Iodine is a trace element which is essential for the synthesis of thyroid hormones. If maternal iodine deficiency in pregnancy is severe, fetal brain damage will occur. This damage is irreversible after birth. Mild/moderate iodine deficiency during pregnancy and early postnatal life is associated with neuro/psycho-intellectual deficits in infants and children. The severity is not only related to the degree of iodine deficiency, but also to the developmental phase during which it is suffered, the most severe being the consequence of iodine deficiency during the first two trimesters of pregnancy. The close involvement between human brain development and thyroid hormones is widely accepted. The effects of T3 on the central nervous system are mediated by the regulation of the expression of genes that synthesize proteins implicated in cerebral neurogenesis, neuronal migration and differentiation, axonal outgrowth, dendritic ontogeny, and synaptogenesis. They are also necessary for cerebellar neurogenesis (predominantly during early postnatal life), gliogenesis (predominantly during late fetal life to 6 months postnatally), and myelogenesis (during the second trimester of gestation to 2 years of postnatal life). From clinical studies on the effect of iodine deficiency of both mother and fetus it becomes clear that T4 is required for brain development during gestation.

Low T4 levels during neonatal life could be a negative factor contributing to the neurodevelopmental problems of very preterm infants. Indeed, retrospective studies have shown a relationship between hypothyroxinemia and developmental delay and an increased risk of disabling cerebral palsy.

Schizophrenia is a complex genetic disorder. The lack of concordance on disease manifestation in monozygotic twins provides clear evidence that environmental factors are key determinants in disease aetiology. In accordance, various environmental modulators such as hormones and vitamins may well contribute to the altered expression pattern of several genes identified in post-mortem brain tissue of patients. We constructed a microarray platform containing 1,808 human genes, where 142 belong to vitamin A, thyroid hormone and estrogens’ metabolic pathways, to specifically address whether these could contribute to a molecular signature of schizophrenia in peripheral lymphocytes. We found that the genes encoding for PLP1, UGT1A6, NTRK1, THRAP1, ESR2, TRIP13, MAPK8, TGFB2, IGFBP4 are differentially expressed in lymphocytes of patients under treatment with clozapine, risperdal or haloperidol. Some of these genes have been previously reported by others to be altered in brain regions of schizophrenic patients, and all are implicated in pathways suggested to be involved in the disease. These observations further support that:

1. 1. studies in peripheral blood lymphocytes may contribute to reveal candidate genes in schizophrenia;

2. 2. transcription modulation of several genes may occur through the mediation of vitamin and hormones, therefore linking genes and environment in schizophrenia.

In order to understand the involvement of these genes in schizophrenia, future studies should investigate whether some of the observed changes are replicated in animal models of the disease, and how antipsychotic treatment interferes with their expression.

There has been strong evidence in recent years that oxygen free radicals may play an important role in the pathophysiology of schizophrenia and bipolar disorder. More recent evidence of altered antioxidant defenses in major mental illnesses has been accumulating. Much of the focus on antioxidant defense mechanism has been on the key scavenging antioxidant enzymes: Superoxide dismutase (SOD), Catalase (CAT) and Glutathione peroxidase (GSH-Px). Of these, SOD activity has been the most frequently examined.

The imbalance between antioxidant and oxidant mechanisms increases what is called oxidative stress, when the oxygen free species react and could damage lipids, proteins, carbohydrates and DNA. Lipids are the main compound of cellular membrane and the oxygen free radicals reaction to them is called lipid peroxidation. Several plasma lipid peroxides, like MDA, are measured by Thiobarbituric acid reactive substances (TBARS). Increased levels of TBARS have been reported in the plasma of drug-free and medicated bipolar disorder and schizophrenic patients. It is hypothesized that psychotic symptoms seen in both disorders might be a consequence of peroxidative injury to membrane phospholipids. Moreover, neuronal functioning is affected by this injury either by changes in membrane fluidity or by alterations in membrane receptors, which can cause neurotransmitter uptake and release impairment and even cell death.

After eight years of tortured negotiations between government, professional psychiatrists and lay pressure groups, England and Wales will begin to use new Mental Health Legislation November 2008. This will not be a new Mental Health Act, but a substantial modification of the 1983 act. There are nine key changes:

1. 1. A single definition of mental disorder: ‘any disorder of mind or brain’.

2. 2. Criteria for compulsion: ‘appropriate medical treatment’ test.

3. 3. Age-appropriate services: special arrangements for under 18 years.

4. 4. Professional roles: approved clinicians and responsible clinicians (non-medical).

5. 5. Nearest relative: recognises Civil Partnerships, allows displacement.

6. 6. Supervised Community Treatment Orders.

7. 7. Mental health Review Tribunal: unified.

8. 8. Advocacy: Independent Mental Health Advocates.

9. 9. ECT: new safeguards.

The Code of Practice identifies five key principles:

1. 1. Purpose - to minimise adverse effects of Mental Disorder.

2. 2. Least Restriction.

3. 3. Respect - diverse needs, values and circumstances.

4. 4. Participation - involving patient in planning, developing and reviewing treatment and care.

5. 5. Effectiveness, efficiency and equity - optimal use of resources.

The protection of human rights and the dignity of persons with mental disorders has not a relatively short history in Romania. We have a short review of legislation and of conditions of hospitalization concerning involuntary commitment of the mentally ill people during our history before and after 1989, having more than 30 years experience in the field. Since 1989 it has been necessary to create committees to investigate abuse during involuntary commitment. On the other hand, before 1989 some persons with (or even without) mental disorders were committed to a psychiatry department to protect them. Generally, Romania's legislation is in keeping with principles set out by the World Health Organisation, United Nations and so on, concerning the protection of people with mental illnesses. The legislation calls for adequate treatment and respect for the human rights of the persons with mental disorders.

Standards and practice regarding involuntary commitment in a psychiatric department and also involuntary ambulatory treatment of person with mental disorders have been improved since the introduction of the new mental health law in 2002. We discuss about the assessment of competence in the elderly and ethical aspect of care and research, and about involuntary commitment of incompetent elderly patients. We also refer to the complications and difficulties when trying to apply the civil commitments compulsive hospital admission measure. Involuntary commitment of incompetent patients took in the consideration the best interest of the patient, but also the well-being of the family and the potential risk for others.

Germany and Switzerland are neighbour countries and have a long history of exchanging cultural and scientific issues especially - because of the common language - with the German speaking part of Switzerland (about 66% of the population). Both are federal states and laws for psychiatric patients are mainly task of the member cantons / states. However, large differences regarding the “liberal” history between both countries may be the reason for differing attitudes and regulations to involuntary admissions and guardianships. Examples will be given, especially concerning demented patients.

The Czech law related to compulsory hospitalization dates back to 1966, but it has been revised several times. Besides having mental illness as a criterion for compulsory admission, the law requires the criterion that the patient may only be committed to the hospital, if he is an acute danger to himself and/or others. The Czech law does not accept the criterion that patient may be committed, if there is a danger to his health or if his behavior is not accepted to the community. The law does not specify the type of psychiatric illness required for a person to be committed. A patient admitted voluntarily to a psychiatric ward can be subsequently detained if he fulfilled the criteria of the law. The psychiatrist must examine the patient, decide and apply for commitment. The court has to be notified of compulsory admission in period of 24 hours. The detention is decided by judge in seven days. The detention could last up to 3 months then should be reevaluated by court. Appeals or complaints regarding compulsory acts are referred to the court by guardian or patient himself. A competence proceeding and the appointment of a guardian is considered in the case of demented, retarded, and in some cases of psychotic people. At issue is whether such people are capable of managing their own affairs, to make sound judgment-to weigh, to reason, and to make reasonable decision. Incompetence is decided by judge. Expert psychiatric witnesses play a role in determining the level of incompetence. The court appoints a guardian.

The European Alliance Against Depression (EAAD) is a 4-level, community-based intervention programme to improve the care of depressed patients and prevent suicidality in Europe (1).

In 2001, a pilot project, the ‘Nuremberg Alliance Against Depression’, was initiated. This community based intervention program comprised a 4-level action programme, implemented in the city of Nuremberg (500,000 inhabitants) (2). Careful evaluation has provided evidence that this program is effective: the number of suicidal acts was reduced by 24% during the two year intervention compared to a baseline year and a control region (2).

Based on these positive results 18 international partners representing 16 different European countries established the ‘European Alliance Against Depression’ in 2004. The EAAD partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international level.

The European Commission listed EAAD as a ‘best practice’ model in its Green Paper (European Commission 2005).

Youth suicide is a significant public health issue that requires effective evidence based interventions. School based suicide prevention programs are popular in many jurisdictions and there is a perception that they are effective in reducing youth suicide rates. This presentation will apply a comprehensive evaluation framework to determine the effectiveness of school suicide prevention programs as described in the literature and will identify those conceptual and research issues that need to be addressed to develop and deliver effective school based suicide interventions.

Firstly, recent data on depressive disorders and suicidality burden in Portugal is presented and treatment gap is stressed as well as the insufficient information until recent years (1).

At the national level, the first epidemiological study on psychiatric disorders embedded within the World Mental Initiative Survey is ongoing and prevalence and needs for care data will be presented.

Implementation process of the EAAD 4-level intervention in Portugal is ongoing along with restructuring of both liaison and specialized mental health care on a regional sector of 350.000 inhabitants with a mental health specialised care department and four large primary care health centres, where liaison between 4 mental health teams and 200 GP was taking place accordingly with varying models (substitute care in most) and different clinical criteria for admission and follow-up.

The restructuring of mental health teams and their missions implied that while a set of sub-teams stood responsible for severe mental disorders, another subgroup was deemed to comply exclusively with common mental disorders and primary care liaison aided by standardisation of clinical criteria for referrals evaluation and reply, specialised therapeutic interventions, as well as collaborative stepped care.

Baseline and some outcome data on suicide and depression will be presented such as rates, psychopharmacological prescriptions, general population knowledge and beliefs, media reporting, and pre and post training evaluation of primary care professionals.

This presentation will give an overview of the aims and progress of the DEMoBinc study. The project aims to develop a toolkit for assessing the living conditions, care and human rights of people with long term mental illness in psychiatric and social care institutions in European countries. The study has been funded for 36 months by the European Commission and started in March 2007. It involves eleven centres across ten countries: UK; Germany; Spain; Czech Republic; Bulgaria; Italy; Netherlands; Poland; Greece; Portugal.

The toolkit will assess domains considered most important for service users’ recovery and is designed for use in a face to face interview with the institution manager. The domains have been identified through an international literature review and Delphi exercises in each country with mental health professionals, clients, carers and advocates and agreed by the research partners and an international panel of experts in rehabilitation and recovery. The toolkit will be refined through the course of the study to maximise:

1. a. its reliability;

2. b. its usability;

3. c. its ability

The DEMoBinc study's main objective is to develop an instrument for assessing the living conditions, the quality of care, and the human rights of long-term mentally ill patients in psychiatric and social residential care. It started on March 2007, with 11 centres and 10 countries participating.

The Portuguese centre has carried out a national literature review of mental health legislation, standards of care related with residential care for mental patients, and mandatory procedures for physical restraint and seclusion.

A three-round Delphi exercise with four groups of experts - advocates, mental health professionals, service users, and carers - was also developed. In the first round the participants were asked to state the ten more important components of care helping recovery in institutional care for the long-term mentally ill. The results were sent back to be rated for their importance on a 5-point scale. Finally, the participants were asked to confirm or change their own scores in comparison with the calculated group median. Between twelve and 18 participants by group were contacted, and the overall rate of participation was 73%.

A pilot study using the first draft of the DEMoBinc instrument was done, and refinement of the instrument is being carried out in twenty institutions and will be completed during the next months.

The results of the Portuguese centre on the national literature review, the Delphi exercise, and the first phase refinement of the DEMoBinc instrument will be presented and discussed.

Recent brain imaging studies indicate subtle functional and also structural brain changes in affective disorders. We report specific neurotransmitter receptor findings in vivo in major depression testing directly the ‘old’ monoamine and also newer peptide neurotransmitter hypotheses of unipolar major depression.

Positron Emission tomography imaging demonstrates relatively consistently a widespread reduction of brain serotonin 5-HT-1A receptors in drug-free or never-treated patients with clinical depression. The reduction of 5-HT-1A receptors is not confined to frontal or temporal cortex but seem to be widespread including multiple brain regions. Our data shows that the 5-HT-1A receptor finding seems to be robust even in primary care patients with mild/moderate depression. Pilot findings in our laboratory suggest that this alteration can be ‘normalized’ with a psychotherapeutic intervention. Substance P NK1 receptors appear not to be altered in never-medicated MDD patients. However, HAM-D total scores correlated positively with NK1 receptor binding in neocortical as well as limbic brain areas suggesting a modulatory role for NK1 receptors in major depression.

Our results indicate specific neurotransmitter changes in clinical depression that could also represent therapeutic targets but the specificity of these findings e.g. in relation to anxiety disorders (or comorbid conditions) needs to be explored further.

Current models for mood disorders and particularly bipolar disorder focus on increaesed activation within the limbic system coupled with reduced inhibitory control from the prefrontal cortex. This presentation will focus on functional magnetic resonance imaging studies that highlight limbic-prefrontal interactions in Mood Disorders and on the potential effect of antidepressants and mood stablisers on these neural networks.

We will present a comparison of serum antineuronal antibody profiles in children with OCD-only (n=13), PANDAS + OCD (n=20), CTD + OCD (n=23), and age-matched controls (n=29). Detection methods used to evaluate anti-brain antibodies included immunohistochemistry (striatum), ELISA (BA 9/10, BA 11, caudate, and cingulate gyrus), and Western immunoblotting (BA 9/10, BA 11, caudate, and cingulate gyrus).

Immunublotting was further used to assess the presence and concentration of putative antigens identified in post-streptococcal patients, i.e., *- and *-enolase, aldolase C, pyruvate kinase M1 and tubulin. Anti-lysoganglioside GM1 activity was measured by competitive inhibition.

New findings on serum antibodies against pyruvate kinase and lysogangliosides plus cytokine data in children with tic disorders compared to helathy control children are presented. Also blood-based gene expression data related to autoimmunity in children with tic disorders are discussed.