adulthood. However, conduct disorder is not a homogenous category that is characterized by a steady development towards a specific antisocial disorder in adulthood. Within the category of conduct disorder there are particularly high differences in emotional processing and an individual's capability to regulate emotions. Regarding the neurobiological correlates of emotional processing in subjects with conduct disorder, psychophysiological data suggest high stability over time with the main finding of hypoarousal in resting states and autonomous hyporeagibility to emotional stimuli. Findings from functional neuroimaging are more heterogeneous probably reflecting subtypes of antisocial disorders which are subsumed under the category of conduct disorder. Developmental research in psychiatry needs a multidimensional diagnostics including a precise psychopathological characterization and subdifferentiation. Although genetic dispositions are stable, they interact with changing psychosocial factors which take influence on the developing brain in more or less vulnerable stages.