A diagnosis of cancer is one of the most distressing events in life. It changes the course of everyday life and causes an existential crisis. This makes some clinicians think that depression is a normal reaction to a diagnosis of cancer. However, the body of evidence suggests that not all people diagnosed with cancer develop depression, but patients with cancer have an increased rate of depression. This presentation will try to combine the latest data on depression and cancer, including the mechanisms underlying depression in these patients and the impact of psychiatric diagnosis on the outcome of cancer. We will then focus on the implications of these data on the diagnosis and management of depression in the clinical setting.

Depression and dementia are two very common clinical entities in the elderly population. Differential diagnosis of these disorders may pose difficulties. On the other hand, when they are comorbid, depression and dementia may affect the outcome of each other. When adequate treatment for depression is provided, patients with dementia may experience a significant improvement in cognitive functioning. Therefore, the possibility of comorbid depression and dementia should always be taken into account in the elderly population. This presentation will address the common clinical obstacles encountered while managing these disorders. Using the latest scientific data, the adequate treatment of depression and dementia will be discussed.

The UK National Institue of Clinical Excellence development group performed a systematic review to determine the efficacy of pharmacological and non-pharmacological treatments for depression in people with depression and chronic physical health problems. The primary outcome of interest was depression.61 studies of antidepressants met our inclusion criteria. Of non-pharmacological RCTs 33 met our inclusion criteria and 21 were meta-analysed. Antidepressants appear to be effective and reasonably well-tolerated in the treatment of depression occurring in the context of chronic physical illness. No particular drug or drug group is preferred, although SSRIs may be better tolerated than TCAs and have a clear benefit on quality of life. Despite clinical concerns over adverse effects and drug interactions, antidepressants should not be withheld in the treatment of depression associated with chronic physical illness. For non-pharmacological treatments, the largest and strongest evidence base supports individual- and group-based cognitive and behavioural interventions (18 trials). The evidence was strongest for those interventions aimed at reducing depression in comparison to those aimed at reducing psychosocial stress. There is also some support for peer (self-help) support and guided self-help interventions based on cognitive and behavioural principles. Overall, the efficacy of pharmacological and non-pharmacological interventions for people with depression and chronic physical health problems is comparable to their efficacy in people with depression without chronic physical health problems. They should be used more widely.

ENBREC (European Network of Bipolar Research Expert Centres) is a disease-oriented network designed to set up a EU-wide network of expert centres, specialized in research and care in bipolar disorders. The European added value is to share expertise in the different fields of research and to have access to large cohorts of patient. It is an FP7 project whith 6 countries involved.

ENBREC will provide an EU-integrated facility for research on epidemiology, diagnosis, treatment and on the mechanisms of bipolar disorders.

A preliminary step was to develop a computerized medical file to collect in a same manner a minimum set of clinical data to perform observational studies. We also include a common cognitive battery. Patients will be re-assessed every 6 months. This systematic assessment is the minimum required to be involved as an expert centre of the network. In parallel, we will collect DNA samples to perform genetic studies on well-characterized patients. Moreover, data from scanners performed for diagnostic purpose will be pooled to provide a large sample of structural brain pictures.

Other modules are proposed in the framework of the expert centres for observational studies with a high frequency of assessment to be able to capture more detailed description in psychopathological variables and in treatment response.

This cohort will allow selecting and recruiting patients for interventional studies or in specific programmes of research. Large cohorts of well-characterized patients are needed to improve the knowledge of this heterogeneous disease and to translate research outcomes into health improvements.

The overall aim of the Imaging work package in ENBREC is to develop a common magnetic resonance imaging (MRI) protocol which allows pooling of data acquired from different MRI scanners, that can be used in multi-site studies of bipolar disorders.

Structural MRI studies usually provide global estimates of gray or white matter volume changes, or a small number of regions of interest (ROIs). Recent advances in structural imaging now allow for a more comprehensive evaluation of brain changes by providing continuous maps of cortical thickness and surface area, subcortical volumes, and measures of white matter microstructure throughout the brain. Such high-resolution structural MRI for morphometric analyses is now being used for automatic quantification of brain structures. There are recent reports of cortical abnormalities in bipolar disorder, which will be reviewed.

White matter can now be quantified using diffusion tensor imaging (DTI). This MRI variant for quantifying the integrity of white matter structure throughout the brain measures water diffusion and its directionality. The degree of anisotropy of overall motion in a voxel is expressed as an index of the directionality of diffusion (fractional anisotropy; FA). Lower FA values are thought to reflect factors such as demyelination and axonal injury, and has been used to show white matter abnormalities in bipolar disorder.

A suggestion for protocol for multi-site brain imaging study in bipolar disorder will be presented.

Bipolar disorder is for most patients a life-long illness, associated with a recurrent, chronic course, and functional disability. Primary treatment goals are to stabilize the patient and prevent recurrence of episodes and suicide.

Although bipolar disorder has traditionally been regarded as an illness with good prognosis and most patients returning to normal functioning when a mood episode is over, several longitudinal studies suggest that the long-term outcome is less favorable than previously thought. Combinations of drugs are frequently used in clinical practice for mood stabilization, especially for those who have not responded to monotherapy. Although combination treatments are commonly administered, full interepisode recovery is not achieved in all patients, and as a consequence, bipolar disorder is one of the leading causes of disability.

Among clinicians and in international guidelines, lithium is widely considered as the ‘gold standard’ for long-term treatment. The choice of treatments is undergoing considerable change as new treatments are available, anticonvulsants and atypical antipsychotics are taking a more prominent position. However, the evidence available for the newer treatment options including the various combination treatments varies greatly.

The episodic nature of bipolar disorder requires prophylactic long-term treatment. Many previous worthwhile treatment effects of available mood stabilizing agents and psychotherapeutic interventions on major outcomes in bipolar disorder are only of moderate size and therefore require large-scale studies. Such trials to investigate longer-term outcomes are logistically challenging and expensive, and therefore only feasible within a multisite and multinational approach based on a common documentation system of the illness course.

Selective serotonin reuptake inhibitors (SSRI) are blocking the serotonin transporter and decreasing the re-uptake of serotonin from extracellular space into the neuron. This mechanism increases time-dependently the serotonin level in the extracellular space, e.g. in the synaptic cleft. However, several adaptive processes including receptor subtypes and transporter down- and up-regulation, desensitization of autoreceptors in the raphe nuclei, increase of neurotrophic factors as the BDNF, etc. have been attributed to the therapeutic response. Increase of serotonin in the extracellular space is an inssuficient explanation of treatment effects according to the latency in the therapeutic response and the in- and decrease in gene expression of several hundreds of genes during SSRI treatment. Network models with the involvement of several core players in this neuroplastic process are necessary. The main focus will be within the serotonergic system using promising neuroimaging methods as molecular neuroimaging with PET and functional magnetic resonance imaging.

Theoretically, high throughput technologies that have become available in molecular biology and are continuously refined to generate even more reliable datasets permit more and more insights into ongoing dynamic events that may result in improvements of biological systems or the development of diseases. The more comprehensive datasets are the more they reflect the status of a molecular system. If they are obtained at various time points, they encompass its development. In practice, however, their biological interpretation remains a challenge. Presently, we do not have the tools required to decode the full biological message encrypted in e.g. expression profiling, genome-wide DNA-methylation patterns or in the so-called “histone code”. Consequently, strategies are aimed at picking molecular subnetworks that we are familiar with from previous work. Alternatively, unbiased approaches use as many data as possible for insertion into mathematical programs to perform time-dependent computer simulations of increasingly larger networks. Although this strategy appears to be straightforward and very attractive, its mandatory extension to large molecular networks presently reveals a lack of efficient mathematical tools and computational power. Advantages and shortcomings of available algorithms will be discussed.

Psychiatric illnesses remain of unclear etiopathogenesis and a variety of them can coexist, partly mimicking each other while contributing to and distorting symptomatic expressions. To understand the processes involved, it is necessary to unravel signalling pathways, complex interaction networks and metabolic alterations involving a plethora of anatomical components. Hence, whatever the nature of the alterations convincingly detected, these must be associated with their most-likely cellular contexts to then have a chance to reverse engineer the events that could have given rise to the observed alterations and predict their most plausible functional consequences. This requires the utilisation of analytical approaches collectively known as “Systems Biology”.

Systems biology explores how parts of biological entities function and interact to give rise to the behaviour of the system as a whole. But having said that, what can we actually do?

Two broad approaches to systems biology currently exist: the frequently followed mathematical (Bayesian) procedures and the more rarely encountered heuristic approaches.

Heuristic modelling plays the role of an architect (defines the nature, the structure, the functionalities and the contextual constrains of a process) while mathematical modelling plays the role of an engineer (reveals the dynamics and robustness of this process while defining the set of parameters sufficient to give rise to similar or very different phenotypes).

This talk will explain, through concrete examples, the approaches whereby one can harness heuristic frameworks to produce multi-level models of complex neurobiological processes that can then be independently tested and biologically validated or refuted.

Mesoscopic brain dynamics, typically studied with electro- and magnetoencephalography (EEG and MEG), display a rich complexity of oscillatory and chaotic-like states, including many different frequencies, amplitudes and phases. Presumably, these different dynamical states correspond to different mental states and functions, and studying transitions between such states could provide valuable insights into brain-mind relations that should also be of clinical interest. We use computational methods to investigate these transitions, with the objective of finding relations between structure, dynamics, and function. In particular, we have developed models of paleo- and neocortical structures, in order to study their mesoscopic neurodynamics, as a link between the microscopic neuronal and macroscopic mental events and processes. I will describe several types of models that emphasize network connectivity and structure, but which also include molecular and cellular properties at varying detail, depending on the particular problem and experimental data available. We use these models to study how phase transitions can be induced in the mesoscopic neurodynamics of cortical networks by internal (natural) and external (artificial) factors. I will discuss the models, and relate the simulation results to macroscopic phenomena, such as arousal, attention, anaesthesia, learning, and certain mental disorders.

With increasing globalisation it is inevitable that along with goods, people will move too. Certain psychiatric disorders are more common among some groups of migrants. It is inevitable that there may be a degree of mismatch between the cultural values and beliefs of patients in comparison with their psychiatrists. Every individual has certain cultural values and it is vital that mental health professionals are not only aware of these values but are also conscious of their own values, prejudices and both strengths and cultural weaknesses. Cultural competence is at the core of good clinical practice. Skills and knowledge about other cultures can be learnt and clinicians also need to be aware of potential sources of conflict and sources from where they can gather information and then utilise it appropriately.

A dynamic view of culture defines it as the semiotic system that people use to interpret their inner and outer worlds and that shapes their responses to it.

Culture is more than the fixed patterns of behaviour acquired and transmitted through symbols and related to a particular cultural group.

Cross cultural psychiatry makes use of both universalistic and relativistic concepts.

It is important to make use of these concepts as clinician in the diagnostic and therapeutic process with patients.

Attention will be paid to the concept of idioms of distress, how does the patient elaborate his suffering?

Clearly elucidation of the idioms of distress is essential in formulating an accurate diagnosis.

Another factor as emphasised in the Cultural Formulation which is highly relevant to this subject is the therapist patient relationship. Transference and countertransference issues related to the necessity of reconciling the meaning of verbal and nonverbal expressions of the patient along with contextual information about the patient and his environment with diagnostic critieria are relevant here.

Some research particularly related to how symptoms are expressed and carried out in the department in Rotterdam will be discussed in this workshop.

About 15% of all Moroccans live abroad (4 and a half million), mostly in Europe and North America. For historic reasons, migration of Moroccans went essentially to France, Belgium, Holland, and more recently to Spain. Many of these migrants are well integrated, but many others do suffer from social bad integration. Those with mental disorders are probably those who are most at risk of non-integration.

Mental health workers are not always aware of the cultural background of the Moroccan migrant, including family structure and interactions, religious and traditional beliefs. In France and Holland, and recently in Spain, a few teams are highly interested in transcultural psychiatry and provide care to the migrants and teaching to other mental health professionals. Their number and resources are however far from being sufficient to cover all the field in the entire country. One of the solutions is to develop a teaching program for post-graduates in psychiatry on "Cultural sensitivity" in all departments of psychiatry. A collaboration between mental health workers from the North and the South of the Mediterranean Sea is highly desirable in this respect. This is why the Euro-Med Network on Migration and Mental Health was created in 2007.