In the beginning of 2026 the Superior Health Council published an advice on the psychosocial well-being in residential care centers. The ‘usual suspects’ on this subject as education, medicalization, innovation and internal organization are evaluated and given new incentives. It soon became clear that the existential is not just another box that needs ticking. On the contrary, it permeates the whole project of living well and well being in general. In residential care centers moreover people are confronted with frailty but also with (renewed) resilience. The importance and implementation of the existential dimension in the centers will be presented and discussed.

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In 2023, the new project NETPHARM was granted in the Czech Republic, developing during the scientific works on WP4 „Geriatric clinical pharmacy and new technologies for the individualization of drug schemes in older patients” international research collaboration in highly individualized geriatric pharmacotherapy among clinical pharmacists, geriatricians and other medical specialities, including psychiatrists.

This project builds upon previous findings of the EU projects describing problems of irrational geriatric pharmacotherapy and importance of the implementation of clinical pharmacy services in different settings of care, e.g. the EUROAGEISM H2020 and I-CARE4OLD H2020 projects, EU COST Action IS1402 ESR7 program, INOMED, EU SHELTER 7th FP EC project and the START/MED/093 project. Using results of secondary analyses from available EU datasets utilized in the NETPHARM research, this lecture describes the situation in inappropriate geriatric prescribing of psychotropics in Central and Eastern Europe.

Results from regionally different nursing home facilities in 4 Central and Eastern EU countries - the Czech Republic (CZ), Bulgaria (BUL), Croatia (CRO), Slovakia (SLO), where in total 876 NH residents were assessed in 2020-2022 by the interRAI-LTCF international tool for comprehensive geriatric assessment (CGA), confirm the high rates of polypharmacy (49.6%, 5+ meds), hyperpolypharmacy (25.7%, 10+, meds), frequent use of psychotropic multicombinations (3+ psychotropics in 36.7% older patients) and overprescribing of benzodiazepines (BZDs), in some countries with the prevalence up to 30 % (CRO, SLO). BZDs were usually prescribed for 5+ years, in non-geriatric dosing (28%) and in risky drug multicombinations (52%). The odds of being prescribed hyperpolypharmacy was significantly higher in patients with moderate to severe frailty (CFS ≥5; proportional OR = 4.3), signalling the need for deprescribing initiatives and for optimizing pharmacotherapy in this multimorbid cohort of older patients.

This lecture documents core problems of irrational use of psychotropics in older adults in nursing homes in Central and Eastern Europe and increases awareness to important role of clinical pharmacists in multidisciplinary clinical teams in optimizing pharmacotherapy in older NH residents.

Grant support: NETPHARM project CZ.02.01.01/00/22_008/0004607, co-financed by the European Union, Cooperatio research program of the Faculty of Pharmacy, Charles University (Research Unit KSKF-1, Chair: Assoc. Prof. Fialová) and SVV260665.

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The presentation will go further into needs-based interventions representing interdisciplinary collaboration, and how an academic knowledge network of a University Hospital and 18 long term care organizations provides the context for developing, evaluating and implementing these. It will elaborate on the Act in case of Depression intervention, a cyclic intervention developed for detecting and treating depression in nursing homes. This intervention was tested in a stepped-wedge cluster randomized trial which showed that it increased Quality of life in nursing home residents, lowered depression prevalence in residents living in nursing home units for somatically frail residents and lowered apathy in residents of specialized dementia units. Further, the development of the Shared Action for Breaking through Apathy intervention for people with dementia in nursing homes will be illustrated.

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The King’s Maudsley Partnership at the Pears Maudsley Centre is the UK’s first fully integrated clinical and research facility dedicated to children and young people’s mental health. The partnership brings together clinical services (South London and Maudsley NHS Trust), academics (Child Psychiatry Department at the Institute of Psychiatry, Psychology and Neuroscience) and the Maudsley Charity. This session will explore how the KMP team aim to integrate research and practice, transforming discovery science, accelerating early clinical translation and delivering impactful implementation.

In this first talk, I will review some of the barriers to progress in child and adolescent psychiatry, highlighting how many stem from a lack of joint working between key partners. I will then consider ways forward: how the Partnership and its new home at the Pears Maudsley Centre might overcome some barriers. This could help clinicians accelerate the early translation of new findings, and academics conducting research that is embedded in clinically vital questions.

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Suicide is often conceptualized as the tragic endpoint of psychiatric illness. However, accumulating evidence suggests that suicidal behavior emerges not merely from diagnostic categories, but from the dynamic convergence of emotional dysregulation and cumulative illness burden. This lecture proposes a crossroad model in which suicide risk reflects the interaction between proximal failures in affect regulation and distal biological and clinical load.

Emotion dysregulation constitutes a central proximal mechanism of suicidal crises. Heightened affective reactivity, impaired prefrontal control, cognitive constriction, and anhedonia converge to reduce the capacity to tolerate distress. Neurobiologically, alterations in fronto-limbic circuitry, stress-axis dysregulation, and impaired reward processing contribute to this vulnerability. Yet these mechanisms unfold within a broader context of illness burden.

Psychiatric comorbidity, chronic somatic disease, pain syndromes, and systemic low-grade inflammation progressively erode resilience. Biological stressors such as inflammatory activation, hypothalamic–pituitary–adrenal axis alterations, and potential blood–brain barrier dysfunction may lower the threshold at which emotional dysregulation translates into suicidal behavior. Illness burden may therefore act as an amplifier, transforming transient distress into existential crisis.

Integrating these dimensions allows a shift toward precision suicidology. Rather than treating suicide risk solely through categorical diagnoses, this framework emphasizes the identification of dominant vulnerability pathways—such as inflammatory profiles, reward-processing deficits, stress-sensitivity phenotypes, or severe emotion regulation impairments. Stratifying patients according to these interacting biological and psychological mechanisms may inform personalized preventive strategies and targeted interventions.

Suicide should not be viewed as a dead end, but as a systemic tipping point—where emotional collapse meets accumulated biological and clinical load. Advancing prevention requires bridging psychiatry, neuroscience, and somatic medicine to develop mechanism-based, individualized models of care.

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Psychiatry sees itself as progressive, yet gender inequality persists within our training systems — subtle, structural, and rarely challenged. Women enter the field in equal or greater numbers, but senior leadership remains disproportionately male. This is not just a pipeline problem; it is a training problem.

Training transmits not only knowledge but norms. What we teach — and omit — shapes who advance and which work is sidelined.

First, the content of training itself often renders gender peripheral. Sex- and gender-sensitive psychiatry is frequently confined to optional modules or niche subspecialties such as perinatal mental health. Core curricula still prioritise “neutral” diagnostic frameworks that implicitly centre male presentations of illness. Gender-based violence, reproductive transitions, caregiving burdens, and intersectional discrimination are treated as contextual add-ons rather than central determinants of mental health. When gender is framed as a “special interest,” those who champion it risk being labelled advocates rather than scientists — a subtle but powerful professional devaluation.

Second, training reinforces unexamined professional norms. Trainees quickly learn which research topics are considered prestigious and career-enhancing or invisible labour. Teaching, mentoring, pastoral support, and diversity work — disproportionately undertaken by women — are rarely rewarded in promotion criteria. Meanwhile, assertiveness in leadership is praised in men and problematised in women. These double standards are not written into curricula, but they are learned experientially.

Third, academic training structures often clash with reproductive timelines. Fellowship schemes and publication metrics assume uninterrupted productivity during years when many trainees take on parental or caring responsibilities. Flexibility is framed as accommodation rather than entitlement, reinforcing the idea that caregiving deviates from the professional norm — and in some countries, is barely supported at all.

If psychiatry is serious about gender equality, training reform must be structural, not symbolic. This means embedding sex- and gender-based science across curricula, integrating intersectionality into core teaching, valuing educational and equity work in assessments, ensuring transparent authorship and sponsorship, and publishing gender-disaggregated data on research, training, and promotion outcomes.

Early-career psychiatrists are uniquely positioned to challenge entrenched norms because they experience them most acutely. But change cannot depend on individual resilience; it requires institutional accountability. Gender equality will not arise from demographic shifts alone. Without redesigning training, evaluation, and culture, we will reproduce the hierarchies we critique. Reforming psychiatric training is not a diversity add-on — it is a scientific, ethical, and professional necessity.

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Gender equality in the workplace is increasingly recognised as a key determinant of mental health, yet it is still often framed as a structural or policy issue rather than a core clinical concern. In psychiatry, where work-related stress, role overload and social expectations directly shape symptom presentation, diagnostic pathways and treatment outcomes, this separation is particularly problematic. Early career psychiatrists—both residents and young consultants—occupy a unique position: they deliver frontline clinical care while simultaneously navigating hierarchical, gendered work environments themselves.

This talk provides a concise, evidence-informed overview of where we currently stand regarding gender equality and women’s health at work, with a focus on its relevance for everyday psychiatric practice. Drawing on epidemiological data, occupational mental health research and clinical experience, it highlights how gendered workplace exposures—such as unequal caregiving burdens, reduced autonomy, discrimination and “invisible work”—translate into well-established psychiatric risk factors, including chronic stress, burnout, depression and anxiety.

The presentation moves beyond theory to focus on practical implications. It explores common gender-related biases in assessment and diagnosis, the importance of routinely integrating women’s health and life-course factors into psychiatric evaluations, and the clinical value of validation-focused communication. In addition, it addresses the workplace as a determinant of mental health for both patients and psychiatrists, linking concepts such as double standards, token roles and leaky pipelines to early career vulnerability and professional sustainability.

Finally, the talk offers concrete, low-threshold strategies that early career psychiatrists can apply immediately in clinical encounters and team settings—micro-level actions that promote equity without requiring formal leadership roles. The central message is that championing gender equality at work is not an ideological stance, but a component of clinically accurate, ethically sound and sustainable psychiatric practice.

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More women than men enter psychiatry in the meantime, but the proportion of female leaders is still very low

In this interactive session you will get to know

• - some data on gender and career in medicine and psychiatry,

• - on career obstacles for women including their structural, but also psychological reasons, esp. the influence of traditional gender roles,

• - on the negative consequences for both female and male psychiatrists and their patients, and

• - on alternative solutions.

overview and discussion

In order to promote careers and work-life balance for both genders in psychiatry we need

• - structural reforms

• - Mentoring with early start and ongoing coaching

• - Questioning of traditional gender roles and promoting role models

Especially in psychiatry we should aim at integration of living and working for both genders.

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While increased awareness in today’s socioeconomic conditions has led to some positive progress in areas related to gender equality, we are still far from the ideal. Achieving gender equality, ensuring equal representation and rights for women in all settings and systems, should occur naturally; however, this is only partially possible through various regulations and their monitoring. Although professional organizations generally have a high level of awareness on these issues, internalized patriarchal codes can prevent our female colleagues from achieving adequate representation and having a voice in the process. Developing awareness and planning sustainable practices in this area is our responsibility and duty. I would like to introduce you to a series of initiatives we have implemented within the Psychiatric Association of Türkiye. In 2018, a policy document was prepared by a task force composed of knowledgeable colleagues in the field. A unit was established under the same name as this document on preventing sexual violence and supporting gender equality. In addition to its primary task of evaluating and supporting complainants in sexual abuse investigations where one of the parties is a psychiatrist, this unit also develops activities to support gender equality. Coordinating with other working units and task groups operating under our association, this unit recently prepared a Guide to Using Discrimination-Sensitive Language and Creating Content. We are working to promote the widespread use of this guide, which also includes gender equality issues, in all the association’s scientific activities. Through informational texts placed in congress’ bag, group work, and workshops at our association’s twice-yearly congresses, we aim to keep the theme of gender equality on the agenda in the theory and practice of our members. This year, during the week of March 8th, International Women’s Day, we are preparing a webinar where we will discuss the representation rates of women in all units and elected boards of our association, listen to suggestions and experiences from senior female colleagues in active roles, and discuss the expectations and challenges of young female colleagues. With the awareness of being part of and transforming the bigger picture, we need to discuss together the importance and impact of professional organizations taking an active role in the field of gender equality, starting from their own internal structures.

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Trauma-related disorders affect a significant portion of the population. Among others, they include post-traumatic stress disorder (PTSD), acute stress disorder and adjustment disorders. Some exposed to trauma will develop PTSD and other conditions such as anxiety, depression and substance use disorder. Those conditions are seen in everyday clinical practice and are expected to increase due to ongoing social issues and conflicts. We will present a case study of a patient that reflects current challenges and possibilities in trauma-related disorders.

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Trauma-related disorders are common in psychiatric practice and often present with heterogeneous symptom profiles, high comorbidity, and significant functional impairment. Beyond canonical post-traumatic stress presentations, complex, dissociative, and somatic manifestations are increasingly encountered, frequently shaped by developmental trauma, repeated interpersonal exposure, and ongoing psychosocial stressors. These features may complicate recognition, risk assessment, and treatment planning across diverse clinical settings.

A pragmatic, clinically oriented framework is presented for (i) identifying trauma-related disorders and relevant specifiers, (ii) differentiating them from overlapping conditions (e.g., mood, anxiety, psychotic, personality, and functional disorders), and (iii) implementing stepped, evidence-based interventions tailored to symptom clusters, comorbidity, and patient preferences.

Current diagnostic frameworks and guideline-concordant treatment evidence are synthesized, and clinical decision points applicable to routine care are integrated. Particular attention is given to structured assessment of trauma exposure and symptom profiles, dissociation, sleep, and substance use, alongside formulation-based case conceptualization and risk management for self-harm, suicidality, and re-traumatization. Emphasis is placed on transdiagnostic mechanisms, including threat processing, avoidance, and emotion dysregulation, and on trauma-informed communication to enhance engagement and retention.

A phased, personalized care pathway is proposed. Initial stabilization focuses on safety, psychoeducation, sleep and arousal regulation, and management of comorbid depression, anxiety, and substance use. Readiness for trauma-focused therapy is addressed through selection and sequencing of first-line psychotherapies, including trauma-focused CBT, EMDR, prolonged exposure, and cognitive processing therapy, with adaptations for dissociation, complex presentations, and ongoing stress. Pharmacological strategies are discussed as adjuncts targeting specific symptoms such as hyperarousal, nightmares, and comorbid mood and anxiety disorders, with caution regarding polypharmacy and agents with dependence potential. Special considerations are outlined for developmental trauma, perinatal contexts, migration-related trauma, and culturally sensitive assessment.

A structured yet flexible clinical approach is required for trauma-related disorders, balancing diagnostic precision with formulation, prioritizing safety and engagement, and applying stepped, evidence-based interventions. Trauma-informed, mechanism-focused pathways may improve outcomes, reduce chronicity, and support integrated care across psychiatric services.

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This Clinical Perspectives presentation describes an anonymised case of an adult patient with complex PTSD following prolonged interpersonal trauma, complicated by substance use and problematic benzodiazepine intake. The patient presented with persistent affect dysregulation, hyperarousal, intrusive symptoms, dissociation, sleep disturbance and severe functional impairment, alongside escalating use of alcohol/cannabis and intermittent high-dose benzodiazepine self-medication to manage anxiety and insomnia. The case highlights key clinical dilemmas frequently encountered in trauma-related care: differential diagnosis (complex PTSD vs borderline personality disorder vs major depression), risk assessment including self-harm, and treatment sequencing when trauma symptoms coexist with addiction-related behaviours. Management is discussed using a phased, recovery-oriented approach, integrating stabilisation and psychoeducation, careful psychopharmacological planning (including benzodiazepine harm reduction and tapering strategy), and referral to evidence-based psychotherapy (trauma-focused therapy when clinically safe), combined with addiction-focused interventions and relapse prevention. The presentation emphasises multidisciplinary collaboration and practical decision-making applicable to outpatient psychiatry, particularly when ongoing stressors and limited resources affect continuity of care.

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Complex Post-Traumatic Stress Disorder (C-PTSD), recognized in the ICD-11, is a mental disorder resulting from chronic and prolonged interpersonal trauma, such as physical or sexual abuse or neglect. In addition to the core symptoms of PTSD (re-experiencing, avoidance, and a persistent sense of threat), C-PTSD is characterized by disturbances in emotional regulation, a negative self-concept, and persistent difficulties in interpersonal interactions, including relationship avoidance and distrust of others. These features can be detrimental to the therapeutic relationship.

We present the case of a 25-year-old woman who came to an outpatient psychiatric clinic with depressive mood, anhedonia, high levels of anxiety, insomnia, and pervasive feelings of shame and worthlessness. Her history included physical abuse within her family of origin and prolonged bullying during childhood and adolescence. She was diagnosed with C-PTSD and major depressive disorder and was started on antidepressant medication and referred for psychotherapy.

During the first nine months of treatment, the patient showed improvement in depressive mood; however, feelings of worthlessness, marked anxiety, and hyperarousal persisted. She subsequently missed two consecutive monthly appointments. At the following visit, she disclosed having recently exited an abusive intimate relationship. She reported feeling too ashamed to discuss the situation earlier but decided to leave her boyfriend after experiencing physical assault. At that time, she presented with panic attacks, emotional lability, flashbacks, hyperarousal, insomnia. Pharmacological treatment was resumed, and psychotherapy was re-initiated.

Leaving the abusive relationship and finding the capacity to disclose her experience and ask for help represented a significant therapeutic turning point. The gradual establishment of trust and perceived safety within the therapeutic relationship enabled the patient to address ongoing trauma-related difficulties.

C-PTSD is a condition associated with high vulnerability, which requires a careful approach. Patients with C-PTSD often struggle with trust and may delay disclosure of ongoing abuse. Providing a consistent sense of safety, emotional attunement, and non-intrusive support is essential to fostering engagement and facilitating recovery.

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Burnout among early career psychiatrists represents a critical and often overlooked crisis that threatens the future of mental healthcare delivery. This presentation examines personal and professional consequences of occupational stress in early career psychiatrists who navigate the challenging transition from training to independent practice. The paradox of our profession is that those entrusted with safeguarding mental health frequently neglect their own psychological well-being, with early career practitioners being particularly vulnerable due to idealistic expectations, inadequate preparation for emotional demands, and the pervasive stigma surrounding help-seeking within medical culture. Personally, burnout manifests through emotional exhaustion, depersonalization toward patients, and a diminished sense of personal accomplishment, with alarming rates of anxiety, depression, and suicidal ideation reported among this population. The shame and fear of professional repercussions often prevent early career psychiatrists from seeking the very support they provide to others, creating a dangerous cycle of silent suffering. Professionally, the consequences extend beyond individual practitioners to directly compromise patient care: burnout correlates with reduced empathy, increased diagnostic errors, poorer therapeutic alliances, and higher rates of suboptimal treatment decisions. At the systemic level, burnout drives premature attrition from the field, contributing to workforce shortages precisely when demand for mental health services is escalating globally. This presentation argues for urgent, multi-level interventions including mandatory supervision and mentorship programs, institutional normalization of help-seeking behaviors, curriculum reforms addressing emotional preparedness, and the destigmatization of vulnerability within psychiatric training. Protecting the psychological health of early career psychiatrists is not merely an occupational health issue but a fundamental patient safety imperative. We cannot effectively heal others when we ourselves are wounded and silenced.

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Stress and interpersonal relationships in the clinical setting greatly impact the well-being of early-career psychiatrists (ECP). Key sources of stress are often related to patient care and suffering, organizational and system-level inefficiencies, workload, unpredictable schedules, and financial strain. Research highlights systemic stressors such as staffing shortages, administrative burden and obstacles, and a lack of resources, as well as individual stressors related to competence, career stagnation, work-life balance, and personal difficulties. Therefore, strategies for reducing burnout include both individual and structural approaches. We will provide an overview of the most common sources of stress, their impact on ECPs’ well-being and propose viable solutions.

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Burnout among early-career psychiatrists is increasingly recognised as a significant threat to workforce sustainability, patient safety, and professional fulfilment. Long working hours, emotional intensity, and systemic pressures often converge during training, before clinicians have developed structured coping strategies. While institutional reform is essential, resilience-building within training programmes offers a powerful complementary approach.

This talk explores how wellbeing and coping skills can be proactively integrated into psychiatric training from the outset, rather than introduced reactively once distress emerges. Drawing on evidence from medical education, occupational psychology, and reflective practice initiatives including insights from the Bucks Movie Club article, which highlighted the value of narrative, shared reflection, and creative spaces in supporting clinician wellbeing-the session will examine practical strategies that can be embedded within training curricula.

Key areas include emotional regulation skills, structured reflective practice, peer-support forums, psychologically safe supervision models, and boundary-setting within high-demand clinical environments. The role of mentorship and facilitated debriefing following challenging clinical encounters will also be discussed. In addition, cognitive-behavioural principles, mindfulness-based approaches, and values-driven career planning will be considered as tools to strengthen professional identity and reduce vulnerability to burnout.

Resilience will be framed not as individual toughness, but as a dynamic process shaped by organisational culture, leadership, and team cohesion. The session will highlight how institutions can foster environments that normalise help-seeking, encourage creative and reflective engagement such as film-based discussion groups and equip trainees with sustainable coping tools early in their careers.

By shifting the focus from crisis response to early prevention, psychiatric training programmes can cultivate clinicians who are not only clinically competent but psychologically equipped to thrive. Integrating structured wellbeing education into training is not an optional enhancement, it is an investment in the future of the profession.

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In this presentation, drawing on experiences from different health care systems and diverse academic environments around the globe, I will reflect on a journey across countries, institutions, and roles, and on the lessons learned while navigating uncertainty, competing clinical and academic demands, and a nonlinear career trajectory. I will discuss the value of adaptability as a deliberate process of recalibration rather than a sign of indecisiveness. Together with the audience, I will explore the following questions: How does one define a coherent professional identity amid constant transition? How can passion be pursued without being consumed by passio? Ultimately, I will attempt to argue that professional identity is not a fixed destination but an evolving construct.

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Early career decisions in psychiatry shape not only individual professional trajectories but also the future quality, accessibility, and scope of mental health care. This workshop contribution reflects on key lessons from established psychiatric careers, focusing on how young psychiatrists can navigate the transition from training to long-term professional fulfillment while responding to evolving clinical, societal, and global challenges.

Drawing on personal experience and collective insights from senior colleagues, the talk addresses core themes such as finding a professional identity, balancing clinical excellence with personal well-being, integrating psychotherapy, research, leadership, and innovation, and remaining adaptable in a rapidly changing mental health landscape. Emphasis is placed on maintaining patient-centered care while expanding horizons through interdisciplinary work, global perspectives, and emerging technologies.

By sharing practical guidance, reflective insights, and realistic narratives of success and challenge, this contribution aims to empower early career psychiatrists to shape meaningful, sustainable careers that contribute to improving mental health care for individuals and societies alike.

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The topic of the ECP Programme, ‘Lessons in Leadership: How to become leaders in psychiatry,’ gives us a broad opportunity to explore different aspects of this important subject. Learning leadership skills is not prioritized in the curriculum, neither as medical students nor as a doctor during specialty training. In my presentation I will focus on Inner Leadership — the process by which a leader prioritizes reflection, motivation, transition and personal development in order to lead others more effectively.

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Leadership in psychiatry is gaining increasing importance as healthcare systems grow more dynamic and complex. Despite psychiatrists’ essential role in mental health care, structured leadership education during medical school and residency remains insufficient. As a result, many clinicians develop leadership abilities through practical experience rather than formal training. This presentation emphasizes the need to make leadership development a standard and mandatory component of psychiatric education. Clinical leadership in mental health is not only about running services efficiently. Management focuses on keeping systems organized and using resources properly, but leadership is about setting a clear path and helping others move in the same direction. A psychiatrist in a leadership role needs clinical knowledge as well as strong people skills, ethical values, and the ability to see the bigger picture. They are expected to organize services, guide teams, use resources wisely, maintain high professional standards, and respond to wider system challenges. Leadership also involves leading change, encouraging others, and balancing the needs of individual patients with the needs of the community as a whole. Some aspects of leadership may be natural, but many key abilities such as clear communication, leading teams, and thinking ahead can be taught and strengthened through structured education and guidance. Making leadership training part of psychiatric residency programs can contribute to stronger mental health services, better patient outcomes, and the ongoing development of psychiatry in a rapidly changing healthcare environment.

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