Multiple terms have been used to describe excessive and interfering patterns of non-paraphilic sexual behaviors including sex addiction, compulsive sexual behavior (CSB) and hypersexual disorder (HD). While a field trial was conducted to investigate the reliability and validity of the criteria for HD, the condition was not included in DSM-5, with this decision in part relating to insufficient data on the proposed condition. Currently, CSB is being considered as a diagnostic entity in the category of impulse-control disorders for ICD-11. In this presentation, we will present data relating to HD/CSB. In particular, we will discuss current issues relating to diagnosis and classification, as well as data regarding the assessment and clinical correlates of sexually relevant constructs (e.g., pornography use and craving). Data relating HD/CSB behaviors to sexual risk-taking, sexually transmitted diseases and mental health problems (including suicidality) will be presented. A strategy for addressing HD/CSB in clinical settings will be proposed and discussed.

Most people recognize that incarceration alone will not solve sexual violence. Indeed, treating the offenders is critical in an approach to preventing sexual violence and reducing victimization. In most cases, a diagnosis of paraphilia is associated with sexual violence. This review is intended to present and summarize the first recently published international guidelines about pharmacological treatment of paraphilias. Pharmacological interventions should be part of a more comprehensive treatment plan including psychotherapy and, in most cases, behavior therapy. Antiandrogens, and mostly GnRH analogues, significantly reduce the intensity and frequency of deviant sexual arousal and behavior. GnRH analogue treatment constitutes the most promising treatment for sex offenders at high risk of sexual violence, such as pedophiles or serial rapists, however informed consent is necessary. SSRIs remain an interesting option in adolescents, in patients with depressive or OCD disorders, or in mild paraphilias such as exhibitionism.

With the strong focus on terrorism in recent years, there is an increasing concern that the fundamental rights of refugees and asylum seekers may be violated in the interest to combat acts of terrorism. It may also lead to increasing racism and discrimination towards these populations.

Racism and discrimination encompass the negative stereotypes and prejudicial beliefs that people may hold, as well as inequitable practices that may result hereof.

Knowledge about the mental health consequences of racism and discrimination is of clear clinical relevance for psychiatrists worldwide, as a significant proportion of psychiatric patients will have a background as refugees and asylum seekers. Many of them have experiences of war, strife, persecution and torture that further ads to their mental distress.

The paper will outline the psychiatric symptomatology related to racism as well as ethical dilemmas and educational needs for the psychiatric profession.

Further the role of national psychiatric associations in combating racism and discrimination by e.g. defining best practices and revising medical training curricula will be outlined.

http://www.mariannekastrup.dk/

Discrimination could be defined as the attitudes and behavior based on the group differences. Any group acknowledged and proclaimed as ‘the other’ by prevailing zeitgeist and dominant social powers, and further dehumanized may become the subject of discrimination. Moreover, internalized discrimination perpetuates this process. In a spectrum from dislike and micro-aggression to overt violence towards ‘the other’, it exists almost in all societies in varying degrees and forms; all forms involving some practices of exclusion and rejection. Hence, almost all the same human physical and psychosocial characteristics that constitute the bases for in-group identities and reference systems could also become the foundations of discrimination towards the humans identified as out-groups. Added to this, othering, arising from imagined and generalized differences and used to distinguish groups of people as separate from the norm reinforces and maintains discrimination.

Accordingly, discrimination built on race, color, sex, gender, gender identity, nationality and ethnicity, religious beliefs, age, physical and mental disabilities, employment, caste and language have been the focus of a vast variety of anti-discriminatory and inclusive efforts. National acts and international legislative measures and conventions, political and public movements and campaigns, human rights movements, education programs, NGO activities are some examples of such anti-discriminatory and inclusive efforts. All these efforts have significant economic, political and psychosocial components.

Albeit the widespread exercise of discrimination, peoples of the world also have a long history of searching, aiming and practicing more inclusive ways of solving conflicts of interests between in-groups and out-groups. This presentation will mainly focus on the psychosocial aspects of the anti-discriminative efforts and search a room for hope and its realistic bases for a more non-violent, egalitarian and peaceful human existence.

Alcohol dependence is a chronic disorder with frequent relapses during recovery. Most studies have pointed out that craving is the main process involved in relapse, but recently other factors have been implicated in it, such as attentional bias and impulsivity. Some authors consider that different stages could be involved in the relapse process, and each may be governed by different mechanisms: Attentional bias; motivational response to alcohol cues and inhibitory control.

Motivationally salient cues attract and hold selective attention, and this “attentional bias, (AB)” is related to individual differences in appetitive and aversive motivation. In a recent review, attentional bias has been shown to be significantly present in alcohol-dependent and is associated with craving and risk to a relapse in alcohol consumption.

In alcohol-dependent subjects, alcohol-related cues reach a very high motivational valence (Motivational response, MR), which, in effect, increases craving for alcohol and activates behavioral strategies towards alcohol intake. One method used to assess motivational valence of alcohol is the craving self-assessment. In addition, in recent years, the affective modulation of the startle reflex has been used as an objective measure of craving. It has been shown that subjects with a low baseline startle response when viewing alcohol-associated pictures are at major risk of relapse compared to those with increased reactions.

Once alcohol craving has appeared, the subject will either drink or not, depending on his ability to resist his behavior towards alcohol consumption (impulsivity or inhibitory control, IC). Moreover, subjects that exhibit greater impulsivity are those more likely to relapse.

Our group has recently conducted a study on a sample of 172 alcohol-dependent patients seen in outpatient therapeutic program during 12 weeks. All of them were assessed with the following measures: Attentional bias was assessed using the dot task, motivational response was evaluated using the affective modulation of the startle reflex paradigm, inhibitory control was assessed by the stop-signal reaction time task. Alcohol relapse variables were: relapse, days to the first relapse and days of accumulated abstinence.

One of the most relevant results was that processes related to inhibitory control (Stop-signal reaction time and attentional bias) were the most relevant measures to explain variables related to relapse in alcohol consumption during the treatment period.

Our results support the use of assessment strategies, therapeutic and pharmacological inhibtoria aimed at improving the ability of serious alcohol-dependent patients.

Social impairment is recognized as a basic aspects of schizophrenia. Although the nature of aberrant self-other relationship in schizophrenia is still poorly understood, it has been suggested that some social impairments could have their roots in self-disturbances typical of schizophrenia. For instance, experiencing otherness could become problematic with anomalous self-recognition. Furthermore, deficits in the processing of self-relatedness of social stimuli disconnect the self from its social environment. On the one hand, this could lead to problems in self-other distinction caused by misattributions of ownership of experience and agency in social interaction. On the other hand, this could result in feelings of isolation and reduced intersubjectivity due to interrupted self-referential processing of social stimuli, likely also mediated by memory and emotion. Brain networks involved in self-referential processing, sense of ownership, and agency also have been implied in social cognition. Whereas cortical midline structures are associated with self-referential processing of external stimuli including social information, sensorimotor and affective networks involved in bodily and interoceptive self-processing are also involved in the ability to share others’ experiences. Schizophrenia has been linked with a reduced integrity of these networks underlying various aspects of self and social impairments, though rather separately. Recent neuroimaging findings will be highlighted explaining how self-disturbances can pervade the social domain in schizophrenia. In particular, disruptions of the social self in schizophrenia will be addressed from a neuronal network and connectiomics perspective providing a unifying framework.

The self is central in our mental life and disturbances of the self-figure most prominently in psychopathological symptoms. The cortical midline structures (CMS) have been associated with self-related processing and its changes in schizophrenia, depression and other psychiatric disorders. However, the exact neuronal mechanisms underlying self-related processing in CMS and its changes in psychiatric disorders remain unclear. Especially the neural overlap between high resting state activity levels and self-related processing in CMS is rather puzzling. I present recent data on the rest-self overlap in healthy subjects showing that resting state activity in CMS can predict self-relatedness. The implications for psychological symptoms as in depression and schizophrenia are pointed out.

There has been little research into the effects of menopause on symptoms, social and cognitive functioning in women with schizophrenia, and the results are controversial. The most replicated finding is that late-onset schizophrenia is more prevalent in women than in men and that this fact appears to be related to the diminution of estrogen levels during menopause.

Estrogens have a known protective effect on CNS. Animal research has shown that estrogen has a modulating effect on the dopaminergic, glutamatergic and serotonergic systems.

There are concerns about long-term use of sexual hormone therapy in postmenopausal women with regard to breast cancer risk, and the use of the selective estrogen receptor modulators (SERMS's) can be a better option.

Raloxifene is a SERM that is used in the preventive treatment of postmenopausal osteoporosis and has no effect in the breast and uterus. A number of studies seem to indicate that raloxifene acts on brain dopamine and serotonin systems in a similar way to conjugated estrogens.

In this presentation, I will show the results of some clinical trials that have studied the efficacy of raloxifene as a coadjuvant treatment of patients with schizophrenia. Our team has done two clinical trials that studied the efficacy of 60 mg of raloxifene for the treatment of negative symptoms in postmenopausal women with schizophrenia. Our results showed that raloxifene improved the negative symptoms better than placebo. We concluded that raloxifene seems to be a promising option to treat some patients with schizophrenia.

Oxytocin is a neuropeptide that is synthesized in the hypothalamus. It acts as a central neurotransmitter, as well as a peripheral hormone. It is called also trust hormone or love hormone. Because of its anxiolytic, pro-social and social cognitive enhancing effects, oxytocin has been suggested as a promising novel treatment for patients with social anxiety disorder. However, controlled research is small and the studies’ results are inconclusive. I will present the results of several studies with several recommendations about the role of oxytocin in social anxiety disorder. Whereas oxytocin shows some promising effects in resistant cases, of course the preferred agents are SSRIs, SNRIs and CBT.

The diagnosis of social anxiety disorder (SAD) has seen substantial changes in the last 35 years from its first appearance in the DSM-III in 1980 up to the most recent ones in the DSM-5. Throughout all these changes, this disorder, previously called social phobia, is still considered one homogenous entity with only one specifier (“performance only”) introduced in the DSM-5 revision with specific fears or associated personality profiles not being considered relevant clinical markers to define SAD subtypes. However, our therapeutic experience suggested substantial particularities associated with the fear of blushing in patients with SAD. Some patients presenting this profile, historically called “erythrophobia”, seem to have a very specific type of social anxiety that does not include shyness and other characteristics of classical SAD. In a study conducted in a sample of 450 new consecutive outpatients seeking treatment for SAD, we compared 142 subjects with fear of blushing without other social fears, 97 subjects with fear of blushing with other associated social fears and 190 SAD subjects without fear of blushing. The group with pure fear of blushing presented a different profile when compared with the two other groups: later age of onset, less comorbidity, lower behavioral and temperamental inhibition, i.e. less shyness, and higher self-esteem. Furthermore, from a therapeutic point of view, some specific strategies such as the Task Concentration Training have shown to be particularly effective in fear of blushing. We will further argue the validity of a possible “fear of blushing” subtype of SAD.

Subthreshold psychotic experiences are widely reported within otherwise healthy populations. Their phenomenology is broad and very heterogeneous ranging from meaningful coincidences and precognitive dreams over haunting to out-of-body experiences and visual as well as auditory hallucinations.

Although creative aspects of these experiences are implied too, a similarity in form and content to positive symptoms in schizophrenia (e.g., delusion, disordered thought, and hallucinations) or schizotypy (e.g. magical thinking, unusual perceptual experiences, ideas of reference or paranoid ideation) seems to be obvious. However, the borderline between normal and pathological experiences and behaviour is unclear.

The so called “continuum approach” assumes that schizophrenia or schizotypy are not discrete or categorical illness entities. It implies a gradient in the severity of the symptoms, ranging from healthy population to full-blown schizophrenia. As such, psychotic signs are no longer restricted to formal diagnoses according to DSM or ICD, but would, instead, complete the spectrum of psychological and biological features that characterize individual variations among human beings.

Can subthreshold psychotic experiences be integrated in this continuum? Do individuals indicating such experiences lack some social cognitive abilities and are particularly vulnerable to false inferences in their social world. How are these experiences related to increased neural activity or an abnormal dopaminergic neurotransmission?

These and similar questions will be discussed in the presentation.

There are only a few studies that have studied the prevalence of psychotic experiences (PEs) in a representative population-based sample and a broad range of age. The association and predictive role of PEs in the context of psychotic and other mental disorders remains a subject of discussion. The Mental Health Module of the German Health Interview and Examination Survey for Adults is the first wave of a German health monitoring survey describing:

– the distribution and frequency, the severity and the impairments of a wide range of mental disorders;

– risk factors as well as patterns of help-seeking and health care utilization;

– associations between mental and somatic disorders.

A total of 4483 participants participated in the mental health section of the survey. The Composite International Diagnostic Interview, the Launay-Slade Hallucination Scale and the Peter's Delusion Inventory were used to assess PEs by clinically experienced interviewers. We can confirm and extend previous findings for younger age groups that PEs are very frequent psychopathological expressions in the general population across genders and all age groups. PEs rates were elevated among those with other mental disorders, particularly among possible psychotic disorders, PTSD and affective disorders. This points to the relevant role of PEs as a marker for psychopathology and mental disorders. Future prospective studies will have to focus on specific properties of psychotic experiences such as their appraisal or underlying social influences to determine their significance for the prediction of psychotic and other mental disorders.