Modern health care systems today are marked by rapid changes in various fields such as ethics, politics and economics, therefore leaders in psychiatry have to focus these topics as additional challenges. To face these aspects and to cover the growing international character of professional self-awareness, special organizations for trainees and young psychiatrists are a useful instrument to give young professionals a voice in the evolution of training, research and clinical practice standards. By those means, young psychiatrists and trainees, consequently, can take influence on their own future, destiny and carrier progress.

Several international organizations where established to focus the needs and rights of psychiatric trainees all over the world: the European Federation of Psychiatric Trainees (EFPT), based on the UEMS (Union of European Medical Specialists) that was founded in 1958 and followed by the constitution of the European Board of Psychiatry in 1992, as well as the Wold Association of Young Psychiatric and Trainees (WAYPT) and the Young Psychiatrists’ Council of the World Association of Psychiatry (WPA YPC). To act as powerful and independent associations, they have to rely on committed and courageous youg psychiatrists and trainees who communicate national and regional standards and characteristics as well as critical aspects and thereupon provide the opportunity to learn from each other. In this way young psychiatrists and trainee associations represent an outstanding and strong advocacy of colleagues at early career stages.

To set up a national trainee organization, whether as a committee within the national psychiatric association or as independent national psychiatric trainee organization, several needs have to be covered right by the start: the establishment of a national network of trainees who then get in touch with national leaders in the field of psychiatry is mandatory. The founding process will be continued by presenting and promoting the organization on national conferences, to constitute and define structure and leadership as well as to organize future funding and to implement profitable cooperations with national and international young trainee and research institutions.

Examine impact of audit and feedback on antipsychotic prescribing in schizophrenia over 4.5-years.

Clinical files in three outpatient psychiatric services in Auckland, New Zealand were reviewed at two time-points (March-2000;October-2004). After the first audit, feedback was provided to all three services. Baseline prescribing variations between services were found for antipsychotic combinations and atypical prescribing, in particular clozapine. In two services audit and feedback continued with two interim reviews (October-2001;March-2003). Specific feedback and interventions targeting clozapine use were introduced in both services. No further audit or feedback occurred in the third service until the final audit. Data were collected (patient characteristics, diagnosis, antipsychotic treatment) and analysed at each audit.

Three prescribing variables (antipsychotic monotherapy, atypical and clozapine use) were consistent with practice recommendations at the final audit (85.7%, 82.7% and 34.5% respectively) and had changed in the desired direction for all three services over 4.5-years. At baseline there were differences between the three services. One service had baseline prescribing variables closest to recommendations, was actively involved in audit, and improved further. The second service, also actively involved in audit had baseline prescribing variables further from recommendations but improved the most. The service not involved in continuing audit and feedback made smaller changes, and atypical and clozapine use at endpoint were significantly lower despite at baseline being comparable to the service which improved the most.

We found high intensity audit and feedback was an effective intervention in closing the gap between recommended and clinical practice for antipsychotic prescribing.

Object working memory performance is abnormal in the early stages of schizophrenia. Such tasks recruit frontal and temporal cortices, possible sites of progressive change over the early illness course. We wanted to clarify if functional changes can be detected in the early stages of schizophrenia, to identify their anatomical location and their relationship to the stage of illness using a functional object working memory task in which the length of memory delay was manipulated.

40 subjects contributed: 10 first episode psychosis (FEp) patients, 16 with an at risk mental state (ARMS) and 14 healthy controls. We collected functional MRI data while the subjects performed a version of the delayed matching to sample (DMTS) task from the Cambridge Automated Neuropsychological Test Battery (CANTAB).

Behaviourally there was a trend to a group by delay interaction, the two patient groups making more errors at longer memory delays. At successful recognition a main effect of group was detected in the medial temporal lobe bilaterally, while a main effect of delay was detected in the left medial temporal lobe. At each length of memory delay the patient groups showed consistently greater activation of medial temporal regions when performing the task accurately.

Both ARMS & FEp groups showed greater activation than controls in the medial temporal cortex across all lengths of memory delay. These differences were not related to poorer task performance, but suggest an inefficiency mechanism that may correlate with the vulnerability to psychosis rather than pychosis per se.

The concept of quality of life has been a topic of increasing interest in the mental health field for more than two decades. Several instruments have been developed to measure quality of life for individuals living with mental illness; however, the majority of these instruments fail to measure quality of life from the client's perspective. This presentation will present results of a qualitative study that explored what individuals diagnosed with schizophrenia and other severe and persistent mental illnesses perceived as important to improving their quality of life.

In-depth interviews and focus groups were used to collect data from more than 50 individuals.

Analysis of the data resulted in the identification of two overarching themes, four domains, several sub components and enablers and barriers to achieving their desired goals. Themes associated with fear of symptoms and stigma were prevalent throughout the data with domains focusing on the challenges of managing the symptoms of the illness, the importance of relationships with a wide range of persons, the acquisition of meaningful occupation and the rebuilding of self esteem.

A discussion of the implications for practice will include the roles that the various professionals can play in assisting individuals in achieving their desired quality of life, as well as the relationship of quality of life with the concepts of recovery, client centered practice and psychiatric rehabilitation.

Previously, when only typical antipsychotic depot injections were available, some clinicians perceived depots as having an “image” problem despite them being associated with reduced rates of rehospitalisation when compared to tablets. This study investigated psychiatrists’ attitudes and knowledge concerning depots (typical and atypical) and whether they had changed over time.

Cross-sectional postal survey of consultant psychiatrists working in NorthWest England. A pre-existing questionnaire on clinicians’ attitudes and knowledge regarding depots was updated. Results were compared with a former sample (SouthEast England, 2001: N=143).

The sample comprised 102 consultant psychiatrists (response rate 71%). Depot use over the past 5 years had: decreased (50%), not changed (27%), increased (23%). Psychiatrists with decreased depot use had significantly lower scores for the side effects knowledge subscale than those who had unchanged or increased rates of depot use (mean 51.5% vs 54.8%, p=0.029). When compared to psychiatrists sampled five years previously, our current participants had more favourable patient-focussed attitudes (63.5% vs 60.4%, p=0.034); other subscales did not differ. Item-by-item analysis revealed specific changes over time including significantly less respondents regarding depots as: (i) compromising patient autonomy (mean 0.99 vs 1.28, p=0.036); being stigmatising (1.88 vs 2.42, p=0.002); being old fashioned (1.49 vs 2.04, p=0.002).

During the period that an atypical antipsychotic depot has been available, and depot prescribing rates have reduced, some attitudes have changed. These mainly encompass aspects regarding the patient rather than the depot injection and include reducing concerns about stigma and autonomy although concerns about patient acceptance continue.

In this study, a summary of the main functional Magnetic Resonance Imaging (fMRI) findings in the field of schizophrenia will be given in order to get a better understanding of this disorder.

The authors conducted an extensive literature review on fMRI and schizophrenia, using PubMed, the internet in general, and research contacts in order to avoid important literature to be left out.

In general, fMRI research on schizophrenia has demonstrated widespread deficits affecting a range of cognitive functions distributed throughout the brain. In addition, schizophrenia is associated with frontal and temporal brain dysfunction (e.g., Van den Noort & Bosch, 2008). This dysfunction is thought to be irreversible, or even worsen over time; even when optimal treatment is given (Lund et al., 2002). However, it is important to note that there is a degree of inconsistency in reported findings, and a pattern of brain dysfunction that would serve as a biological trait marker or predict treatment response has not emerged to date (e.g., Van den Noort & Bosch, 2008).

In this study, it was found that patients with schizophrenia show widespread deficits affecting a range of cognitive functions distributed throughout the brain, but there is a degree of inconsistency in reported findings. Although the development of fMRI has provided the technological advance necessary to examine schizophrenia; the scientific challenge will be to incorporate this technique appropriately through prudent experimental design (e.g., Honey & Bullmore, 2002).

To present basic principles and requirements of a network consisting of research institutions and routine care facilities, which aims at the improvement of treatment and care in schizophrenia.

The concept, structure and the management of such a network will be exemplified by the German Research Network On Schizophrenia, which is funded by the German Ministry of Education and Research (BMBF).

The experiences so far make very clear, that it requires carefully tuned projects, an efficient and well-financed network management, acceptance and dissimination of the network idea within (and outside) the network as well as collateral political measures to improve the research environment to incorporate single research projects and single institutions, researchers or clinicians into a network.

These general conditions fulfilled, network research is a clever strategy to bundle competence (horizontally and vertically) and to improve treatment and care of psychiatric patients.

Improving treatment in Consultation-Liaison Psychiatry requires better targeting of psychological treatments at the patients who benefit from them most. This paper will demonstrate that patients with severe irritable bowel syndrome (IBS), who also have somatisation, benefit greatly from antidepressants or psychotherapy.

257 patients with severe IBS were randomized to receive over 3 months brief interpersonal psychotherapy, 20 mg daily of the SSRI antidepressant, paroxetine, or treatment as usual. They were assessed at baseline for somatisation and psychiatric disorder. One year after treatment total costs and health-related quality of life, using SF36 physical component summary (PCS) score were assessed and scores adjusted for baseline values.

The patients with the highest baseline somatisation score had the most severe IBS, most psychiatric disorders, were most impaired and the highest total costs. At 1 year after the end of treatment these patients had significantly higher (improved) quality of life scores in the active treatment groups compared to usual care: mean (standard error) PCS scores at 15 months were 36.6 (2.2), 35.5 (1.9) & 26.4 (2.7) for psychotherapy, antidepressant and treatment as usual groups respectively (adjusted p= 0.014). Corresponding data for total costs over the follow-up year, adjusted for baseline costs were £1092 (487), £1394 (443) and £2949 (593) (adjusted p=0.050).

Patients with severe IBS who have high somatisation scores have marked impairment and incur very high costs but they improve greatly with treatment and show marked reduction of costs. Methods of recruiting the patients most likely to benefit from psychological treatments in C-L psychiatry will be discussed.

The complex sulco-gyral pattern results from fetal and early childhood processes that shape the cortex anatomy from a smooth lissencephalic structure to a highly convoluted surface. Abnormal brain maturation has been suggested as risk factor for schizophrenia. Thus, measures of the cortical folding pattern could provide cues for the neurodevelopmental aspects of pathopsychology.

Brain morphometry softwares providing 3D sulci descriptors (e.g. surface) from MRI (Mangin, 2004 ; Cachia, 2007). This automatized method avoids biases inherent to image normalisation and partial volume effect. Therefore, statistics on sulcal measurements should generalize across patients. T1 MRI datasets were studied in at-risk subjects, adolescent onset schizophrenia, and patients with treatment-resistant depression and auditory hallucinations.

Decreased in sulci surface were detected in whole brain sulcal indices and in regional sulcal indices. Decreases in global sulcal indices were detected in most patient groups, except in at risk subjects. Decreases in local sulcal indices were detected in langage-related areas in resistant hallucinators (Cachia 2007), and confined to left temporal regions in adolescent schizophrenia (Pentilla, submitted). In patients with treatment-resistant depression, sulci descriptors differed in right hemisphere sulci adjacent to limbic regions (Pentilla, submitted).

The potential of the gyrification pattern for the inference of neuroimage-based developmental biomarkers will be further examined using multivariate classification approaches (Duchesnay 2006).

[1]. Mangin et al., Neuroimage 2004 - Cachia et al., Neuroimage 2007 – Duchesnay et al., Neuroimage 2006

We have recently completed a ten year longitudinal study of brain structure and function in a group of individuals at high risk of schizophrenia for familial reasons, and have taken blood for genetic analyses. We can therefore study the effects of recently discovered candidate genes for schizophrenia in a large well characterised cohort of those at risk, including some who went on to become ill, but without illness related potential confounders such as antipsychotic medication.

162 initially healthy people aged 15-25 at high genetic risk of schizophrenia, because they had at least one close relative with the disorder, were recruited and examined with structural MRI and functional MRI. The development of psychotic symptoms and/or schizophrenia itself was monitored at serial assessments, which most participants had at 18-24 month intervals over up to 10 years.

21 developed schizophrenia during the study and an additional 66 subjects had psychotic symptoms at one or more assessments. 78 of the subjects were genotyped. Single nucleotide polymorphisms in the Brain Derived Neurotrophic Factor (BNDF) and D-amino acid oxidase (DAO) genes were associated with abnormalities of frontal and temporal function in the high risk cohort as a whole. A risk allele (SNP8NRG243177) in the Neuregulin 1 (NRG1) promoter region, on the other hand, was associated with psychotic symptoms, decreased premorbid IQ and decreased activation of pre-frontal and temporal lobe regions. The Val(158)Met polymorphism in the Catechol-O-MethylTransferase (COMT) gene predicted schizophrenia in this cohort in a dose-dependent manner. It was also associated with reduced gray matter density and BOLD signal in anterior cingulate cortex.

These patterns of altered brain structure and function have previously been associated with schizophrenia in this and other samples. In the Scottish population, BDNF and DAO may have trait effects, while the NRG1 variant appears to be a risk factor for an extended or intermediate phenotype and the COMT Val allele is associated with an increased risk of schizophrenia. This genetic background may provide a mechanistic framework in which to study the effects of environmental risk factors, perhaps particularly in subjects at increased familial risk.

To investigate associations between schizophrenia candidate gene polymorphisms and regional cortical thickness and volume in patients with schizophrenia and healthy control subjects.

Genotyping was performed using PCR and pyrosequencing techniques. Cortical morphology was analyzed by processing magnetic resonance brain images with the FreeSurfer software package. General linear model analysis was used to study associations between gene variants and cortical thickness in patients and controls, respectively. Regional cortical volumes were defined from automatic cortical parcellations. Our first studies from 96 patients with schizophrenia and 104 healthy control subjects demonstrate that polymorphisms in the brain derived neurotrophic factor (BDNF) gene may be associated with variation in frontal lobe morphology. Associations seem to be stronger in patients with schizophrenia than in healthy controls.