The mental health of the EU's population is a value by itself, and a key determinant for health and quality of life. It is an important factor for the realisation of the EU's strategic objectives: prosperity, solidarity and social cohesion, security.

The situation in the EU is marked by significant differences with regard to the mental health status, mental health policies and systems in Member States. At the same time, a commonality across the EU is the increase of diagnosed mental disorders, which severe and growing implications for health, economic and social systems. It can be expected that this trend will continue.

Mental health is a priority of public health policy at Community-level and it is also addressed by other Community policies. Action at EU-level needs to respect subsidiarity and the diversity of situations in Member States. Strengthened exchange and cooperation between Member States can help to tackle the existing inequalities, and action through Community policies can complement measures in Member States.

Experiences through the EU Public Health Programme (2003-2008) showed that responding to the challenges of mental ill health is more effective, if it involves the range of policies and actors who have an influence on the mental health of the population, such as the health, educational and workplaces' areas. The important role of mental health promotion, prevention, early recognition and combating stigma, further to treatment, care and reabilitaion, is now well established.

In October 2005, the European Commission published a consultative Green paper on Mental Health. In this document it proposed the development of a strategy on mental health at EU-level, in line with the competencies established in the European Treaties. The document proposed the following priorities: mental health promotion; prevention of mental disorders and suicidal behaviour; raising the quality of life of people experiencing mental disorders through social inclusion and the protection of their rights and dignity; providing mental health information and research. The document argued that action on mental health at EU-level could promote the exchange and coordination between Member States and between the relevant sectors.

The Green paper initiative attracted much interest and support among EU-institutions, in Member States, in the health and social sectors as well as among patient and family organisations and the civil society. A White Paper to be presented in spring 2007 will draw the conclusions from the consultation.

The European Brain Council (EBC) brings together European based stakeholders in the field of “Brain Research”. It is an exceptional organisation as it brings together science, society and industry at the European level.

EBC's scientific member associations are European Association of Neurosurgical Societies (EANS), European Federation of Neurological Societies (EFNS), European College of Neuropsychopharmacology (ECNP), Association of European Psychiatrists (AEP), Federation of European Neuroscience Societies (FENS). The patient associations are European Federation of Neurological Associations (EFNA) for the neurological disease groups and GAMIAN-Europe for the psychiatric patients. Industry, pharma as well as the device industry, have voted delegates to sit on the EBC board.

EBC actively lobbies at the EC and EP level to promote and enhance research on the brain. This research is not conceivable without considering also the importance of the mental health of Europe's citizens.

Therefore, EBC actively participated in the Green Paper Consultation on Mental Health carried out by DG SANCO. Aware of the challenge such an important initiative poses, EBC pointed out priorities that need to be met and the lack of available evidence for mental health in Europe that needs to be gathered and completed. EBC also strongly suggested not to overlook the importance of diagnosis and treatment as complementary to promotion, prevention and recovery.

Randomized controlled clinical trials mostly focus on very specific outcome parameters. These may include symptom relief, psychosocial measures, specific safety issues or compliance, just to name a few. As they often represent early attempt to provide information on new treatments, the homogeneity of the studied population is a crucial study prerequisite. This generally calls for strict inclusion criteria and a large set of exclusion criteria. Understandably, these requirements allow only a certain selection of patients to enter such studies, which, in turn, jeopardizes the generalisability of the obtained results. Alternatives to this approach include so called “large pragmatic clinical trials” with broad inclusion criteria, designed to study a population of patients closer to real life. More comprehensive outcome criteria, such as the effectiveness or remission paradigms, have also contributed to the effort. In the end, results from various types of clinical trials will have to be evaluated in a synthetic fashion in order to enable the clinician to make a rational treatment choice for individual patients.

Abstract not available at the time of printing.

Since the introduction of antipsychotic drugs into schizophrenia treatment patients complained feeling ‘fuzzy or dull’, of being ‘unable to think straight’, feeling ‘like a zombie’. All these feelings were labeled as a syndrome of ‘neuroleptic dysphoria’. Patients may even fail to distinguish adverse events from symptoms of illness; they simply classify drugs as ‘good’ or ‘bad’, or alternatively they believe that medication makes their condition worse. Negative impact of side-effects on quality of life was repeatedly confirmed in various studies. The subjective acceptance of medication is becoming increasingly important outcome measure of tolerability in trials of new drugs, naturalistic observational studies and switch studies. Similarly to the quality of life assessment, impact of drugs on patients' well-being, subjective response to treatment, attitude towards medication, or preference of medication can be measured. Variety of side-effects is associated with antipsychotic treatment. Traditionally, most of the attention is being paid to EPS, akathisia, tardive dyskinesia, and lately weight gain, metabolic, endocrinological, or ECG abnormities. However, beyond the usual list, largely overlooked adverse events, such as sedation and somnolence, orthostatic hypotension, sexual side-effects may have more severe and direct impact on patient's well-being. The outcome of illness, including treatment compliance, can be negatively affected by the group of clinically highly relevant but mostly ignored side-effects, including sexual dysfunction. Their incidence in clinical trials and everyday practice, together with their consequences, thus deserve closer scrutiny.

Nowadays treatment and rehabilitation of schizophrenia patients demonstrate promising results, especially for symptom remission. E.g. up to 80% of first-episode patients show symptom remission at 1 year after starting pharmacological treatment. But despite initial symptom reduction there is still poor functional recovery following a first psychotic episode: about the same percentage fail to demonstrate former social and occupational functioning or quality of life within 6 months after starting pharmacological treatment despite symptom recovery. These functional impairments are present up to 5 years after illness onset even when optimal pharmacological treatment is provided. Different studies point out that deficits in neurocognition (e.g. attention, memory, executive functioning) and social cognition (e.g. emotion and social perception, insight, social schema, attributional style) might be a main source for explaining this poor functional outcome.

Against this background our research group in Bern has developed therapy programs focussing especially on neuro- and social cognition. Integrated Psychological Therapy (IPT) was tested in 32 controlled studies in different countries with a total sample of 1420 patients. A further development of IPT is the Integrated Neurocognitive Therapy (INT) that is evaluated in a still ongoing multi-centre study. Data of a metanalysis of IPT and first results with 28 patients of the INT study indicate beneficial improvements in neuro- and social cognition, self-efficacy and self-perceived quality of life. These results confirm the importance of psychological therapies in combination with pharmacological treatment to optimize functional outcome and recovery.

This workshop will focus on diagnostic and clinical issues in the treatment of Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. Dr. Carrion, a Puerto Rican will speak on the role of coping, social support, temperament and subjective stress on posttraumatic symptoms, using “Coming-Out” or integration of a LGBT sexual orientation. He will discuss findings from a cohort of children who have experienced interpersonal violence and develop posttraumatic symptoms. Temperament will be discussed as a potential mediator and coping style as a moderator of posttraumatic symptoms. Dr. Garza, a Mexican American will describe concepts of gender identity and gender roles, and what role psychiatry has played in this area and how it may become a source of support for individuals struggling with gender dysphoria. Dr. Navarro-Barrios from Granada, Spain will speak about transcultural psychiatry and immigrant gay men. Transcultural psychiatry emphasizes the relation that exists between the culture of the subject, and the different presentation of the mental pathology. He will emphasizes the application of transcultural model in therapy with the immigrant gay subjects. Dr. Nakajima, a Japanese American will discuss problematic diagnoses related to homosexuality in ICD-10 like ego dystonic sexual orientation, and the drive to eliminate these diagnoses in ICD-11.

Cognitive impairment is increasingly regarded as a core aspect of schizophrenia. It is associated with poor functional outcome, may represent a rate limiting factor in rehabilitation programs and is not largely influenced by pharmacological interventions.

Several studies suggest the efficacy of cognitive training programs and advice their inclusion in treatment strategies, while others discourage clinical application.

We recently completed a study involving three Mental Health Departments located in the South of Italy and coordinated by the Department of Psychiatry of the University of Naples SUN. Fifty-eight patients with either a diagnosis of schizophrenia or schizoaffective disorder were recruited and randomly allocated to one of two rehabilitation programs: Social Skill Training (SST) + Computerized Cognitive Training (CCT) (Group A) and usual rehabilitation activities of the Department (Group B). The active treatment phase lasted 6 months. Psychopathological aspects, as well as psychosocial and neurocognitive functioning, were assessed both before and after treatment. Group A subjects participated in two one-hour sessions of CCT and one two-hour session of SST. Group B patients spent an equivalent amount of time in the usual rehabilitation activities.

The two groups did not differ on baseline clinical, neurocognitive and psychosocial variables.

At the end of treatment, a worsening of the negative dimension was observed in group B, but not in group A, in which a significant improvement of two psychosocial indices (participation in family life and availability to work) was found.

The experimental program (SST+CCT) was more effective than usual rehabilitation activities of the departments.

Aggressive behavior in mental disorders may occur in childhood in the context of conduct disorder or in adulthood as a leading feature of personality disorders. Those children, who meet the criteria for conduct disorder already in early life (“early starters”) tend to exhibit high levels of aggression throughout development and continuation of violence in adulthood. They exhibit autonomic underarousal and low autonomic responses which have been shown to be predictive of adult antisocial behavior and which have been suggested to act as biological mediators through which genetic influences operate on antisocial behavior. This predictor is stronger in boys without psychosocial disadvantages compared to those boys with unfavorable social backgrounds and may therefore particularly reflect the biology-antisocial behavior relationship. There are several lines of evidence that aggressive behavior at any age is closely related to an individual's capability to regulate emotions. Emotions of anger or fear trigger reactive, impulsive aggression whereas a failure to experience fear, empathy or guilt facilitates instrumental aggression. Brain structures significantly involved in affect regulation, such as the amygdala and hippocampus, have been found to be smaller in early-onset CD boys compared to healthy controls. In emotional challenge tasks these boys exhibited increased amygdalar hyperresponsiveness to emotional stimuli; this finding might reflect a time-limited mechanism of compensation for smaller amygdala volumina in the maturating brain. Data from neuroimaging and electrophysiology will be forwarded to clarify the neurobiological underpinnings of children with conduct disorders and their risk of being the fledging adult violent offenders.

In Switzerland, forensic psychiatric assessment is a legally defined prerequisite for a trial, if the judges are in doubt about the defendants mental healthiness. In every such case assessment of criminal responsibility and prognosis is mandatory. The Swiss law knows since long the preventive and temporally limitless detention of mentally ill offenders, if their mental state and therefore their dangerousness cannot be ameliorated by means of therapy. Actually around 130 mentally ill offenders are under preventive detention, with an additional 12 every year. In 1993 a Swiss prisoner, sentenced for two cases of sex murder and several cases of rape, killed during his unattended free weekend trip a young girl. As a consequence committees reviewed procedures for risk assessment and decisions about release in high risk offenders, finding important shortcomings. In 1996 commissions for the assessment of offenders dangerous to the public began their work and a catalogue for risk assessment was defined. These commissions do not take decisions, they only advise responsible authorities upon their request. Since the introduction of those commissions, no severe reoffences occurred in any of the cases reviewed. For risk assessment the commissions use an instrument called “Catalogue for risk assessment in offenders dangerous to the public” witch was developed in Basel. This catalogue is rather a toolbox, not an instrument to measure dangerousness. With this method a systematic and standardized assessment between cases and over time is ensured.

In the aftermath of a highly mediatized sex offender case the Belgian authorities decided harsher legal rules for sex offenders and at the same time developed a comprehensive treatment pathway from prison to community. Forensic psychiatry needs tools for the measurement of outcome, quality and service evaluation.

Psychiatric Reports for legal purposes play a key role for the entry of sex offenders into the penal legal system and their orientation toward the treatment pathway, including their return to the community.

In order to improve the questionable quality of the Psychiatric Reports we are in the process of creating qualitative criteria for these Psychiatric Reports, a basic template for the report itself and an adapted training including an accreditation as ‘expert’.

The aim is to meet the quality standards of validity, reliability and comparability. Developing guidelines in this domain at a European level is desirable notwithstanding the diversities of penal laws.

Attention-deficit/hyperactivity disorder (ADHD) is a clinically heterogeneous, highly heritable and genetically complex disorder. The pathways from genes to behaviour are still unknown. Endophenotypes or intermediate phenotypes that are more closely linked to the neurobiological substrate than the core symptoms of ADHD may help to disentangle these complex relationships between genes and behaviour and to clarify its etiology and pathophysiology. Heritability and stability (state independence) represent key components of any useful endophenotype. Various other criteria for the selection of useful endophenotypes have been proposed. A review of the current state of the research on potential endophenotypes for ADHD will be given.