For years, addiction prevention was centered on substance abuse. This focus has shifted recently, especially in regard to children and teenagers, with a growing concern on potentially knotty behaviors, namely gambling and computer, Internet or video game abuse. With the recent soar and availability of the new technologies, it is however extremely difficult to assess which kind of behavioral patterns can be considered as normal, or not, in the contemporary teenage population. To gather benchmark results, we therefore initiated two nationwide surveys, reaching all the students enrolled in the public or private high schools in the Grand Duchy of Luxembourg.

The first survey aims at assessing the frequency and modalities of gambling in Luxembourg's high school students. These data will be especially relevant for the pending legislative discussions whether the national gambling regulations should include a paragraph about the protection of minors or not.

The second survey aims at assessing multimedia use by Luxembourg's high school students. These questions not only inquire the accessibility to various technologies, but also try to depict teenagers’ daily behavior and use of the available technologies. The main objective of this survey is to assess to which extend the technologies are used in different tasks (i.e. work, communication, leisure), but also to appraise whether this population has pleasing access to the current media.

Schizophrenia is an ethologically heterogeneous disorder with a complex gene environment interaction as the most likely cause. A number of susceptibility genes, such as DTNBP, NRG1, DISC1, G72 and others have been identified. However their pathophysiological mechanisms are not yet fully understood. Further, a number of environmental factors (birth complications, cannabis abuse, etc) have been replicated as risk factors. Traditionally, Schizophrenia is being diagnosed according to psychopathological criteria. Yet, there is little data on the interaction between etiological factors, psychopathology and brain function/structure. On the behavioural level, psychopathological symptoms can hardly separate the many pathophysiological subgroups. Contrary to nosological categories, biologically based phenotypes - referred to as intermediate phenotypes - consisting of neuropsychological, electrophysiological, functional and structural brain imaging parameters, could represent the etiological basis more directly, but these findings have to be linked to psychopathology. In this presentation, we will try and bridge the gap between these levels of description in an attempt to disentangle nosological and dimensional features of psychosis.

Promotion, prevention and early intervention (PPEI) are now part of the jargon in health policy statements, but accommodating this in conventional health and mental health services is proving difficult. Effective collaboration across services in mainstream health, psychiatry, other social agencies and into the community is not easily accomplished. One fundamental problem is that the terms: “early intervention” and “mental health” are defined differently by different disciplines and specialties; another is that underlying issues for the woman and family are poorly understood. In addition, there are many silos, stakeholders, egos and agendas, and much competition for funds. For best PPEI results in the perinatal field, these barriers must be overcome. An inclusive model of service delivery being implemented in both public and private health systems in several States in Australia will be described and the resistances discussed.

Contrary to the previously spread myth, pregnancy does not protect women from either relapses of previously diagnosed psychiatric illness nor development of new ones. Prevalence of psychiatric illnesses during pregnancy is similar to that in the general population, whereas that number significantly increases in the postpartum period. Peripartum has its own uniqueness for both etiology and presentation of different psychopathological conditions.

Multiple studies have been published describing affective, anxiety, and psychotic illnesses in peripartum. Specific psychosocial circumstances during that time along with multiple physiological changes occurring in female body in that reproductive period predispose women with and without previous psychiatric histories, to various psychiatric illnesses. Several potential contributing factors for these phenomena have been proposed so far. One of the most frequently studied ones has been the drastic hormonal shift occurring during peripartum that could directly increase the sensitivity for developing mood instability, anxiety and/or psychotic symptoms. Genetic predisposition and previously existing psychiatric disorder especially those occuring during specific reproductive phases significantly increase the risk as well. Presentation of psychiatric illnesses during peripartum has its’ particularities which are essential to understand of in order to provide an appropriate care.

Being aware of the potential etiology and risk factors as well as sensitivity to psychopathology of some women in peripartum could greatly improve treatment as well as open up avenues for prevention in this area. Unrecognized and untreated psychiatric illnesses in peripartum have serious consequences.

Psychiatric disorders are relatively common among women of childbearing age, who may become pregnant while they are taking psychotropic drugs. There remains a high level of anxiety regarding their safety among women and healthcare providers alike, most likely because of the conflicting studies that have been published in the literature and warnings from government organizations. In addition, most recently in the case of paroxetine, a successful lawsuit against the manufacturer, holding them responsible for a baby born with a heart defect, following use of the drug by the mother in the first trimester of pregnancy. Consequently, treating a psychiatric disorder during pregnancy with pharmacotherapy, is a complex decision making process, which has to be made between the pregnant woman and her health care provider following careful evaluation of the evidence-based information.

The objective of this presentation is two-fold,

1. 1) to discuss models used for studying the use of drugs in pregnancy and

2. 2) to provide current information on the safety/risk of psychotropic drugs used in pregnancy.

The body of evidence in the literature to date suggests that psychotropic drugs as a group are relatively safe to take during pregnancy and women and their health care providers should not be unduly concerned if a women requires treatment. Optimal control of the psychiatric disorder should be maintained during pregnancy, the post partum period and thereafter. All pregnancies where a mother has a serious psychiatric disorder should be considered high risk and the mother and fetus, carefully monitored.

Treatment with antipsychotic drugs is, despite the introduction of many new compounds, far from optimal in a large proportion of patients. Apart from lack of or insufficient response, various adverse drug reactions often limit the use of otherwise efficient drugs, and increase the risk of non-compliance and poor treatment outcome. Thus, there is considerable need for individualized treatment in order to maximize the therapeutic outcome. This variability in drug response may be related to both pharmacokinetic and pharmacodynamic factors, many of which are genetically regulated. In the presentation, the contribution of allelic variability in genes coding for drug metabolic enzymes (CYP2D6, CYP1A2 and others) and transport proteins (ABCB1), as well as drug targets, to the pharmacokinetics and clinical effects of atypical antipsychotics will be discussed, using olanzapine and clozapine as model drugs. While CYP2D6 had no influence, carriage of two CYP1A2 allelic variants was associated with higher dose-adjusted plasma concentrations of clozapine and its metabolite desmethylclozapine. Patients with elevated insulin levels more frequently carried the *1C and *1D alleles, had higher plasma drug levels, higher blood lipids and HOMA-IR compared to patients with normal insulin levels. Associations were found between HTR2C and HTR2A haplotypes and increased BMI and C-peptide levels. A HTR2C haplotype was also shown to be significantly more frequent among obese than non-obese patients on long-term clozapine treatment. The data illustrate the need of an integrated approach involving both pharmacokinetic and -dynamic aspects in pharmacogenetic studies aiming at personalized antipsychotic treatment.

Pharmacogenetics in schizophrenia comprises pharmacokinetical and pharmacodynamical aspects as well as an approach to identify candidate genes associated with therapy response or side effects. Firstly focussing on classical drug targets like dopaminergic or serotonergic receptors, currently also developmental and regulatory genes presumably associated with effects of antipsychotic therapy are identified. The aim of this study was to investigate associations between therapy response in schizophrenic patients and different polymorphisms previously been identified within a genome wide array in rodents treated with MK-801 and/or haloperidol combined with some well-known schizophrenia candidate genes. We genotyped for 200 different polymorphisms in 285 schizophrenic patients, who were treated with different antipsychotics within randomized controlled trials. Psychopathology was measured weekly using the PANSS scale. Correlations between psychopathology and genotypes were calculated by using a linear model (ANCOVA).

We found significant associations between some well-known candidate genes (e.g. D2-, 5HT1A-, and α1A-receptors) and different PANSS subscales at baseline and after four weeks of antipsychotic treatment considered as therapy response. Furthermore we also identified several significant associations between some genes introduced from the animal model and psychopathology at baseline and towards therapy response. Some of them were formerly described in the literature (e.g. Homer1, Phospholipase C and Transthyretin), but most of them have not been related to schizophrenia or antipsychotic treatment by now (e.g. PLEKHA6, CLIC6 and SOSTDC1).

This indicates an involvement of genes in the pathophysiology of schizophrenia apart from yet known candidate genes and might further help in detecting differential therapy response in individuals with schizophrenia.

The vast majority of alcoholics consumes coffee as well as tobacco in addition to alcohol. The present study investigated the effects of these two psychotropic substances on the alcohol withdrawal syndrome. Therefore, personal structured interviews were performed in 128 alcohol-dependent women and men who were admitted to hospital for alcohol detoxification. They all regularly consumed tobacco and caffeinated coffee. Quantity and frequency of their consumption patterns were recorded. The severity of their alcohol withdrawal syndrome was measured using a validated scale.

A multiple regression analysis revealed a significant positive correlation between quantity of alcohol and the severity of alcohol withdrawal. In addition, we could demonstrate that not only the quantity of alcohol consumed, but also tobacco and coffee consumption influenced the severity of the alcohol withdrawal syndrome. The more the patients smoked and the more coffee they drank, the less they suffered from withdrawal symptoms during alcohol detoxification.

1. 1. Psychotropic medications and use of other treatment modalities for major psychiatric disorders in pregnancy. Victoria Passov, M.D.

2. 2. Chemical dependency issues in pregnancy and treatment modalities currently available. Catherine Friedman, M.D.

3. 3. Developmental outcomes on children born to mothers with psychiatric illness: complications in children of mothers who received treatment for their psychiatric conditions during pregnancy, as well as developmental and psychological consequences in kids born to untreated mothers will be discussed. Leo Passov, M.D.

4. 4. Psychology of reproductive loss and guidelines for helping families cope with the trauma of a miscarriage or stillbirth. We will discuss what makes reproductive loss unique and the physical and psychological sequelae that women experience after the loss of a pregnancy. Jennifer Alt, M.D.

The relationship between films and psychiatry remains an ambivalent one. Mentally ill patients are often portrayed unsympathetically in a comic, villainous or inaccurate manner; and film makers often see their responsibility towards financial aspects rather than educational direction. Increasingly, films are being used for training medical students and trainees in psychiatry. Films can also be used to study therapeutic relationships between therapists and patients, especially observing transference and counter-transference. The portrayal of mental illness in films can be negative for a variety of reasons: stigma, lack of knowledge and understanding with a focus on entertaining rather than on educating. The portrayal of ECT and leucotomy and associated negative connotations have increased stigma against mental illness and even led to a reduction in the prescription of these treatments. Using films to teach is relatively recent in the UK compared with the USA, where couple therapists have used films with their patients in therapy to illustrate relationship difficulties and potential solutions. ‘Cinematherapy’ as a term has been used to work with teenagers to deal with relationship and individuation issues. An advantage of using films in teaching mental illness is that their use does not involve the confidentiality of a real patient. In addition the ‘patient’ can be seen interacting with others, giving a clearer understanding of the impact of the illness on others. Unlike clinical consultations in very narrow settings focussing on symptoms and treatment which are time limited, films can be used to learn about cultures and their embedded values.

According to the Jasperian model, phenomenology ‘gives a concrete description of the psychic states which patients actually experience and presents them for observation’ (Jaspers, General Psychopathology, 1963, 44). Narrative cinema is arguably no less phenomenological in that it employs a phalanx of aesthetic strategies (visual design, framing, editing, camera angle, point of view) to materialise subjective consciousness and thereby facilitate the process of emotional identification with onscreen characters. But in representing psychosis, most popular cinema resorts to a shorthand of Expressionist cliché and crudely objectifying stereotypes. We suggest that the concern for clinicians and responsible filmmakers is much the same: how to treat psychotic conditions empathetically, testing empirical understanding and knowledge against ‘first-person’ accounts of mental illness. Our paper focuses on a case study of a short film in production. Sal Anderson's observational fiction Froth: Whose Drama is it Anyway? juxtaposes the media-fed public perception of epilepsy with its subjective experience. During shooting, the neurological condition was explored through a series of improvisatory workshops where people with epilepsy re-enacted and then reflected on the stages of a seizure. This methodology is proposed as a template for the development of alternative strategies in the portrayal of psychosis on film. Finally, we offer a speculative link between Jaspers’ notion of the ‘ununderstandable’ in relation to psychosis and the intractably resistant nature of the cinematic image.

Schizophrenia, epiphany and Kafka's “The Trial”K. Conrad wrote Die beginnende Schizophrenie in 1958, but his description of the psychopathology of schizophrenia and his concepts of schizophrenia are still very enligthning to contemporary readers. One of several important concepts described is that of epiphany. In his description he stressed that this was a way of experiencing the whole world, perceptions, emotions, notions, etc. The schizophrenic patient not only experiences that every thing has a certain meaning attached to it, also this meaning has something to do with the patient. Nothing seems to be coincidential, but on the contrary seems to be specifically important for the patient. This sudden, intuitive perception of or insight into reality or essential meaning of the world resembles the experience of a revelation (=epiphany from ancient Greek). This way of experiencing/living in the world feels so “natural” to the patient, that he never questionswhat is obvious discrepancies and incompatibilities to others.Frans Kafka has been called the best descriptor of the schizophrenic world. His novel The Trial (Der Prozess) is commonly viewed as a description of bureaucracy, but can also be seen as a matchlessly description of the schizophrenic world. In the film the spectator sees every thing through the eyes of Joseph K and thereby has the opportunity to a first person experience of the self-reference, oddness and inconsistencies of the schizophrenic world. This brings the notion of epiphany to the lived world of the spectator.