In 2002, the euthanasia law was voted in Belgian parliament, depenalising physician-assisted dying under certain conditions for irremediable physical or mental suffering caused by an incurable condition for which all therapeutic options have been exhausted. The euthanasia request needs to be repeated, well-considered and voluntary and the patient should be competent. If the patient is not in a terminal condition, there should be at least one month between the written request and the euthanasia and three independent physicians have to be involved in the evaluation.

Psychiatric suffering was not excluded in the law, but there is discussion whether the possibility of psychiatric euthanasia was intended by the legislator. In the first years after the euthanasia law, psychiatric euthanasia was limited to a few cases, but then rose to a mean of 25 cases per year. There was a peak in 2013 of 54 cases, but after 2013 there was no more increasing trend.

In 2017, the Flemish Association for Psychiatry issued an advice regarding due diligence in psychiatric euthanasia. Controversy regarding psychiatric euthanasia kept stirring the public debate, especially after one court case in which a psychiatrist and general physician were accused and acquitted after a psychiatric euthanasia.

Another prominent topic in the public debate in Belgium is broadening the euthanasia law for advanced dementia based on an advance directive. Now euthanasia is only possible in the earlier stages of neurodegenerative disease, when competence is still sufficiently intact.

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The presence of large numbers of Ukrainians looking for refuge in Poland is a new experience for Poles. The ongoing war and the uncertainty of the situation of those displaced may cause anxiety and lead to stressful reactions, exacerbated by endlessly circulating information on hostilities. Therefore, the sense of security may be threatened not only among Ukrainians who have fled to Poland, but also among people who support Ukrainians, who offer them help and shelter. Prolonged support, if not accompanied by proper selfcare can increase the risk of burnout as well as lead to distressful emotional states, such as a feeling of helplessness, reluctance to provide further help, or even demonstrate hostility. The Polish government and polish NGO’s have pledged to help refugees from Ukraine, including the provision of mental health care. Raising awareness of the whole society and training employees from sectors other than medical may help in the proper protection of mental health of refugees and the people supporting them. Dividing the organization of mental health care into the four levels (Intervention Pyramid (Inter Agency Standing Committee, 2007)and offering support depending on the needs, ranging from building a basic sense of security, acceptance, and support for meeting the needs of refugees, to the level of highly specialized psychological and psychiatric assistance, enables the use of the resources of the entire society and specialists in an appropriate manner. By activating refugees themselves and training employees and volunteers of various sectors and fields of support, the goal of mental health promotion is spread across many environments, which mental health professionals themselves cannot cope with in these new, difficult conditions.

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Sweden has a long history as a host country for refugees. In recent years there has been a shift from being one of the most generous host countries in Europe to one of the most restrictive. In Sweden, refugees with a residence permit have a full right to care, but asylum seekers and undocumented migrants only have a right to care that cannot be deferred. Despite relatively good formal access to mental health care, and so far, the availability of free language interpreters, refugees face barriers to and within mental health care.

To give a brief overview of the current challenges for mental health care in Sweden and the work on solutions for people on the move.

Ongoing research and clinical development are summarised in parallel with the identification of challenges.

A complex picture of the development and challenges of mental health care for people on the move in a situation of increasing social pressure on refugees is described.

There is a need for equal treatment of people on the move without discrimination and exclusion.

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Germany is one of the countries that has taken in a large number of refugees. Around 2.25 million now have recognised protection status in Germany. In addition, Germany has taken in over 1,215,048 refugees from Ukraine. All of these people are very vulnerable refugees who are exposed to many risk and stress factors before, during and after their migration. As a result, they have a high prevalence of mental disorders such as post-traumatic stress disorder (PTSD), depression, anxiety, substance use and persistent grief disorder. At the same time, refugees face numerous barriers to accessing medical care, such as language and cultural barriers, administrative barriers, structural, institutional and interpersonal discrimination and racism. There is also unequal treatment in Germany between refugees from Ukraine and other regions of the world. In addition, healthcare provision has recently been tightened due to changes in the Asylum Seekers’ Benefits Act. This presentation will focus on the sitaution in Germany and discuss üossible solutions.

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Comorbidities in addiction: It is a rule rather than an exception. The story starts in childhood; even before, in infancy, and may be in prenatal life. The dimensional traits have already been there, existing obviously far before any DSM-5 diagnosis. Among these traits, the developmental features named as stress sensitivity, impulsivity and emotion dysregulation are the leading ones. Comorbidity research addressed childhood abuse, neglect or other childhood adverse experiences as a definite risk factor for adolescence and adult mental disorders, particularly substance use disorders. Developmental and environmental adversities in a mutually amplifying pattern make a vicious cycle in which the individual finally finds an illusionary exit, a pathway to addiction.

This presentation aims to discuss the complexities and challenges for the diagnosis and treatment of cases presenting with ASUD (alcohol and substance use disorders) and comorbid neurodevelopmental and affective or psychotic disorders . The history as well as the life and the management charts of the patients are reviewed in the light of information collected during the follow-up years revealing significant alterations with regard to diagnoses and therapeutic approaches. A specific focus of the case studies will be the missed or mis-diagnoses, and the impact of them on the treatment courses and the outcomes. One of the case studies with an eight year follow-up period, shows ADHD traits, alcohol use disorder, affective disorder and a later emerging severe stimulant use disorder. The second case with a similar ADHD history, presents with a stimulant use disorder, co-occuring with a severe psychotic disorder, that has been mis-diagnosed as schizophrenia. The life and management charts of the studied cases convey the drawbacks of the diagnostic difficulties, the treatment failures and the implication of efficient therapeutic strategies.

The challenges faced by clinicians due to co-occuring disorders that have become a common practice for addiction professionals. should be managed by transdiagnostic and integrative modalities. While big data or empirical large datasets can have their own limitations to help the practitioner for overcoming such complexities of real world situations, as stated in Stein’s article (2022, Psychiatric diagnosis and treatment in the 21st century: paradigm

shifts versus incremental integration) “the age-old single-case studies, may sometimes provide clinical insights that outweigh those from big data analyses.”

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Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD) frequently co-occur. Patients with this comorbidity report poorer qualtiy of life, and have worse treatment outcomes for both disorders, including high relapse rates of the SUD. In this case based discussion, clinical dilemma’s in the diagnosis and treatment of patients with this comorbidity will be discussed. Recent findings of the International Collaboration on ADHD and Substance Abuse (ICASA) will be used as background, including findings from ICASA’s most recent work: the longitudinal International Naturalistic Cohort Study of ADHD and SUD (INCAS), where nearly 600 patients with both ADHD and SUD in treatment were followed for nine months. In addition, ICASA’s consensus statements on diagnosis and treatment of co-occurring ADHD and SUD in youths and adults will be shortly discussed.

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During the workshop about this complex case, I will discuss aspects of the case and the challenges the individual has faced from a neurodevelopmental and transdiagnostic perspective. It is the norm that those presenting for treatment or support with problematic drug/alcohol use will also have co-occurring neurodevelopmental, mental and physical health traits or disorders. Their relationships are often complex and ingrained. It is generally unhelpful to consider such complexity in terms of ‘primary’ vs ‘secondary’ as this may lead to exclusion from some services. For instance, someone with depression and problematic alcohol use may not be seen by psychiatric services or psychologists due to their drinking and an ‘addiction’ service may not have sufficient mental health expertise for managing their depression. Such ‘silos’ are common and need to be addressed through better understanding of the relationships between problematic drug/alcohol use and co-occurring neurodevelopmental, mental and physical health traits or disorders, through better training of health and social care staff and reducing stigma.

A. Lingford-Hughes Grant / Research support from: Research supported by Lundbeck, GSK, Indivior; unrestricted funds support from Alcarelle for a PhD, Consultant of: Silence, NET Device Corps, Sanofi-Aventis, Astra Zeneca and also consulted by but received no monies from Britannia Pharmaceuticals, GLG, Opiant, Lightlake and Dobrin, Paid Instructor of: Received Honoraria paid into her Institutional funds for speaking and Chairing engagements from Lundbeck, Lundbeck Institute UK, Janssen-Cilag, Pfizer, Servier; receives Honoraria for teaching for British Association for Psychopharmacology.

There are clear unmet medical needs in the treatment of Cocaine Use Disorder (CUD), since there are no pharmacological treatments approved. The neurobiological circuitry of addiction has been described in recent years, and it provides a solid rationale to target specific brain regions to treat addictive behaviors, including CUD. The stimulation of the left Dorsolateral Prefrontal Cortex (DLPFC) with repetitive transcranial magnetic stimulation (rTMS) has proved to reduce craving for various drugs, including cocaine.

We present the results of a retrospective study performed in a private setting with 93 patients with CUD, who were treated with rTMS following the protocol from Terraneo et al. In 12 weeks patients received 32 sessions of 2400 pulses (100% MT; 10 Hz; 60 pulses per train, 15 seconds interval; 40 trains per session), for a total of 76800 pulses.

The main outcome was total abstinence of cocaine (self-reported plus urinalysis). Abstinence rates at days 30, 60 and 90 were 55,9%; 40,8%; and 34,4% respectively.

Psychiatric comorbidities (insomnia, depression and anxiety) were also assessed with validated questionnaires. Drop-out was directly related to recent cocaine use, but initial levels of psychological distress did not predict drop-out.

No relevant side effects were reported. Mild and transient headache was reported by a few patients after the first session.

In conclusion rTMS was well tolerated, drop out rates were high and 34% of the patients remained abstinent after the 90 days treatment period.

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Transcranial Direct Current Stimulation (tDCS) has already been proven to be an effective modality in substance use disorder (SUD), often targeting the dorsolateral prefrontal cortex bilaterally. However, addiction is a very broad concept, comprising many different neurocognitive defects.

To better guide and investigate the potential benefits of tDCS for people who suffer from SUD, we shall take a transdiagnostic approach to SUD to see which other targets for tDCS might lead to additional clinical use, paving the way for personalised neurostimulation.

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Treatment-resistant depression (TRD) remains a major clinical challenge, necessitating novel and more effective therapeutic approaches. The BRIGhTMIND study is the largest transcranial magnetic stimulation (TMS) clinical trial conducted in the UK. This multicentre, randomised controlled trial compares the efficacy of connectivity-guided intermittent theta burst stimulation (iTBS) with standard repetitive transcranial magnetic stimulation (rTMS) in patients with TRD. This talk will present key findings from the study, including response and remission rates, reported side effects, and key differences between the novel iTBS protocol tested and the conventional rTMS protocol used as the control condition. Additionally, we will explore the clinical implications of using functional connectivity to optimise stimulation targets. The results contribute to the growing evidence supporting TMS as an effective intervention for TRD and offer insights into the future of precision psychiatry in brain stimulation.

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Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It is primarily used to treat depression and other mental health conditions. When it comes to the safety of TMS during pregnancy, the current evidence is limited but generally suggests that it may be a safer alternative to medications that could potentially harm the fetus. Several small studies and case reports have indicated that TMS does not appear to pose significant risks to the pregnant woman or the fetus. However, the data is not extensive, and more research is needed to fully understand the implications. The procedure is typically avoided in the first trimester unless absolutely necessary, as this is a critical period for fetal development. In summary, while TMS is considered relatively safe during pregnancy, especially compared to some pharmacological treatments, it should only be used when the potential benefits outweigh the risks, and under the close supervision of a healthcare provider. Pregnant women considering TMS should discuss their specific situation with their doctor to make an informed decision.

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The turn of the century was an important era for the field of psychiatry. Influential physicians such as Sigmund Freud (1856-1939) or Eugen Bleuler (1857-1939) made headlines and new theories on the pathogenesis of psychological disorders emerged with the psychoanalytic approach – the whole field seemed in a state of transition. But did this modern image correspond to how two of psychiatry’s most famous conditions – psychoses and delusions – where framed in the mass media of film? Surprisingly, there are no systematic works on these question, neither by medical nor film historians. This lecture tries to close this gap and, for the first time in international research, provides a systematic overview of the representation of the theme in silent cinema. With the aim of sketching a representative image, 36 works portraying psychoses and / or delusions were identified and, among other things, historically classified, analyzed and evaluated for medical correctness. In summary, it is shown that the early film depicts the condition in a highly ambivalent way, from dangerous and untreatable Insanity to curable illness, thereby reflecting one of the most significant transitions in the history of the understanding delusional symptoms. The presented therapy methods – e. g. psychoanalysis, hypnotherapy, electrotherapy, water therapy and even music therapy –, thus rarely utilized, appear highly modern, while the depiction of the patients seems more influenced by the shadows of the past. Accompanied by scenes from representative works such as The Other (1913), Wolf Blood (1925), Shadows (1923) or the German classic The Cabinet of Dr. Caligari (1920), the presentation aims to illustrate all these characteristics of the early ‘psychosis und delusion film’ and explores the important role of cinema as a source of medical history.

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Under the rubric of cinema therapy, or movie therapy, research has been undertaken for some time to test the effect of films in different therapeutic settings and with different patient groups. Taking a closer look at the history of film therapy, it becomes apparent that at the time of the silent film, there was already a medical discourse on the effect of films in a therapeutic context. In this lecture, principal philosophical-therapeutic elements of consideration regarding cinema therapy are presented along with historical and current discourses; the most important publications are indicated; and the author’s own cinema-therapeutic models, experiences and reflections are reported. In addition, selected case studies show how films can be utilized in a clinical context and which effects and unwanted side effects result from film therapy. The final focus of the lecture is on films that depict psychotherapy, love films, and films that address the phenomena of intoxication, ecstasy, and addiction, and how these have been applied by the author in the inpatient treatment of addicts.

Martin Poltrum (2025) Cinema Therapy––The Film as a Medicine. From the Silent Film Era to the Present Day. In: Martin Poltrum et al. (eds.) The Oxford Handbook of Mental Health and Contemporary Western Aesthetics, Oxford: Oxford University Press.

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The presentation juxtaposes the practice of psychiatry with the creative processes involved in filmmaking. It proposes a correlation between the representation of reality in film, and the processing of visual information. It is informed by autobiographical case study films written and directed by individuals with experience of psychosis. In-depth analysis of film conventions employed by filmmakers with experience of psychosis indicate the potential benefits of further research into collaboration with, and contributions from, those filmmakers.

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Although cognitive impairment is a core symptom of schizophrenia related to poor outcome in different functional domains, it still remains a major therapeutic challenge. To date, cognition is still poorly assessed in both research and clinical settings and no comprehensive treatment guidelines for assessment and treatment of cognitive impairment in schizophrenia are implemented.

The aim of the European Psychiatric Association (EPA) guidance paper was to provide a comprehensive meta-review of the current available evidence for the assessment of cognitive functions in schizophrenia both in research settings and in real-world clinical practice and for treatment of cognitive impairment, structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments.

Based on the reviewed evidence, the EPA guidance recommends a comprehensive and systematic assessment of neurocognitive and social cognitive domains in schizophrenia, in all phases of the disorder, as well as in subjects at risk to develop psychosis. It is recommended not only the use of observer reports, but also of self-reports and interview-based cognitive assessment tools. As for treatment, the EPA guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive symptoms in schizophrenia. Among psychosocial interventions, cognitive remediation and physical exercise, and some variables have been confirmed as core elements for cognitive remediation effectiveness.

The dissemination of the EPA guidance papers may promote the development of shared guidelines concerning the assessment and treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve clinical recovery in this population.

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The presentation will summarize recent findings on the role of the two domains of negative symptoms (motivational impairment and expressive impairment) and social cognition as mediators of the impact of neurocognitive impairment on functional outcomes in people living with schizophrenia (PLWS).

One hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive impairment predicted global functioning and together with motivational impairment fully mediated the effects of neurocognition on the same outcome. Motivational impairment was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational and neurocognitive impairments predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome.

Our results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive impairment on different domains of functioning. Our results suggest that psychosocial interventions should target both negative symptoms and social cognition to enhance the functional impact of cognitive remediation.

A. Mucci Consultant of: Angelini, Gedeon Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka Pharmaceutical, Pfizer, Pierre Fabre, Rovi Pharma and Boehringer Ingelheim.

Cognitive impairment associated with schizophrenia (CIAS) is a relevant problem and can be well assessed in different ways, as described in an EPA guidance paper (1). In routine clinical practice, the clinician usually relies on targeted questions to elicit psychopathological findings, as described in the AMDP system (2), for example. If there is a need for a more precise assessment of cognitive dysfunction, also in a transdiagnostic way, the Screen for Cognitive Impairment in Psychiatry (SCIP) (3) has recently been used by several working groups.

In a recent pilot study (4), we used the German version of the SCIP (SCIP-G) (5,6) to assess cognitive impairment in acute psychiatric inpatients diagnosed with psychotic disorders, bipolar disorder and depression.

(1) Vita A, Gaebel W, Mucci A, Sachs G, Erfurth A, Barlati S, Zanca F, Giordano GM, Birkedal Glenthøj L, Nordentoft M, Galderisi S. European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry. 2022 Sep 5;65(1):e58. doi: 10.1192/j.eurpsy.2022.2316.

(2) The AMDP System: Manual for Assessment and Documentation of Psychopathology in Psychiatry, 9th edition. 2017. Ed.: Broome MR, Bottlender R, Rösler M, Michael; Stieglitz RD. Hogrefe Publishing GmbH. ISBN: 978-0-88-937542-0

(3) Purdon SE. The Screen for Cognitive Impairment in Psychiatry (SCIP): Instructions and three alternate forms. 2005. PNL Inc, Edmonton, Alberta

(4) Maihofer EIJ, Sachs G, Erfurth A. Cognitive Function in Patients with Psychotic and Affective Disorders: Effects of Combining Pharmacotherapy with Cognitive Remediation. J Clin Med. 2024 Aug 16;13(16):4843. doi: 10.3390/jcm13164843.

(5) Sachs G, Lasser I, Purdon SE, Erfurth A. Screening for cognitive impairment in schizophrenia: Psychometric properties of the German version of the Screen for Cognitive Impairment in Psychiatry (SCIP-G). Schizophr Res Cogn. 2021 May 12;25:100197. doi: 10.1016/j.scog.2021.100197.

(6) Sachs G, Bannick G, Maihofer EIJ, Voracek M, Purdon SE, Erfurth A. Dimensionality analysis of the German version of the Screen for Cognitive Impairment in Psychiatry (SCIP-G). Schizophr Res Cogn. 2022 Jun 6;29:100259. doi: 10.1016/j.scog.2022.100259.

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Cognitive impairments are present from the first manifestations of the disorder, including social cognition in individuals at ultra-high risk for psychosis (UHR). While advances in psychopharmacology in recent decades have significantly altered the course of the illness, antipsychotic therapy is more effective in treating positive symptoms than negative symptoms, comorbid depression, and cognitive and social cognitive dysfunction. Again, cognitive impairment has a significant impact on functional outcome, more so than symptom severity.

Due to the particular significance of cognitive deficits, it is very important to identify them accurately at an early stage. Strategies for identifying cognitive deficits are presented in an EPA guidance paper.

To improve cognition in patients with schizophrenia, it has been suggested to combine pharmacotherapy with neuropsychological training. A meta-analysis showed the positive effect of cognitive remediation programmes in schizophrenia. While the strategies available today for the treatment of cognitive dysfunction are useful and should be implemented, it is hoped that pharmacological add-on strategies will come onto the market to have a greater effect on cognitive impairments.

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An experienced practitioner describes the fundamentals of crisis support and Psychological First Aid – the knowledge base for the ongoing work in Västra Götalandsregionen, Sweden, using VR to practice crisis support. How is crisis support defined and what is the difference between crisis support and psychological treatment? What is the aim of crisis support? The presentation includes current knowledge about how humans react in a crisis, in the acute phase as well is in the longer term. What are the guidelines for providing Psychological First Aid and how can we implement them in practice?

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This presentation will explore the development and implementation of the Crisis Support VR project, funded by the VGR Innovation Fund and involving five hospitals and primary care. In today’s society, the need for crisis support is more pressing than ever. However, we identified a significant gap in opportunities to practice Psychological First Aid. To address this, Region Västra Götaland collaborated with VirtualSpeech to create a system that has been tested by hospital staff, emergency services, and crisis support teams. This presentation will detail the project’s journey from its inception to its current state, highlighting the challenges and successes encountered along the way.

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