JS07
Can ecstasy treat the agony of PTSD?
- M. Mithoefer
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- Published online by Cambridge University Press:
- 23 March 2020, p. S10
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Introduction
Two serotonin reuptake inhibitors (SSRIs) have received FDA indication for treatment of PTSD, however the effectiveness of pharmacotherapy for PTSD is limited. Psychotherapy, including several well established evidence based methods, is the mainstay of PTSD treatment. Despite advances in this area, a significant percentage of PTSD patients are refractory to existing treatments. Recent research has explored the possibility that certain drugs could increase the effectiveness of psychotherapy when administered intermittently in conjunction with psychotherapy sessions. The most robust published. Results to date using this approach have been in early clinical trials of ± 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. These studies primarily involved civilians with treatment-resistant, crime-related PTSD. A more recent phase 2 trial, completed in 2015 yielded equally promising. Results in a cohort of military veterans, police officers and firefighters, mostly veterans from the wars in Iraq and Afghanistan.
MethodologyIn these double blind controlled trials subjects with PTSD refractory to prior treatment are randomized to an active dose of MDMA or an active or inactive placebo administered to each individual on only two or three occasions during eight-hour psychotherapy sessions one month apart, in conjunction with preparatory and follow-up psychotherapy sessions. Outcome measures are repeated one or two months after the second MDMA-assisted session before the blind is broken. Subjects who were randomized to full dose MDMA are then eligible for one additional, open label, MDMA-assisted session. Those randomized to placebo or a lower dose of MDMA are eligible for three open-label full dose sessions. Outcome measures are repeated two months following the third MDMA-assisted session. The primary outcome measure is the Clinician Administered PTSD Scale (CAPS). Additional measures include the Beck Depression Inventory-II (BDI-II), Global Assessment of Functioning (GAF), Pittsburgh Sleep Quality Index (PSQI) and Posttraumatic Growth Inventory (PTGI).
ResultsIn the original study comparing MDMA with inactive placebo along with the same psychotherapy PTSD was resolved in 83% of the MDMA group vs. 25% of the placebo group receiving the same therapy. Improvement was maintained for at least 74% of subjects at long-term follow-up a mean of 45 months later. In a more recent, unpublished, study both the high dose and the medium dose of MDMA showed large effect sizes in reducing CAPS scores, and improvements in secondary measures: and BDI-II, PSQI, GAF and PTGI.
ConclusionEvidence in phase II trials suggest that MDMA-assisted psychotherapy is effective in treating PTSD in both civilians and veterans who have not responded to established treatments. Phase III trials are necessary to definitively establish safety and efficacy of MDMA-assisted psychotherapy for PTSD.
Disclosure of interestThe author has not supplied his declaration of competing interest.
JS08
Treatment of heroin dependence with ibogaine
- A. Schellekens, T. Oosteren, T. Knuijver, R.J. verkes, M. Belgers
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- 23 March 2020, pp. S10-S11
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Background
The use of the hallucinogen ibogaine as an anti-addiction agent has been described in several case reports, dating back to the eighties. The anti-addiction properties of ibogaine have been confirmed in a large body of animal work. Ibogaine has been shown to be effective in reducing withdrawal severity and substance use for a variety of substances, including cocaine and opiates. Animal studies also show some potentially dangerous adverse reactions, including cerebellar toxicity and potential cardiac effects. While pharmacological treatment options for opiate and cocaine dependence are still limited, ibogaine assisted treatment might be a promising new option. Therefore more systematic studies on its toxicity and efficacy are warranted. In our studies we address these two research questions: is ibogaine treatment for opiate dependence safe and effective for treating opiate withdrawal and relapse prevention? A secondary objective is to explore the pharmacokinetic properties of ibogaine.
MethodsAnimal work: first we performed a systematic review and meta-analysis of animal studies on ibogaine. Thirty studies were included in the systematic review, of which 27 could be analyzed in meta-analysis. Human studies: fifteen opiate dependent patients will be treated with ibogaine (10 mg/kg), on top of treatment as usual. Ibogaine toxicity will be assessed through close monitoring with electrocardiography, with QTc prolongation as main outcome measure, repeated assessments of ataxia using the (SARA) and observation of psychotic symptoms by using the Delirium Observations Scale (DOS). Ibogaine efficacy will be measured, using repeated evaluations of opiate withdrawal severity (Subjective Opiate Withdrawal Scale: SOWS; Objective Opiate Withdrawal Scale: OOWS), craving intensity (using a Visual Analogue Scale) and substance use, with a six-month follow-up. Clinical observations in ibogaine treated individuals will be compared with a cohort of opiate dependent patients treated with a rapid detoxification procedure. Both acute and long-term effects will be linked with serum ibogaine and noribogaine levels.
ResultsAnimal work: overall, ibogaine reduced drug self-administration, particularly during the first 24 hours after administration. Ibogaine had no effect on drug-induced conditioned place preference. Ibogaine administration resulted in motor impairment in the first 24 hours after supplementation, and cerebral cell loss even weeks after administration. Data on ibogaines effect on cardiac rhythm as well as on its neuropharmacological working mechanisms are limited. Human studies: human data are still being collected. Treatment of the first patients confirmed strong effects of ibogaine on heart rhythm (QTc prolongation) and ataxia, while the opiate withdrawal symptoms were relatively mild. The first observations on the clinical effect of ibogaine on craving and substance use will also be shared.
ConclusionsBased on our meta-analysis of animal data, there is strong evidence that ibogaine is effective in reducing drug self-administration in animals. This warrants further studies into the clinical efficacy of ibogaine in substance dependent patients in reducing craving and substance use. Our first clinical experiences in a limited number of patients confirm that ibogaine treatment may be effective in reducing opiate withdrawal, but can potentially have transient cardiac and cerebellar toxicity.
Disclosure of interestThe authors have not supplied his declaration of competing interest.
JS09
Social psychiatry in a global perspective
- T. Jamieson-Craig
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- 23 March 2020, p. S11
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Social psychiatry starts from the position that as social animals, the cause, course and response to treatment of mental health problems are powerfully determined by the social environment. For example, childhood trauma within the home and bullying at school is associated with both internalizing and externalizing disorders and exerts its influence through life-long impacts on the individual's ability to form supportive relationships with others, their self-esteem and their resilience in the face of future adversity. Difficulties forming and sustaining personal relationships are intensified by the emergence of illness, consequent social exclusion and discrimination that in turn intensifies damaging beliefs of low self-worth and rejection. In contrast, we have considerable evidence for the “therapeutic” value of good relationships, notably the role of family and social support in the remarkable resilience shown by those who have come through the most appalling environmental and personal crises. It is therefore surprising that the balance of psychiatric therapeutic effort is stubbornly focused on the individual patient as the problem with less attention paid to developing and implementing social interventions targeted at the family and wider social network to prevent and alleviate mental illness. In this presentation I will argue that psychiatrists should be more active in developing and leading interventions that focus on the social and interpersonal networks of their patients with illustrations from past and ongoing efforts to this end.
Disclosure of interestThe author has not supplied his declaration of competing interest.
JS10
Psychiatric trainees’ view on a European curriculum of psychiatry
- M. Pinto da Costa
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- Published online by Cambridge University Press:
- 23 March 2020, p. S11
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The European Federation of Psychiatric Trainees (EFPT) represents the consensus of psychiatry trainees associations across more than 30 European countries, advocating for the improvement and harmonization of psychiatry training across Europe. This federation has as priority to get direct feedback from psychiatry trainees, analyzing the concerns related to psychiatry and training in Europe, collaborating with other national and international partners to translate trainees’ views into action, while offering trainees several opportunities.
Surveys of psychiatry trainees show that the main concerns around Europe revolve around differences of duration of training in the different countries, the discrepancies between the European training standards, the national programmes and the real experience of trainees. Likewise, levels of recruitment into psychiatry and inadequate working conditions also concern trainees, especially at the current times of economic challenge, where the choice to migrate abroad is quite frequent. Nevertheless, the involvement of psychiatry trainees in the development of national programmes and in the quality assurance of training varies significantly around Europe.
This presentation will highlight the current differences observed in the structure, content and duration of psychiatry training programs in Europe, reporting trainees’ views on a European curriculum of psychiatry, and exploring mechanisms to evaluate and harmonize the postgraduate training in Europe.
Disclosure of interestThe author has not supplied his declaration of competing interest.
SA01
Psychosocial intervention in schizophrenia
- T. Wykes
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- Published online by Cambridge University Press:
- 23 March 2020, p. S12
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Psychological treatments aimed at symptoms or behaviours that impede recovery now have a relatively strong database but it is not clear which treatments are more effective and when they should be applied. For large-scale roll out we need to consider which are the most helpful and cost-effective at which stage of the illness and to which individuals. This requires knowledge of how service users ascribe value to different outcomes and treatments as well as which individuals are likely to benefit the most from different treatments to produce a coherent mental health recovery programme. Tailoring treatment requires an understanding of adherence requirements as well as therapeutic interactions to explain how therapy fits with the service users’ personal goals. Not all information for making these clinical decisions is embedded in any database so the burden on research is to provide enough information to signal to health professionals the best course of action. More research on dissemination of treatment approaches as well as training and supervision requirements is needed in the form of dissemination science if patients with a diagnosis of schizophrenia are to receive the best intervention programme.
Disclosure of interestThe author has not supplied his declaration of competing interest.
SA02
Nutrition, sleep, physical exercise: Impact on mental health
- W. Rössler
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- Published online by Cambridge University Press:
- 23 March 2020, p. S12
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Until recently nutrition and various other lifestyle factors were predominantly in the focus of medical disciplines like cardiology, endocrinology or gastroenterology. As mental disorders are multifactorial diseases and as such are complex, emerging evidence suggests that nutrition, exercise and sleep also play an important role in the aetiology, progression and treatment of mental disorders. In this regard research has mostly focused on depression and anxiety, but there is also evidence for other mental disorders like schizophrenia or autism. Some details concerning the relationship between diet and sleep on neuro-transmitter processes, immune-inflammatory pathways or oxidative stress will be demonstrated.
Modifications of life style factors and diet are increasingly recognized as potential therapeutic options. Mostly used are nutrient-based supplements and essential elements in combination. But also healthy diet patterns with a high intake of vegetable, fruits and fish have proven beneficial in the treatment. If we better understand the microbiota-gut-brain axis and its impact on behavior, mood and cognitive processes, diet and lifestyle factors can not only contribute to the treatment but also to the prevention of mental disorders.
Disclosure of interestThe author has not supplied his declaration of competing interest.
SA03
Can alcohol-dependent patients really reduce their alcohol consumption over time?
- K. Mann
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- Published online by Cambridge University Press:
- 23 March 2020, pp. S12-S13
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Introduction
Treatment of alcohol dependent patients is moderately successful but it only reaches about 10% of the population in need. A new harm reduction strategy aims at abstinence in the long run but claims to benefit patients already early on by reducing their alcohol consumption.
ObjectivesA brief outline of the debate on abstinence versus controlled drinking will be followed reporting several RCTs striving for reduced drinking in alcohol dependent patients.
AimsThe participant will find guidance whether and how to treat patients following this new approach.
ResultsStudies testing behavioural treatments and counselling (MATCH, UKATT) indicate that a reduction over time is possible. Using nalmefene (a mu and delta opioid antagonist and a partial agonist) RCTs with more than 2500 patients were performed showing a benefit over placebo. On this basis the EMA approved this drug for the reduction of alcohol consumption in alcohol dependent patients. Other compounds such as naltrexone showed similar effects in smaller trials but are not approved for reduction. More studies testing further compounds are underway.
ConclusionsThis new approach has the potential to lower the barriers which to date prevent many patients from accepting treatment for their alcohol problems. Two research questions warrant further study: (1) does the reduction in alcohol consumption translate into health and other benefits, and (2) are there specific subgroups of patients who benefit more than others. Preliminary answers will be given in the lecture.
Disclosure of interestThe author has not supplied his declaration of competing interest.
EECP 01
The political and social mission of psychiatry
- S. Priebe
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- Published online by Cambridge University Press:
- 23 March 2020, p. S14
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Psychiatry is based on values and scientific evidence. The presentation will argue that both bases come with a social and political mission.
The values require a commitment to help those in need of support, which cannot be fully achieved without social and political action. The scientific evidence points to the central role of societal factors, such as inequality and poverty, for the development of mental disorders. Influencing these factors requires political decisions.
It will be concluded that taking up the social and political mission is a moral imperative for both psychiatrists as a professional group and individual psychiatrists, and may make the profession more relevant in society, more attractive to medical students, and more effective in helping patients with mental distress.
The discussion will address the challenges and practical options for such a mission.
Disclosure of interestThe author has not supplied his declaration of competing interest.
EECP 02
The tension between identity and competency: Comparing behavioural and constructionist approaches to professional formation
- A. Brittlebank
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- Published online by Cambridge University Press:
- 23 March 2020, p. S14
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Contemporary approaches to medical education emphasize the importance of doctors in training demonstrating the acquisition of competencies. This approach to educating doctors has been criticized on a number of grounds, not least because a solely behavioural focus risks trivializing medical professionalism. An alternative approach is to look at the formation of professional identity as a legitimate goal of training.
In this presentation, I will describe the behavioural and constructionist approaches to medical education and their implications for psychiatry training. I will make a plea for psychiatry training to renegotiate the balance between the two approaches.
Disclosure of interestThe author has not supplied his declaration of competing interest.
EECP 03
Should all psychiatrists be skilled to practice psychotherapy?
- T. Gargot, E. Sonmez
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- Published online by Cambridge University Press:
- 23 March 2020, pp. S14-S15
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Psychiatrists have a unique place in the spectrum of mental health services, as being able to integrate psychotherapy and pharmacotherapy in clinical practice. It is through psychotherapy training that a trainee gains optimal communicative skills and competence in establishing therapeutic alliance with a patient. It helps developing empathic understanding, which is very important for a good collaboration and enable understanding, diagnostic and treatment. It improves trainees’ own insight. All are these fundamental aspects of a biopsychosocial approach of psychiatry.
In many countries psychiatry trainees have a positive attitude towards psychotherapy during their training. Moreover, patients often prefer and adhere to combined psychotherapy and medication than split-care treatments. Research in psychotherapy provides ample evidence that these treatments are effective. The UEMS considers psychotherapy education as mandatory. EFPT advocates that all trainees must gain competence in at least one recognized form of psychotherapy and have a basic knowledge for other forms. Altogether, there is a consensus among all actors of mental health services that psychotherapy training is essential and should be improved. Yet, it is still far from being a priority in psychiatric training and is subdued by biological training and research, which is easier, faster and prevailing in training institutions. Also, psychotherapy training is found less affordable by trainees.
With collaboration from other organizations, EFPT aims to improve standards of psychiatry training, including psychotherapy. We present some initiatives led by UEMS, EPA, WPA and ECNP. Today's technology allows trainees to reach various psychotherapeutic training availabilities, including online tools (Webinar, MOOCs, online guidebooks) and international courses. It is advisable that training institutions devote more time on psychotherapy training and supervision, associations provide costly training availabilities or scholarships, encourage more scientific research on psychotherapeutics and take into account the progress of research in psychology and neuroscience [1–5].
Disclosure of interestThe authors have not supplied their declaration of competing interest.
EECP 04
Is addiction medicine part of psychiatry?
- L. Orsolini, D. Papanti, A. Valchera, R. Vecchiotti, J. Corkery, F. Schifano
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- Published online by Cambridge University Press:
- 23 March 2020, p. S15
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Addiction medicine/psychiatry, a medical subspecialty founded on October 1991 by the American Board of Psychiatry and Neurology, was granted as subspecialty within psychiatry. It mainly deals with medical assessment, diagnosis and treatment of subjects who suffer from an addiction (i.e. drug and/or alcohol addiction; gambling; sexual addiction; game addiction; and so on). Addiction psychiatry also deals with subjects in dual diagnosis, i.e. individuals with addiction issues along with co-occurring psychiatric disorders. However, despite its well established “dignity” to be part of psychiatry, most mental health's professionals believe that it is not a primarily psychiatric field due to the frequent co-occurrence of internistic/medical issues. In addition, the situation of psychiatric training specifically addressed to addiction is widely diversified across the European countries. Therefore, most psychiatrists do not possess specific qualifications and formation on this increasing field of psychiatry. The present lecture aims at providing an insight into the issues related to the diatribe between psychiatry and medicine on addiction medicine/psychiatry, specifically focusing on differences across European countries.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
EECP 05
Should all psychiatrists be skilled to practice psychotherapy?
- E. Sönmez, T. Gargot
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- Published online by Cambridge University Press:
- 23 March 2020, p. S15
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Psychiatrists have a unique place in the spectrum of mental health services, as being able to integrate psychotherapy and pharmacotherapy in clinical practice. It is through psychotherapy training that a trainee gains optimal communicative skills and competence in establishing therapeutic alliance with a patient. It helps developing empathic understanding, which is very important for a good collaboration and enable understanding, diagnostic and treatment. It improves trainees’ own insight. All are these fundamental aspects of a biopsychosocial approach of psychiatry.
In many countries psychiatry trainees have a positive attitude towards psychotherapy during their training. Moreover, patients often prefer and adhere to combined psychotherapy and medication than split-care treatments. Research in psychotherapy provides ample evidence that these treatments are effective. The UEMS considers psychotherapy education as mandatory. EFPT advocates that all trainees must gain competence in at least one recognised form of psychotherapy and have a basic knowledge for other forms. Altogether, there is a consensus among all actors of mental health services that psychotherapy training is essential and should be improved. Yet, it is still far from being a priority in psychiatric training and is subdued by biological training and research, which is easier, faster and prevailing in training institutions. Also, psychotherapy training is found less affordable by trainees.
With collaboration from other organizations, EFPT aims to improve standards of psychiatry training, including psychotherapy. We present some initiatives led by UEMS, EPA, WPA and ECNP. Today's technology allows trainees to reach various psychotherapeutic training availabilities, including online tools (Webinar, MOOCs, online guidebooks) and international courses. It is advisable that training institutions devote more time on psychotherapy training and supervision, associations provide costly training availabilities or scholarships, encourage more scientific research on psychotherapeutics and take into account the progress of research in psychology and neuroscience [1–5].
Disclosure of interestThe authors have not supplied their declaration of competing interest.
EECP 06
Involving people with intellectual disabilities in the formal assessment of psychiatrists’ skills
- S. Soni, I. Hall, P. Doulton, , P. Bowie,
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- Published online by Cambridge University Press:
- 23 March 2020, p. S16
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Purpose
It is widely recognised that people with intellectual disabilities receive a poorer quality of healthcare than their non-disabled counterparts. Training for healthcare professionals in intellectual disability is often scant or non-existent. The purpose of this work is to explore the usefulness of employing actors with intellectual disabilities as simulated patients in the assessment of trainee psychiatrists.
Design/methodology/approachThe development of a structured clinical exam “station” designed to assess the ability of trainee psychiatrists to communicate with a simulated patient played by an actor with an intellectual disability is described. The paper also assesses the potential benefits of this kind of assessment and the experience of actors and examiners taking part in this process.
FindingsThe station was found to perform well in discriminating between candidates of various abilities and was well received by actors, examiners and observers. The station is now routinely used in the formal assessment of trainee psychiatrists in the UK.
Practical implicationsThe use of people with intellectual disabilities in training and assessment appears to be advantageous in terms of improving knowledge, attitudes and skills amongst healthcare professionals and gives increased opportunities for people with intellectual disabilities to undertake valued social roles.
Originality/valueFew institutions currently employ actors with intellectual disabilities as simulated patients as part of their training programmes and as a result there is little in the way of literature on this subject. This paper describes an alternative approach to teaching and assessment which falls in line with recommendations from the UK Department of Health to involve service users in the training of healthcare professionals.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
EECP 07
Discussion
- G. Stanghellini
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- Published online by Cambridge University Press:
- 23 March 2020, p. S16
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The concept of “dissociation” covers a rather wide array of psychopathological conditions, ranging from dissociation of consciousness (e.g., post-traumatic conditions), to dissociation of personality, (i.e., multiple personality disorder) and dissociation of the basic structures of the pre-reflexive self (as it is the case with schizophrenic abnormal experiences). I will focus on this last issue and describe the dissociation of time experiences in people with schizophrenia as a characterizing feature of this condition.
Schizophrenic persons often describe their sense of temporal reality as: “things to a standstill”, “immobility, but not calm”, “time going back to same moment over and over”, “people like statues”, “frozen moment”, “out of time”, “marmoreal”, “unreal stillness”. Time is fragmented, there is a breakdown in time Gestalt, and an itemization of now-moments. The mere succession of conscious moments as such cannot establish the experience of continuity. Another typical phenomenon is that a revelation is on the verge to happen, the world is on the verge of ending, a new world is coming, one's own life is on the point of undergoing a radical change. The schizophrenic mood can be characterized as the dawn of a new reality, an eternally pregnant now in which what is most important is not present, what is really relevant is not already there, but is forever about to happen. Time in the schizophrenic mood is “a state of suspense”, “pregnant now”, “being is hanging”, “something imminent”, “something… I didn’t know what … was going to happen … between inspiration and expiration”. The main feature of abnormal time experience in schizophrenia is disarticulation – a breakdown of the synthesis of past, present and future. This includes four subcategories: disruption of time flowing, “déjà vu/vécu”, premonitions about oneself and the external world. The integrity of time consciousness is the condition of possibility of the identity through time of an object of perception as well as of the person who perceives it. Abnormal time experience may be related to the manifold of other schizophrenic subjective abnormal experiences and symptoms, including anomalies of phenomenal consciousness (e.g., disintegration of the appearance of external objects and itemization of external world experience), selfhood (e.g., disruption of the implicit sense of being a unified, bounded and incarnated entity), and sociality (e.g., breakdown of one's sense of being naturally immersed in a meaningful flow of social interactions with others).
Disarticulation of time experience includes four subcategories. Disruption of time flowing: Patients live time as fragmented. Past, present and future are experienced as disarticulated. The intentional unification of consciousness is disrupted. The present moment has no reference to either past or future. The external world appears as a series of snapshots. Déjà vu/vécu: Patients experience places, people and situations as already seen and the news as already heard. This abnormal time experience entails a disarticulation of time structure as the past is no more distinguishable from the present moment. The already-happened prevails. Premonitions about oneself: patients feel that something is going to happen to them or that they are going to do something. This abnormal time experience entails a disarticulation of time structure as the immediate future intrudes into the present moment. The about-to-happen prevails. Premonitions about the external world: patients feel that something is going to happen in the external world. As the previous one, this abnormal time experience entails a disarticulation of time structure as the immediate future intrudes into the present moment. The about-to-happen prevails.
Disclosure of interestThe author has not supplied his declaration of competing interest.
EECP 08
How EFPT trainee-led cross-national research can change training in psychiatry
- L. De Picker, T. Mogren, S. Tomori
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- Published online by Cambridge University Press:
- 23 March 2020, p. S17
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Established in 2008, the Research Working Group of the European Federation of Psychiatric Trainees (EFPT) creates a platform for trainee-led collaborative studies. Several large-scale transnational studies on training-related subjects have been initiated and carried out, driven by psychiatry trainees. Examples of recent and ongoing projects are the Brain Drain study, which investigated migratory experiences and attitudes among trainees in Europe, and the TEO-PC project, which aims to raise awareness on UEMS Psychiatric competencies as well as to compile data on trainees’ experiences and satisfaction with their national training programs.
Earlier projects leading to publications have looked into drug prescription habits of trainees [1,2] and the interactions trainees with pharmaceutical industry [3]. Besides these projects, EFPT yearly gathers reports from the representatives of the national trainees associations on the structure, content and conditions of psychiatry training in all member countries. The information obtained through these channels is used actively to guide and influence policy related to psychiatry training, through collaboration with relevant organizations involved in the creation of guidelines, and through the EFPT statements, which serve to empower trainees themselves.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
EECP 09
Brain Drain Project
- M. Pinto da Costa
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- Published online by Cambridge University Press:
- 23 March 2020, p. S17
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Despite the ongoing reality of workforce migration, information on medical migration is missing, with lack of detailed evidence of transnational migrations within Europe, obscuring the extent of how migration occurs amongst the different medical specialties.
The European Federation of Psychiatric Trainees (EFPT) has been pioneer in researching workforce migration in junior doctors, conducting the EFPT Brain Drain study, which explored the reasons and patterns of mobility and migration in 33 European countries among junior doctors training in psychiatry.
The intention has been to better understand the migration phenomena, its reasoning and effects in order to give practical proposals to improve education, training and work conditions and ultimately the health care itself in both donor and host countries.
Migration among medical professionals can take place throughout the career: before, during or after training. Exploring attitudes towards migration among junior doctors can help to understand the factors that shape the decision-making processes related to migration in future specialists.
These findings provide objective data that can assist policy makers, providing instruments to address the critical conditions leading to migration from at-risk countries, adjusting the pull factors and improving the standards of education, work and salaries.
Future studies should explore whether the presented results differ for junior doctors in other medical disciplines, as well as physicians in general and psychiatric consultants in Europe and in other areas of the world. Furthermore, the follow up of the respondents from this study could assess to what extent the migratory tendency and intention predicts the future migration itself.
Disclosure of interestThe author has not supplied his declaration of competing interest.
S01
The synthetic psychosis substances induced: A clinical case study
- G. DiPetta,
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- Published online by Cambridge University Press:
- 23 March 2020, p. S18
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The presentation intends to examine a new kind of clinical psychiatric syndrome, called by the author “synthetic psychosis”, which can occur in people who abuse novel psychoactive substances (NPS). This syndrome will be considered from both a psychopathological and a phenomenological perspective. The contemporary trend of poly-abuse of NPS in young people can lead to a sort of very intense paraphrenic state characterised by continuous hallucinations and formed by a mental automatism syndrome and by secondary (interpretative) delusions. The clinical case of G., discussed in this paper, is an exemplary case of this synthetic psychosis. The psychopathological understanding of the core symptomatology of the patient examined has been fundamental for the successive therapeutic approach. If this attempt at understanding is ineffective, the frequent consequences include: the worsening of the psychopathology and addiction; the patient's admission into a psychiatric hospital; his/her arrest for crimes related to antisocial behaviour; a diffusion of infective diseases commonly found in addicts; more frequent overdoses; aggressive behaviour; an increase in the costs of public health system and, finally, the suicide of the patient [1].
Disclosure of interestThe author has not supplied his declaration of competing interest.
S02
Corollary discharge, auditory hallucinations and schizophrenia – a structural network analysis
- R. Henze, C. Goch, J. Richter, P. Parzer, R. Brunner, F. Resch, B. Stieltjes
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- Published online by Cambridge University Press:
- 23 March 2020, pp. S18-S19
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Introduction
Corollary discharges (CDs) are the reason most people cannot tickle themselves. They are the brain's way of distinguishing whether a stimulus is associated with one's own actions or something else. In neural terms, CDs are copies of motor plans that are propagated to sensory cortex where they can be compared with inputs. A range of phenomena associated with schizophrenia from auditory hallucinations to visual processing difficulties to the ability of patients to tickle themselves can be explained as pathologies in CD mechanisms. Auditory hallucinations for example involve patients failing to perceive themselves as the author of their own inner speech.
Objectives and aimsTo test whether schizophrenia is associated with a structural network disruption that could impair CD signals involved in language processing, adolescents with schizophrenia were examined using magnetic resonance imaging and compared to healthy controls.
MethodsA graph theoretical approach was used to analyse the connectivity in networks centered on:
– Broca's area;
– Wernicke's area.
Connectivity information was acquired using diffusion tensor imaging (DTI).
ResultsCompared to healthy controls, adolescents with schizophrenia displayed a lower average degree of connectivity with the left inferior frontal gyrus (Broca's area). No significant differences were found in the degree of connectivity with the right inferior frontal gyrus and the superior temporal gyrus bilaterally (Wernicke's area).
ConclusionsThe results suggest a link between schizophrenia and impairment to areas where CDs associated with inner speech plausibly originate.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S03
GRIN2B mediates susceptibility to affective problems in children and adolescents
- M. Nobile
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- Published online by Cambridge University Press:
- 23 March 2020, p. S19
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Objectives
Association studies have implicated the N-methyl-D-aspartate receptor 2B subunit gene (GRIN2B) as candidate for different brain illnesses, also including both internalizing and externalizing disorders. Here, we explored the association between selected SNPs of GRIN2B (rs5796555-/A; rs1012586C/G; rs2268119A/T; rs2216128A/G; rs11609779C/T; rs2192973G/A) and attention problems in children an adolescents as assessed by CBCL 6/18 (Achenbach and Rescorla, 2001).
MethodsIn a large cohort of 320 Italian nuclear families selected from an ongoing comprehensive project on child and adolescent psychopathology performed at two sites of our Institutes (BP and UD), we performed a family-based association study to determine whether the GRIN2B gene influence and/or mediates susceptibility to attention problems through time. Genetic association was investigated by the quantitative transmission disequilibrium test (QTDT, version 2.5.1; Abecasis et al., 2000). Quantitative traits were analyzed using the ‘-wega’ and the ‘-ao’ options. Empirical P-values were computed from 10,000 Monte-Carlo permutations, and the significance levels were adjusted by the false discovery rate method (Storey, 2002) applied to the tests performed for each marker (i.e., 8 phenotypes) at two different point times. Latent profile analysis was performed to assess the effect of gene on different trajectories over time. The effect of environmental determinants was also evaluated.
ResultsEvidence for significant association of GRIN2B-rs5796555-/A was found with attention problems both at first and second evaluation. Latent profile analysis suggested significant association with specific trajectories and specific environmental factors.
ConclusionsThese results provide preliminary evidence of an association between the GRIN2B polymorphism and continuity of attention problems throughout adolescence within an Italian population of referred children and adolescents, suggesting that the GRIN2B genes could play a role in susceptibility to attention problems during developmental age.
Disclosure of interestThe author has not supplied his declaration of competing interest.
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Brain glutamate levels and antipsychotic response in schizophrenia
- A. Egerton
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- Published online by Cambridge University Press:
- 23 March 2020, p. S19
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There is considerable interest in identifying biomarkers of antipsychotic response in schizophrenia. Glutamate is one key candidate. The development of brain imaging techniques for measuring brain glutamate levels has allowed this hypothesis to be tested directly in patients. This talk will present our ongoing research examining the relationship between brain glutamate levels and antipsychotic response in first-episode psychosis and in treatment-resistant schizophrenia. I will summarise our results from both our completed and ongoing studies, to consider whether glutamate imaging might be useful in the future to identify patients who would benefit from non-dopaminergic antipsychotic drugs and inform novel, glutamate-based, treatment strategies.
Disclosure of interestThe author has not supplied his declaration of competing interest.