Autism spectrum disorders (ASD) and schizophrenia were separated into different diagnostic categories in the late 1970's (DSM-III) having previously been considered as related diagnostic entities. Since then, several lines of evidence have indicated that these disorders show clinical and cognitive overlaps as well as some common neurobiological characteristics. Furthermore, there is a group of patients presenting with ASD and psychotic experiences who pose particular diagnostic and management challenges and may represent a subgroup of ASD more closely linked to psychosis. Evidence from a study of the first empirically derived classification of children with ASD in relation to psychosis based on three underlying symptom dimensions, anxiety, social deficits and thought disorder, will be presented. Further phenomenological, genetic and neuroimaging research on the clinical boundaries and overlapping pathophysiology of ASD and psychosis may help better define their relationship and lead to more effective interventions. Understanding this relationship will also provide a framework of working with patients with mixed clinical presentations.

Autism Spectrum Disorders (ASD) is a group of neurodevelopmental disorders with heterogeneous etiology characterized by deficits in social cognition, communication, and behavioral flexibility. Disturbances on molecular and cellular level in early brain development incl. intercellular communication, an unbalanced ratio between certain neuronal populations and maturation/differentiation process, oxidative stress, happening in embryonal stages, might be promising candidates to explain the development of autistic symptoms.

In order to get a deeper understanding of these processes, valid “disease models” are pivotal. A new cutting edge technique, named brain organoids, has been highlighted as a promising candidate for obtaining a better “disease model”.

Brain organoids derived from patients induced pluripotent stem cells (iPSC) follow in vivo timeline development; they also have the ability to recreate the right complexity of the brains, developmental stages. On the cellular and gene expression level, organoids demonstrate a high similarity to the developing brain in vivo and can therefore recapitulate early stages of the neurogenesis. To date organoids are the most relevant cellular in vitro platform for the understanding of the mechanisms behind ADS pathology. Investigations of “mini brains” at different time points in their development will give a wider and more detailed picture of the disease dynamic and thus the development of therapeutic and prevention strategies. It is a tool that can be used for effective high throughput screening of chemical compounds as potential drugs (“in sphero” drug testing). Organoids are a good modeling system for elucidating the role of epigenetic and environmental factors for development of ASD.

Structural and functional brain alterations as well as cognitive deficits are well-documented findings in schizophrenia patients. Cognitive impairments affect the long-term outcome of schizophrenia and are the main contributors to disability. Despite their clinical impact, however, no effective options are available to treat them sufficiently. Aerobic endurance training has been shown to have effects on brain plasticity, gray and white matter volume as well as functional connectivity measures and on cognitive functioning in animal models and healthy humans. However, effects of physical exercise in combination in combination with cognitive remediation are unknown in Schizophrenia. 21 chronic schizophrenia patients and 21 age and gender–matched healthy controls underwent 3 months of aerobic exercise (endurance training, 30 min, 3 times per week). 21 additionally recruited schizophrenia patients played table soccer (known as “foosball” in the USA) over the same period. After 6 weeks of endurance training or table soccer, all participants commenced standardized cognitive training with a computer-assisted training program. We could show that a 3-month endurance-training program combined with CR therapy had positive effects on everyday functioning in multi-episode Schizophrenia patients. Deficits improved from medium to mild as assessed with the GAF. Negative symptoms, short and long-term verbal memory and cognitive flexibility also improved with training. We could demonstrate grey matter volume increase in the left temporal lobe in schizophrenia patients undergoing endurance training. A non-endurance and coordinative training stimulus like playing table soccer led to a clearly distinct pattern of grey matter alterations in Schizophrenia patients.

Cognitive Remediation Therapy (CRT) deals with the cognitive impairment, which is one of the most disabling symptoms of schizophrenia. Unfortunately, the understanding of its neurobiological correlates is far from complete. Neuroimaging studies have shown that CRT is able to induce neurobiological changes although the results have not always been enough replicated. The most commonly reported changes were those that involved the prefrontal and thalamic regions. Additionally, structural changes were described in both the grey and white matter, suggesting a neuroprotective effect of cognitive remediation. Neuroimaging studies of cognitive remediation in patients with schizophrenia suggest a positive effect on brain functioning in terms of the functional reorganisation of neural networks. From a different perspective, some changes in serum levels of Brain derived neurotrophic factor (BDNF) have been described. However, our replication of this trial has not been able to find any significant differences. So, nowadays the status of BDNF as a biomarker of cognitive recovery is possibly premature. One possible explanation can be the role of genetics and their different polymorphisms. COMT and BDNF polymorphisms could be accounting for the different outcomes of CRT. Moreover, some studies suggested a role of genes affecting dopamine modulation on outcomes of cognitive remediation.

Cognitive remediation (CR) has proved to be effective in improving cognition, symptoms and psychosocial functioning in schizophrenia and other psychoses, but its impact on the use of psychiatric services and patterns of care of patients suffering from these diseases is still scarcely known. In fact, it would be particularly relevant to know if such intervention may have any modifying effect on use of services and costs of treatments. There is preliminary evidence that such an impact does exist, with possible reduction of number and duration of hospitalizations and of long-term residential stays and consequent reduced costs of inpatient treatment. On the other hand, community treatment costs could be increased as an effect of a shift of psychiatric and psychosocial interventions from inpatient to outpatient activities. A critical review of the existing literature on the issue will be provided, together with a discussion of the impact of this shift towards the attainment of increased functional and social recovery in the individual patient.

Electrodermal Activity (EDA) refers to changes in electrical conductance of the skin. Electrodermal hyporeactive individuals are those who show an unusual rapid habituation to identical non-significant stimuli. Previous findings suggested that electrodermal hyporeactivity has a high sensitivity and a high negative predictive value for suicide. The aim of the present study is to test the effectiveness and the usefulness of the EDOR® (ElectroDermal Orienting Reactivity) Test as a support in the suicide risk assessment of depressed patients.

One thousand five hundred and seventy three patients with a primary diagnosis of depression, whether currently depressed or in remission, have been recruited at 15 centres in 9 different European countries. Depressive symptomatology was evaluated through the Montgomery-Asberg Depression Scale. Previous suicide attempts were registered and the suicide intent of the worst attempt was rated according to the first eight items of the Beck Suicide Intent Scale. The suicide risk was also assessed. During the EDOR® Test two fingers are put on gold electrodes and a moderately strong tone is presented through headphones now and then during the test. The EDOR® Test is able to register the electrodermal responses to those tones, along with the blood volume in the fingers. Each patient is followed up for one year in order to assess the occurrence of suicidal behaviors.

Expected results would be that patients realizing a suicide attempt with a strong intent or committing suicide should be electrodermally hyporeactive in most cases and non-hyporeactive patients should show only few indications of death intent or suicides. Preliminary findings will be presented.

Suicidal behavior and its prevention constitute a major public health issue, and the moderating effect of sociodemographic factors has been studied for more than a century. In the last years it has become evident that the relationship between social factors and suicidal behavior is complex and highly dependent on the context. For instance, minorities suffering marginalization, such as the Inuit in Canada or the aborigines in Australia, present high rates of suicide. However, other minorities, such as immigrants arriving to tightened communities, can be protected from suicide compared to the social majority. Other contradictory effects have been reported concerning income per capita and the evolution of the economy. Unfortunately, the interplay of social factors in suicidal behavior and the social consequences of suicide attempts are rarely represented in theoretical models of suicidal behavior, despite their importance to adapt suicide prevention policies to social groups at risk. In this presentation, recent advances and new and integrative avenues for future research in the social aspects of suicidal behavior will be summarized.

Psychiatric illness, psychotropic drugs and driving ability. For most people driving is an important activity in daily life affecting physical, social, and economic well-being. Driving mobility is also an important part of one's self-identity that may influence health status. It could be demonstrated that 67% of psychiatric patients reported to have a valid driver's license and 77% of them referred to regularly use their cars. Closer inspection of data reveals, that road mobility is largely linked to psycho-functional status. In this context a significant issue is the impact of medical conditions and/or psychoactive medicines on road safety. Psychiatric patients, considered as a group, seem to have a moderately elevated risk of being involved in a road traffic accident with high-risk rates especially for organic mental disorders. With respect to pharmacotherapy, within psychotropic medicines an increased road traffic crash risk for benzodiazepines, z-hypnotics and some antidepressants has been well documented. The combination of psychoactive drugs additionally increases risk that is highest when combined with alcohol. However, therapeutic drug use may also lower risk, as the illness itself constitutes a higher risk of road traffic accidents. As many studies did not adequately control for confounding factors, results of epidemiological studies must be interpreted cautiously.

Driving a vehicle is an important everyday life skill associated to a psychiatric patient's autonomy and identity. Nevertheless, the right to drive is not a right at all, it is a privilege granted and regulated by rules and restrictions from the States that have also the duty to pull this privilege and deny the ability to legally drive in potentially unsafe drivers. The decision about for whom and when to forbid driving is a difficult matter of judgment that must remain a clinical and professional judgment within the medical encounter. Both antipsychotics as the psychiatric disorders target of these psychoactive drugs produce changes of psychomotor performance that can interfere with the ability to drive safely. Moreover, it is really hard to distinguish between the effects of the disease itself as opposed to the effects of the medication when studying the interaction between antipsychotics and driving ability. Previous results of our research in the field indicate that psychiatric patients who improved clinically after drug treatment also showed improvements in driving ability. So, adequate psychotropic treatment causes a positive effect on driving performance that outweighs the possible deleterious effect of medication. However, it remains essential to supply mental health professionals with new information, which is quantitatively and qualitatively valid, on the role of antipsychotics in driving ability. The purpose of the present lecture is to review research undertaken to-date on the effects of antipsychotic medications on driving ability. A search of various databases, including Medline, Embase and PsycInfo, will be conducted.

Depression is a mental disorder that is likely to affect daily functions, including driving ability. However, driving performance of depressed patients remains poorly investigated. We will present 2 studies designed to assess driving performance of patients receiving long-term antidepressant treatment. The first study compared driving performance of untreated depressed patients, depressed patients receiving SSRI or SNRI treatment for 6–52 weeks and matched healthy controls. The second study compared driving performance of long-term users of sedative antidepressants to that of matched healthy controls. A standardized on-the-road driving test was used to assess standard deviation of lateral position (SDLP), a measure of weaving. In the first study, mean SDLP of untreated and treated patients were significantly higher as compared to SDLP of matched controls. Driving impairment in the treated group was significantly less as compared to the untreated group. SDLP was positively correlated to severity of depression across both groups of patients. In the second study, SDLP of patients receiving sedative antidepressants (e.g. mirtazapine) during 0,5–3 yrs was significantly higher as compared to matched controls. Driving performance of patients receiving sedative antidepressants for more than 3 yrs did not differ from matched controls. Severity of depression in these patients groups was low. It is concluded that symptoms of depression are a major cause of driving impairment. Reductions in severity of depression through antidepressant treatment reduce severity of driving impairment. Sedative antidepressants such as mirtazapine however can still induce driving impairment in patients with remission for up to 3 yrs of use.

Although the rate of victims of road traffic accidents is already relatively low in Switzerland compared to other western countries, still 253 people died in 2015. The Swiss parliament therefore issued in 2012 already a program called “Via secura” to increase road traffic security by means of a package of measures, ranging from immobilizing systems for the car in case of drunken drivers to stricter rules for medical assessment of ability to drive a car and better training for doctors in such assessment to finally stricter laws regarding lower tolerance for alcohol levels and zero tolerance for drug consumption when driving a car. The presentation will focus on changes in legal regulation for both medical assessment as well as rules for alcohol or drug consumption when driving a car. Positive and negative consequences for the field of forensic psychiatry are discussed.

European intellectual history teaches us that beauty is not just an adornment to life but is also a major source of strength for our life. Moreover, the positive aesthetic experience also has healing power. That beauty is a highly effective antidote to life's suffering, i.e. acts as an anti-depressant, has been documented in the tradition of philosophical aesthetics from Plato to Bloch. Beauty reveals truth and goodness (Plato), it shows the harmonious order and the glory of things (Pseudo-Dionysius the Areopagite), it is one of the transcendental names of God (Thomas of Aquinas), in beauty the world appears in its perfection (Baumgarten), beauty is the daughter of freedom (Schiller), it offers a temporary escape from the suffering of existence (Schopenhauer), aesthetic values are the only values that withstand nihilism and the meaninglessness of existence and are thus the actual stimulus of life (Nietzsche), the beautiful is the sensual appearance of the idea (Hegel), beauty is an anti-depressant and Weckamin of being, it tears people out of their forgetfulness of Being (Heidegger), there is a close relationship between the shining forth of the Beautiful and the evidentness of the Understandable (Gadamer), in an artwork and through the aesthetic attitude the Other, foreign, the non-identical that is mangled and mutilated in the administered world is preserved and saved (Adorno). Many more positive affirmative descriptions from the tradition of philosophical aesthetics demonstrate that beauty and the aesthetic have a therapeutic dimension.

Global migration and the increasing number of minority groups, including immigrants, asylum seekers, refugees and ethnic minorities, mean that increasingly, psychiatrists and patients may come from different cultural backgrounds. Therefore, cultural differences between patients and clinicians have become a matter of growing importance to mental health care as western societies have become increasingly diverse. This talk will attempt to illustrate how attention to these cultural differences enriches the discussion of ethics in mental health care. This talk will also attempt to underline that cultural competence is able to enhance the ethical treatment of mental health of patients from different cultural backgrounds. Consequently, to be culturally competent, a clinician must be sensitive, knowledgeable, and empathetic about cultural differences. Therefore, cultural competence is a concrete, practical expression of bioethics ideals. According to Hoop et al. in 2008, it is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly), the cornerstones of ethical codes for the health professions.

In this talk the complex relationship between culture, values, and ethics in mental health care will be analyzed and discussed.