Intellectual disability is a mental disorder which appears during the developmental period in childhood and continues life-long. It is characterized by intellectual deficits on the one side and maladaptive social functioning on the other. The intellectual deficits include problems in abstract and logic thinking, problem solving, reasoning, learning from experience and judging. The deficits in adaptive functioning appear in problems in social communication and participation as well as in mental overload phenomena caused by daily life activities. This overload often results in psychopathological features and psychosocial reactions which are usually observed in Burn-out-Syndromes as e.g. general exhaustion (depletion of primarily reduced mental resources), additional reduced efficacy (accompanied by feelings of insufficiency and poor self-esteem), and most typically feelings alienation (towards intrinsically familiar situations, towards relatives and friends and at least also against oneself) typically accompanied by irritability and dysphoria. Treatment programs therefore should not only focus on intellectual deficits but should include also the multiple sufferings from psychopathological phenomena and psychosocial effects of such daily life overload syndromes.

Major problems in treating patients suffering from addictions derive from the fact that the diagnostic category dependence syndrome covers a highly inhomogeneous patient group. Therefore uniform therapeutic approaches inflexibly following treatment guidelines have not fulfilled prognostic expectations. This was the starting point for developing a new modular resource-oriented treatment program in the Anton Proksch Institute Vienna.

Changing paradigms in the treatment of addiction, the Orpheus Programme offers a host of different modules designed to help patients to discover their own aims, objectives, values, and resources. The main task of the Orpheus modules is an increasing autonomous and joyful life. Abstinence represents no longer the only final goal of therapy, but is an important step to offer space and possibilities for the patients’ new life. When life becomes once again beautiful and filled with joy and meaning, addictive substances lose their seductive power: The more beautiful and attractive the patient's life, the less the drugs attractiveness. As illustrated by Orpheus, who defeated the sirens (as a symbol for addictive agents) by making the better, louder, and more attractive music, it becomes the patients’ main task to make a better “music of life”; the Orpheus modules are not training programs telling the patients how the better life looks like (as in former moral therapy); they intend to provide places, spaces and atmospheres encouraging and promoting the patients to make possible the possible.

Concluding the literature in definition, pathogenesis, nosological position and treatment of delusions we are confronted with a wide range of opinions. In the first part of the course the various definitory approaches and their value in clinical practice will be discussed. The main focus of second part of the course is dedicated to the manifold results concerning the pathogenesis of delusions, which showed that delusions are caused by complex interactions of various mental, physical and social factors. The choice of a particular delusional theme is determined by gender, age, civil status, social isolation, and special experiences ("key experiences") whereas the incorrigible conviction is based on cognitive disorders and/or emotional derailments and reinforced by social factors. But delusions cannot be longer reduced to psychopathological manifestations once established and therefore persisting. The delusional conviction is a dynamic process which only persists if disorder maintaining factors become active. These disorder maintaining factors are not necessarily corresponding with the delusion's predisposing and triggering factors. In the third part classificatory problems will be raised. Assumptions concerning nosology and classification of delusions have ranged from an independent nosological entity to the attribution to a certain mental disorder, to multicategorical classification models. Previous polydiagnostic studies indicate that delusional disorders are neither a nosological entity nor due to one particular disorder (e.g. schizophrenia) but represent nosologically non-specific syndromes which may occur superimoposed on all mental disorders. Most of the so-called primary delusions (or delusional disorders in a narrower sense - delusions not due to another mental disorder) have to be considered as diagnostic artefacts caused by the use of diagnostic criteria in particular classification systems. The final part of the course will focus on differentialdiagnostics and differentialtherapeutics. As delusions represent nosological non-specific syndromes with a multifactorial pathogenesis modern integrative treatment approaches (including psychopharmacological, psychotherapeutic and socio-therapeutic methods) have to be based on a multidimensional differential diagnosis of all the predisposing, triggering, and disorder maintaining factors. In this context the disorder maintaining factors provide the basis for effective, pathogenesis-oriented treatment of the actual symptomatology, whereas the predisposing and triggering factors provide informations for planning prophylactic long-term treatment.

In the last decades a large number of co-morbidity studies were published indicating a strong relationship between affective disorders and alcohol addiction. Patients with affective disorders suffer also from dependence disorders at about 6 times more often than the rest of the population. In 30 to 60 percent of patients with alcohol addiction also affective disorders are present. In this context authors emphasized that depressive states observed in the course of alcohol addiction may be reactions to problems occurring in the frame of dependence disorders. In contrast to that depressive mood disorders in general (and above all states of anxiety and increased tension often connected with depressive states) can also be considered as starting points of addictive behaviour. Furthermore alcohol itself may induce and catalyze depressive mood. Less attention has been paid to the role of manic or hypomanic states in dependence disorders. The few studies indicate an increased co-morbidity rate between bipolar II disorders and alcohol addiction. In a psychopathological study carried out on 200 alcohol addicts in the Anton Proksch Institute Vienna we focused on the co-morbidity with bipolar II as well as on the pathogenetic role of hypomanic states in the frame of constellations of conditions of alcohol dependence using among other scales and a standardized interview, the Hypomania Self Rating Scale (HSRS, Angst). Preliminary results underline a strong relationship between Bipolar II Disorders and Alcohol Addiction: hypomanic states induce high risk behaviours which may become responsible for relapse and increased alcohol consumption.

The main requirement of diagnostics is the improvement of communication in daily practice on the one hand and the clinical relevance of diagnostic entities with respect to treatment and prognosis on the other hand. A main problem of the classical psychodermatological classifications is that the assignment to classes is based on more or less unproven assumptions and postulations concerning pathogenesis and nosology. This unsatisfactory diagnostic situation was the incentive to develop the Vienna Diagnoses Schedule for Psychodermatological Disorders, which was created on the basis of clinical experience in psychodermatological treatment units and includes four main diagnostic categories: 1. mental disorders without dermatological symptoms; 2. Mental disorders combined with dermatological disorders, e.g.classical psychosomatic disorders and stress-related disorders, secondary dermatological disorders due to mental disorders, secondary mental disorders due to primary dermatological disorders, mental disorders due to dermatological treatment, dermatological disorders due to psychiatric treatment, dermatological disorders often associated with mental disorders, and dermatological and mental disorders occurring simultaneously but independently from each other; 3. Dermatological disorders without mental disorders (troublesome patients, misdiagnosed patients, etc.); and 4. dermatological and/or mental problems not reaching the level of a disorder. Such a categorical classification has to be enlarged in clinical practice by a dimensional diagnostic approach, including not only deficiencies but also the resources of the patient in order to provide effective treatment strategies focusing not only on the disorder itself but on the suffering human being in its entirety.

Major problems in treating patients suffering from addictions derive from the fact that the diagnostic category dependence syndrome covers a highly inhomogeneous patient group. Therefore uniform therapeutic approaches inflexibly following treatment guidelines have not fulfilled prognostic expectations. This was the starting point for developing a new modular resource-oriented treatment program in the Anton Proksch Institute Vienna.

Changing paradigms in the treatment of addiction, the Orpheus Programme offers a host of different modules designed to help patients to discover their own aims, objectives, values, and resources. The main task of the Orpheus modules is an increasing autonomous and joyful life. Abstinence represents no longer the only final goal of therapy, but is an important step to offer space and possibilities for the patients’ new life. When life becomes once again beautiful and filled with joy and meaning, addictive substances lose their seductive power: The more beautiful and attractive the patient's life, the less the drugs attractiveness. As illustrated by Orpheus, who defeated the sirens (as a symbol for addictive agents) by making the better, louder, and more attractive music, it becomes the patients’ main task to make a better “music of life”; the Orpheus modules are not training programs telling the patients how the better life looks like (as in former moral therapy); they intend to provide places, spaces and atmospheres encouraging and promoting the patients to make possible the possible.

Impulse-control disorders are characterized by the presence of irresistible urges or impulses. With regard to phenomenology and pathogenesis of these disorders two yet unsolved questions attracted researchers: do Impulse-Control Disorders represent disorders of impulses (are the urges so penetrating that the individuum is no longer able to control them) or are they primary disorders to control ubiquitary impulses, or both of them. An answer to these questions is essential for pharmacological and psychotherapeutic treatment planning. In ICD-10 and DSM-IV, however, these questions remain untouched. There, the diagnosis impulse (control) disorders should be used for kinds of persistently repeated maladaptive behaviour that are not secondary to a recognized psychiatric syndrome, and in which it appears that there is repeated failure to resist impulses to carry out the behaviour and the patients report a prodromal period of tension with a feeling of release at the time of the act. Pathological gambling, pyromania, kleptomania, and trichotillomania must be attributed to the rest-category named “Impulse Control Disorders” in DSM-IV or named “Habit and Impulse Disorders” in ICD-10. As we know from clinical praxis, patients suffering from pathological gambling show a much more complex psychopathology quite similar to substance-related disorders. Therefore we propose for DSM-V that pathological gambling should be attributed as gambling addiction (or gambling dependence syndrome) together with other substance-related and non-substance related addictions (e.g. internet addiction, buying addiction, working addiction) to a new group of dependence disorders.

Nowadays different professions are involved in mental heath care in Europe, e.g. general practitioners, psychiatrists, psychologists, psychotherapists, social-workers, case-managers, prevention specialists, health ministry bureaucrats etc. As mental health represents a weak concept with vague and ambiguous definitions and delimitations it remains quite unclear who should be responsible for mental health today and in the future. In the last decades psychiatrists gained high expertise in treating mental disorders (e.g. psychopharmacological, psychotherapeutic and social measures) but lost terrain in mental health matters because of a lack of interest in such questions leading to the hardly acceptable contemporary situation that professionals without any psychopathological knowledge and without clinical experiences in mental illnesses as well as in the various transitional states between mental health and disordered health have taken the leading positions in the field of mental health care. Of course, the main tasks of psychiatry are to diagnose and to treat mental disorders, but as the prognosis of mental disorders and the treatment efficacy highly depend on the time of recognizing the disorder (the earlier the recognition of a mental disorders and the earlier the start of therapy the better the treatment out-come and prognosis) early recognition of mental disorders and prevention measures (esp. secondary and tertiary prevention) have to become core fields of psychiatry. Therefore psychiatry cannot any longer restrict itself to the treatment of severe mental disorders but has to take again a crucial role in future mental health care system in cooperation with other mental health stake-holders. This implies that future training programs for psychiatrists have to take into account such considerations and have to include beside usual fields of interests (e.g. psychopathology, neurosciences, psychopharmacology, psychotherapy, medical humanities, etc.) also topics like early recognition, transitional states and prevention of mental disorders as regular parts.

In modern psychiatry a main task is the exploration and explanation of the nature of mental disorders and its treatment. Post-modernity with its change of paradigms opens up new perspectives in diagnosis and treatment of mental disorders. Not only the nature of disorders but also the narratives creating our world of illnesses and the dialogue with the patient suffering from it becomes more and more the main interest of medical and psychotherapeutic measures. It is no longer the disorder itself but the human being suffering from it which will be the main target of diagnostic and therapeutic procedures. The human being is not only a disorder producing physico-psycho-social apparatus. In postmodern medicine the human being cannot be longer considered as a machine which can be explored and repaired; it is much more the expression of active and reactive processes. As individuums we are not only complex machines reacting to external and internal stimuli; we are on the contrary “doers”, “makers” and “creators”. As cosmopoets we constitute and design our world and ourselves. But this creation is not a creation out of nothing. Our patients suffering from mental disorders are thrown in a world not of their choosing; but nevertheless they are able to (re)construct their life and their narratives. As psychiatrists, it is our duty not only to analyze the conditions and nature of mental disorders but also to enter into a dialogue with the human being suffering from the disorders’ nature and its narratives.

Several authors have pointed out that in the next few decades dementia will affect a considerably increasing number of the elderly. To our knowledge there exist no calculations of the number of demented persons for the whole European region. We made calculations on the number of dementia cases for the period 2000–2050 based on the population projections of the United Nations. For this purpose, we used the results of several meta-analyses of epidemiological studies. The number of prevalent dementia cases in the year 2000 was 7.1 million. Within the next 50 years, this number will rise to about 16.2 million dementia sufferers. The number of new dementia cases per year will increase from about 1.9 million in the year 2000 to about 4.1 million in the year 2050. Contrarily, the working-age population will considerably decrease during the next 50 years. In the year 2000, 7.1 million dementia cases faced 493 million persons in working-age. This equals a ratio of 69.4 persons in working-age per one demented person. Until the year 2050, this ratio will decrease to only 21.1. Thus, the financial and emotional burden placed by dementia on the working-age population will markedly rise.

During decades abstinence has been the only major treatment goal in addiction treatment; the efficacy of addiction clinics in general and treatment programs in particular usually has been evaluated with the aid of abstinence rates: the higher the number of abstainers, the better the treatment program. But for many of the patients suffering from addiction abstinence is not a very attractive treatment goal, for some of them not even an unattainable one. For many of our patients abstinence means weakness, handicap, stigmatization, a feeling of restraint, declining, inhibition, not being accepted, suppression, tension, being ill, social withdrawal, no fun, no relaxation anymore, isolation, etc.. In any case the term abstinence is strongly connected with abstention from, loosening of and distance to something. In this way a quite unattractive form of the nothing becomes the final goal of addiction treatment. Among others, this could be considered as one of the reasons of poor patient adherence in abstinence-oriented treatment programs. A way-out of this highly unsatisfactory situation for both, the patients as well as the therapists, could be a change of paradigms to abstinence-supported treatment. In abstinence-supported programs, abstinence is no longer the final goal but one of the important steps in order to reach other treatment goals according to an autonomous and mostly joyful life: on the basis of dimensional diagnostics, which are in contrast to classical categorical diagnostics not disease-oriented but phenomenology-, pathogenesis- and process-oriented, the patient and the therapist plan in dialogue accessible treatment goals according to the patient's deficiencies and resources; in this perspective abstinence is not the final aim but offers the patient a chance for transformation.

In contrast to the hypothesis of different nosological entities of so-called “endogenous” psychoses (e.g. schizophrenia, manic-depressive psychosis) the model of unitary psychosis has been discussed in controversial terms. The starting point of those discussions was the concept of a unitary nosological and pathogenic entity which may be traced back to Joseph Guislain and has inspired the work of Wilhelm Griesinger, who further elaborated the concept of Unitary Psychosis ("Einheitspsychose"). Griesinger, who was also influenced by Zeller's idea of the unified human soul or character (“Gemüt”), argued that madness was the consequence of a single disease of the brain. In comparison to that the Unitary Psychoses concept of Janzarik focuses not on the nosological position but on the pathogenetic mechanisms of endogenous psychoses (e.g. structural-dynamic coherence model). Recent co-morbidity studies as well as trans-nosographical analyses have called classical categorical diagnosing more and more in question. The development of dimensional diagnostics, as an alternative to categorical diagnostic systems led to a renaissance of the unitary psychosis ideas. Such dimensional diagnostics do not focus any longer on artificial disease constructs and their nosological position but on single psychopathological phenomena, on their plasticity during the pathological process, and their constellations of conditions. The main task of Dimensional Diagnostics, as introduced here in this paper, is not only the accurate description and explanation of psychopathological phenomena and processes but has to include also the understanding of the suffering person's deficiencies and resources.