No significant relationships.

No significant relationships.

No significant relationships.

Mental health support for parents, infants and children as an interdisciplinary, cross-sectoral task has existed for decades in many European countries. A highlighted goal of integrated services (medical, social and educational) is to support competent parenting and the positive parent-child relationship, for the optimal development including mental health of infants and children. In clinical practice, the role of psychiatrists is often linked to healing and rehabilitation, even though we also have an important role in prevention. The mental support, treatment and prevention of psychiatric disorders during the pre-, peri- and postnatal period are often not considered being preventive measures. The perinatal period is the most sensitive and at the same time one of the most important stages of our lives. The traumas suffered during this period affect both the mother and the newborn, in fact it affects the family as a whole. Models for the prevention of early trauma appear at the level of social community and, inter alia, health and social care. Traumas are closely linked to social determinants of health. Gene environment interactions also allow for the transgenerational transmission of trauma. The presentation introduces individual and family levels of interdisciplinary care, good practices and programs the knowledge of which may be important to psychiatrists. How the practicing psychiatrist can contribute to trauma prevention and how to understand the development of resilience. The presenter will detail good practices, and highlight the possibilities for all clinicians on ways to work in their respective field with a trauma preventive approach.

No significant relationships.

In perinatal clinical practice (PCP), the focus of care has shifted from the mother and then the baby-mother dyad to the emphasis on the role of fathers. Individual and therapeutic interventions are multimodal, and in almost all cases interdisciplinary cooperation is assumed. The preferred therapeutic methods for perinatal mental disorders are psychological and psychotherapeutic interventions. Through the life-course model, the central, therapeutic-conceptual role of the family can be understood, which - in clinical practice - reflects the need for “think-family” in psychiatric care. Hence there is a growing need for evidence-based family-interventions. Parental mental health disorders may have an impact on family functioning and partner relationship, as well as parent-child interactions, the quality of attachment and relationship with the child. Even though we have an increasing number of evidence regarding the aims and effectiveness of family interventions, additional evidence is needed to determine what interventions and modalities are effective in the perinatal period. And we also need information when these interventions are contraindicated and regarding their risk. It is conceivable that there is not much difference between the efficacy of family intervention methods used in other indications and the perinatal application of the same methods. We have gathered evidence primarily on perinatal depression, which opens the path of family interventions in other disorders. When thinking in the family as a general framework, it should be filled with evidence-based quantitative and qualitative anchors. The conceptual framework can be based on systems- and network theory. The presentation is illustrated with clinical vignettes.

No significant relationships.

Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.

The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.

We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.

We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance.

We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding).

Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level).

There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels.

Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare.

Several studies have shown that excessive emotional involvement leads to burnout (Zapf et al 2001; Brotheridge&Grandey 2002).

The study of the causal factors of empathy and burnout and the effect of emotional involvement on the medical doctors.

Descriptive study at the 4 Hungarian medical faculties with 67 psychiatry residents. Maslach Burnout Inventory, (Maslach and Jackson, 1986), Interpersonal Reactivity Index (Davis, 1980), Patient-Practitioner Orientation Scale (Krupat, E. et al. 2000) and Secondary Traumatic Stress Scale (Bride 2003). Standardised film scenes of doctor patient interactions. (Csabai et al 2009).

High emotional exhaustion among 32,8% of residents, high level of depersonalisation of 29,9%, decrease of personal effectivity of 52,2%. Significantly higher depersonalisation for men (p ≤ 0,05). Marriage or partnership meant significantly lower likelihood of depersonalization.. Empathetic concern (IRI) showed significant correlation with the number of children. Factor analysis of the questionnaires revealed two main factors: the first factor we named “reactive empathy” or “mentalization”. The second factor included components related to emotional contagion and its consequences: burnout.

Responses to the film, correlate with the questionnaire's PPOS caring scale, IRI perspective change, IRI empathic concern. These factors are protective in nature.

The film test is suitable to measure and teach skills that protect against burnout. Experience of emotional contagion may predict the manifestation of burnout. Regulation of the intensity of emotional states, perspective change and empathic concern determine that form of empathy which has a positive effect on both the patient and the therapist.

Baby-mother unit introduction into the local and the Hungarian health service.

The aim of the program is to apply a collaborative therapeutic and rehabilitation model utilizing the multidisciplinary team work in the treatment of the pre-, peri- and post-natal period of mothers suffering mental disorders as well as to facilitate the early interactions and attachment with the baby.

Since 2007, 82 mothers, 1 father entered into the program. 54 mothers were participated as inpatient, 29 were treated only as outpatient. 24.9% of the cases were diagnosed (ICD 10 – F20–F29) schizophrenia or spectrum disorders, 27,6% were in the major affective disorders, including bipolar, (F 31, 14.5%). 38,6% were diagnosed in the anxiety disorders spectrum. 23% entered in the prenatal period (pregnancy), while 76,3% entered post-natal.

Case-management, individual, group and family interventions (psychotherapy), pharmacotherapy, case conferences, individual and staff supervision, video-feedback, mother-child consultation.

New treatment model introduction in Hungary, which may reduce the risk of the separation of the baby, enhances the mother recovery, as well as the utilization of the family's and the supportive network resources. Further research is needed to prove the higher efficacy.

According to the WHO GBD Study depression will be the second most frequent cause of disability by 2020. Although many activities and research have been done against depression, and devidence-based therapies are also available, depression remains a top health concern with increasing significance.

Joint Action of Mental Health and Well-being Workpackage 4 aims to develop a framework for action at the level of policies, infrastructures and interventions for prevention and treatment of depression and suicide. The first step is the data collection about the best practices in the participating countries.

Comprehensive assessment was conducted for evaluating the utilisation of evidence-based tools: 1.) systematic review of scientific publications and policy documents in the field, 2.) assessment of best practices 3.) situation analysis in national frameworks. The evaluation do not focus only to scientific and clinical excellence but also management and activity on policy level. Data collection is conducted with the help of the JA WP4's key stakeholders.

The preliminary data of the evaluation revealed that although many evidence-based tools are available, there are considerable differences in their utilisation, and many of them are not enacted into a policy context in the different participating countries. The final data will be presented in more details.

Although combating depression and suicide is a significant need in public health, evidence-based tools are partly exploited in the practice. In the next phase of JA an action framework will be developed, for tackling the obstacles of dissemination of evidence-based practices in Europe, with the invocation of policy context.

statistical and qualitative analysis of clients’ reports of 529. The clients were before judicial process and detained in custody in the MDC.

to analyse the frequent problems and the clinical questions by the referral doctors, the necessity of these problems, and the severity of the clients symptoms.

We analysed all the files, and the objectives: referral diagnosis, diagnosis after our examination, suicide intentions, intentional aggravation, heteroagression, psychiatric history, drug use and dependency, current medication, presence of psychotic symptoms.

Between 2007-2014 September there were 529 examinations. The most frequent question was to evaluate the suicide risk and to measure the necessity of the admission to an acute psychiatric unit. The number of the referrals remains 80-90 per year since 2012, 33% of the examined clients were diagnosed with personality disorder at our unit.

Specialised service is needed (Forensic Psychiatric Unit) to evaluate more precisely the severity of suicide risk, and to exclude the intentional behaviour. Consultation and training of the MDC medical staff can enhance the more precise psychiatric evaluation especially to differentiate between personality and major psychiatric disorders.

Several studies have shown that excessive emotional involvement of health care professionals may lead to burnout (Zapf et al 2001; Brotheridge&Grandey 2002). As our perevious studies (Fülöp, Devecsery & Csabai 2012) also showed, medical and paramedical professionals who are prone to overinvolve in the interactions of the patients experiencing distress, may suffer from emotional exhaustion for long run.

We looked for correlations between disturbances of emotional regulation, lack of mentalization, and intensive emotional distress.

We used a descriptive approach, where a set of questionnaires were applied. The sample consisted of 200 health care professionals - nurses, and assistents for oxyology-, from all over Hungary. Questionnaires used: Maslach Burnout Inventory, (Maslach and Jackson, 1986), Interpersonal Reactivity Index (Davis, 1980), Difficulties in Emotional Regulation Scale, (Gratz és Roemer, 2004) and Secondary Traumatic Stress Scale (Bride 2003). Our research team developed a test for mentatalization consists of 3 pictures of provider/patient interactions, and exposed with different instuctions according to 3 levels of mentalization.

Our preliminary results show that the “3-picture test”, as a global one, can be useful to measure the complexity of mentalization, its components, as spontaneous mentalization, emotional identification, and emotional anticipation. This test may help the further understanding of the relationships between emotional regulation and the phenomenon of burn-out.

Due to the unprofessional closure of the Hungarian National Institute of Psychiatry and Neurology at 2007, the forensic psychiatric outpatient consultation service of the Main Detention Centre of Budapest (MDC), was officially transferred to the Psychiatric Department of Saint John Hospital. Hungary has had neither a Forensic Psychiatric Unit nor a single Security Units Department. At our psychiatric department first we started operating this type of consultation. in 2007 May. Before our consultations the clients are examined by the medical doctor of the MDC, and his/her decision to ask for psychiatric examination with specific questions.

We analysed retrospectively these cases of 5 years.

Statistical and qualitative analysis of clients’ reports of 346. The clients were before judicial process and detained in custody or before it in the MDC.

To analyse the frequent problems and questions, the necessity of these problems, and severity of the clients symptoms.

We analysed all the files, and the objectives: referral diagnosis, diagnosis after our examination, suicide intentions, intentional aggravation, heteroagression, psychiatric history, drug use and dependency, current medication, presence of psychotic symptoms.

Between 2007–2009 August there were 67 examinations, and between 2009 September and 2012 were 280 visits. The most frequent question was to evaluate the suicide risk. (three-quarter of the sample.)

Specialised service is needed (Forensic Unit) to evaluate more precisely the severity of suicide risk, and to exclude the intentional behaviour. External causes may influence the higher number of the cases, after 2009 August.

Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.

We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.

We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.

The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.

Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.