Day 3 :
- Symposium on Personalized Medicine in Psychiatry: A Look to the Future
Location: SEGRE
Chair
Charles B Nemeroff
University of Miami, USA
Session Introduction
Charles B Nemeroff
University of Miami, USA
Title: Personalized medicine in Psychiatry
Time : 09:00-09:30
Biography:
Charles B. Nemeroff received his MD and PhD (Neurobiology) from the University of North Carolina at Chapel Hill. His residency training in psychiatry was conducted at both the University of North Carolina and at Duke University, after which he joined the faculty of Duke University. His research has concentrated on the biological basis of the major neuropsychiatric disorders, including affective disorders, schizophrenia, and anxiety disorders. His clinical research is focused on the use of genetic, neuroendocrine, neuroimaging and neurochemical methods to comprehensively understand the pathophysiology of depression. In recent years he has uncovered the neurobiological mechanisms that mediate the increased risk for depression in victims of child abuse. In 2006 he received the American Psychiatric Association Research Mentoring Award and Vestermark Award, and in 2008 The Judson Marmor Award for Research. He is currently a member of the Board of Directors of the American Foundation for Suicide Prevention, and the Anxiety and Depression Association of America. He served as chair of the APA Committee on Research Training. In 2002 he was elected as a member of the Institute of Medicine of the National Academy of Sciences.
Abstract:
Severe psychiatric disorders are, based on recent data from the Global Burden of Disease Study, one of the most significant contributors to disability and disease burden. One of the major factors driving this finding is the absence of reliable laboratory or imaging tests to predict vulnerability, for diagnosis and for response to one or another of the effective treatments for these devastating disorders. This symposium will review the burgeoning findings on personalized medicine in psychiatry with a focus on identifying at risk populations for depression, bipolar disorder and the major anxiety disorders and the evolving data base on matching well defined endophenotypes with specific treatments. Thus, Charles B. Nemeroff (University of Miami) will discuss the long term consequences of child abuse and neglect and how this environmental factor interacts with genetic vulnerability to increase risk for depression and PTSD. The implications of these findings for current treatment as well as novel treatment development will be described. Felix Hausch (Max Planck Institute for Psychiatry, Munich) will describe novel findings on the FKBP5 gene polymorphism, its modification by epigenetic mechanisms and the development of novel small molecules with potential for treatment of PTSD and depression. Giampaolo Perna (Lake Como, Italy and University of Miami) will describe the currently available data on personalized medicine in anxiety disorders with a focus on panic disorder. Thomas Schlaepfer (University of Bonn) will describe how functional brain imaging studies have led to the identification of brain circuitry altered in mood disorders and how these findings have led to the development of deep brain stimulation (DBS) for management of treatment resistant depression. These novel research findings suggest that psychiatry will eventually become much more like oncology and infectious disease in being able to predict optimal treatments for individual patients.
Giampaolo Perna
Hermanas Hospitalarias, Italy
Title: Personalized Medicine in Anxiety Disorders
Time : 09:30-10:00
Biography:
Giampaolo Perna has completed his MD and PhD from Milan State University becoming psychiatrist in the same university. He is the chairman of the department of clinical neurosciences of Hermanas Hospitalarias - Villa San Benedetto Menni near Como Lake. He has published more than 100 papers in impacted journals. He is voluntary professor at Leonard Miller School of Medicine, University of Miami and associate professor at Maastricht University. He is the chair of the WPA section on personalized psychiatry and member of the executive board of the Italian Association for Behavior Analysis and Modification and Cognitive Behavioral Therapy (AIAMC).
Abstract:
In anxiety disorders, pharmacotherapy reports non response rates of 30–60% and relapses rates of 53–80%. Similar data are reported for cognitive behavioral psychotherapy. Causes of treatment-resistance are reported in chronicity of illness, severity of symptomatology, psychiatric comorbidity, physical comorbidity, personality traits and molecular causes. In this context, personalized psychiatry (PP) represents a way to come to the aid of these shortages. To date no one discussed this topic in anxiety disorders and among these panic disorder has the unique characteristic to be quite homogenous in its psychopathologic features, with a strong root in body physiology, and to be variable in responses to panic provocation procedures, to treatment options and in long term prognosis. Physiology of panic patients is different from those of healthy controls in particular for respiratory, cardiovascular and postural systems. Specific abnormal physiological functions might be the premise to the identification of differential diagnostic subgroups of patients. Moreover, in the recent years there are evidences of an association between genetic polymorphisms of serotonin transporter, 5-HT1a receptor, MAO and COMT genes and the response to treatment with drugs and with cognitive behavioral psychotherapy. Less consistent findings have been reported for social phobia and generalized anxiety disorder. The identification of genetic and physiologic markers in their interaction with clinical features might help to find tailored treatments that will ensure the best intervention possible for each patient. Parallel findings, although not yet fully consistent, have been reported for social phobia and generalized anxiety disorder.
Thomas Eduard Schlaepfer
University of Bonn, Germany
Title: Deep Brain Stimulation targets for Depression – On the way to personalized treatment?
Time : 10:00-10:30
Biography:
Schläpfer studied medicine at the University of Bern. After residency training at the University Hospital in Bern, he was there head physician of the psychiatric outpatient clinic. Schläpfer is in the area of translational research on mood disorders active. Particular areas of interest are Transcranial magnetic stimulation, deep brain stimulation, and ethical aspects of interventional procedures in psychiatry. In 1992 he moved as a Fellow to the Johns Hopkins Hospital in Baltimore to the Department of Psychiatry and Behavioral Sciences, where he was appointed Associate Professor 1997th In 2003 he became a university professor at the Department of Psychiatry and Psychotherapy at the Rheinische Friedrich-Wilhelms University of Bonn appointed. Since 2006 he has been Vice Dean for Academic Affairs at the local medical school.
Abstract:
A core symptom of major depression is anhedonia (decreased drive and reward for pleasurable activities) and reduced motivation. The human reward system consists of the neural pathways involved in eliciting rewarding experiences in animals and humans its structures, the striatum (particularly the ventral striatum or nucleus accumbens (NAcc) and the medial forebrain bundle (MFB), are important in emotional memory, and might mediate those symptoms. Antidepressant effects of Deep Brain Stimulation (DBS) to the NAcc and two additional targets have been systematically assessed and results in response in 50-60% of patients studied, albeit only at relatively high stimulation intensities. Using probabilistic diffusion tensor imaging (DTI) we were able to demonstrate that all stimulation sites stimulate fibers of the MFB and hypothesized that DBS to the MFB closer to its origin in the ventral tegmental area might be associated with higher antidepressant efficacy at lower stimulation intensities since the extent of antianhedonic effect might be related to the recruited amount of fibers of the MFB. Recently we demonstrated unexpectedly rapid effects of this procedure.
Felix Hausch
Max Planck Institute for Psychiatry, Germany
Title: FKBP51, a risk factor and potential drug target for stress-related disorders
Time : 10:30-11:00
Biography:
Felix Hausch .He was appointed as Exhibition Group Director in Max Planck Institute for Psychiatry. His Research was in Transitional research in Psychiatry. He done his experiment on GermanyFKBP5, the gene encoding FKBP51, has repeatedly been associated in humans with numerous stress-related end phenotypes and with the risk to develop PTSD. Several animal models confirmed FKBP51 as a key regulator of stress responses. How FKBP51 enhances vulnerability to stress-related disorders or how affects neurobiological pathways to impinge on behavior is unknown. Mood and anxiety disorders, including major depression, panic disorder and post-traumatic stress disorder, have a high life-time prevalence and account for more disability than most other diseases worldwide as they are associated with significant morbidity, mortality and increased medical comorbidities.
Abstract:
FKBP5, the gene encoding FKBP51, has repeatedly been associated in humans with numerous stress-related endophenotypes and with the risk to develop PTSD. Several animal models confirmed FKBP51 as a key regulator of stress responses. How FKBP51 enhances vulnerability to stress-related disorders or how affects neurobiological pathways to impinge on behavior is unknown. Here, I will describe novel mechanistic findings from cellular and animal models on the role of FKBP51 in neurons and in stress-coping behavior. I will present SAFit1 and SAFit2, the first selective FKBP51 inhibitors, and their effects in vivo. Finally, I will discuss the prospect of FKBP51 inhibitors as novel class of antidepressants and possible strategies for patient stratification.
- Diagnosis: Psychoactivity and Cognition
Chair
Chantal Martin Soelch
University Fribourg, Switzerland
Co-Chair
Vladimir V Lazarev
Oswaldo Cruz Foundation, Brazil
Session Introduction
Carmen M Sarabia Cobo
Professor, University of Cantabria, Spain
Title: Apathy and leukoaraiosis in mild cognitive impairment and Alzheimer’s disease: Multicenter diagnostic criteria according to the latest studies
Time : 11:30-11:50
Biography:
Carmen M Sarabia Cobo is full Professor in the Nursing Department, at University of Cantabria (Spain). She has completed her PhD at from University Complutense of Madrid (Spain), she is specialist in Neuropsychology, Aging and Dementia. She also has the following degrees: Nurse, Psychologist and Social and Cultural Anthropologist. Her subjects taught are Nursing of Aging. Dementia o neurodegenerative diseases. Skills and Competence through Coaching and Emotional Intelligence. Research interests: aging, dementia, cognitive and emotional processing, emotions, Mild Cognitive Impairment, care in old age, Coaching and Emotional Intelligence.
Abstract:
Aims: The aim is to study the prevalence and possible relationship of apathy and leukoaraiosis in cases of cognitive impairment of varying severity in Spain. Methods: We conducted a cross-sectional, descriptive, multicenter study involving 109 patients with Alzheimer’s disease (AD) and 59 with mild cognitive impairment (MCI). Results: The older group with AD had a higher prevalence of leukoaraiosis and apathy, with significant differences compared to the MCI group. Conclusions: To our knowledge, this is the first multicenter study in our country that jointly analyzes the presence of apathy and leukoaraiosis in the institutionalized elderly with varying degrees of cognitive impairment according to the most recent criteria for detecting apathy in dementia. The term apathy is frequently used in the neuropsychiatric literature, but is not included in the current nosological classifications such as the DSM -IV [21] and ICD -10 [22] as a separate term. Apathy can be defined as a persistent deficit of motivation, a lack or decrease in feelings, emotions or interests that give rise to a significant reduction in self-generated goal-directed behavior [23, 24]. There are several standardized scales with which apathy can be diagnosed; however, they are not unified, so that the percentage of patients suffering from apathy AD varies markedly between 19% and 76% [25, 26]. However, apathy is the most frequent symptom in neuropsychiatric AD [27, 28] and other dementias, and is associated with increased cognitive and functional impairment and a high burden on the caregiver [29, 30]. There is also a growing body of evidence that apathy is a prominent feature of pre-dementia states [31–33]. In fact, there are indications that apathy could be a predictor of progression to dementia [34] to the point that the severity of apathy would be closely related to cognitive function [35]. Robert et al. [36] evaluated patients meeting the criteria of amnestic MCI using the Apathy Inventory (AI), and then checked whether the AD had evolved after a year. The results showed that the cognitive function of patients with MCI who had apathy was higher than those in which apathy was not present. However, given its high prevalence in dementia cases in almost all studies, a 2009 work developed a set of several international associations to establish a consensus on the diagnostic criteria for apathy, mainly in AD cases [33]. Following the new consensus on leukoaraiosis and apathy, especially in cases of dementia, this study was proposed with the intent of establishing the prevalence and possible association of leukoaraiosis and apathy in two clinical groups, one with MCI (prodromal state as possible AD) and another with AD institutionalized in seven residential centers in Spain. To our knowledge, it is the first study of its kind serving the two above factors (leukoaraiosis and apathy) conducted in Spain using the new diagnostic criteria for apathy.
Dexter R Voisin
Professor, The University of Chicago, USA
Title: Examining the relationship between psychotropic medication use and testing positive for chlamydia and gonorrhea among detained adolescents
Time : 11:50-12:10
Biography:
Dexter R. Voisin is a Professor in the School of Social Service Administration at the University of Chicago and and a Faculty Affiliate at the Center for the Study of Race, Culture, and Politics and the Center for Health and the Social Sciences. His fields of special interest include community violence exposure, adolescent sexual risk behaviors, the role of gender in adapting to risks, international HIV prevention, and social work practice. Professor Voisin received his B.A. (psychology, cum laude) from St. Andrews College, M.S.W. (practice) from the University of Michigan, and Ph.D. (advanced practice) from Columbia University School of Social Work.
Abstract:
Objective: Youth with juvenile detention histories have higher rates of psychological problems, especially externalizing symptoms, relative to their peers with no such histories. This study examine whether psychotropic medication (PTM) use was related to testing positive for laboratory confirmed chlamydia and gonorrhea among detained adolescents. Methods A convenience sample of 550 detained adolescents ages 14–18 years were recruited from eight youth detention centers in Georgia. Using A-CASI technology, data were collected on demographic factors such as age, gender, socioeconomic status, use of PTM, and sexual risk behaviors. Chlamydia and gonorrhea diagnoses were assessed by laboratory testing. Results Thirteen percent (13.1%) of adolescents not using PTMs tested positive for STIs compared to only 4.9% of those reporting PTM use. PTM users had a 62% smaller odds ratio for testing positive for Chlamydia or Gonorrhea. Conclusion Findings suggest that use of psychotropic medication, if deemed useful by detained youth, may be a protective factor against engaging in behaviors which may culminate in contracting some sexually transmitted infections. These findings have important practice and psychiatric treatment implications for this population.
Vladimir V Lazarev
Oswaldo Cruz Foundation, Brazil
Title: EEG in psychiatry: Driving Reactions to Intermittent Photic Stimulation Improve the Method’s Sensitivity and Information Value
Time : 12:10-12:30
Biography:
Vladimir V. Lazarev is a full professor of Psychophysiology and Clinical Neurophysiology and Director of Laboratory of Neurobiology and Clinical Neurophysiology at the National Institute of Women, Children and Adolescents Health Fernandes Figueira / Oswaldo Cruz Foundation (Ministry of Health), Rio de Janeiro, Brazil (since 2002). Doctor of Biological sciences in Neurophysiology (National Mental Health Research Center of the Russian Academy of Medical Sciences / Moscow State University, 1991). Ph.D. in Psychophysiology (Institute of Psychology of the USSR Academy of Sciences, Moscow, 1977).
Abstract:
The functional test of intermittent photic stimulation (IPS) induces in the EEG photic driving - a rhythmic response (PDR) time-locked to the stimulus and its harmonics. The IPS can reveal a fuller set of the individual’s potential bioelectrical oscillators of different frequencies including latent ones not present or weak in the resting state and enhanced by resonance-like driving reactions. The frequency and amplitude characteristics of PDRs, together with their topography and coherence, can provide additional information regarding the structure and spatial organization of neurophysiological processes as compared to the spontaneous EEG. In the search for latent EEG signs of the brain development alterations in functional neuropsychiatric disorders, the PDR characteristics of the children and adolescents with partial epilepsy (n=95), autism (n=16) and ADHD (n=30), aged 5 to 18 years, were compared to those of the normally developing subjects (n=120) of the same age. Eleven stimulation runs were presented at fixed frequencies of 3-24 Hz for 20-30 s each. The reduced topographic generalization of PDRs over non-visual cortical areas and the lower level of the driving coherence showed a reducing effect of the antiepileptic drug therapy and a possible delay in brain maturation in partial epilepsy. The latter was also reflected in the increased driving amplitudes at the lower IPS frequencies. In high-functioning autistic patients, the IPS at the fast alpha and beta frequencies revealed a reduction in the right hemisphere activation and in the interhemispheric connectivity together with potential hyperconnectivity in the left hemisphere. In the ADHD patients, some alterations in the PDR topography were also revealed. The results obtained were not observed in the resting spontaneous EEG. This shows that the PDR application improves the sensitivity and information value of EEG and looks very promising for neurophysiological studies and diagnostics of different psychiatric disorders which are not usually evident under traditional examination.
Chantal Martin Soelch
University Fribourg, Switzerland
Title: Dysfonctions of the neural reward system in psychopathology: Vulnerability factor or consequence?
Time : 13:30-13:50
Biography:
Chantal Martin studied Bilingual study in Clinical Psychology, General Psychology Neurobiology and PhD in Psychology, in University of Fribourg. Her Publication in 2011 is “Habitation” in University of Zurich. Her interests of Research are, treatment and prevention of mental disorders and psychopathologies, the identification of vulnerability factors. she was appointed as Head Psychologist, Head of Research Division, Department of Psychiatry of Psychotherapy, in University Hospital Zurich, Zurich, Switzerland.
Abstract:
Mental health is a major cause of disability worldwide. The major challenges related to this burden are the development of efficient treatment and preventive interventions. For both, treatment and prevention of mental disorders and psychopathologies, the identification of vulnerability factors is essential. The presence and value of rewards, their predictability and accessibility as well as the effort to reach them are crucial in controlling our behavior. Neurophysiological, neurochemical and neuroimaging studies in human and in experimental animals have delineated a network of cortical and subcortical brain regions, including in particular the ventromedial prefrontal cortex (i.e. orbital and medial prefrontal regions), amygdala, striatum and dopaminergic midbrain, that are specifically involved in the processing of reward information. A role of the mesocorticolimbic and mesostriatal dopamine (DA) systems in the processing of reward information was also well documented, although other neurotransmitter systems, such as the opiate system, also seem to play a role in the mediation of reward information. Blunted responses to reward and impaired function of the DA system were observed in several psychopathological conditions including addiction, depression, eating disorders and PTSD. The observed impairments could be associated with the symptoms of anhedonia, apathy and loss of interest observed in these conditions, an hypothesis supported by findings that evidenced an improvement of the blunted response to reward after psychotherapy. This could however also indicate that blunted responses to rewards are a vulnerability factor for the development of psychopathological symptoms. We will present here results from studies investigating the responses to reward in populations vulnerable for developing psychopathological symptoms as well as in remitted patients. We will discuss the role and origin of the blunted responses to rewards as a potential vulnerability factor or as a consequence of psychopathological process with a particular focus on the interaction between the experience of reward and stress. This question is important to understand psychopathological processes, but also to develop targeted preventive strategies.
Carmen M Sarabia Cobo
Professor, University of Cantabria, Spain
Title: Heart coherence: a new tool in the management of stress on professionals and family caregivers of patients with dementia
Time : 13:50-14:10
Biography:
Carmen M Sarabia Cobo is full Professor in the Nursing Department, at University of Cantabria (Spain). She has completed her PhD at from University Complutense of Madrid (Spain), she is specialist in Neuropsychology, Aging and Dementia. She also has the following degrees: Nurse, Psychologist and Social and Cultural Anthropologist. Her subjects taught are Nursing of Aging. Dementia o neurodegenerative diseases. Skills and Competence through Coaching and Emotional Intelligence. Research interests: aging, dementia, cognitive and emotional processing, emotions, Mild Cognitive Impairment, care in old age, Coaching and Emotional Intelligence.
Abstract:
We describe a stress management intervention intended to reduce the damage and stress impact on the heart physiology and function of a group of caregivers (professional and non-professional) who work with patients with dementia. The intervention consisted in applying heart coherence techniques in a population of 72 caregivers of patients with dementia (42 professional and 29 non-professional caregivers) who had high scores in heart stress and burden tests. Six months after the training they were able to generate appropriate patterns of heart coherence, with a statistically significant decrease in their heart overload. We conclude that training in techniques of heart coherence and positive psychology had effective results on the stress management of the participant caregivers. This was a simple, inexpensive technique with lasting results. To our knowledge this is the first research in Spain studying the application of heart coherence techniques to caregivers of people with dementia. Caregivers of patients with dementia In recent years, an increasing number of studies in stress have been focused on professionals (Knudsen, Ducharme & Roman, 2009). Affected professionals speak of burnout to define a state of emotional and physical exhaustion caused by the stressful demands of their daily work. The equivalent concept in caregivers is the Caregiver Burden (identified by the nursing diagnosis of “Fatigue in the caregiver role”). The study of these two conditions has been developed in areas of high demand for services such as care for people with dementia (Judkins, 2003). As dementia is a progressive, disabling and long-term neurodegenerative disease, the risks of being exposed to chronic stress situations both professional and caregivers is very high (Scott, Hwang & Rogers, 2006; Salmond & Ropis, 2005). Many studies show the consequences of professional stress, both emotional and physical (Chandola, Britton, Brunner, Hemingway, Malik, Kumari et al., 2008), which can cause communication problems in the team and families (Mikels et al., 2008), and affect the general welfare of the person (Salmond & Ropis, 2005). Adopting effective techniques of stress management may require improving the emotional and physical state of the caregiver, and promoting a better working environment and a better relationship with others in both the institutional and home and family environments (Salmond & Ropis, 2005). Improving the ability of caregivers to effectively meet the challenges of the daily work is valuable not only for institutions (having less stressed and healthier workers) but also for people receiving care (Pipe & Bortz, 2009). This is why in recent years, the management of burnout and overload situations has been addressed in areas such as Positive Psychology (Seligman, & Csikszentmihalyi, 2000), which studies resilience and optimism as predictors of effective coping in difficult and demanding situations. In this context, resilience refers to the ability to adapt to changing situations, being able to effectively handle stress or potential stressors in the process (Tugade, Fredrickson & Barrett, 2004). Positive Psychology studies have begun to confirm that chronic stress or certain stressful situations lead to negative emotional states (anxiety, frustration, anger, sadness, etc.), which not only affect caregivers and other professionals themselves, but also have an impact in their performance at work. This suggests that emotional and mental factors play a key role in situations of stress, and maintains that the dimensions of resilience must begin to be taken into account in the study of these groups, as evidenced by recent investigations (Otake, Shimai, Tanaka ‐ Matsumi, Otsui & Fredrickson, 2006).
Mira Jakovcevski
Max Planck Institute of Psychiatry, Germany
Title: Neuronal Kmt2a/Mll1 histone methyltransferase is essential for prefrontal synaptic plasticity, anxiety-like behavior and working memory
Time : 14:10-14:30
Biography:
Mira Jakovcevski is in Postdoc and working in the Department of Stress Max Planck Institute of Psychiatry, Germany. Neurobiology and Neurogenetics, Research Group Deussing. Her research was in Neuronal Kmt2a/Mll1 histone methyltransferase is essential for prefrontal synaptic plasticity, anxiety-like behavior and working memory. She was also done her research in Neurobiology and Neurogenetics.
Abstract:
Neuronal histone H3-lysine 4 methylation landscapes are defined by sharp peaks at gene promoters and other cis-regulatory sequences, but molecular and cellular phenotypes after neuron-specific deletion of H3K4 methyl-regulators remain largely unexplored. We report that neuronal ablation of the H3K4-specific methyltransferase, Kmt2a/Mixed-lineage leukemia 1 (Mll1), in mouse postnatal forebrain and adult prefrontal cortex (PFC) is associated with increased anxiety and robust cognitive deficits without locomotor dysfunction. In contrast, only mild behavioral phenotypes were observed after ablation of the Mll1 ortholog Kmt2b/Mll2 in PFC. Impaired working memory after Kmt2a/Mll1 ablation in PFC neurons was associated with loss of training-induced transient waves of Arc immediate early gene expression critical for synaptic plasticity. Medial prefrontal layer V pyramidal neurons, a major output relay of the cortex, demonstrated severely impaired synaptic facilitation and temporal summation, two forms of short-term plasticity essential for working memory. Chromatin immunoprecipitation followed by deep sequencing in Mll1-deficient cortical neurons revealed downregulated expression and loss of the transcriptional mark, trimethyl-H3K4, at <50 loci, including the homeodomain transcription factor Meis2. Small RNA-mediated Meis2 knockdown in PFC was associated with working memory defects similar to those elicited by Mll1 deletion. Therefore, mature prefrontal neurons critically depend on maintenance of Mll1-regulated H3K4 methylation at a subset of genes with an essential role in cognition and emotion.
- Discrimination and Stigma Related to Mental Health
Location: SEGRE
Chair
Jesus Garcia Martínez
University of Seville, Spain
Session Introduction
Jesus Garcia-Martínez
University of Seville, Spain
Title: Stigma and victimization: similarities in psychological processes between victims of social violence and psychotic persons
Time : 14:40-15:00
Biography:
Jesús Garcia-Martínez completed his PhD at the University of Valencia in 1992. He works at the University of Seville since 1991 and obtained the place of tenured professor in 2002. He is an accredited therapist and supervisor of the Spanish Association of Cognitive Psychotherapies. His field of research is focused in the treatment of victims and aggressors and in the narratives of change. He has published 15 papers in reputed journals and has presented more than 200 communications in international congress and conferences.
Abstract:
Victims of social violence are characterized by a set of symptoms (low self-esteem, anxiety, in some case post-traumatic manifestations) and too by a set of narrative construction processes (absence of empowerment, fragmentation, low coherence). Therapy is usually oriented to de-construe this kind of discourse and making meaning about his/her skills and capacities in order to get a more personal and empowered narrative. Victimization narratives usually too incorporate a lot of meanings from social forms of control (minus-valuation, believes about the other’s adequacy and a lack of personal sense). This kind of narratives is found too in persons who suffer from psychotic disorders, including when they are in a no-symptomatic or acute phase. Stigma (the self-believe about the own incompetence) is incorporated in the personal narrative in a similar way to victimization process. In this paper, two clinical vignettes are presented to describe the similarities between the two cases and to illustrate similar therapeutic processes to empower both kinds of clients
Sam Warner
Barnardos childrens charity, UK
Title: Maximizing hope and minimizing harm: Researching and working with children and adults who self-harm and self-injure
Time : 15:00-15:20
Biography:
Sam spent 20 years at Manchester Metropolitan University, UK first as a PhD student and then as a research fellow, leaving in 2015 to concentrate on clinical work and strategic development. Sam is a consultant clinical psychologist, qualifying nearly 25 years ago. As an academic and practitioner, Sam has always specialized in child abuse, sexual violence and domestic abuse, and their impact on mental health: from dissociation to self-harm. She has written books, reports and papers on these issues. Sam has worked for the British Department of Health as a national advisor on sexual violence and mental health. Currently Sam provides clinical oversight to Barnardos Safer Futures services, North West, UK.
Abstract:
Children and adults who self-harm and self-injure present a major challenge for social care and mental health services and numerous serious case reviews in the UK and beyond have identified many areas for improvement in respect of children and adults who are at risk of suicide. Such children and adults represent a highly stigmatized, and too often misunderstood and mistreated group. I will argue that clinical research in this area has suffered from a too narrow understanding of what constitutes evidenced-based practice and this has led to an over-reliance on pre-determined outcomes; reductive behavioral goals; and an undue focus on treatment techniques. In this paper, I argue for clinical research that is flexible, user-centered and practice-based. Drawing on theory, research and clinical case studies I demonstrate the utility of triangulating knowledge from multiple data sources in understanding self-harm and self-injury. Using this triangulated knowledge-base, I identify key factors associated with self-harm and self-injury. I build on this analysis to consider what is needed in developing and delivering effective practice with children and adults who use self-harm and self-injury to cope, communicate and/ or as a means to end life. I identify key factors in determining suicide risk. I then contrast harm stopping approaches with positive risk taking and harm reduction strategies, elaborating how and when to use them. Finally, I consider the emotional cost of working with self-harm and self-injury, and the need for policy and research which embeds principles for practice, rather than fetishizes techniques.
P Roberto Bakker
Psychiatric Centre GGZ Centraal, Amersfoort, The Netherlands
Title: Public mental health promotion and networks
Time : 15:20-15:40
Biography:
Roberto Bakker works in Psychiatric Centre GGZ Central, Amersfoort, Netherlands. His research mainly focus on function of public mental health (PMH) in medicine is both health promotion and disorder prevention. He added project of his new findings in research field of complex systems in PMH promotion.
Abstract:
The main function of public mental health (PMH) in medicine is both health promotion and disorder prevention. However, in psychiatry public health has been rather neglected, and, therefore, research is warranted. The past decade has seen a rise in (or renewed) interest in complex systems — like biological (e.g. psychiatric), economic, social, internet, and epidemic (ebola) systems— to uncover their pervading hidden laws (http://www.santafe.edu/). In the next few years network architecture will be central in complex system research. These paradigms may encourage new promising public health programs. With this project we hope to add new findings to this important research field of complex systems in PMH promotion.
Nigel Rees
Senior Research Lead at Welsh Ambulance Services NHS Trust
Title: To explore paramedics’ perceptions and experiences of caring for people who Self Harm (SH) in order to inform education and policy
Time : 15:40-16:00
Biography:
Nigel Rees research was on mainly to explore paramedics’ perceptions and experiences of caring for people who Self Harm (SH) in order to inform education and policy. Effect of SH education and training, age of staff, gender, attitudes towards SH, setting, influence of policies and guidelines. Metasynthesis revealed metaphors: Frustration, futility and legitimacy of care. Nigel Rees was appointed as Senior Research Lead at Welsh Ambulance Services NHS Trust.
Abstract:
Background: The U.K. has one of the highest rates of SH in Europe. SH is amongst the five top causes of acute hospital admissions. Paramedics are often the first professionals encountered following SH, yet few have investigated their care Methods: The theoretical perspective draws on Evolved Grounded Theory. Systematic reviews of quantitative and metasynthesis of qualitative literature were conducted. Fifteen paramedics participated semi structured interviews, generating themes by constant comparison, open, axial and selective coding. Results: Systematic review identified themes: Effect of SH education and training, age of staff, gender, attitudes towards SH, setting, influence of policies and guidelines. Metasynthesis revealed metaphors: Frustration, futility and legitimacy of care. First contact in the pre hospital environment: Talking, immediate and lasting implications of the moral agent. Decision making in SH: balancing legislation, risk and autonomy. Paramedics’ perceptions: harnessing professionalism and opportunities to contribute to the care of SH. Paramedicine: Culture and education in transition. Themes emerging from interviews including professionalism, legislation and ethical issues. The theme: Relationships with Police: Procedural, historical practices and evolution of surreptitious strategies. “if you wanted somebody detained then we all know detention under Section 136 needs to take place in a public place. Therefore often the easiest way to do it, to prevent somebody, or to treat somebody with self harm was normally to try to coax them into a public place where a police officer could take action, because they were, obviously, very reluctant to do it in a private property.” (para3) Conclusion: Paramedic care for SH is a complex professional, clinical and social interaction, the developing theory is continuing to evolve our understanding of this encounter, and potential contribution of paramedics to SH care.