Accumulating evidence supports the view that deregulation of the immune system represents an important vulnerability factor for mood disorders and that this may be a common pathophysiological mechanism that underlies the development and progression of these disorders, at least in a subset of patients. Furthermore, mood disorders are also often accompanied by chronic medical conditions related to immune dysfunction such as autoimmune diseases, diabetes and atherosclerosis. The reviewed data suggest that if immune biomarkers exist for such immune abnormality they may be found in raised macrophage/monocyte inflammatory activation patterns (monocytosis, high inflammatory gene expression, raised GRβ/GRα ratio, and high levels of pro- and anti-inflammatory monocyte/macrophage derived cytokines in serum/plasma). This activation of the inflammatory response system may be suggestive for microglia activation as these cells are the macrophages of the brain, although evidence from human studies is still lacking. However, animal models of mood disorders suggest that such monocyte/microglia activation could be seen as the result of a combination of genetic predisposition and environmental factors. It has been proposed that the abnormal immune activation state of these cells is reached after an aberrant development/maturation from precursors. In the case of microglia, this in turn may lead to impaired neuronal development. This developmental/maturation abnormality may render the cells more vulnerable to subsequent stressors such as inflammatory stimuli thereby leading to increased incidence of mood disorders.

The evolution of the Romanian Health System during the last twenty years was marked by the transition from an overly centralized system to a social, self-financing system, facing many economic and administrative problems. Between the congestion of issues that plagued the new system, and the authorities’ slow response to these issues, a bottleneck has been produced, which is currently preventing the health system from providing appropriate services to any of its affiliates.

The current crisis arose as a result of perpetuating a reactive instead of a proactive attitude toward the challenges of the health reform -- meaning that all problems were only acknowledged and considered after they had occurred, instead of being anticipated and planned for in advance. At the time that the reform was being implemented, profound changes were also occurring in Romania in domains other than health (such as government, education etc.), and it was not taken into consideration how these systems would interfere with each other. Problems quickly surfaced due to the state of general transition and the insufficiently planned division of resources among many, often unstable, networks. When faced with this, the decision-makers traded planning and analysis for post-hoc responding to the incoming problems, an attitude which over time has led to a loss of perspective, and a distorted view of the current needs and functions of the health system.

Starting with the year 1999, the health reform process has led to the rapid development of medical services in both public and private sectors. The general public became increasingly informed with regard to their options and available technologies, the demand for health services increased and the supply diversified. In the context of these rapid legislative, economic and social changes, absent a solid strategy to control and stabilize the swift development, the typical difficulties associated with the start of any reform slowly spiraled out of control, becoming harder and harder to contain.

The quick pace at which the health system developed modified the profile of the main players: health professionals were able to perform better, but at the same time bureaucracy and restrictions increased. Patients received better care and subsequently demanded more services, but at the same time the financiers became less able to accurately predict the medical services needed, and the cost of these services became harder to control. A general state of dissatisfaction emerged as a consequence, which the current institutional health system is not prepared to handle.

The proposed reform, if properly implemented, creates exciting opportunities: it promotes public-private partnerships in Romania, provides a better framework to inform the population about available medical services and health insurance options, and increases the involvement of the community in broad interest health issues. However, with the global economic crisis and escalating costs, the lack of vision and consistency on the part of the decision-makers and the lack of confidence on the part of the population when it comes to reform processes could pose a threat to the success of the new health law. To avoid that, it is necessary to have a clear understanding of the current structure and needs of the health system, and tailor the measures of the reform to fit and fulfill these needs.

It requires the development of coherent health strategy, aimed to create concrete and feasible objectives and to ensure protection against both threatening diseases and financial risks. Any desirable implementation strategy that would exploit the strengths and guard against the weaknesses of the proposed law should include measures such as standardizing the health system to the highest possible extent, resizing and reconfiguring it based on integrated health care services, and stimulating private health insurance as a complementary alternative for financing health services.

Cognitive impairments have a high prevalence in schizophrenia, and are important determinants of functional outcome and treatment responsiveness. They are well-documented in chronic schizophrenia patients but are already apparent before the onset of the disorder and are predictive of transition to psychosis. Cognitive Remediation approaches have proved to be effective in enhancing cognitive functions and functional outcome in multi-episode schizophrenia patients. Recent studies suggest that younger people with an early course of illness are even more likely to benefit from these interventions. Therefore, Cognitive Remediation approaches may be especially appropriate for early intervention in psychosis. However, there is still a paucity of studies that evaluated Cognitive Remediation in early psychosis patients and in those symptomatically at-risk for psychosis. Moreover, several approaches are summarized under the umbrella term Cognitive Remediation. Consequently, they differ in content, setting, and practical application. Therefore, it remains rather unclear which type of therapy works best for the specific treatment needs of these patients. Against this background, this presentation will summarize and critically discuss current CRT approaches and their efficacy in early psychosis and in at-risk mental states with regard to cognitions, symptom levels, and functional outcome. Furthermore, we will present novel treatments and study designs specifically developed for early intervention in psychosis.

In his presentation, Bert Johnson, president of EUFAMI, will speak about the needs and rights of people directly by mental illness from the perspective of the family. He will discuss, amongst a number of issues, the optimal balance between the promotion of the rights of the individual to full citizenship and the issue of social protection. Bert will highlight what he sees as some of the implications for those who are affected by mental illness when their individual citizenship rights are curtailed or taken away. Also, he will enunciate EUFAMI strong held view that the rights of any individual as set out in the UN Charter must always remain sacred and that legislation, at both national, European and international level must always have this as their core principle. Bert will also speak about some of the work EUFAMI and its members are undertaking which is related to the subject matter.

The excess of psychosis among migrants and ethnic minorities is a well defined phenomenon in North Europe, while it should be still demonstrated in south Europe. Because of the variation in prevalence and distribution of risk factors in different national contexts, similar studies in different countries are needed to test the hypotheses and to ensure the generalizability of the findings. Moreover, available studies have been mostly focused on risk factors of psychosis during the post migration phase (such as ethnic fragmentation, unemployment, etc) and among well established ethnic minorities (second and further generations of migrants). In Italy, first generation migrants are still the larger component of the ethnic minorities’ populations and we can evaluate risk factors of psychosis related to the migration history as whole considered (pre-migration, migration and post migration phases). I will present results on risk factors of psychosis among first generations migrants in the three sites involved in the EU-GEI Project in Italy (Bologna, Palermo and Verona) (European Network of National Schizophrenia Networks Studying Gene Environment Interactions Project EU-GEI European Community's Seventh Framework Program, grant agreement No. HEALTH-F2-2009-241909). Particularly, I will discuss our efforts to understand the role of the migration process characteristics in the development of psychosis.

Although CBT stresses the importance of cognitions in activating or maintaining negative affects, there has been increasing emphasis on considering the role of emotional processing. Many patients believe that one should be rational and logical all the time, never have conflicting feelings, and should ruminate in order to figure things out. Meaningful cognitive and simultaneously experiential technique for working with deep emotional schemas, formatted in childhood, is writing therapeutic letters. Inclusions of emotion regulation skills in the treatment especially for patients with personality disorder enhance the efficacy of CBT.

We used therapeutic letters to help the patient identify difficult feelings and process firstly outside of therapy session and working with them repeatedly with the therapist. Typical therapeutic letters are address to important close persons from the patient life, like parents, siblings, a partner and friends, children. The patient uses the letter to impress his/her feeling and needs, inclusive defenses of his rights in past and present.

Patient writes a letter at home, and he brings it then into the session and reads it to the therapist. These letters are not intended to be sent to that important person, but to process strong emotions inside the patient. In fact the patient writes a letter to his inner representation of an important person, who was connected with the development of the maladaptive schemas. The letter-writing process is inherently collaborative and enables the patient to work at his or her own pace while also facilitating patient empowerment.

Transference and counter transference could be significant sources of insight about the patient's, therapist's and supervisor's inner worlds. Transference phenomena are viewed as a reenactment in the treatment relationship of key elements of previous significant relationships. Counter transference occurs in CBT when the relationship with the patient activates automatic thoughts and schemas in the clinician, and these cognitions have the potential for influencing the therapy process. Counter transference also occurs during supervision and is an indispensable part of the supervisor's response to the supervisee. Schema therapy shares the view that schemas are crucial to understanding of personality disorders, but also can help to understand the emotional reaction of therapist. A mode is the set of schema operations that are in one moment functioning for a person. It is a circumscribed complex pattern of emotional, cognitive a behavioral experiences, which operate in typical situations. When therapist suspects that counter transference may be developing, he/she could try to identify her/his automatic thoughts and schemas. More comprehensive approach is to quickly identify in which mode him/her are at that moment and reflect it such reaction is for the patient benefit or not. Understanding therapist counter transference reactions and theirs management are a significant point of supervision. Self reflection and realizing the counter transference can therapist help to overcome it and may be necessary for overcoming stagnation in therapy. Understanding own mode and their flipping into the therapeutic session is an important tool in psychotherapy and supervision.

Through treatment of BPD is complicated, many CBT therapist can learn schema therapy (ST) principles and strategies to used them as an additional tool. ST began as an extension of Beck's cognitive therapy model and has grown to become a unique integrative treatment for the personality disorders. A schema is a extremely stable, constant negative pattern which develops during childhood and is elaborated during person's life. There are two main schema operations: healing of schema and schema maintenance. ST devotes considerable attention to modes, the predominant emotions, schemas, or coping reactions working for an individual at a particular time. The aim of the therapy is to engage in schema healing processes, which are intended to reduce the early maladaptive schemas and coping styles, and build up the person's healthy side. The history of the schemas, modes and coping strategies are systematically discussed, their origin are explored, they are linked to current problems, and the opportunity of modifying is explored. In treatment phase, the therapist flexibly uses cognitive, emotional/experiential, behavioral, and relational/interpersonal strategies to change schemas and change maladaptive coping styles with healthier forms of behavior. Schema therapists use the relationship itself quite extensively, in two main ways. First, it is a area in which behaviors modes, and schemas can be observed, assessed, and modified. Second, the relationship is used as a ‘corrective emotional experience’. Through what schema therapy terms ‘limited reparenting,’ the therapist acts in ways that supply as an cure to early unmet needs.

Childhood trauma may be accompanied by biological changes that are caused by the stressful events. Once the events take place, amount of inner changes happen in the child. Thought suppression, developmental regressions, deliberate avoidance, sleep problems, exaggerated startle responses, fears of the mundane, irritability, and hypervigilance are prominent among these. Terr (1991) describes four characteristics related to childhood traumas that appeal to last for long periods of life. These are visualized memories of the traumatic event, trauma-specific fears, repetitive behavioral patterns, and changed attitudes about others, life, and the future. The intend of therapist during imagery rescripting is to improve the patient memorizing the traumatic events and expressing affective experience and then help him/her to rescript experience to less painful. Therapist helps the patient to understand, how symptoms connected with the events from childhood and how they are interconnected with actual problems in life (Smucker & Neiderdee 1995). Therapeutic process can be divided into of several steps (Prasko et al 2012c, Vyskocilova & Prasko 2012b):

1. (a) formation of the therapeutic atmospheres (with feelings of security and control, acceptance, approbation, validation of any emotions);

2. (b) description of the painful memories;

3. (c) formulating the needs of the child in this situation;

4. (d) discussing ‘safety person’, who could help the child;

5. (e) imagination the event rescripted with the experience of better resolution in imagination – rescripting the story;

6. (f) general calm down.

Imagery with rescripting techniques that focus on changing unpleasant memories have also been used as main components of schema therapy programs.

Implementing a new system like telemedicine into the clinical care process is not an easy task to do. In this context it is important to know what the patients’ attitude is on systems that directly affects their treatment. In this presentation implementation of a new system is made visible with a case history in a large mental health institute. Operations management can help overcome the challenges during implementation and a tool in this field can make the effects visible and acceptable. Also the attitude of patients towards new systems like telemedicine will be discussed. If patients are not willing to participate during their treatment the effectiveness of telemedicine is less. A solid foundation starts with knowledge of their attitudes and the factors that play a role in the implementation. In this presentation a study will be presented on the attitude of patients concerning new systems.

Metabolic syndrome (MS) and prehypertension (PH), are associated with an increased risk of developing a vascular disorders and dementia. We examined the associations of cognitive disorders (CD) with body mass index, the components of the lipid spectrum, arterial hypertension and glucose level (GL) in middle age subjects.