Schziophrenia is widely considered the most “philosophical” of all mental disorders. One main reason is that many persons with schizophrenia undergo experiences akin to what some philosophers want to attain by the suspension of common-sense attitude and beliefs. This phenomenon is quintessential to the formation of schizophrenic delusions. The typical metaphysical tinge to the contents of schizophrenic delusions is supposed to be the final configuration that this condition eventually comes to take on.

Thus, the clinical characterisation of persons’ with schizophrenia - as it commonly argued by phenomenologically-oriented clinicians - may take profit from a philosophical understanding of the symptoms of this syndrome and from a rigorous and philosophically-informed definition of concepts like ‘consciousness’, ‘self’, ‘subjectivity’, ‘intersubjectivity’ and ‘identity’. A number of recent as well as classic papers and books contributed to establish a model of schizophrenic psychoses as disorders of pre-reflexive self-awareness and other-awareness. This model is now receiving increasing consensus from clinicians as well as from philosophers, and also empirical validation. This symposium will build on and extend these ideas.

Cognitive impairment (CI) is present in the majority of subjects with schizophrenia, is not an epiphenomenon of symptoms, is a risk factor for psychotic disorders and contributes to poor functional outcome. Most probably, in the near future clinicians will be faced with the need of assessing CI in order to complete the diagnostic work-up and to choose among treatment options aimed to target cognitive deficits.

In spite of the progress made by research in this field, relationships between cognitive impairment and other dimensions of schizophrenia remain controversial. On the one hand, empirical data show that CI is independent from psychopathological dimensions, on the other hand, significant associations between CI and negative symptoms have been frequently reported, and associations with positive symptoms or disorganization were also found, although less consistently. Reasons for discrepancies include differences between study samples, cognitive test batteries, medication status, variability of dimensions severity, but also the lack of adequate modelling of the investigated associations. In the presentation, the role of CI in cognitive accounts of psychopathological dimensions will be discussed, limitations of current research on the topic will be highlighted and directions for future research will be outlined.

For the individual a psychotic episode involves the profound experience of distress and identity confusion. The process of recovery includes redefining the self, understanding what has happened and finding new meaning and purpose in order to establish a personally satisfying, hopeful and contributing life.

Hope may be defined as a primarily future-orientated expectation of attaining personally valued goals that will give or restore meaning to one's own experiences. As such it may be seen as a pre-requisite for recovery but also as an important outcome of the recovery process.

This presentation will explore the connection between hope and the attribution of meaning in the process of overcoming demoralisation, resolving psychological defense and integrating the experience of severe mental illness from a psychological, philosophical, and therapeutic viewpoint. Empirical data on hope and its relation to personal explanations following a psychotic episode will be presented.

Schizophrenia is characterised by profound distortions of the tacit world-embeddedness, which can be articulated both in flamboyant, characteristic symptoms - such as positive, negative and disorganised ones - or more subtle, quasi-ineffable changes in the structure of subjective experience. Such dislocation from the tacit milieu of common sense, rests in-between the jaspersian articulations of understanding and explanation, and remains problematically unsaturated even in the comprehensive post-jaspersian frames offered by existential, narrative-hermeneutic, psychodynamic, constructivist and cognitive-behavioural modes of understanding.In this context, a phenomenologically-informed approach can illuminate - in the very hic et nunc of the clinical-therapeutic encounter - those structural changes in the field of awareness which constitute the antepredicative, pre-psychological matrix of schizotropic vulnerability.

Immune system dusfunction is a consistent finding in mood disorder research. One of the relevant metabolic pathways in this regard is the kynurenine pathway which forms a bridge between immune activation, serotonergic deficiency and disturbed NMDA-R function. Given the potential importance of the kynurenine pathway in the pathogenesis of MDD, a SNP based gene association analysis was undertaken, focusing on three major players in this pathway: the genes coding for Trytophan Hydroxylase 2 (neuronal THP, TPH2), Kynurenine-3-MonoOxygenase (K3MO), and Kynurenine AminoTransferase III (KATIII). In order to assess the potential role of these three genes, SNP maps covering the gene were constructed, and single SNP and haplotype association analyses were performed in a sample of 338 German patients with mood disorders and 310 control individuals matched for age, ethnicity and gender.

At the single SNP level, SNP rs1053230 in the K3MO gene shows borderline significant evidence for association. Looking at the haplotype analysis (using the Plink program), the KATIII gene showed significantly different overall haplotype distributions (OMNIBUS) between patients and control individuals for all windows (p-values between 1.75 × 10−5 and 0.006). These findings were mainly due to an overrepreseantation of the CGCTCT risk haplotype, with a frequency of 7,1% in bipolar patients, 5,3% in MDD patients and 1,9% in healthy control individuals.

The identification of a KATIII risk haplotype for mood disorders should be considered preliminary. A next step would be to completely sequence the KATIII promoter, exons and intron-exon-boundaries in patients carrying the risk haplotype.

Proinflammatory cytokines, such as IL-6, IL-1 and TNF-a appear to be elevated at least in the peripheral blood of depressed patients. Thus IDO activity may be enhanced in depressed patients through these cytokines. Although IL-6 does not directly act on IDO, its elevated levels in serum may contribute to IDO activation within the CNS by the stimulatory effect on PGE2, which acts as cofactor in the activation of IDO. This fits with a report on the correlation of increased in vitro IL-6 production with decreased tryptophan levels in depressed. Due to the increase of proinflammatory cytokines and PGE2 in some psychiatric patients, antiinflammatory treatment would be expected to show advantagous effects in schizophrenic and depressed patients. Cyclo-oxygenase-2 inhibitors have been evaluated in major depression. We were able to demonstrate a statistically significant therapeutic effect of the COX-2 inhibitor on depressive symptoms in a randomized double blind pilot add-on study using the selective COX-2 inhibitor celecoxib in MD. Another randomized double-blind study in fifty depressed patients suffering from MD also showed an statistically significant better outcome of the COX-2 inhibitor celecoxib plus fluoxetine compared to fluoxetine alone. Further therapeutic strategies based on immune-modulatory effects will be discussed, too.

In the UK less than 4% of medical students choose psychiatry. This number has remained reasonably static but there have been an increase in the number of medical schools. There are many reasons why medical students in the UK get put off by psychiatry among these are the stresses experienced, not the right type of placement, stigma against psychiatry and psychiatrists by other disciplines and specialties. There has been massive changes in training system in the last 3 years and changes are continuing. Foe any psychiatric trainee the aim of training is to provide a doctor with an educational programme, which enables him or her to practice independently in psychiatry, whether as a consultant or as a senior member of an academic department. The Royal College of Psychiatrists has been in existence in some form since 1841 and as a body responsible for training is taking the shortfall in recruitment seriously. The report of a scoping group will be described along with lecture historical lessons which will be linked with the present and the way forward in recruiting and retaining medical students into psychiatry.

Medical curricula in Central and Eastern Europe share the tradition and transformation of the university training under the strong German influence, modified by decades of communistic educational system. This tradition is characterized mainly by the classical educational formats (plenary lectures and practices), by the split of a discipline into “general” (psychopathology) and “special” (diseases) parts, and by predominating medical approach based on Kraepelinian nosological system. In recent decades, however, more problem oriented, integrated and interactive style of medical training penetrated also into this part of Europe. It was reflected by the introduction of new medical curricula with diversified teachings psychiatry in different modules including applied neuroscience, medical ethics, patient oriented approach and modern educational formats including electives in psychotherapy, biological psychiatry, psychopathology, assessment techniques, and methodology. Psychiatry becomes to be a part of modules such as pain, dyspnoea, basic medical problems and broader medical context. Neurobehavioral sciences are now more integrated and clinical rotation is more practically oriented (problem oriented). The example of a new curriculum introduced at the Third Medical School of Charles University in Prague will be presented.

The development of the medical student is not based solely on the acquisition of knowledge but also on development of skills and appropriate attitude. This requires ability to communicate effectively with patients and colleagues, sensitivity to patient needs, and the capability to influence patients to take the appropriate decisions and maintain behaviour change.

Recent years have seen marked changes in medical school curricula to support this and greater emphasis has also been made post Shipman.

The Faculty of Medicine and Surgery of the University of Malta has moved strongly in this direction. The Department of Psychiatry has led this and developed new courses, longitudinally throughout the curriculum.

The course in Behavioural Sciences was developed with emphasis on student-centred learning in small groups. It focuses on interpersonal communication, teamwork, reflective experience, holistic and patient-centred care, personal development and avoidance of burn out.

A vertical course in Psychology and Sociology in Relation to Health Care has also been introduced and the Course in Psychiatry has been redeveloped in accordance with recommendations of the World Federation of Medical Education and the World Psychiatric Association.

These new developments in the curriculum are described and explored.

Subthreshold depression has a considerable impact on the quality of life and carries a high risk of developing major depressive disorder. Psychological treatments for subthreshold depression may be able to reduce depressive symptomatology and prevent the onset of major depression. In this presentation, an overview is given of psychotherapies that have been examined as treatments of subthreshold depression, including cognitive behavior therapy, problem-solving therapy, interpersonal psychotherapy, and internet-based guided self-help. Furthermore, the results of a meta-analysis of the effects of these psytchotherapies on subthreshold depression are presented. This meta-analysis shows that these psychological treatments have significant effects on subthreshold depression, and that these interventions may prevent the onset of major depression. After one year the effects of the psychotherapies are smaller, but still significant.

Minor depression, subsyndromal and subthreshold depression are frequent conditions in primary care which do not fulfil the criteria of a depressive disorder but are associated with functional disability, impairment of quality of life, and health care use. The symposium will discuss studies on the clinical evidence of pharmacotherapy, psychotherapy, and primary care improving interventions. To this concern, it will be critically discussed if clinical relevance may be concluded from placebo-verum-differences of the respective studies, with respect to psychopharmacological and psychotherapeutic approaches. Pragmatic therapeutic approaches in those patients due to lacking clinical evidence will be introduced. Moreover, the symposium will emphasize when exploring the efficacy of antidepressants in depression the core items depression have to be considered as demonstrated in recent studies. The relation between baseline severity of depression and outcome in clinical trials will be critically discussed. Although symptom severity is a most important issue when treating depression in primary care the relationship between patients’ treatment preference and the treatment they actually are evident and will be addressed in the symposium.

Mild depressive syndromes are highly prevalent among primary care patients. Evidence based treatment recommendations need to be derived directly from this diagnostically heterogeneous group. Primary aim was to assess the efficacy of sertraline and cognitive-behavioral group therapy for treatment of depressed primary care patients, secondary aim was to evaluate if receiving treatment according to free choice is associated with a better outcome than randomization to a particular treatment. We conducted a randomized, placebo-controlled, single-center, 10-week trial with five arms: sertraline (flexible dosages up to 200 mg/day) (n=83); placebo (n=83); manual-guided cognitive-behavioral group therapy (1 individual session and 9 group sessions per 90 minutes) (n=61); guided self-help group (control condition (n=59); treatment with sertraline or cognitive-behavioral group therapy according to patients’ choice (n=82). From 1099 consecutively screened adult patients, 368 formed the intent-to-treat population with milder forms of depression. Primary outcome was a global efficacy measure combining z-converted Hamilton Depression Rating Scale and clinician-rated Inventory for Depressive Symptomatology. Sertraline was superior to placebo (p = 0.03). Outcome for guided self-help groups was worse compared to cognitive-behavioral group therapy (p = 0.002) and compared to all other treatment arms including pill placebo (secondary analyses). Outcome in the patients’ choice arm was similar to that in the sertraline and cognitive-behavioral group therapy. Overall, sertraline is efficacious in primary care patients with milder forms of depression. The superiority of cognitive-behavioral group therapy over guided self-help groups might partly be explained by “nocebo” effects of the latter.

This workshop will describe the methods and results of a small RCT of active music therapy, and discuss some of the challenges of conducting outcome studies in this treatment modality and how to overcome them.

Following a successful randomized controlled trial (Röhricht & Priebe 2006, results will be briefly reported), another trial was conducted aiming to investigate as to whether body oriented group psychotherapy (BOPT) will be effective in chronic schizophrenia under “real-life” clinical conditions in order to establish the effectiveness of this novel intervention. The therapy was provided by three different therapists at two different outpatient sites in London, and the therapists were all trained to administer a manualised approach. Data regarding main outcome criteria (PANSS negative symptom scores) and secondary outcome measures (Social Functioning scale and Quality of Life scores) as well as mediating factors and processes under therapy (Differential Emotional Scale) will be reported.