KEYNOTE LECTURE Research in psychiatry: Ongoing debate and evolving priorities Mario Maj Department of Psychiatry, University of Naples SUN, Naples, Italy The notion that psychiatric research is in a crisis has recently become a sort of cliché, but is largely incorrect. There will certainly be no more “spirochete-like discoveries” in psychiatry, while what is occurring is the gradual elucidation of a multiplicity of risk and protective factors for mental disorders, exerting small to moderate effects at different levels and variously interacting with each other. However, it is probably true that we need some reconsideration and rebalancing of the priorities of psychiatric research, and it is certainly true that the viewpoint of the various stakeholders involved in the field, and in particular of users, has to be taken into account. Within the ROAMER project, funded by the European Commission, we conducted a survey among various categories of stakeholders about the priorities for mental health research in Europe. The survey was carried out with the national associations of psychiatrists, psychologists and other mental health professionals, the national organizations of users and carers, and the national organizations of psychiatric trainees of the 27 countries of the European Union. Research on the quality of mental health services was identified as the top one priority by both the associations of psychiatrists and the organizations of users and carers. The stakeholders pointed out that we need more collaboration in mental health research (more formal networks, more multidisciplinary studies, sharing of databases) and we should try to integrate research through the lifespan, giving priority to longitudinal cohort studies. LECTURES L1.1-Fukushima project: Nuclear disaster stress relief project Tsuyoshi Akiyama NTT Medical Center Tokyo Evelyn Bromet reported that mental health is a leading cause of disability, physical morbidity and mortality as consequence of Chernobyl disaster. In order to prevent the health damage in Fukushima, we have been carrying out Fukushima Project--Nuclear Disaster Stress Relief Project as follows; 1. Parent child play and peer discussion Young mothers play with their children and exchange peer discussion with other mothers. The purpose is to reactivate the contacts between mothers and children and to enhance peer support and self- affirmation among the mothers. 2. Focus group with public health nurse The purpose is to gather information on the experience of the public health nurse in providing care to the residents and to formulate it into a useful material. The result is being published. 3. Lecture and discussion with residents Nuclear plant stress divides the residents. In order to enhance the cohesion among the residents, a combination of general health lecture and following small group discussion has been provided. 4. Outside of the Wire care The purpose is to enhance peer emotional support among the public health nurse and young mothers, utilizing Outside of the Wire method. This method comprises dramatic theater reading and following discussion and has been used for various mental health support purposes in the States. This session is scheduled at the end of November 2014. The project team is composed of experts in Fukushima, Tokyo and New York. Akiyama T. Addressing the mental health consequences of the Japan triple catastrophe. World Psychiatry, 10:85, 2011. Bromet EJ. Mental health consequences of the Chernobyl disaster. Journal of Radiological Protection, 32: N71–N75, 2012. Kayama M, Akiyama T, Ohashi A et al. Experiences of Municipal Public Health Nurses Following Japan’s Earthquake, Tsunami, and Nuclear Disaster. Public Health Nursing, (in press) L1.2-Needs, opportunities and implications of gaps in mental health Afzal Javed Chairman Pakistan Psychiatric Research Centre, Lahore, Pakistan Mental disorders are highly prevalent and cause considerable suffering and disease burden all over the world. To compound this public health problem, many individuals with psychiatric disorders remain undiagnosed and untreated although effective treatments exist. The public health impact of mental disorders is profound as the estimated disability-adjusted life-years attributable to mental disorders has been shown to be around 11.6% of total disability in the world. This represents more than double the level of disability caused by all forms of cancer (5.3%) and even higher than the level of disability due to cardiovascular disease (10.3%). Despite the growing evidence about the impact of mental illnesses, mental health services continue showing big gaps. Even the current radical changes in organization, financing, treatment technology, and consumer demand for access and delivery of health services are not showing any big influence on the mental health scene in many countries. There are clear differences in the practice of psychiatry around the Globe but the low income and developing countries witness more visible gaps in many areas of mental health care. Less number of mental health professionals, scarcity of mental health resources & now often facing additional problems of migration of trained psychiatrists and mental health professionals to the already resource rich countries, the situation gets even worse. This paper will present an overview about the mantel health gaps and their impact on the delivery of services with a special focus on the developing countries in Asia. It will be argued that there is no health without mental health and Innovation, networking and basic training as well as better models of care using simple but effective paradigms need to be put in place if these countries are to provide better health services. L1.3-Decision making in psychiatry Dinesh Bhugra World Psychiatric Association Psychiatrists make clinical decisions all the time and these are very strongly influenced by a number of factors. As clinicians, professionals and as leaders in their clinical settings they are expected to work with patients and their families. The framework provided by the society influences where and how these decisions are made and what impact that has on individuals. The clinical decisions will affect the patients in a number of ways. Furthermore directly or indirectly these may also influence the progress of the institution directly or indirectly. Decisions in clinical settings are made within a specific frame and patient needs but equally importantly these decisions carry with them a number of responsibilities. For clinicians, therapeutic alliance and communication with patients, their carers, team workers and subordinates are important aspects of clinical decision making. Often in clinical decision making, psychiatrists use a bio-psychosocial mode as a result of their training to explain and explore underlying aetiological factors and then on the basis of this model make decisions regarding clinical management. Part of the decision making process relies on clinicians routinely creating and testing hypotheses whichare then tested and confirmed through history taking and treatments. Even in non-clinical settings leaders test out hypotheses before reaching decisions. It must be emphasised that decision making is markedly different from problem solving. Experts make decisions differently from non-experts. Three decision making techniques have been described and these include catchball, point-counterpoint, and intellectual watchdog approaches. Experts and novices make decisions in different ways. After interviewing 40 psychiatrists on their decision making processes various strand shave been described. These will be further developed and discussed in this lecture. L2.1-Interdisciplinary collaboration: The psychiatrist and the psychoanalyst as possible co- workers in the mental health field today Stefano Bolognini President of the International Psychoanalytical Association (IPA), Bologna, Italy Why should Psychiatry and Psychoanalysis collaborate today? And how can they realistically do that? Historically, over the past thirty years in particular, there were probably two antagonistic trends: one was the idealized vision of Psychoanalysis as a superior scientific theory, able to found a new psychiatric practice based on its sophisticated concepts and its technique; the other was the hope of Psychiatry to substantially solve the issue of mental disease via drugs, in a pragmatic, shorter and more effective way. These two visions and approaches alternated historically for decades with underlying ideal omnipotent illusion, supported by the narcissistic ambitions of the two professional groups, in an implicit atmosphere of competition and rivalry. More realistically, a collaboration seems today to be possible and desirable, with mutual advantages, through the recognition of their specific competences. In my presentation I will explore some fundamental issues: - The change in contemporary pathology treated all over the world by psychoanalysts and psychoanalytic therapists, who deal more and more with borderlines, personality and narcissistic disorders, severe depressions and psychoses; so that pharmacological support (sometimes with hospitalization) is frequently needed for long periods in some treatment. - Psychoanalytic training today must include a period of practice in a psychiatric structure, in order to provide future psychoanalysts with direct experience of severe pathological illnesses and their specific phases and vicissitudes. - On the other hand, a number of experienced psychoanalysts are