The number of diagnostic categories of eating disorders have increased over time. The term transdiagnostic has been commonly used for eating disorders as in general they share problematic eating patterns and variations in weight. However, there are also extreme differences, for instance in the realm of personality style. One example of contrasts is the polygenic correlation with ADHD which is positive in binge eating disorders and absent in anorexia nervosa. This is concordant with the clinical presentation whereby AN is associated with compulsive, rigid perfectionistic features consistent with an obsessive-compulsive personality style whereas BED is associated with impulsivity. ARFID and AN have features that overlap with characteristics of autistic spectrum disorders. Nevertheless, traits of neuroticism are shared across eating disorders and other psychiatric disorders. Another contrast is in the exposure to adversity in childhood. People with binge eating disorder have many forms of childhood adversity including the ramifications of weight stigma and this leaves an imprint on personality development. Thus, there is no one size that fits all in terms of the unfolding links between personality and eating disorders.

Anorexia Nervosa (AN) has the highest mortality of all psychiatric disorders. Patients who experience the onset of AN in their teens suffer on average 10 years from an eating or other mental disorder. Recently many clinicians in the US and Europe have addressed the inadequacy of treatment for this disabling disease which – at least in adult patients - is mainly based on individual psychotherapeutic interventions. Against the background of a recent GWAS and genetic correlations with other mental disorders, but also inverse correlations with important metabolic parameters such as fasting insulin and leptin new treatment strategies must be developed. This presentation wants to elucidate two different interventions, a biological strategy, and a more pragmatic treatment setting in the “real world”. The biological strategy refers to the gut-brain axis which has been shown to be severely affected in AN. Patients show a deep perturbation of the gut microbiome with no significant improvement with weight rehabilitation. Thus, additional ways must be found such as nutritional strategies (e.g., administration of pre- or probiotics, stool transfer) to probably improve the outcome of this disorder. In addition, inpatient treatment which is still the gold standard for treatment of AN in Europe, has not been proven to alter the long-term prognosis of AN. Consequently, other interventions such as home treatment which involve the family and interrupt eating disorder associated habits as disease preserving factors will be introduced and the results of a pilot study in adolescent AN be presented.

Despite being preventable, approximately 800,000 people die by suicide each year worldwide. Evidence suggests that suicide rates decrease during crises, but once the immediate threat passes, suicide rates are expected to increase. The COVID-19 pandemic likely affects risk and protective factors for suicide. Studies show mixed results regarding whether suicide behaviours have increased among adults during the pandemic. The results are however different for young people. An increase in suicidal behaviours has been identified in some countries among young people after lockdown period and when returning to schools. Data also suggests that there may have been a rise in deaths by suicide among those younger than 18 years in China, and during the first phase of lockdown in the United Kingdom. Studies have found significant decreases in hospital admissions for suicidal behaviours and visits to emergency departments both for adults and adolescents. Suicide can be prevented if evidence-based methods that exist are implemented in a systematic way. Wasserman, D., Iosue, M., Wuestefeld, A., & Carli, V. (2020). Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic. World psychiatry: official journal of the World Psychiatric Association (WPA), 19(3), 294–306.

The COVID-19 pandemic and its associated restriction measures have a great impact on patterns of substance use throughout the general population. Interestingly, in contrast to initial expectations on an overall negative impact, data of large surveys show a differentiated picture of impact. A recent systematic review (Roberts et al., 221) showed mixed tendencies towards increased alcohol consumption, contrasting with a clear trend towards the use of other psychoactive (illicit drugs and prescription drugs) substances. patterns of use before COVID-19 (e.g. habit of drinking at home) and availability (illicit drug traffic changes) are among the significant factors. In addition, mental health factors (depression, anxiety) and social isolation are common correlates with substance use. These factors may be of specific importance impacting substance use in adolescents during the COVID-19 pandemic. Exemplary is an increase in the use of sleeping medication among Belgian adolescents and young adults. In the current presentation data of national (Belgium) surveys on substance use in adolescents will be presented and discussed within the context of findings in international surveys.

Maternal health cannot be separated from infant, child and adolescent health, which includes mental health as well. Expecting mothers go through a number of changes during their pregnancy. Due to the specific alterations of their physique and immune system, pregnant mothers are more vulnerable to the Covid-19 infection. This highlights the importance of the vaccinations in their cases. During the pandemic, mental health problems such as anxiety, depression and stress aroused in greater numbers. This affected mothers, and younger children as well. Expecting mothers, without pre-existing mental disorder (>50%) reported a weightier level of anxiety in their first trimester. Also, infants can suffer developmental disadvantages, as their infected mothers are separated from them. Even though evidence is not yet clear in this topic, vertical transmission seems to be fairly uncommon. Treatment guidelines, that could help Covid-19 infected mothers to handle their infants, are scarce. Hence the importance of telehealth has started to be outlined. Separation from the children might be necessary, while the mental health of mother and infant is continuously screened, since the long-term consequences of the symptoms are still unknown. Hence, prevention is imperative to avoid any negative effects. Even still, WHO advises mothers to breastfeed safely, with good respiratory hygiene, emphasizing the importance of skin-to-skin contact of newborns and sharing the room with them. On policy level: investment into pre-, peri-, post-natal care, family supporting national programs, inter-sectoral collaborations, monitoring and research are important elements of prevention and treatment efforts during the Epidemic and the post-Covid-19 era.

The United Nations Convention on the Rights of Persons with Disabilities as well as the new guidance on community mental health services recently published by the World Health Organization formulate clear goals for the future of psychiatry and psychosocial support. Innovative concepts of psychiatric care that focus on full participation, recovery-orientation and the prevention of coercion play an important role in achieving these goals. Implementing and scientifically evaluating the effects of such models in mental health services needs to be prioritized in national mental health planning and budgeting decisions. In this lecture, Dr. Lieselotte Mahler will address the requirements of psychiatric concepts, specifically on acute psychiatric wards, to enable participation and prevent coercion. Using practical examples and evaluated models (e.g. Weddinger Modell, standardized post-coercion review sessions), she will make suggestions on how a psychiatry oriented towards human rights can also be implemented within existing clinical structures. Dr. Lieselotte Mahler will discuss, based on the current state of research as well as practical experience, which challenges exist with regard to patient autonomy and prevention of coercion in clinical practice and how these can be addressed from a human rights perspective.

Functional recovery of subjects with schizophrenia remains an unmet need despite the availability of effective pharmacological and psychosocial treatments. The focus of recovery-oriented approaches is on fostering hope and resilience, fighting self-stigma, supporting self-determination and promoting social inclusion. The implementation of recovery-oriented plans requires an in depth understanding of key factors influencing real-life functioning, health status and quality of life. Recently published data from the Italian Network for Research on Psychoses have provided evidence that baseline variables associated with functional outcome at follow-up included domains not routinely assessed and targeted by intervention programs in community mental health services. As pointed out by experts in schizophrenia research and care, the management of subjects with schizophrenia has not significantly improved and only a minority of them receives integrated and personalized treatments. Shared decision-making and integrated pharmacological and psychosocial treatments, tailored on subjects’ needs, might significantly improve the outcome of subjects with schizophrenia, supporting independent living and inclusion in the community.

In this session I will discuss recent publications that have advanced the field of forensic psychiatry or changed clinical practice. Content will be current so that it is not possible to specify at present.

Covid had a profound impact on services for eating disorders because of the huge increase in demand. Nevertheless, services quickly adopted a virtual form of working. This rapid change in prevalence was attributed to a number of factors, including a general increase in fear and fragmented social functioning, with a specific accentuation of higher risk associated with body weight. Recent advances in the conceptualisation of eating disorders include a move from a transdiagnostic to a more to a personalised approach. For example, it has been further demonstrated that reducing the duration of untreated illness within three years of onset is associated with a better outcome (1). This has led to the rollout of FREED, an early intervention service in the UK. Genetic associations have been compared and contrasted across the spectrum of eating disorders. People with binge eating disorders share a profile with those at risk of metabolic syndrome whereas people with anorexia nervosa have the opposite profile (2). This reconceptualization of eating disorders as conditions with both brain and body underpinnings has led to new treatment approaches. For example, there have been small proof of concept studies in which metreleptin has been administered. These show promise with rapid reductions in depression and other symptoms (3, 4). Meanwhile the value of “experts by experience,” in co designing and delivering services is an area of active investigation which offers the much needed potential of improving treatment outcomes (5).

There is a growing evidence that social determinants of health influence the health outcomes. These non-medical factors, i.e., social determinants of health / mental health, are defined as the conditions in which people are born, grow, live, work and age, including the factors shaping these conditions. They either have direct effects on health and ill health or work as mediators. In this respect, racial discrimination is a fundamental social determinant of ill health / mental health and health inequalities. A strong correlation between reported experiences of racial discrimination and poor general health and poor mental health has been reported. Besides, racial discrimination may lead to risk taking behaviors increasing poor health / mental health especially in vulnerable disadvantaged populations. A leading factor mediating the negative effects of any biopsychosocial factor on mental ill health is the degree of discrimination. Furthermore, racial discrimination is one of the processes explaining and reinforcing racial disparities in health and ill health. From a conceptual point of view, racial discrimination and its effects on ill health could be discussed in the context of the issue of othering and related dehumanization and violence. Psychiatrists and mental health workers have accumulated considerable knowledge and experience on understanding and overcoming some of the consequences of racial discrimination, especially via anti-stigma studies. The unfair and avoidable influences of racial discrimination on mental health are neither fated nor inevitable. As Gramsci had said, we have the pessimism of the intellect and optimism of the will.

Discrimination is a violation of human rights. The Universal Declaration of Human Rights proclaims in Art. 1 the equality of all human beings without distinction as to race, colour, sex, sexual orientation, religion, age or health. International law assigns three main characteristics to discrimination: disadvantageous treatment, based on unlawful grounds, and lack of reasonable and objective justification. Thus, it must be based on an unlawful characteristic: Ethnicity, religion, national or social origin, language, physical appearance, descent, gender, sexual orientation, age or disability. A growing body of literature has recognized health disparities and has investigated the relationship between discrimination and poor health outcomes. Ethnic minority groups across the world face social and psychological challenges linked to their minority status, often involving discrimination. Furthermore, cumulative exposure to racial discrimination has incremental negative long-term effects on the mental health of ethnic minority people.Studies that examine exposure to discrimination only at one point in time may underestimate the contribution of racism to poor health. Lower patient-centered care was associated with higher perceptions of discrimination, despite experiences of continuous discrimination or discrimination experienced as different types. Further, dissatisfaction with care was associated with discrimination, particularly when experienced in various forms. These findings reinforce a need for patient-provider communication that is inclusive and eliminates perceptions of discrimination and bias, increases patient-centeredness, and improves overall clinical care. Additionally, these results stress the need for more research investigating the relationship between discrimination and outcomes in patients, as perceived discrimination manifests as a significant barrier to effective disease management.

Comorbidity of severe mental disorders and physical illness: issues arising Comorbidity of mental and physical illness is a major, perhaps main problem facing medicine in the years before us. In addition to shortening the life expectancy of people with mental illness comorbidity with physical illness comorbidity significantly and negatively affects the quality of life of the people who experience the mental and physical illnesses and their carers and increases the cost of health care. What makes the problem even more and challenging is that medicine is currently in the process of fragmentation into ever more narrow specialties which adds difficulty in the provision of care, Most of the solutions which have been proposed – collaborative care, in-service education of general practitioners and others did not turn out to be effective solutions in dealing with the problems of comorbidity. A significant revision of undergraduate and postgraduate training in medicine is most probably an essential component of the answer to the challenge of this type of comorbidity which will also require a reorganization of health services and their financing.

Schizophrenia is a severe brain disorder characterised by positive, negative, affective and cognitive symptoms and can be regarded as a disorder of impaired neural plasticity. This lecture focusses on the beneficial role of exercise in schizophrenia and its underlying mechanisms.Apart from the established pharmacological treatments in schizophrenia, aerobic exercise has a profound impact on the plasticity of the brain of both rodents and humans such as inducing the proliferation and differentiation of neural progenitor cells of the hippocampus in mice and rats. Aerobic exercise enhances LTP and leads to a better performance in hippocampus related memory tasks, eventually by increasing metabolic and synaptic plasticity related proteins in the hippocampus. In healthy humans, regular aerobic exercise increases hippocampal volume and seems to diminish processes of ageing like brain atrophy and cognitive decline.Several meta-analyses demonstrate the beneficial effect of exercise on function, positive as well as negative symptoms and brain structure in multi-episode schizophrenia.

BACKGROUND Against the treatment gap and the long delays in seeking treatment for mental health problems, primary care psychology (PCP) was added to reimbursed outpatient mental health services in the Belgian healthcare system. PURPOSE Within the Evaluation of Primary Care Psychology study (EPCAP), which provides evaluation of the measure of reimbursement of PCP, the objectives were: (1) To describe the patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) of patients treated with PCP and (2) formulate guidelines to integrate patient-related findings and experiences within community mental health services. METHOD 428 patients participated in an online survey at the start of their PCP treatment in Belgium and after 3 and 6 months. Besides sociodemographic characteristics, DSM-5 mental disorders, suicidality, and service use, they were questioned about their findings (PROMs) and experiences (PREMs). RESULTS Almost 90% met the criteria of a lifetime as a 12-month DSM-5 mental disorder or STB at the start of PCP treatment. Both subjective well-being and the proportion of patients who had positive experiences regarding their PCP treatment increased with 46% resp. 23.2% after 3 months and remained stable after 6 months. CONCLUSION Although PCP in Belgium serves a clinical patient population with high proportions of lifetime and 12-month mental disorders and suicidality, their subjective well-being increased after 3 months and remained stable after 6 months. Despite differences between groups of patients, PCP seems to have a positive effect on subjective well-being of these patient in short term. Integration of PROMs and PREMs into PCP were recommended.

Background: Measuring and interpreting outcome is challenging in mental health services than in some other areas of health care. Objectives: The aims of this study were to (1) explore results of Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) in psychiatric hospital settings, (2) describe the relation between generic PROMs (measure of well-being) and specific PROMs (disorder-specific symptom assessments), (3) describe the congruence between patients and clinicians evaluation of the care experience (based on Patients reported experience measures and Clinician reported experience measures). Methods: A total of 269 consecutive patients participated in this study. Results: (1) Subjective experience of well-being (outcome) improved after hospitalisation (+15%, avg). High satisfaction with subjective experience of care (85%, avg). (2) Significant correlation between patients’ assessment of subjective well-being (generic PROMs) and clinical improvement (specific PROMs) (p <0.007). (3) Significant correlation between patient and clinician experience of care (p= 0.002). Conclusions: One of the first French studies on the use of standardised PROMs and PREMs in psychiatric hospital settings. Results suggest that subjective well-being measures complement the assessment of the patient’s clinical symptoms and social functioning. The effectiveness of care depends on the consideration of these three dimensions. The use of core patient-reported measures, as part of systematic measurement and performance monitoring in mental health care, provides valuable input to the clinicians’ practice.

Background: Eating disorders (EDs) are severe psychiatric disorders which, when left untreated, can lead to psychosocial impairment, physical disability and death. In the United Kingdom, many specialist ED services collect routine outcome measures (ROMs) which serve to assess illness severity, patients’ quality of life and function. The repeated collection of ROMs over the course of treatment allows for the objective evaluation of patient progress towards recovery. Recent National Health Service (NHS) guidance on adult ED care in England suggests that all services should use ROMs, not just to track progress, but also to support the achievement of collaboratively identified, person-specific recovery goals, to empower patients and inform individualised treatment. To achieve this objective, clinicians need access to psychometrically sound ROMs which can be utilised in a collaborative and person-centred manner. Traditionally, ROMs have been collected using standardised patient-reported outcome measures (PROMs), but increasingly individualised PROMs (i-PROMs) are also being developed. Methods & Findings: In this talk I will review the ‘why, what and how’ of ROMs, PROMs, I-PROMS and of associated normative and ipsative feedback on these measures in the eating disorders context. Conclusions: Use of PROMs has much to be commended both in regard to treating individual patients, at service level and also the wider health care system.

Introduction Bipolar disorder is a severe disorder that is often accompanied by deficits in both neurocognitive (1) and psychosocial function (2). At the Department of Psychiatry and Psychotherapy of the Medical University of Vienna we performed a study to further identify potential cognitive, clinical and treatment-dependent predictors for functional impairment, symptom severity and early recurrence in bipolar patients (3). Methods Forty-three remitted bipolar patients and 40 healthy probands were assessed with a cognitive battery. In a randomized controlled trial, remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy (CPEGT) over 14 weeks or treatment-as-usual. At 1 year after therapy, functional impairment and severity of symptoms were assessed. Results As compared to healthy probands, bipolar patients showed lower performance in executive function, sustained attention, verbal learning and verbal fluency. Both attention and CPEGT predicted occupational functioning. In our study verbal memory recall was a predictor for symptom severity. Discussion Our data suggest that bipolar patients benefit from CPEGT in the domain of occupational life. Implications for treatment strategies are discussed. Solé B, Jiménez E, Torrent C, Reinares M, Bonnin CDM, Torres I, Varo C, Grande I, Valls E, Salagre E, Sanchez-Moreno J, Martinez-Aran A, Carvalho AF, Vieta E. Int J Neuropsychopharmacol (2017) 20:670–80. Tohen M, Zarate CA Jr, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, Salvatore P, Baldessarini RJ. Am J Psychiatry (2003) 160:2099–107. Sachs G, Berg A, Jagsch R, Lenz G, Erfurth A. Front Psychiatry (2020) 23;11:530026.

One reason behind the failure to understand the neurobiological background of affective disorders and develop more effective treatments is their heterogeneity warranting identification of clinically meaningful endophenotypes. Affective temperaments, considered subclinical manifestations and pathoplastic contributors of affective illnesses may constitute such endophenotypes. 775 general population subjects were phenotyped for affective temperaments using TEMPS-A, and genotyped using Illumina’s CoreExom PsychChip yielding 573141 variants. Primary SNP-based association tests were calculated using linear regression models assuming an additive genetic effect with the first 10 calculated principal components, gender, age, and other affective temperaments as covariates; a Bonferroni-corrected genome-wide significance threshold set at p≤5.0×10−8, and suggestive significance threshold set at p≤1.0x10-5. SNP-level relevances were aggregated to gene-level with the PEGASUS method, with a Bonferroni-corrected significance level set at 2.0×10-6, and suggestive significance thrshold set at p≤4.0×10-4. Functional effects of most significant SNPs as reported in public open databases based on expression quantitative trait loci (eQTL) and 3D-chromatin interactions were explored using FUMA v1.3.5. In SNP-based tests a novel genome-wide significant variant, rs3798978 (p=4.44x10-8) and several other suggestively significant SNPs in ADGRB3 were found for anxious temperament along with suggestively significant SNPs for the other four affective temperaments. In gene-based tests suggestively significant findings emerged for all five temperaments. Functional analysis suggested that several of the identified variants influence gene-expression levels or participate in chromatin interactions in brain areas implicated in affective disorders. In the next step these findings should be investigated in patient samples, and in other models of affective disorders and related phenotypes.

The risk rate of criminality is increased in ADHD, especially in children who, in addition to ADHD, express externalizing behavior of oppositional defiant disorder (ODD), later followed by conduct disorder (CD), substance misuse and antisocial personality disorder (ASPD). Studies report ADHD to be about ten times more common in prison populations than in the general adult population. Prisoners with ADHD have compared to prisoners without ADHD, an earlier onset of offending, higher rates of coexistent psychiatric disorders, and are more often incarcerated due to violent- and drug-related offences. Within prison settings, inmates with ADHD are more often reported for intra-institutional aggression and they are often experienced as more difficult to manage and costly to rehabilitate. Further, they relapse comparably more often and faster into criminality after being conditionally released. Despite high prevalence rates of ADHD within prisons and serious consequences related to untreated ADHD, few controlled trials have evaluated methylphenidate treatment in prisoners with ADHD and coexistent disorders. Evidence and clinical experience of pharmacological and psychosocial interventions of prison populations with ADHD will be presented briefly.

Intimate partner violence (IPV) has a very high prevalence (25%) in society and has serious consequences for its victims. As former studies showed minimal effectiveness of therapeutic interventions addressing IPV, the Dutch guideline for Familial/Domestic Violence (NVVP, 2008) recommends to focus more on systemic factors and on individual risk factors of IPV. ADHD is one of these individual risk factors. This presentation focuses on the association between ADHD and IPV, presenting data and clinical examples. ADHD was missed in 56% of a sample of forensic outpatients. Reasons for this issue of underdiagnosis of ADHD in case of aggression and IPV are discussed. Also, data of the ITAP (impact of treatment of ADHD on IPV) study are presented, showing that ADHD in offenders of IPV with ADHD scored higher on minor physical aggression, minor and severe psychological aggression and clinician-rated IPV than offenders without ADHD. Further, after a one year treatment of ADHD and IPV, decrease in IPV was mainly associated with decrease in ADHD symptoms. The importance of screening and treatment of ADHD symptoms in all IPV offenders is discussed to make treatment of IPV more effective.