The Kraepelinian dichotomy posits that patients with schizophrenia (SCZ) and bipolar disorder (BD) present as two separate psychotic entities such that they differ in terms of clinical severity including neurocognitive functioning. Based on clinical impression within a tertiary psychiatric hospital context and extant data, we hypothesized that patients with SCZ had a similar level of neurcognitive impairment compared with BD. Forty-nine healthy controls (HC), 72 SCZ and 42 BD patients who were matched for age, gender, and premorbid IQ were administered the Brief Assessment of Cognition battery (BAC), the Positive and Negative Syndrome Scale for SCZ patients, the Young Mania Rating Scale (YMRS) for BD patients, and Global Assessment of Functioning (GAF) for both patients groups. Both BD and SCZ groups demonstrated similar patterns of neurocognitive deficits across several domains (verbal memory, working memory, semantic fluency, processing speed) compared with HC subjects. However, no significant difference was found in neurocognitive functioning between BD and SCZ patients, suggesting that both patient groups suffer the same degree of neurocognitive impairment. Moreover, patients with lower level of psychosocial functioning as indicated by lower GAF score (F(1,112) = 2.661, p = 0.009) and older age (F(1,112) = −2.625, p = 0.010), not diagnosis or doses of psychotropic medications, predicted were associated with poorer overall neurocognitive functioning as measured by the(lower BAC composite score). Our findings of comparable neurocognitive impairments between SCZ and BD affirm our hypothesis and support less the Kraepelinian concept of dichotomy but more of a continuum of psychotic spectrum conditions.

Abnormalities in glutamate signaling and glutamate toxicity are thought to be important in the pathophysiology of bipolar disorder (BD). Whilst previous studies have found brain white matter changes in BD, there is paucity of data about how glutamatergic genes affect brain white matter integrity in BD. Based on extant neuroimaging data, we hypothesized that GRIN2B risk allele is associated with reductions of brain white matter integrity in the frontal, parietal, temporal, occipital regions and cingulate gyrus in BD. Fourteen patients with BD and 22 age, gender, handedness matched healthy controls were genotyped using blood samples and underwent diffusion tensor imaging. Compared to G allele, brain FA values were significantly lower in BD patients with risk T allele in left frontal region (p = 0.001), right frontal region (p =0.002), left parietal region (p = 0.001), left occipital region (p = 0.001), right occipital region (p <0.001), left cingulate gyrus (p = 0.001). Further elucidation of the interactions between different glutamate genes and their relationships with such structural, functional brain substrates will enhance our understanding of the link between dysregulated glutamatergic neurotransmission and neuroimaging endophenotypes in BD.

The causes of why certain people engage in suicidal behaviors involve both environmental and genetic factors, and interactions in-between. The aim here was to study certain aspects of stress-vulnerability in SA, i.e. the association of polymorphisms in genes which e.g. regulate the neuroendocrine hypothalamic-pituitary-adrenal (HPA) axis stress-response, as well as the importance of gene-environment interactions (GxE).

We studied genetic associations in the context of parent-child inheritance, as well as gene-environment interaction (GxE) patterns considering life timing of trauma and gender, concerning polymorphisms in candidate hypothalamic-pituitary-adrenal (HPA) axis gene networks, as well as on a genome-wide scale. For GxEs, we assessed exposures to physical assault (PA, below or over age of 18) or cumulative, lifetime exposure to a panel of stressful life events (SLEs) in male and females. Studies were conducted by a family-based design (n=660 trios) in relation to the outcome of severe lifetime SA in the offspring.

We have previously shown the associations of several HPA-regulatory candidate genes. The current results aim to present an extension involving more genes and make an attempt to shift towards polygenetic associations, which may lead to a better understanding of etiology. We investigate the patterns of GxE vs non-GxE associations, with the aim to better define the genetic components of the stress diathesis model for suicidal behaviors.

Personalised approaches have a long history in the treatment of alcoholism. ‘Matching treatments to patient's heterogeneity’ was the codeword for these attempts. Large studies failed to show a matching effect, maybe because they only took behaviour and psychophathology as basis for matching. More recent studies included biological variables for stratification of patients. Genetics, neuroimaging and psychopathology showed very promising results. Examples of the PREDICT study (Mann et al., 2013) will be given.

424 patients were randomised to either placebo, naltrexone or acamprosate. Using neuroimaging we confirmed that an increase in brain activity in the ventral striatum is related to time to relapse. We also found support for our hypothesis concerning the rewarding characteristics of alcohol in a certain subgroup of patients. Here f-MRI BOLD response in the ventral striatum predicted a positive naltrexone response. Finally a psychometric test distinguished between ‘reward cravers’ and ‘relief cravers’ (Glöckner-Rist et al., 2013).The former respond significantly better to pharmacotherapy.

In conclusion the treatment of alcoholism is moving towards a personalised approach. This holds the potential for a significant increase in effect sizes of our treatment trials and thus for better treatment options for our patients.

Mood disorders, including depression and bipolar disorder, have a strong familial basis and unaffected offspring of affected individuals have a substantially increased lifetime risk of these and other psychiatric disorders. It is increasingly understood that risk is conferred through the cumulative effects of a number of common genetic variants each of low-effect size. Using data from the Psychiatric Genomics Consortium, we conducted polygenic risk profiling of cohorts of individuals with brain imaging (Bipolar Family Study) and/or cognitive data. We showed that increased polygenic risk of mood disorder is associated with functional abnormalities of ventral prefrontal limbic areas and with reduced connectivity, measured using diffusion tensor imaging (DTI). We discuss the utility of polygenic profiling for biomarker and mechanism discovery and its potential role in predicting disease-associated phenotypes and clinical illness.

Changes taking place nowadays, such as globalisation, increased mobility, population ageing, financial crisis and social networking force us to test the old views and adapt to the new realities. This consequently leads to interrogations that reflect current differences of perception created by the great velocity and intensity, followed by an unprecedented degree of interconnectivity and lowering of international barriers.

Therefore, it is worthwhile to look for actual and future migration onto the new global context by recognizing the push factors that pressure people to leave the donor country, the pull factors that make the recipient country seem attractive, while confirming patterns and duration of migration. Despite the concern for migration has moved to the forefront agendas raising questions, nevertheless, there is lack of data of migration flows, as significant highly skilled migration has been within the European Union, and additionally, there is scarcity of data in psychiatry.

For that reason, as an attempt to explore migration among psychiatry trainees, the European Federation of Psychiatry Trainees (EFPT) has been doing a survey to assess opinions and experiences of international migration. This data analysis and discussion will permit further comparisons with other groups, such as physicians in general and psychiatry consultants.

The results provided by this study bring an overview of migration among psychiatric trainees and the different challenges faced in this pathway to a psychiatry career. Migration within psychiatry will probably continue, being therefore essential to enhance support to those who migrate, and actually influence the mental health care provided internationally.

Microglia express the TSPO (TranSlocalor PrOtein) receptor formerly known as the PBR (peripheral benzodiazepine receptor). The densitiy of the TSPO is dependent on the inflammatory state of microglia. The radiopharmaceutical [11C]PK11195 binds in excess to the TSPO in activated microglia. We showed that the hippocampus of psychotic patients experienced significantly more [11C]PK11195 binding than the hippocampus of healthy controls. To elucidate the effect of antipsychotic medication on brain inflammation the herpes encephalitis rat model was chosen, because of pathophysiological similarity: Herpes simplex virus preferentially infects hippocampus. In adult rats 10E5 pfu of HSV-1 (clinical strain) was administered intranasally. After 3–5 days sickness behavior developed. At the 6th day and at the 13th day after inoculation a [11C]PK11195 PET scan was performed. Drugs were delivered by osmotic minipumps (haloperidol, clozapine, saline). Only clozapine treatment delayed sickness behavior. Clozapine treatment reduced the inflammation in the mesecephalon and immediate surrounding regions after 6 days and reduced dissemination of inflammation to brain cortex at 13 days after inoculation.

Hypersexuality can be defined as an uncontrollable sexual behaviour that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. These out-of-control sexual behaviours can be described as compulsive, impulsive, or addictive. Some authors argue that it serves to anesthetize feeling of pain, inadequacy, low self-esteem, social and personal phobias, isolation, and loneliness. Hypersexuality is conceptualized as primarily a nonparaphilic sexual desire disorder, but paraphilic sexual fantasies, arousal, urges, and behaviours can co-occur.

In the literature there is little evidence about a correlation between hypersexuality and sexual aggression. Even in a common risk assessment instrument, such as the SVR-20 (Sexual Violence Risk-20) manual, hypersexuality is not included as a risk factor for the assessment of sexual violence risk. However, the SAPROF (Structured Assessment of PROtective Factors for violence risk) manual has ‘a well developed self-control’ item as a protective factor against violence. It is obvious that people suffering from hypersexuality have developed no or poor self-control. Internalizing comorbid disorders are common in hypersexuality, but also externalizing comorbid disorders do occur.

In this paper, scientific evidence for the relationship between hypersexuality and sexual aggression will be reviewed. Next, clinical vignettes and data from a Belgian sex offender population (at the University Forensic Centre, Antwerp University Hospital) will be presented. and finally, the importance of this topic for caregivers in general and forensic psychiatry will be discussed.

Impairments of neurocognitive functioning were largely documented in patients with schizophrenia. These deficits have strong relationships with functional outcome and represent unmet needs of available treatments for schizophrenia. Studies on the efficacy of cognitive remediation (CR) targeting these dysfunctions produced encouraging results. In fact, several reviews and meta-analyses (1,2) and our own data (3) indicate that CR approaches determine improvements of cognitive functioning in patients with schizophrenia. An impact on functional outcome was reported more consistently when the CR program was combined with a psychosocial intervention, such as vocational rehabilitation or social skills training (1–4). The mechanisms underlying synergistic effects of combining CR with other interventions are not clear. At the moment, studies with an optimal design to address mechanisms of interactions between the two rehabilitation approaches are lacking. Our data on differential effects of the two programs on functional outcome suggested that programs integrating cognitive and social skills training might target a larger number of functional impairments, but should be planned carefully and individually to fully exploit the synergistic potential, while avoiding the interference of detrimental effects of one program component with the favorable impact of the other component.

Psychogeriatric patients frequently suffer from comorbidities such as dementia, depression, and somatic diseases. In addition, patients with dementia often display a heterogeneous group of symptoms, the Behavioral and Psychological Symptoms of Dementia (BPSD), for which both pharmacotherapy with several drugs and non-pharmacological treatments are recommended. They are frequently comedicated with different psychopharmacological agents including antidepressants, antipsychotics, anxiolytics, hypnotics, cognitive enhancers, and Li, antipychotics and anticonvulsants used as mood stabilizers. In addition, somatic drugs are co-prescribed for the treatment of other concomitant diseases. As a consequence, these patients, who are characterised by an increased sensitivity to adverse effects, by a lowered homeostatic reserve and by decreased compliance are nonetheless often exposed to complex drug regimes. Such patients are therefore vulnerable to pharmacokinetic and pharmacodynamic interactions with severe clinical consequences. Studies in very old patients (> 80 y) are often lacking. Therefore, treatment needs to be carefully and individually tailored. Therapeutic drug monitoring may be a useful tool to optimise treatment, as some ‘classical’ indications apply for this population: Lack of compliance, adverse effects despite the use of generally recommended doses, suspected drug interactions, combination treatment with a drug known for its interaction potential, patients with pharmacokinetically relevant comorbidities (hepatic or renal insufficiency, cardiovascular disease). The increasing knowledge on the role of cytochrome P-450 isozymes in the metabolism of drugs and their interaction potential has fortunately led to a situation, which allows, to some extent, predicting risks for adverse effects after introducing a polymedication.

The treaty of Rome aimed at the realisation of free exchange of persons, services, goods and capital all over Europe.

The need for mutual recognition of basic and specialist medical qualifications was very quickly recognised. The European Directive 93/16/EEC (1993) established the most recent legal basis for it.

Ever since its founding in 1958 the Union Européenne de Médecins Spécialistes - official name for the European Union of Medical Specialists - has been standing for high standards in postgraduate training (PGT), Continuing Medical Education and Professional Development (CME and CPD) and Quality Assurance. Only these elements will be able to provide patients witht high quality care all over Europe.

This presentation will highlight main past and future strategies of the UEMS Section of Psychiatry in view of increased migration after the major political changes in Europe during the early nineties of last century.

The EFPT (European Federation of Psychiatric Trainees) is the first and only Federation of medical trainee associations, to our knowledge.

It is composed of 38 member associations from 35 countries across Europe. With 22 years of experience it is well placed to comment on training issues and of those transversal to a large number of countries, such as mobility and its impact on healthcare.

One of EFPT's current main activities is the Exchange Programme which is trainee-led and was created in order to facilitate mobility during training. For over 10 year trainees from Europe have identified mobility as need in training, acknowledged in EFPT statements. But is was only in 2011 that the Programme was established with the objective to provide trainees with opportunities to:

1. - Promote awareness of intercultural aspects of Psychiatry

2. - Engage in clinical, and/or research, and/or teaching activities

3. - To become acquainted with different mental health systems

4. - To gain experience of different illness manifestations and treatment options

5. - To experience a different training programme

6. - To socialise with peer group, promote networking and discuss coping strategies regarding work life balance

There are 11 countries offering vacancies (Fig. 1). To date, 44 exchange placements were completed and by December it is expected there will be 61 (Fig. 2). Feedback has been overly positive.

Training is the core of excellence in healthcare. By equipping trainees with additional skills through mobility during training, we believe we are contributing to improving mental healthcare globally.

The suicide rate has been traditionally high compared to countries of the European Union. The rate increased during decades after second world war until the early 1990's. Moreover, the suicide rate has followed closely the alcohol consumption rate. A national suicide prevention project was carried out in the late 1980's, which had the intent to increase access to low-threshold services and specialized psychiatric care. Physicians and psychiatrists were educated in the recognition of depression at a time when novel antidepressants were introduced and secondary level services were deinstitutionalized.

Greenland is the largest Island in the world with a spare population. This huge island with it's spare population has a major challenge to the health care program. Although every settlement with more than 50 inhabitants, today are able to talk to a psychiatrist by using the telecommunication system it is not unimportant wheter the patient speaks to a psychiatrist with the same cultural background and who speaks the same language or the psychiatrist needs an interpreter.

The presentation will give you an insight into the importance of using Telepsychiatry in Greenland. What it means for the people, that we are now ready to reach them, although they living isolated. and what does it mean in general sense to the community.