Family and twin studies point towards a partial heritability of suicidal behavior. We investigated the role of a comprehensive set of genes in this behavior. Their selection was driven by results from post mortem and genetic studies. 250 suicide attempters with various psychiatric disorders were compared with 2200 volunteers which were randomly selected from the general population. All subjects were administered standard psychiatric interviews including SCID as well as self-report questionnaires for anger-related traits. Especially, aggressive-impulsive behavior has been studied and associations with these intermediate phenotypes will be presented.

Additionally a large-scale gene expression analysis using cDNA-microarrays to identify new candidate-genes for suicide was conducted. We found several genes to be differentially expressed in the orbitofrontal cortex of suicide completers. Cross-validation experiments using quantitative RT-PCR validated a few genes so far. These genes have been genotyped in our patients and controls and associations with suicidal behavior and intermediate phenotypes, like aggression and impulsivity will be presented.

The first challenge in diagnosing female sexual dysfunction(s) originates in our diagnostic system. The traditional model of classifying sexual dysfunction is anchored in the sexual response cycle: desire - arousal - orgasm - resolution. However, as some experts have pointed out, this classification may be problematic in the area of female sexuality. Both the diagnoses of female hypoactive sexual desire disorder (FHSDD) and female arousal disorder (FSAD) probably need to be redefined and refined. Examples include adding the lack of responsive desire to the FHSDD criteria and creating categories of subjective FSAD and genital FSAD.

The second challenge in diagnosis female dysfunction is the lack of solid diagnostic instruments, diagnosis-specific laboratory assays and other specific testing. Specific measures of female sexual functioning, such as Female Sexual Functioning Index, Profile of Female Sexual Functioning, Sexual Function Questionnaire, Sexual Desire and Interest Inventory, and Female Sexual Distress Scale were mostly developed as outcome measures. No solid diagnostic instrument for sexual dysfunction exists, not even a version of the Structured Clinical Interview for DSM sexual dysfunctions. The contribution of imaging techniques, such as ultrasonography, magnetic resonance imaging or thermography, to the diagnosis is unclear, and these techniques are far (if ever) from clinical use.

Thus, a detailed comprehensive clinical interview combined with physical examination, possibly a gynecological examination, and in some cases laboratory hormonal testing remains the cornerstone of diagnosing and assessing female sexual dysfunctions.

The diagnostic system for the sexual dysfunctions in the Diagnostic and Statistical Manual was originally developed by expert opinion, literature review and from feedback from experts in the field of human sexuality. In spite of considerable research in the area of human sexuality over the intervening years, there have been minimal changes to the diagnostic criteira for the sexual dysfunctions since their description in DSM III. These critieria sets lack precison. Progress within the field requires precise defintions to select homogenous groups for clinical research,. Current data suggests that many of the sexual dysfunction diagnoses can be updated with severity and duration criteria. This presentation will suggest revision to the diagnositc criteria based on recent clinical research.

Sexuality is the ultimate union of mind and body; sexual functioning or dysfunction depends on complex bio-psycho-social conditions.

Sexual dysfunction (SD) may be primarily due to physical disorders, including endocrinologic (diabetes, androgen deficiency, hyperprolactinemia, hypothyroidism and hyperthyroidism), cardiovascular and pelvic illnesses. SD can be secondary or indirectly related to impairments of the physical disorder such as fatigue, weakness and bladder incontinence, or to the psychosocial stress of the illness. Not only the disease itself, but the treatment prescribed, may also cause sexual impairment.

SD is prevalent among psychiatric patients and maybe related to both the psychopathology and the psychopharmacology. SD has been reported in as many as 30%-60% of patients with schizophrenia treated with antipsychotic medication, up to 78% of individuals with depression treated with antidepressants and up to 80% in patients suffering from anxiety disorder. Eating disorders and personality disorders, mainly borderline personality disorder, are also associated with SD.

Psychosocial factors, like interpersonal relationships, length of relationship, lifestyle, socioeconomic class and cultural background have been shown to correlate with SD, especially in hypoactive sexual desire disorder in women.

An evaluation of SD should take into consideration the primary sexual functioning, the physical and mental disorders, the various medications and the psychosocial factors.

It is recommended to identify the specific cause of the SD and to treat the patient according to the individual's mental disorder, physical disorder and interpersonal relationship.

Adult ADHD is a serious risk factor for co-occuring psychiatric disorders and negative psychosocial consequences. Given this background, instead of or in addition to psychopharmacological treatment there is a need for effective psychotherapeutic treatment options for adults with ADHD. Previous trials on psychotherapeutic concepts were based on cognitive behavioural and/or dialectical behavioural approaches and showed significant effects. In a pilot study, our structured skills training group program for adult ADHD led to significant symptomatic improvements (Hesslinger et al. 2007). The following study evaluated the program's effectiveness, feasibility and patient acceptability in a multicentre setting (N = 72, Philipsen et al. 2007). The therapy was well tolerated and led to significant improvements of ADHD, depressive symptoms and personal health status (p < 0.001). Patients regarded the program topics “behavioural analyses”, “mindfulness” and “emotion regulation” as the most helpful. As in our initial study, patients in the multicentre study rated the group setting as highly effective. This might be explained as result of greater peer support and the opportunity of learning from positive role models (e.g. during homework discussion). Following our staged approach, we are currently running a large randomized multicentre placebo-controlled study for the evaluation of the efficacy of this structured group program in adult ADHD that has been approved by the German Federal Ministry of Research and Education. In this study we compare the effects of purely medical management, specific psychotherapy, and the combination of both, comparable with the Multimodal Treatment Study of Children with ADHD (MTA).

Patients with health-anxiety are very often unable to describe concrete consequences of their putative somatic diseases. They block their thoughts due to anxiety attended this thoughts. The health-anxious patients try not to think about illness at all, by attempting to control their thoughts or by distraction. Our method is based on therapeutic dialogue, using Socratic questioning, and inductive methods which force patient to think beyond actual blocks.

In second step, patients are asked to think out all other possibilities of newly discovered future. They are forced to imagine the worse consequences of all dread situations. Dialogue is led through one's serious illness status, with its somatic, psychological and social consequences, and the dying experience to the moment of death, which has to be described with all related emotions and details. Further, we ask patients to fantasize and constellate possible "after death experiences". In the next session the patient brings a written conception of the redoubtable situation previously discussed. Than we work with this text as in imaginative exposure therapy.

This method seems to be quite effective and not too time-consuming. Several patients with health-anxiety underwent this exposure in our therapeutical groups. All of these patients profited from this therapy, as confirmed by follow-up data.

Participants will learn:

• • conceptualization of health anxiety with the patient;

• • Socratic questioning with the hypochondriacal patient;

• • how to apply the exposure to the imaginative death experience.

Supported by the research project No. 1M0517 from Ministry of Education, Youth and Sports, the Czech Republic.

In the revision of the International Classification of Mental Disorders (currently 10th revision, hence ICD-10), an international scientific partnership network group was founded by the World Health Organisation (Chair: N. Sartorius, Geneva) in order to review the international scientific evidence of putative significance for the revision of ICD-10 in different language areas. The group of German-speaking countries was founded during the annual congress of the German Society of Psychiatry, Psychotherapy and Nervous Diseases in 2007. The core group consists of representatives from Austria, Germany, Switzerland and representatives of other German-speaking countries.

A major task of the German-speaking group was to design and test an international survey questionnaire addressing the perceived need for changes to the classification criteria in ICD-10 for mental disorders, the scientific rationale for such proposals, and a general assessment of the foodnes of fit with which the current classification criteria represent the respective mental disorders. The survey was started in August 2008 and results will be presented in this symposium.

The results of and experiences with this questionnaire are expected to influence the questionnaires to be distributed in other language areas, allowing for regional or national differences to be reflected, but also allowing a comparison with previous editions used when ICD-10 was developed. Taken together, the questionnaire is expected to yield insights into the perceived need to adjust ICD-11 to comply with new scientific evidence, but also with practical clinical experiences with its predecessors.

In the course of the revision of the International Classification of Mental Disorders (currently 10th revision, hence ICD-10), an international scientific partnership network group was founded by the World Health Organisation (Chair: N. Sartorius, Geneva) in order to review the international scientific evidence of putative significance for the revision of ICD-10 in different language areas.

In the course of this project we reviewed several areas of activity that may be of importance for the review process to develop ICD-11. First of all, general questions arise about how a psychiatric classification system should be organized. Will it still depend on classical psychopathological information with additional information from imaging, genetic and laboratory studies, and finally the patient history? An alternative approach is based on functional psychopathology be based on functional neural modules which represent functional activities of the human brain and their disturbances in mental disorders. Another area of debate is whether dimensions rather than categories shall lay a new foundation for the classification of mental disorders. A further issue arises when considering narrative elements of psychiatric history taking. In how far can or should such factors be integrated? All these questions are interwoven with the classical German contributions to psychiatric nosology by Kraepelin and Bleuler, which will be reassessed on the background of these current topics in revising ICD-10.

Family work for psychosis has a strong evidence base demonstrating that a marked reduction in relapse rates can be achieved when information and support is offered to the family, and when relatives are helped to develop effective strategies to deal with the challenging situations they face. In some countries such as the UK, the strength of the evidence base has resulted in the development of guidelines and policies stipulating that families should receive appropriate interventions. In other countries, where such policies do not exist, whether or not families receive support tends to depend on the interests of individual clinicians.

Those attempting to implement family work in routine mental health services can encounter various obstacles. Some staff do not posses the skills to deliver family work. Some services, particularly in adult mental health, concentrate on the individual with the mental health difficulties and are not aware of the importance of the person's social network in their recovery. Some managers do not prioritise family work or facilitate their staff in having the time needed for training or for implementing this type of intervention.

This paper will outline effective strategies for ensuring that evidence-based family interventions are available to the families of those with psychosis and other serious mental health difficulties. These will include strategies to address the following:

• • Organisational issues;

• • Training of staff;

• • Supervision;

• • Role of management;

• • Involving family members to advocate for change;

• • Changing service structures to ensure the delivery of family work.

Studies aimed at implementing supportive treatments for families in clinical practice report that after a training course 7 to 27 percent of professionals apply these treatments in clinical work and a mean of 1.4 to 1.7 families per trainee receive these interventions.

We carried out a study in 23 Italian mental health centres in order to explore the feasibility of providing psychoeducational interventions for persons with schizophrenia and their families in routine conditions.

Two professionals from each center attended three monthly training sessions for psychoeducational interventions. After the training, each professional provided informative sessions on schizophrenia to five families of service users with schizophrenia, which consisted of three meetings with each family on clinical aspects of schizophrenia, drug treatments, and detection of early signs of relapse. Each professional then provided the intervention to families for six months.

Thirty-eight of the 46 participants completed the training course, and 34 provided the intervention to 71 families. Twenty-nine of the 34 provided the entire intervention to the families and five of the 34 held only informative sessions on schizophrenia. Ninety-one percent of the participants who completed the study reported difficulties in integrating the intervention with their work responsibilities, and 96 percent acknowledged the positive effect that the intervention had on the center's relationship with patients with schizophrenia and their families.

These results support the idea that it is possible to introduce psychoeducational interventions in mental health centres after a relatively brief period of training and supervision.

It is well known that due to deinstitutionalization, faster discharge from wards and insufficient community resources, direct contact of the severe mentally ill patients with their families has increased a lot in the last years.

In the last two decades, mental health services across Europe developed a diversified offer of programmes, including psychoeducation and family interventions, in order to ensure an effective response to the different care needs.

In Portugal, the lack of planning and consistent support in the improvement of mental health services means that the country is lagging behind significantly in this field in relation to other European countries.

Concerning the specific subject of psychoeducation and family interventions for psychotic patients and their families, its true that treatment in Portugal seldom comport with the best scientific evidence, but so far there has been no pressure on the services to change this oddly situation.

The new National Mental Health Plan, launched in 2008, sets that i. People with mental disorders should be involved and participate in the planning and development of the services they benefit from, and that ii. Family members of the mentally ill should be considered as important partners in care provision, and encouraged to participate in this provision and to receive the necessary training and education.

Based on these principles, the Mental Health Plan may be a critical opportunity to implement psychoeducation and family interventions in Portugal. The authors address this issue, discussing also the potential role of new models of contracting, financing, accounting and monitoring.

The adverse influence of parental psychopathology on child development has been the focus of intense research in recent years, yet we are only beginning to understand the factors that explain this intergenerational transmission. Depressive symptoms in fathers have received relatively little attention when compared to research on the impact of maternal depression on children's emotional and behavioural problems. Recent evidence suggests that paternal depressive symptoms in the postnatal period are associated with an increased risk of toddler behaviour problems, which persist in clinical significance into childhood. This research examines a model of ‘social-environmental transmission’ of paternal psychopathology. We compared patterns of parent-infant interactions among families with depressed and non-depressed fathers to address the following question: Are the early interactions of depressed fathers characterised by maladaptive affect, behaviour and cognitions? This study is part of an on-going longitudinal investigation, The Oxford Fathers Project (OFP) of families who are followed when infants are 3 months to 2 years of age. Paternal behaviours, including verbal comments and interactive behaviour were examined during free-play with their 3-month old infants. Father's behaviour was coded from Fiori-Cowley and Murray's (1996) Global Rating Scale and verbal transcripts were examined for cognitive and mentalizing statements.

Preliminary results suggest a higher proportion of infant directed negativity, in the verbal content of depressed fathers. Further analysis will be conducted and presented at the meeting. Discussion emphasises the importance of dysfunctional communication patterns in father-infant interactions that provide important clinical hypotheses as well as targets for identification and early intervention.