Prevention of Mental Disorders

Section Board

Aims & Objectives

Section's mission

This section deals with primary and secondary prevention of mental disease.

Primary prevention denotes an action to prevent the development of a disease in persons who are well, thereby aiming to lower the incidence of this disease in the population. The appropriate strategies for achieving this aim are risk detection and prevention.

Primary prevention has three levels:

  1. universal prevention, targeting the general public (e.g. actions against illegal drug use will result in lower prevalence of drug addicts),
  2. selective prevention, targeting groups or individuals who are at higher risk of developing a mental disorder (e.g. soldiers in war or persons with a family history for certain mental disorders)
  3. indicated prevention, targeting individuals with prodromal signs or symptoms but without an actual or previous full blown syndrome of the disease.

Secondary prevention is directed at people who have already developed the disease and are still in an early stage (e.g. first episode). Secondary prevention intends to:

  1. reduce disability (e.g. early treatment of dementia or psychosis)
  2. prevent relapses (e.g. needs-adapted interventions in first-episode schizophrenia)

Background

For many years prevention of mental illness has been conceptualized as universal prevention focussing on the general population of socially defined subgroups (e.g. work place, school classes). In industrialized countries many of these programmes revealed disappointing results. Thus psychiatrists were not convinced that preventive psychiatry, particularly primary prevention before the first manifestation of the disorder is an option. Yet, since 2 decades primary as well as secondary prevention of mental disorders became viable through new scientific insights and new service initiatives:

• Primary prevention:

The target-populations of primary prevention were shifted from the general population to subjects without fulfilling the full criteria for mental disorders, but with either predisposing risk factors (including other medical disorders) or prodromal signs and symptoms (including subthreshold conditions).; the first approach is called “selective prevention”, the second “indicated prevention”. Due to the research in premorbid course and risk factors and due to the establishment of early recognition programmes preventive measures were developed for several disorders. There is now steadily growing evidence that preventive intervention are successful in a series of mental disorders: metaanalysis have proven that full-blown depression can be prevented through psychosocial interventions in subthreshold depression and there is mounting evidence that psychosis can be prevented or at least delayed in a prodromal stage. Community based prevention programs have been shown to lower the incidence of suicidal acts and have already been implemented in more than 100 European regions. Selective or indicated prevention for other indications like bipolar disorder are just in a phase of promising beginning.

• Secondary prevention:

Efficient secondary prevention is now feasible through successful first episode programmes: they strive for early diagnosis and early treatment. The final goal is to achieve more beneficial medical and social outcomes for mental disorders. It is now well recognized and often reported that mental disorders have a better outcome when they are treated earlier. It is generally recognized that early intervention alleviates remission; this is important given that e.g. 30-50% of treated depressed patients turn out as non- or partial remitters.

The prevention of mental disorders therefore became conceptually and practically feasible.

Need for action

The following actions are needed in order to promote prevention of mental disorders in Europe:

• Implementation of primary prevention:

Early detection and early intervention are important tasks for mental health professionals. Targeted programmes currently are nearly exclusively developed on a research basis. Transfer in the clinical care is still widely missing.

• Implementation of secondary prevention:

First episode programmes are not available in most places where mentally ill subjects seek treatment. Therefore widespread transformation into clinical practice is required.

• Fostering of expertise and identity:

Selective and indicated prevention as well as first episode programmes require disease specific expertise and the participation of psychiatrists. These upcoming prevention strategies require individualized medical care for the at risk person what is only possible in the medical service system. Thus, psychiatrists are dedicated to be the main drivers of prevention of mental diseases. These new tasks must become a core element of the professional identity.

• Financing of prevention programmes:

Despite of this progress in prevention and early intervention of mental illness, ongoing financial investments in research are needed, as well as continued reimbursement of preventive services in regular care. In many EU-countries, prediction and prevention as well as early recognition and intervention programmes are only financed by research funds but should be disseminated into general health care. The current state in this respect is insufficient.

• Stimulation of EU activities:

The EU is an important stakeholder in this respect because of the following reasons:

(a) prevention is (in contrast to patient care for full blown disorders) by constitution a European responsibility and (b) the EU has actively formulated this priority goal in several documents (e.g. the “Green Book”).

Research Development and Translation:

The very active research is to be expanded in order to address the following issues:

- to promote the understanding of the neurobiological basis of at risk states as well as of resilience

- to translate the progress of knowledge on vulnerability and on risk factors into more efficient risk detection, risk prediction, early recognition and prevention strategies.

- to explore factors contributing to resilience in spite of an accumulation of risk and vulnerability factors in longitudinal studies

- to expand research and services for preventive psychiatry.

These statements are valid for all major mental disorders with some areas of indication being more advanced than others.

Section's objectives

  1. Increase awareness for the possibility and for the need of selective and indicated prevention of mental illness among psychiatrists and other medical disciplines (particularly primary care).
  2. Argue for and contribute to the introduction of risk related syndroms in official classification systems for promoting research on causes and interventions and for providing persons in need for care g
  3. Disseminate the growing progress in knowledge about the pathogenesis and the prevention of mental disorders on conference and through publications (particularly in an EAP context with yearly symposia)
  4. Disseminate the knowledge of service strategies in recognition of risk states, of early signs of mental diseases and of possible preventive interventions through symposia and seminars
  5. Bring together specialists of risk detection and prevention as well as early recognition and early intervention in the various indication areas to create a European body of expertise and stimulate exc
  6. Simulate and offer programmes to educate young psychiatrists risk detection and prevention as well as early recognition and early intervention of mental illness (e.g. at EPA-congresses and through coo
  7. Stimulate European wide prevention and early intervention trials and associated research efforts (with hopefully successful national and EU lobbying)
  8. Offer evidence and expert guided device on prevention and early intervention to the EPA-boards and - through these boards - also to EU commissions in charge

Activities

Meetings/events

EPA Section Meeting 2014

Description:

Preparation of the election of a new board: Proposal of Joachim Klosterkötter (Chair), Anita Riecher (Co-chair), Stephan Ruhrmann (Secretary). To enable a voting by all members, even if they did not have the opportunity to attend the congress, it was decided to elect the new board by E-Mail. Discussion of the progress of the guidance paper on prediction and prevention of psychosis. A distinguished group of authors spanning different part of Europe has been invited. A first draft is expected in July/August 2014, submission to the EPA for approval in September 2014. Prevention of Bipolar disorders, of work place related mental disorders and of mental disorders in children of mentally ill parents are discussed as possible topics for future guidance papers of the section. To further elucidate the current state of the art, it was agreed to oranize two section symposia at the next conference in Vienna, one on the prevention of mental disorders (topics: suicide, bipolar disorder, depressive disorder, psychoses, alcohol addiction) and one on prevention of mental disorders in children of mentally ill parents, planned as a joined symposium with the Section on Child and Adolescent Psychiatry.


Venue: EPA Munich, Congress Center


Date: 04/03/2014


Attendance: Section Members


EPA Section Meeting 2015

Description:

Members from Germany, Finland and the Switzerland took part in the annual section meeting. It was agreed to distribute guidance materials and to organize guidance workshops in different parts of Europe. Prevention of Bipolar Disorders of Work Place related to Mental Disorders and of Mental Disorders in Children of mentally ill parents were discussed as topics for future guidance papers of the section. To further elucidate the current state of the art, it was agreed to organize two section symposia at the 5th European Conference on Schizophrenia Research 2015 in Berlin with the focus on epidemiological aspects of prevention. The next section meeting will be held at the next EPA conference, too.


Venue: ACV – Austria Center Vienna


Date: 30/03/2015


Attendance: Section members from Germany, Finland and the Switzerland


EPA Section Meeting 2016

Description:

Preparation of a Survey on early detection and -intervention services for psychosis designed as a short questionnaire.
The 16-item questionnaire was sent to representatives (presidents and secretaries) of 40 EPA national societies/associations (NPAs) representing 37 countries. The representatives were also invited to recommend a person for additional information about ED/EI services/programs in the country. A total of 25 responses were received. The results will be presented in the presentation ‘The current European status’ at the Section Symposium ‘Early Detection and –Intervention for Psychosis – The European Status and Perspective’ at the EPA congress 2017 in Florence.


Venue: Madrid/Spain


Date: 14/03/2016


Attendance: Section Members from Switzerland, Serbia and Germany


EPA Section Meeting 2017

Description:

It was agreed to distribute guidance materials and to organize guidance workshops in different parts of Europe. The two EPA guidance publications (on prediction and on prevention of first episode psychosis) found a broad and positive resonance in the European psychiatric community and the recommendations have meanwhile been published in German (Resch et al. , Psych up2date 2017; 11: 131-147) and French (Michel et al. 2017, L'Encéphale doi:10.1016/j.encep.2017.01.005). As Martina Rojnic Kuzman reported that a Croation version is under preparation. To further elucidate the current state of the art, a survey of the early detection and early intervention program programs and services in Europe was conducted by N. Marić-Bojović and A. Riecher-Rössler in collaboration with S. Andric , A. Raballo, M. Rojnic-Kuzman, J. Klosterkötter. It was was based on a 16 item questionnaire, which was sent to representatives (presidents and secretariats) of 40 EPA National Societies/Associations (NPAs), representing 37 countries. Results were presented at the sectzion symposium at the EPA-congress (abstract: http://www.epa-congress.org/scientific-information/interactive-programme#.WP-Lp_5PoaU)


Venue: Florence, Italy


Date: 03/04/2017


Attendance: Nađa Marić-Bojović (Serbia), Cyril Höschl (Czech Republic), Joachim Klosterkötter (Germany), Andrea Raballo (Italy/Norway), Martina Rojnic Kuzman (Croatia), Stephan Ruhrmann (Germany)


Joint Section Symposium with the "Schizophrenia" Section Tailoring Intervention to early psychosis and at-risk mental states

Description:

Joint Section Symposium with the "Schizophrenia" Section

Tailoring intervention to early psychosis and at-risk mental states

Chair: Stephan Ruhrmann, Germany
Co-chair: Anita Riecher-Rössler, Switzerland

Clinical Needs of Individuals in an At-risk State of Developing Psychosis
Stephan Ruhrmann, Germany

Cognitive Remediation in Early Psychosis and in At-risk Mental States – Approaches and Efficacy
Stefanie J. Schmidt, Switzerland

Can Psychotherapy Prevent Psychosis?
Mark van der Gaag, Netherlands

Treatment of Negative Symptoms – Current State and Future Perspectives
Silvana Galderisi, Italy


Partners

EPA Section "Schizophrenia"


Venue: Munich/Germany


Date: 02/03/2014


Attendance: well attended


Can psychiatric disorders be predicted and prevented?

Description:

Section Symposium

Can psychiatric disorders be predicted and prevented?

Chair: Joachim Klosterkötter, Cologne
Co-Chair: Danuta Wasserman, Sweden

Suicide Prevention
D. Wasserman, Stockholm (SE)

Prevention of Bipolar and Depressive Disorders: Is this an Attainable Goal?
C. Correll, NY (US)

Prediction and Indicated Prevention of Psychoses
S. Ruhrmann, Cologne (DE)

Prevention of Alcohol Addiction
W. van den Brink, Amsterdam (NL)


Venue: Vienna/Austria


Date: 30/03/2015


Attendance: well attended


Prevention of Mental Disorders in Children of Mentally Ill Parents

Description:

Joint Section Symposium

Prevention of Mental Disorders in Children of Mentally Ill Parents

Chair:  Hans Grabe, Germany   
Co-Chair:  Stephan Lawrie, United Kingdom

Mentally Ill Parents and Their Children
Hans Grabe, Germany

Early Risk Prediction of Schizophrenia in Children and Adolescents   
Stephan Lawrie, United Kingdom

Transgenerational Experiences of Childhood Adversities in the Development of Adolescent Borderline Personality Disorder  
Ronuald Brunner, Germany

Gene-Environment and Timing in the Trans-Generational Transmission of Mood Disorders   
Gil Zalsman, Israel


Partners

EPA Section "Child and Adolescent Psychiatry"


Venue: Vienna/Austria


Date: 30/03/2015


Attendance: well attended


Prevention related symposium at the 5th European Conference on Schizophrenia Research 2015 in Berlin with the focus on epidemiological aspects entitled:
"Epidemiological and clinical aspects of psychosis risk syndromes and psychotic experiences in children, adolescents and adults"

Description:

Section Symposium

Epidemiological and clinical aspects of psychosis risk syndromes and psychotic experiences in children, adolescents and adults

Chair: S. Ruhrmann, Cologne, Germany
Co-Chair: F. Schultze-Lutter, Bern, Switzerland

Prevalence, familial liability and clinical correlates of psychotic experiences and symptoms in children of the general population:
the Copenhagen Child Cohort 2000

P. Jeppesen, Glostrup, Denmark, J. T. Larsen, L. Clemmensen, A. Munkholm, M. K. Rimvall, C. U. Rask, J. van Os, L. Petersen, A. M. Skovgaard

Follow-up findings of the bern Epidemiological At-Risk (bEAR) study
F. Schultze-Lutter, Bern, Switzerland, C. Michel, B. G. Schimmelman

Age as a source of heterogeneity in psychosis high risk research
S. Ruhrmann, Cologne, Germany, S. Schmidt, F. Schultze-Lutter

Social environment as a risk factor for psychosis proneness
J. Kirkbride, London, United Kingdom, J. Stochl, J. Zimbron, C. Crane, A. Metastasio, E. Aguilar, R. Webster, S. Theegala, N. Kabacs, P. Jones, J. Perez


Venue: Berlin, 5th European Conference on Schizophrenia Research (ECSR)


Date: 20/09/2015


Attendance: well attended


Chances of a personalized medicine for early diagnosis and therapy of mental illnesses took place in Göttingen (Germany)

Description:

On December 8, 2016 a symposium entitled 'Chances of a personalized medicine for early diagnosis and therapy of mental illnesses' took place in Göttingen (Germany). This symposium was conducted in cooperation with three sections of the German Psychiatric Association (DGPPN), the Prevention of Mental Disorders Section, the Predictive Mental Disorders Section, and the Neurobiology and Genetics Section.


Partners

German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) - Sections "Prevention of Mental Disorders", "Predictive Psychiatry", Neurobiology and Genetics"


Venue: Göttingen/Germany


Date: 12/08/2016


Attendance: well attendeed


Early Detection and Early Intervention for psychosis – the European Status and Perspectives

Description:

Joint Section Symposium

Early Detection and Early Intervention for psychosis – the European Status and Perspectives

Chair: J. Klosterkötter (Germany)
Co-Chair: S. Galderisi (Italy)


The current European Status
N. Maric Bojovic (Serbia), A. Riecher-Rössler 

Diagnostic Procedures for Prediction of Psychosis - Achievements and Challenges
A. Raballo (Norway)

Intervention in Clinical High Risk States - Current Status and Future Perspectives
S. Ruhrmann (Germany), J. Klosterkötter

Intervention in Early Psychosis - Current Status and Future perspectives
S. Galderisi (Italy)


Partners

EPA Section "Schizophrenia"


Venue: Florence/Italy


Date: 04/03/2017


Attendance: well attended


Prevention related symposium at the 6th European Conference on Schizophrenia Research 2017 in Berlin
"Prevention of schizophrenic and other psychoses - activities for implementation in Europe"

Description:

Section Symposium

Prevention of schizophrenic and other psychoses - activities for implementation in Europe

Chair: Joachim Klosterkötter, Cologne, Germany
Co-Chair: Paolo Fusar-Poli, London, United Kingdom

The Clinical High Risk state for psychosis (CHR-P): challenges and future implementations
Paolo Fusar-Poli, London, United Kingdom

EPA guidance on the early detection of CHR states
Frauke Schultze-Lutter, Bern, Switzerland

EPA guidance on the early intervention of CHR states
Stephanie J. Schmidt, Bern, Switzerland

EPA survey on the early detection and intervention programs
Nadja Maric, Belgrade, Serbia


Venue: Berlin, 6th European Conference on Schizophrenia Research (ECSR)


Date: 15/09/2017


Attendance: well attended


Prediction and Prevention of Psychoses – what has been achieved and where to go next?

Description:

Joint Section Symposium

Prediction and Prevention of Psychoses – what has been achieved and where to go next?

Chair: Joachim Klosterkötter, Cologne (GER)
Co-Chair: Patrick D. McGorry, Melbourne (AUS)

Prediction of Psychoses – State of the Art and Future Perspectives
F. Schultze-Lutter, Bern (CH)

Optimization and Personalization of Psychoses Prediction by means of Biomarkers
N. Koutsouleris, Munich (GER)

Indicated Prevention of Psychoses - State of the Art and Future Perspectives
P.D. McGorry, Melbourne (AUS)

Latest Developments and Implementation Possibilities of Psychological Psychosis Prevention Strategies
Mark van der Gaag, Amsterdam (NL)


Partners

German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) - Sections "Prevention of Mental Disorders", "Predictive Psychiatry


Venue: Berlin, WPA XVII World Congress of Psychiatry


Date: 12/10/2017


Attendance: well attended


Introduction in the Assessment of Clinical High Risk (CHR) Criteria of Psychoses Recommended by EPA Guidance Project

Description:

Section Course

Introduction in the Assessment of Clinical High Risk (CHR) Criteria of Psychoses Recommended by EPA Guidance Project

Director:
Frauke Schultze-Lutter (Switzerland)

The course programme was based on the two guidance papers on “Prediction and Prevention of Psychoses”, published by the section in European Psychiatry in March 2015. The course bot “Introduction in the Assessment of Clinical High Risk (CHR) Criteria of Psychosis” recommended by the EPA Guidance Project” for all interested parties from the European Member Countries of the EPA. The first author of the Guidance paper on Prediction, Frauke Schultze-Lutter, Switzerland/Germany organized and held this course in Florence.


Venue: Florence, Italy


Date: 03/04/2017


Attendance: well attended


Publications

EPA guidance on the early detection of clinical high risk (CHR) states of psychoses

Journal

Eur Psychiatry. 2015 Mar;30(3):405-16


Authors

Schultze-Lutter F, Michel C, Schmidt SJ, Schimmelmann BG, Maric NP, Salokangas RK, Riecher-Rössler A, van der Gaag M, Nordentoft M, Raballo A, Meneghelli A, Marshall M, Morrison A, Ruhrmann S, Klosterkötter J.


Acknowledged as official Section publication? Yes


EPA guidance on the early intervention in clinical high risk states of psychoses.

Journal

Eur Psychiatry. 2015 Mar;30(3):388-404


Authors

Schmidt SJ, Schultze-Lutter F, Schimmelmann BG, Maric NP, Salokangas RK, Riecher-Rössler A, van der Gaag M, Meneghelli A, Nordentoft M, Marshall M, Morrison A, Raballo A, Klosterkötter J, Ruhrmann S.


Acknowledged as official Section publication? Yes


Handbuch Präventive Psychiatrie (Clinical Manual of Preventive Psychiatry)
Forschung - Lehre - Versorgung

Journal

Schattauer GmbH – Verlag für Medizin und Naturwissenschaften, Stuttgart 2017


Authors

Editors
Joachim Klosterkötter, Wolfgang Maier
(edited in cooperation with the EPA and the DGPPN Prevention Sections)


Acknowledged as official Section publication? Yes


European status and perspectives on early detection and intervention in at-risk mental state and first episode psychosis: Viewpoint from the EPA section for prevention of mental disorders.

Journal

Eur Psychiatry. 2017 Oct;46:48-50


Authors

Maric NP, Raballo A, Rojnic Kuzman M, Andric Petrovic S, Klosterkötter J, Riecher-Rössler A.


Acknowledged as official Section publication? Yes


Presentations at non-section events

Other Section activities

Other Section activities

Desciption

A survey of the early detection and early intervention programs and services in Europe was conducted by N. Marić-Bojović  and  A. Riecher-Rössler  in collaboration with S. Andric , A. Raballo, M. Rojnic-Kuzman, J. Klosterkötter. It was based on a 16 item questionnaire, which was sent to representatives (presidents and secretariats) of 40 EPA National Societies/Associations (NPAs), representing 37 countries. Results were presented at the section symposium at the EPA congress (abstract: http://www.epa-congress.org/scientific-information/interactive-programme#.WP-Lp_5PoaU).

Time period: 2016-2017


Outcomes

Publication see above.

A second publication in preparation.


Other Section activities

Desciption
  • Riecher-Rössler A: State of the art lecture: Working together for early detection of psychosis. Paper presented at the 25th European Congress of Psychiatry, 1-4 April 2017; Florence. Eur Psychiatry 2017; 43 (Suppl): S6
  • Video with Elsevier by Anita Riecher-Rössler on the topic of the state of the art lecture. http://schizophrenia.elsevierresource.com/interview-anita-riecher-epa-2017-florence
  • Riecher-Rössler A: Chair of Ask the Expert Session: "Organizing services for early detection of mental disorders." 25th EPA Congress, Florence, 02.04.2017
  • Riecher-Rössler A: Chair of Oral Communications " Epidemiology and Social Psychiatry; Migration and Mental health of Immigrants; Forensic Psychiatry; Suicidology and Suicide Prevention; Prevention of Mental Disorders and Promotion of Mental Health" 25th EPA Congress, Florence, 02.04.2017
  • Riecher-Rössler A: Co-Chair of the Working Group "Mental Health in the Workplace" at the EPA Council of National Psychiatric AssociationsMeeting, 25th EPA Congress, Florence, 01.04.2017

 

Publications, e.g.:

  • Riecher-Rössler A, Studerus E. Prediction of conversion to psychosis in individuals with an at-risk mental state: a brief update on recent developments. Curr Opin Psychiatry 2017;30(3): 209-19.
  • Studerus E, Ramyead A, Riecher-Rössler A. Prediction of transition to psychosis in patients with a clinical high risk for psychosis: a systematic review of methodology and reporting. Psychol Med 2017;47(7): 1163-78.
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