Keynote Lecture 1: Maria Melchior
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Keynote Lecture 1: Maria Melchior 4108 - Social inequalities in children's mental health - from observation to prevention Dr Maria Melchior Children growing up in poverty have high levels of emotional and behavioral problems, which can hinder well-being, school achievement and social integration, as well as predict the occurrence of psychiatric disorders later in life. Population-based studies indicate the existence of a socioeconomic gradient with regard to child mental health. That is the effects of low socioeconomic position are not curtailed to groups of individuals who experience poverty, but are widely distributed. I will present data from contemporary epidemiological studies documenting socioeconomic inequalities with regard to child and adolescent mental health across different socioeconomic indicators, different forms of psychopathology and different age groups. I will also show currently available evidence suggesting that changes in families’ socioeconomic circumstances can have beneficial effects on children’s mental health. Finally, I will suggest possible avenues for intervention which could help reduce socioeconomic inequalities with regard to child and adolescent psychopathology. Keynote Lecture 2: Patrick McGorry 4110 - Transition to 21st Century Mental Health Care: Early Intervention for Young People with Emerging Mental Disorders. Prof. Dr. Patrick McGorry Orygen, The National Centre of Excellence in Youth Mental Health,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Mental and substance use disorders are among the leading health and social issues facing society, and now represent the greatest threat from non-communicable diseases (NCD) to prosperity, predicted by the World Economic Forum to reduce global GDP by over $16 trillion by 2030. This is not only due to their prevalence but critically to their timing in the life cycle. They are by far the key health issue for young people in the teenage years and early twenties, and if they persist, they constrain, distress and disable for decades. Epidemiological data indicate that 75% of people suffering from an adult-type psychiatric disorder have an age of onset by 24 years of age. Young people on the threshold of the peak productive years of life have the greatest capacity to benefit from stepwise evidence-based treatments and better health care delivery. Furthermore, the critical developmental needs of adolescents and emerging adults are poorly met by existing conceptual and service models. The paediatric-adult structure of general health care, adopted with little reflection by psychiatry, turns out to be a poor fit for mental health care. Youth culture demands that young people are offered a different style and content of service provision in order to engage with and benefit from interventions. In Australia a new system of enhanced primary care, headspace, has been developed for 12 – 25 year olds. This is now operating in 100 communities in Australia. Access has been greatly improved especially for some traditionally hard to engage subgroups. Outcomes include reduced distress, better functional outcomes and reduced self harm. Similar programs are in place in Ireland, France, Israel, the UK and Denmark and are under development in Canada and the Netherlands. The need for international structural reform and an innovative research agenda represents one of our greatest opportunities and challenges in the field of psychiatry and a huge opportunity for child and adolescent psychiatry which may be able to “come out of its shell” and form the vanguard of mental health reform. Keynote Lecture 3: Patrick Luyten 4111 - A radical shift in the treatment of child and adolescent depression Perhaps the time ripe? Professor Patrick Luyten Patrick Luyten, PhD is Associate Professor at the Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Reader at the Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Depression ranks among the leading causes of disability, morbidity, and mortality in young people (YP). Although the last decades have led to considerable progress in our understanding of the causes of mood problems in YP and in the development of effective treatments, limitations of current theoretical and intervention approaches have also become increasingly clear. First, with regard to diagnosis, there is a clear shift away from a categorical, disease-oriented model to a dimensional approach that focuses on underlying systems implicated in psychopathology. The Research Domain Criteria (RDoC) is a good example of this change in approach. Second, with regard to treatment, although a variety of effective interventions for pediatric depression have been developed, they are equally effective, response rates are realtively low, with a substantial number of YP dropping out of treatment and thus being “hard-to-reach”. Together, these findings force us to ask the “hard questions” about our views concerning the nature of depression and its treatment in YP. Based on evolutionary biological and developmental psychopathology considerations, we present an integrative developmental cascade model of depression that essentially suggests that depression emerges out of a three-pronged series of interacting impairments in the domains of stress regulation, reward, and mentalizing (SRM). We also focus on how this model may explain in large part the heterogeneity and thus marked comorbidity of depression with other psychiatric disorders, as well as with functional somatic and somatic disorders. We outline the implications for the development, evaluation, training and dissemination of interventions for YP with depression. Keynote Lecture 4: Tony Charman 4115 - Tracking the emergence early autism symptomy in at-risk infants: Possibilities for prodromal intervention? Prof. Tony Charman King's College London Until recently, most of what we knew about the emergence of autism in infancy relied on retrospective accounts. A new approach, the study of infants at familial risk, aims to identify the earliest “pure” manifestations of autism, before subsequent years of atypical development exacerbate, or compensate for, initial atypical development. An emerging picture from these studies is that early impairments in one or more of several functional cognitive systems are associated, respectively, with familial risk and with a later autism diagnosis. Understanding the temporal associations between these impairments over time will reveal the underlying mechanisms of atypical development in autism and inform approaches to early intervention. I will present new data from our ongoing prospective longitudinal and intervention studies. Keynote Lecture 5: Dieter Wolke 4109 - Peers and siblings matter for mental health: long term consequences of bullying Prof. Dr. Dieter Wolke University of Warwick Objective: This keynote presentation will review longitudinal research on the effects of bullying in childhood on mental health and economic functioning into adolescence and adulthood. Bullying is the systematic abuse of power and defined as aggressive behaviour or intentional harm doing by peers that is carried out repeatedly, and involves an imbalance of power, either actual or perceived, between the victim and the bully. One in 3 children report having been bullied at some point in their lives, and 10 - 14% experience chronic bullying lasting for more than six months. Being bullied by peers is the most frequent form of abuse encountered by children, much higher than abuse by parents or other adult perpetrators. Methods: Review of propsective longitudinal studies. Results: Children who were victims of bullying are at higher risk for common somatic problems, internalizing problems and anxiety disorder or depression disorder and at highly increased risk to self-harm or think about suicide in adolescence. The mental health problems of victims and bully/victims remain in adulthood. Indeed, we showed that peer bullying in childhood has more adverse effects on diagnosed anxiety and mood disorders than being physically or sexually abused or neglected by parents. The service use of mental health services has been found to be highly increased across adulthood in those who were bullied. Victimised children reach also lower educational qualifications, were poorer in financial management and earned less than their peers even at age 50. Victims also report to have more trouble with making or keeping friends in adulthood and were less likely to live with a partner and have social support. In contrast, bullies had no increased risk for any mental or general health problems, were healthier than their peers, emotionally and physically. Conclusions: Being bullied has highly adverse health effects and service use implications. Sadly, many bullied children suffer in silence for fear of reprisals or shame. Children will have spent much more time with their peers than their parents by the time they reach 18 years of age. It is thus surprising that childhood bullying is not at the forefront as a major public health concern. To prevent dropping out of school, violence against oneself (e.g. self-harm) and reduce mental and somatic health problems, it is imperative for health practitioners, families and schools to address bullying. Keynote Lecture 6: Paul Hoff 4113 - Conceptual transitions: What will happen to the concept of mental disorders in the 21st century? Prof. Dr. Paul Hoff Psychiatrische Universitätsklinik