Access to adequate mental health care services is one of the identified problems within EU mental health services. Increased migration into and within EU cause the increased demands for clinicians with selected skills.

TeleMental Health applications could improve access to mental health care in rural, remote and under-served as well as in metropolitan areas all around EU. Telepsychiatry is the most common telemental health application. Furthermore, there are various internet based approaches to treatment of mental conditions on distance. Transcultural telepsychiatry model, developed in Denmark during last decade was aimed to treat ethnic minorities via their own mothertongue(s) by use of telepsychiatry. Patient satisfaction rapported within telepsychiatry service in Denmark is very high. The restricted physical contact and non-verbal communication of telepsychiatry compensates by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references.

Ongoing international telepsychiatry collaboration established between Sweden and Denmark is a success that may be exported to other european countries. The experiences from this pioneer international transcultural telepsychiatry service may contribute to further development an European Telepsychiatry Network. However, this model may be used as an inspiration for conducting of larger international telepsychiatry service capable to provide mental health care toward diversity of patient populations underserved on their mother tongue within EU.

ICBT in GP is a joint project between General Practice Research Unit and the Research Group of Mental E-Health at the Department of Psychology, Faculty of Health Sciences, University of Tromsø, Norway. In Norway the yearly incidence of depression is 7% and rapidly increasing. Two thirds of the patients experiences recurrence within 10 years. The yearly treatment costs of depression is 200 millions Euros. The burden on specialist health care is heavy with waiting lists of 3 to 6 months. The Norwegian Directorate of Health recommends that patients with mild to moderate depression should be treated in General Practice (GP). Self help programs should be introduced in the treatment. The aim of the present project is to develop a strategy whereby general practitioners will use the internet as a treatment option for mild to moderate depression and to measure the effect of this treatment. We will use the internet-based self help program MoodGYM. The program has five treatment and evaluation modules. MoodGYM reduces symptoms of depression, but few patients complete all modules. If patients have a consultation with their GP between each module, they may be more motivated to fulfil the program. In addition, MoodGYM provides the GP with a tool to evaluate the severity of symptoms.The presentation will focus on the economic and structural properties facilitating the use of internet in treatment of depressed patients in GP.

Prevention of mental illness and promotion of mental health are a significant component of any clinician's clinical work load. However, often this aspect is omitted from training and service delivery due to insufficient resources and the sheer volume of clinical load. Considerable evidence confirms that prevention can significantly reduce the onset of and subsequent related burdens to mental illness, and associated personal, social and economic costs. Often prevention and promotion get confused, and further mental illness and mental health are related but distinct dimensions. Acute mental illness usually prevents positive mental health or wellbeing, yet similarly someone without mental illness can have poor mental health and poor well being. Prevention of mental illness relates closely to and can result from promotion of mental health and associated resilience.

Prevention can be categorised in multiple ways and most clinicians regularly utilise secondary and tertiary prevention. Primary prevention addresses wider determinants across whole populations. Selective prevention targets groups at higher risk of developing disorder. Secondary prevention involves early detection and intervention and corresponds to indicated prevention. This lecture summarises these challenges and the impact of mental illness, and develops the case for prevention. The risk and protective factors for mental illness and various ages of onset are presented. Interventions at different life stages are also outlined. The lecture relies on the EPA Guidance on prevention of mental ill health and promotion of mental well being using the development of UK policy as structure. Future steps will be presented within European and global context.

This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality, their place in a complex psychiatric treatment strategy including psychotherapy.

The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5–7 for acute treatment and 4 for maintenance treatment. Monotherapy with one drug is often not sufficient but has to be followed by other antidepressants or by comedication/augmentation therapy approaches.

Generally antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect.

The capacity of psychiatrists to individualise and optimise treatment decisions in terms of ‘the right drug/treatment for the right patient’ is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome.

The ideal that all steps of clinical decision making can be based on evidence-based medicine is far away from reality. Clinical experience still has a great impact.

Conflict of interest (COI) is a set of circumstances that creates a risk that professional judgments or actions regarding a primary interest will be unduly influenced and compromised by a secondary interest. It might arise in clinical practice, research, and education, and might include individuals and institutions.

Primary interests include the pursuit of well-being of patients, ensuring the independence of medical education, and protecting the objectivity and integrity of medical research.

Secondary interests might involve financial interests, pursuit of recognition and professional career advancement. COI might result from the multiple roles of physicians in patient care, research, administration, provision of expert opinion and policy advice, and consultancy to commercial organizations. The purpose of the COI policy is to protect the interests of the patients, strengthen the integrity of the profession, and preserve public trust in medicine and psychiatry. The aim of the guidance is to eventually prevent these conflicts from arising rather than remediate them ex post. It is desirable to identify factors that might lead to their occurrence, offer a framework for their recognition and assessment, introduce the principles and standards of their disclosure, and provide recommendations for their transparent resolution.

Evidence-based treatment decisions depend on the accumulation of empirical data from individual studies. Individua studies use a variety of methods with variable quality, reflect random fluctuations and systematic biases, and may yield inconsistent findings. Meta-analysis offers a statistical approach to pool relevant studies together, which can reduce the effect of random error and bias, and produce more reliable effect estimates than individual studies. Despite the important contributions that this method provided for evidence-based medicine, it has been criticised as “statistical alchemy for the 21st century” and described as “new bete noir” which should be “stiffled at birth”. Some of this controversy has been driven by poor practice: the arbitrary pooling of dissimilar studies with unrelated outcomes, the application of statistical technique without sufficient expertise, and with insufficient attention to the clinical context. However, controversy also arises from methodological limitations of the meta-analytic approach, which need to be critically examined in order to evaluate the findings. In this presentation, we examine the limitations of meta-analyses both in terms of current procedures (e.g., biased selection, lack of prospective planning, increased likelihood of chance findings due to multiple testing) and methodological shortcomings (e.g., limited ability to handle multivariate outcomes or to incorporate covariates in the meta-analytic model simultaneously at the level of the study, treatment arm and the individual). By bringing together the weaknesses in a systematic way, it is hoped to foster a more reliable and critical appraisal of the empirical evidence both by researchers and clinicians, which will improve treatment decisions.

The ELAN study is a prospective multi centre observational trial on the effectiveness and safety of long-term antipsychotic treatment of people with schizophrenia or schizoaffective disorders with quetiapine in comparison to olanzapine and risperidone under real world treatment conditions.

374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine or risperidone were included at discharge from inpatient treatment. Psychotropic regimen, psychopathological symptoms, general and cognitive functioning, negative side-effects and quality of life were assessed before discharge and at 6, 12, 18 and 24 month follow-up assessments. Intention-to-treat analyses and crossover analyses were conducted by mixed-effects regression models including random linear time effects and time x treatment effects, controlling for baseline differences and additional psychotropic medication and using propensity scores to control for selection bias.

As indicated by significant linear time effects the patients improved with regard to psychopathological symptoms, general functioning, subjective quality of life and cognitive processing speed. No change of extrapyramidal motor side-effects, body mass index or waist circumference was obtained. The lack of any significant time x treatment interaction effects indicated no differences in the safety or effectiveness between the three antipsychotics. Nevertheless, the average hospital admission rate of patients receiving olanzapine was lower in comparison to patients receiving quetiapine or risperidone.

Outcome measurement tools were almost exclusively used, so far, in research studies, while in routine clinical practice gross descriptive evaluation was generally provided. Discrepancies among studies and among stakeholders as to the effectiveness of one or the other treatment, study designs based on strict inclusion and exclusion criteria unlikely to generalize to clinical practice, the choice of outcome measures not always clinically meaningful, difficulties in the interpretation of clinical trials results and the relatively short trial duration have contributed to clinicians’ skeptical attitude toward clinical trials findings. Researchers designing future clinical trials are confronted with the need of providing clinically meaningful outcome measures, without undermining the statistical power of the study. However, integrative measures, such as "time to discontinuation for any reason", thought to convey information about efficacy, tolerability and safety, can be influenced by several nonspecific variables likely to vary from site to site and from doctor to doctor. Simple and global measurements, such as CGI-SCH, while preferred by many clinicians, might not capture the non unitary nature of the schizophrenia outcome constructs. Remission criteria are still limited to symptoms and clinicians would certainly like to see criteria for functional remission implemented as well. Clinical trials based on simple designs and on more comprehensive outcome measures will probably contribute to reduce the gap between research findings and clinical practice.

Bulimia nervosa (BN) is a highly disabling disorder with severe health consequences. In a stepped care approach the NICE (National Institute of Clinical Excellence) guidelines recommend the application of guided self-help as a first step in the treatment of bulimia nervosa before continuing with face-to-face psychotherapy. Most of the self-help supports - available as books, CD-Rom or on an Internet surface - are based on cognitive behavioural concepts and have been proven to be effective. In this workshop we will present advantages of this treatment approach and provide you with a survey of research work implementing new technologies in the treatment of BN. We will give you an insight into the treatment modules involved in SALUT - BN developed by Netunion in cooperation with the University of Geneva and present the latest results and longterm outcome of a RCT comparing Internet-based Self program for BN with bibliotherapy.

Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohen's d = 1.47) and for secondary outcome measures (d = 1.16). No substantial and significant between-groups effects were found on any of the measures (Cohen's d = .00−.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as sessions or exercises completed.

Despite considerable advances in the evidence-based treatments, the long-term management of depressive disorders remains a challenge. Many depressive disorders follow a chronic or recurrent course. Substantial proportions of patients end treatment, especially those with residual symptoms, leave treatment with considerable risk for relapses and/or persistent psychosocial impairment. Long-term strategies are needed that can effectively help patients minimize the negative consequences of their illness without imposing a too much of an extra burden. We present the protocol of a multi-center RCT on the efficacy of an Internet based disease management strategy for the specific health conditions in recurrent depression. 234 patients who are treated for their minimum third episode of a major depression (MD) in one of the six participating centers will participate post-treatment in one of two internet delivered interventions or usual care alone. The interventions continue over 12 months and consist of supportive monitoring, an online forum for peer support, and individual crisis management either with or without personal clinical support. Primary outcome of the trial is the ratio of “well” to “unwell weeks” over a 24-month observation period after index treatment assessed with the Longitudinal Interval Follow-Up Evaluation. We would like to discuss the new options that information and communication technology offers for long-term disease management strategies for patients with recurrent depression and invite for a discussion about strategies for other chronic mental disorders.

While the efficacy of family psychoeducational interventions in the treatment of schizophrenia is now well documented, few data are available on its efficacy in major depression. This study aimed to verify the effectiveness of a family psychoeducational intervention according to the Falloon model on patients’ clinical status, social functioning and lifestyle and on relatives’ burden and social network.

The study was coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 7 Italian mental health centres. In each centre, 8 patients with major depression and their relatives were recruited if they fulfilled the following criteria: a) diagnosis of unipolar major depression according to the DSM-IV; b) aged between 18 and 65 years; c) in charge to the local mental health centre for at least 6 months; d) at least one depressive episode in the last two years; e) living with at least one relative aged between 18 and 70 years.

Recruited families have been randomly allocated to the experimental group, which received the psychoducational intervention for 6 months, or to the control group, which received the treatment as usual plus an informative brief intervention.

22 families have been treated with the experimental intervention and 22 with the control one. At the end of the intervention, patients’ clinical status and life-style significantly improved in the treated group, as well as family objective burden and social contacts.

Family psychoeducational intervention are useful in reducing personal and family difficulties caused by depression and in improving patients’ lifestyles.