Psychogeriatric patients frequently suffer from comorbidities such as dementia, depression, and somatic diseases. In addition, patients with dementia often display a heterogeneous group of symptoms, the Behavioral and Psychological Symptoms of Dementia (BPSD), for which both pharmacotherapy with several drugs and non-pharmacological treatments are recommended. They are frequently comedicated with different psychopharmacological agents including antidepressants, antipsychotics, anxiolytics, hypnotics, cognitive enhancers, and Li, antipychotics and anticonvulsants used as mood stabilizers. In addition, somatic drugs are co-prescribed for the treatment of other concomitant diseases. As a consequence, these patients, who are characterised by an increased sensitivity to adverse effects, by a lowered homeostatic reserve and by decreased compliance are nonetheless often exposed to complex drug regimes. Such patients are therefore vulnerable to pharmacokinetic and pharmacodynamic interactions with severe clinical consequences. Studies in very old patients (> 80 y) are often lacking. Therefore, treatment needs to be carefully and individually tailored. Therapeutic drug monitoring may be a useful tool to optimise treatment, as some ‘classical’ indications apply for this population: Lack of compliance, adverse effects despite the use of generally recommended doses, suspected drug interactions, combination treatment with a drug known for its interaction potential, patients with pharmacokinetically relevant comorbidities (hepatic or renal insufficiency, cardiovascular disease). The increasing knowledge on the role of cytochrome P-450 isozymes in the metabolism of drugs and their interaction potential has fortunately led to a situation, which allows, to some extent, predicting risks for adverse effects after introducing a polymedication.

The treaty of Rome aimed at the realisation of free exchange of persons, services, goods and capital all over Europe.

The need for mutual recognition of basic and specialist medical qualifications was very quickly recognised. The European Directive 93/16/EEC (1993) established the most recent legal basis for it.

Ever since its founding in 1958 the Union Européenne de Médecins Spécialistes - official name for the European Union of Medical Specialists - has been standing for high standards in postgraduate training (PGT), Continuing Medical Education and Professional Development (CME and CPD) and Quality Assurance. Only these elements will be able to provide patients witht high quality care all over Europe.

This presentation will highlight main past and future strategies of the UEMS Section of Psychiatry in view of increased migration after the major political changes in Europe during the early nineties of last century.

The EFPT (European Federation of Psychiatric Trainees) is the first and only Federation of medical trainee associations, to our knowledge.

It is composed of 38 member associations from 35 countries across Europe. With 22 years of experience it is well placed to comment on training issues and of those transversal to a large number of countries, such as mobility and its impact on healthcare.

One of EFPT's current main activities is the Exchange Programme which is trainee-led and was created in order to facilitate mobility during training. For over 10 year trainees from Europe have identified mobility as need in training, acknowledged in EFPT statements. But is was only in 2011 that the Programme was established with the objective to provide trainees with opportunities to:

1. - Promote awareness of intercultural aspects of Psychiatry

2. - Engage in clinical, and/or research, and/or teaching activities

3. - To become acquainted with different mental health systems

4. - To gain experience of different illness manifestations and treatment options

5. - To experience a different training programme

6. - To socialise with peer group, promote networking and discuss coping strategies regarding work life balance

There are 11 countries offering vacancies (Fig. 1). To date, 44 exchange placements were completed and by December it is expected there will be 61 (Fig. 2). Feedback has been overly positive.

Training is the core of excellence in healthcare. By equipping trainees with additional skills through mobility during training, we believe we are contributing to improving mental healthcare globally.

The suicide rate has been traditionally high compared to countries of the European Union. The rate increased during decades after second world war until the early 1990's. Moreover, the suicide rate has followed closely the alcohol consumption rate. A national suicide prevention project was carried out in the late 1980's, which had the intent to increase access to low-threshold services and specialized psychiatric care. Physicians and psychiatrists were educated in the recognition of depression at a time when novel antidepressants were introduced and secondary level services were deinstitutionalized.

Greenland is the largest Island in the world with a spare population. This huge island with it's spare population has a major challenge to the health care program. Although every settlement with more than 50 inhabitants, today are able to talk to a psychiatrist by using the telecommunication system it is not unimportant wheter the patient speaks to a psychiatrist with the same cultural background and who speaks the same language or the psychiatrist needs an interpreter.

The presentation will give you an insight into the importance of using Telepsychiatry in Greenland. What it means for the people, that we are now ready to reach them, although they living isolated. and what does it mean in general sense to the community.

SUPREME is a mental health promotion programme, which comprises a multi-language, culturally adapted, highly interactive website accessible to the general public that is particularly aimed at adolescents. The general objective of the programme is to enhance and improve the mental health and well-being of European adolescents through developing, strengthening and sustaining Europe's scientific community. Subsequently, the contribution of the proposed project to European society is multifaceted: it provides a common goal amongst leading research centres across Europe to improve the mental health and well-being of its adolescent citizens; it supports the utilization of state-of-the-art technology for mental health promotion; and significantly enhances mental health research and collaboration amongst Europe's leading scientific centres. The project will started in 2010 and has a duration of 42 months. NASP at Karolinska Institutet is the leading center. Associated partners are based in Italy, England, Spain, Lithuania, Estonia and Hungary. The project is cofunded by DG SANCO (60%) and the consortium (40%).

The long-term benefits realized by this project comprise evidence-based information on the most effective methods in Internet-based mental health promotion to reach the most vulnerable adolescents in need; and ultimately improve adolescents’ mental health and well-being by reducing depression, anxiety, conduct disorder, and other mental ill-health symptoms. The objectives of the programme are developed to be efficient and practical for successful implementation in authentic and real-life settings. The target group for the project are adolescents and young adults aged 14-24 years. This population was chosen on account that mental health problems identified in adulthood are often developed and progress during childhood and adolescent years. Research suggests that mental health problems are rapidly increasing, from being 12% of the total burden of disease, with projections of up to 15% by 2020 (WHO 2003). Mental health problems, such as depression, anxiety, and conduct disorder that persist without treatment establish a foundation for adolescents’ pattern of behaviour and life choices. The transition between adolescence and adulthood is a fundamental period for ascertaining current and future health status for an individual. Therefore, targeting vulnerable adolescents and promoting mental health is vital in preventing future mortality and morbidity associated with mental health problems. During the presentations the main results of the SUPREME project will be described.

Current evidence-based guidelines for generalized anxiety disorder (GAD) tend to recommend initial treatment with either a selective serotonin reuptake inhibitor or a serotonin-noradrenaline reuptake inhibitor, although there is also good evidence for the efficacy of pregabalin and quetiapine. NICE guidelines recommend that cognitive behaviour therapy is reserved for patients not responding to initial interventions based on self-help and psychoeducation. The findings of a mixed treatment comparison and meta-analysis demonstrate the difficulty in establishing the relative efficacy and tolerability of pharmacological treatments. It is hard to predict which patients will respond well to pharmacological treatment, but response to antidepressants or pregabalin is unlikely if there is no onset of effect within four weeks. The value of combining pharmacological with psychological interventions is uncertain. The small number of relapse prevention studies causes uncertainty about optimal duration of treatment after a satisfactory initial response, but continuing treatment for at least twelve months is advisable. However many patients will not respond well to current interventions, and there is much room for improvement in the development of more effective and better tolerated treatments. Challenge studies in healthy volunteers, involving the inhalation of air ‘enriched’ with 7.5% CO2 provide a robust experimental medicine model of GAD and are being used to evaluate novel pharmacological and psychological interventions. In addition, advances in understanding of the potential role of neuroinflammatory factors in GAD also suggest other potential targets for pharmacological treatment.

Efforts focused on prevention and early intervention may have a significant impact on public health by avoiding onset of mental illness and limiting severity of onset. The European project ProYouth investigates the potential of an Internet-based program in the prevention and early intervention of eating disorders where we know that only a minority of affected individuals seek professional help and additionally we often see a substantial delay between symptom onset and the uptake of treatment.

The functions of the ProYouth online platform are a) to raise awareness and to educate about eating disorders, b) to provide individualized feedback on eating disorder related attitudes, behaviours, and symptoms, c) to provide peer support and professional support online, and d) to refer individuals to regular professional healthcare if online support is not sufficient. These functions should allow for an early detection of eating disorder related impairment, early intervention via the Internet as well as timely access to regular care if necessary.

Via various dissemination channels (e.g., Internet, print media, social media, workshops), more than 100.000 young people have been informed about the ProYouth initiative in six European countries, more than 15.000 have used the online screening tools and more than 6.000 have registered to get full access to the information and support modules of the platform.

Findings confirm poor mental health literacy, shame, and stigmatization of eating disorders as barriers in the helpseeking process and point to the potential of the ProYouth platform in overcoming such barriers.

There are several neuropsychological deficits found in anorexia nervosa (AN) patients. These include impairments of visuospatial ability and memory, set-shifting deficits, weak central coherence, and impaired decision making. Cognitive remediation therapy (CRT) for AN was devised to target these main cognitive impairments, especially the deficient set-shifting and weak central coherence. Utilizing our experience with CRT for AN inpatients and with multifamily therapy for eating disorders, we have developed a family-based cognitive remediation program for anorexia nervosa. Eight families participated in our pilot study, including parents and daughters with anorexia nervosa. Our aim was to assess feasibility and acceptability of the intervention. We describe the first results of quantitative and qualitative evaluation of the program, and suggest modifications for future use.

Organic schizophrenia, or schizophrenia-like syndrome is an important concern in psychiatry and various medical conditions and substances may be associated with it. Among them, Inborn Errors of Metabolism (IEM) are rare disease with interesting features : (i) some of them could be (or seems to be) presenting with schizophrenic psychiatric symptoms; (ii) when they are treatable, treatment leads to decrease schizophrenic symptoms; (iii) treatment is more efficient when beginning at early stage (i.e. before neurological or physical signs) and (iv) most psychiatrists have no specific knowledge about IEM. Moreover, IEM is a growing field in medicine because of improvement of biochemical and genetic techniques and new treatments are approved. Incidence is underestimated and psychiatric patients may be an at risk population. We propose a brief and comprehensive review of the literature focuses on treatable IEM with possible presenting psychiatric signs (Cerebrotendinous- Xanthomatosis, Wilson Disease, homocysteimia due to MTHFR deficiency, homocystinuria due to cystathionine beta-synthase deficiency, urea cycle disorders and Niemann Pick type C). We also present a simple diagnosis tool helping psychiatrist and caregivers in this field. The key objective is to devise a simple means of identifying patients with atypical psychiatric symptoms and to: (i) know when schizophrenic symptoms may be atypical and should draw our attention to organic disease, and IEM and (ii) learn which physical and neurological signs may trigger for each of the specific IEM. Looking for atypical signs of psychosis or minor physical signs may be extremely useful in rare cases of treatable disease.

Recent research in bipolar disorder points at the relevance and persistence of cognitive deficits in bipolar patients (BPD) even beyond acute episodes of depression or mania. Impairments were found in attention, processing speed, memory and executive functioning. Up to now, the mechanisms, why some BPD do not reach their former level of cognitive performance and psychosocial functioning, while others are remitted completely, is not understood. In this study we aimed to identify a’deficit vs. nondeficit subgroup’ within BPD. For this purpose, we investigated the association between demographic and disease specific variables and the cognitive performance of BPD. The test performance of 70 remitted outpatients (Bipolar-Type I and II) was compared to 70 healthy controls (HC). Participants performed an extensive neuropsychological test battery.

As expected our sample of euthymic BPD performed significantly worse than HCs in three of eight cognitive domains, namely Planning, Cognitive Flexibility and Divided Attention. In line with previous findings, more than a half of the euthymic BPD did not have any neuropsychological deficits. We found no significant correlations between test performance and clinical variables. But interestingly, we revealed significant associations between subthreshold depressive symptomatology and psychomotor slowing, impaired long term and working memory.

In sum, these results suggest the presence of cognitive subgroups in bipolar disorder. However, we found no evidence of underlying etiologies: Clinical characteristics seem to have no influence. However, our results indicate that cognitive deficits found in euthymic BPD could result from a subdepressive syndrome and not per se by disease characteristics.