Prevention of Mental Disorders
Aims & Objectives
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:
- universal prevention, targeting the general public (e.g. actions against illegal drug use will result in lower prevalence of drug addicts),
- 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)
- 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:
- reduce disability (e.g. early treatment of dementia or psychosis)
- prevent relapses (e.g. needs-adapted interventions in first-episode schizophrenia)
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.
- 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).
- 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
- 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)
- 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
- 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
- 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
- Stimulate European wide prevention and early intervention trials and associated research efforts (with hopefully successful national and EU lobbying)
- 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
EPA Section Meeting 2016
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.
March 14, 2016
Section Members from Switzerland, Serbia and Germany
EPA Section Meeting 2017
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)
April 3, 2017
Nađa Marić-Bojović (Serbia), Cyril Höschl (Czech Republic), Joachim Klosterkötter (Germany), Andrea Raballo (Italy/Norway), Martina Rojnic Kuzman (Croatia), Stephan Ruhrmann (Germany)
2016 - Chances of a personalized medicine for early diagnosis and therapy of mental illnesses took place in Göttingen (Germany)
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"
2017 - Early Detection and Early Intervention for psychosis – the European Status and Perspectives
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)
EPA Section "Schizophrenia"
2017 - 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"
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
Berlin, 6th European Conference on Schizophrenia Research (ECSR)
September 15, 2017
2017 - Prediction and Prevention of Psychoses – what has been achieved and where to go next?
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)
German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) - Sections "Prevention of Mental Disorders", "Predictive Psychiatry
Berlin, WPA XVII World Congress of Psychiatry
October 12, 2017
2017 - Introduction in the Assessment of Clinical High Risk (CHR) Criteria of Psychoses Recommended by EPA Guidance Project
Introduction in the Assessment of Clinical High Risk (CHR) Criteria of Psychoses Recommended by EPA Guidance Project
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.
April 3, 2017
2019 - NEW - Training for Early Detection and Intervention in Psychosis (EPA EDUCATIONAL COURSE)
Early detection and intervention in psychosis has an already established role in reducing the duration of untreated psychosis, preventing or at least delaying psychosis onset in high risk individuals and relieving them from their presenting symptoms. Although there is enough evidence from research and clinical practice to justify the implementation of early detection and intervention services for psychosis with low-threshold access for all patients, the implementation of such services is very unevenly distributed over countries. Moreover, in many countries neither pre-graduate, nor post-graduate curricula include a specific education focusing on the concept of early detection and principles of early intervention in psychoses. Thus, there is a great need for training professionals to understand the concept of early detection and intervention in psychosis, to recognize the early signs and to know the basics of recommended pharmacological and non-pharmacological interventions in clinical high risk individuals and first episode patients. The course participants will learn and discuss the rationale for this clinical approach, the existing evidence-base and the main theoretical challenges, will learn to approximate risk for psychosis through several instruments and to develop a personalized intervention plan. Moreover, the course will address the current status of the service implementation across Europe and discuss the possibilities to overcome common obstacles. The knowledge and experience acquired in this course are relevant and applicable to all areas of mental health.
Course Director Anita Riecher-Rössler, Switzerland
Course Co-Director Nadja P. Maric, Serbia
27th EPA Congress, Warsaw, Poland
You can register for a EPA course through the congress registration system.
2019 - European status and perspectives on early detection and intervention in at-risk mental state and first episode psychosis
27th EPA CONGRESS, Warsaw, Poland Sunday, April 7th, 2019 - 08:00 - 09:30, Hall D Session title:Symposium: Early Intervention in Psychoses: the State of the Art
European status and perspectives on early detection and intervention in at-risk mental state and first episode psychosis
Psychiatric University Hospital Basel, Switzerland
Over the last two decades psychiatry has taken an important and overdue step, which other medical disciplines had taken much earlier, by recognizing the chances of early detection and intervention – in a first step mainly regarding emerging psychosis. It could be shown that early detection and intervention not only in first episode psychoses, but also in the at-risk mental state for psychosis, bears a great potential for improving the mental health of many people.
Especially early detection shows very promising results. Duration of untreated, frank psychosis could be reduced. Identification of individuals at risk and prediction of transition to psychosis is in the meantime possible with an excellent accuracy comparable to other preventive approaches in medicine and there is growing evidence of how this accuracy can be even more improved. Regarding early intervention, staged interventions according to the degree of risk seem feasible.
Long-term studies now show that we have even underestimated the magnitude of the problem, i.e. that only a minority of those at risk make a full clinical and functional recovery, and that there is quite a number of patients with a late transition to psychosis even after many years.
Thus, we urgently have to take action. There is now enough evidence to justify the implementation of early detection and intervention services with low threshold access for all patients all over Europe. However, implementation of such services is very unevenly distributed over European countries, and a lot of effort will have to be taken to establish early detection and intervention for all European patients.
27th EPA Congress, Warsaw, Poland
2019 - Workshop: A Quickstart Guide to Set Up a Team in Early Intervention/Detection of Psychosis
(Proposed by the EPA Section on Prevention of Mental Disorders)
This workshop is aimed as a practical and guiding tool on how to successfully implement or improve intervention teams and services in European countries. Psychosis patients form one of the patient groups where is possible to apply successful secondary prevention and early intervention is a relatively new model for managing treatment. In the frame of this workshop, specialists who work in intervention teams will share their experience and the practical aspects of this complicated work. There will be included also an expert opinion about using network based approach to early interventions. At the end of the workshop the audience will have new insights into the process- what are the first steps when starting intervention programs, advice for skilled detection of high risk patients, what are the possible struggles and possible approaches to overcome them, what are some specific examples for intervention teams, as well as encouraging, educational, and motivational speaks on leadership and excellence in early intervention.Partners :
27th EPA Congress, Warsaw, Poland
EPA Section Meeting 2018
Last Meeting Follow-up
Section has a very productive scientific work, there are released publications and completed new surveys. Also in preparation is new publication for European journal of Psychiatry with last, updated data from surveys
The section workshop has been held in last congress and as well there were section workshop on this EPA congress
The section members actively communicate via e mail
The election proposals via e mails for this year section new board election
To be more collaborative with health economics, find new ways how to implement early intervention services via government; find strong arguments for government financial funding for intervention services;
Maintain previous goals, support and promote early intervention development in countries which do not have this service system; support existing intervention and ensure its quality;
To collect ideas and need from section members in connection to real life practice in working in early intervention in psychiatry
Co work with sections (Women, Gender and Mental health and Early career specialist) to do survey on MeToo movement in Mental Health work environment
Involve more measurements for collaborate in research / Put an effort to develop an educational material for psychiatrists, trainees, health policy makers, general society / To do translation in more languages of EPA early intervention/ detection guidelines document (at this time it is translated in polish and croation) / Reach out via e mail NPA to encourage put an early intervention into national mental health plan, promote the idea of intervention centers in government level / To organize workshop with advises and experience from colleagues who are in process of starting intervention service, to share experience/contacts and help each other
To involve actively via EPA the NPA for asking for taskforce to promote and support the implementation of early intervention services;
To suggest via EPA Prevention of mental disorders section to put an early intervention/ detection in National guidelines;
Propose a symposium and workshop on next EPA congress (EPA 2019 at Warsaw) of the Prevention of Mental Health section
To work with educational material (Something similar as EPA MOOC?)
Board members election - Chair: Anita Riecher-Rössler, Co Chair: Nadja Maric Bojovic, Secretary: Andrea Raballo, Board member: Olivier Andlauer and Martina Rojnic Kuzmanc
Acropolis congress Centre, Nice, France
2018 - PARTICIPATION OF THE SECTION TO INTERNATIONAL ADVISORY COMMITTEE - VIZDOM PROJECT
(NIMH Czech Republic: Pilot implementation of ED/EI teams)
Within the context of ongoing mental health care reform, the National Institute of Mental Health of Czech Republic is establishing a pilot implementation of Early Detection and Intervention Services in Psychosis. The main aim of the project is to train and establish teams in three Czech regions, and to evaluate their impact, including on the medico-economic level.
In order to make sure that teams are built based on the best international experiences, an international advisory board has been established. Prof Anita Riecher-Rössler, Chair of the EPA section on Prevention of Mental Disorders, and Dr Olivier Andlauer, member of the section board, have been asked to participate in this board. The role of the board is to help making strategic decisions, review different care models and their relevance for the Czech Republic, advise on the structure of training, or design the scientific evaluation of the project.
As interest in Early Intervention and Early Detection of psychosis is growing with its evidence-base, this collaboration shows how EPA and its sections can have a leading role in spreading good practices and supporting countries in learning from each other through the expertise of EPA sections.
REGULAR PUBLICATION OF UPDATES FROM THE SECTION IN THE INTERACT EPA NEWSLETTER
Prof. Anita Riecher-Rössler is Head of the Center for Gender Research and Early Detection at the Psychiatric University Clinics in Basel, Switzerland. She has specialised in psychiatry, psychotherapy, psychoanalysis, consultation & liaison psychiatry and gerontopsychiatry. In 1998, she became the first woman to be appointed to a full chair for psychiatry in a German speaking country. Her research interests include schizophrenic psychoses, gender differences in mental disorders, and mental disorders in women.
Our Section warmly congratulates to our president on this well-deserved Prize, which recognises her outstanding role in working towards better mental health care in Europe!
Acropolis congress Centre, Nice, France
EPA guidance on the early detection of clinical high risk (CHR) states of psychoses
Eur Psychiatry. 2015 Mar;30(3):405-16
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.
EPA guidance on the early intervention in clinical high risk states of psychoses.
Eur Psychiatry. 2015 Mar;30(3):388-404
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.
Handbuch Präventive Psychiatrie (Clinical Manual of Preventive Psychiatry)Forschung - Lehre - Versorgung
Schattauer GmbH – Verlag für Medizin und Naturwissenschaften, Stuttgart 2017
EditorsJoachim Klosterkötter, Wolfgang Maier (edited in cooperation with the EPA and the DGPPN Prevention Sections)
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.
Eur Psychiatry. 2017 Oct;46:48-50
Maric NP, Raballo A, Rojnic Kuzman M, Andric Petrovic S, Klosterkötter J, Riecher-Rössler A.
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.
Riecher-Rössler A, Studerus E.
Survey of the European Psychiatric Association on the European status and perspectives in early detection and intervention in at-risk mental state and first-episode psychosis.
Early Interv Psychiatry. 2018 Jun 8. doi: 10.1111/eip.12682. [Epub ahead of print]
Maric NP, Petrovic SA, Raballo A, Rojnic-Kuzman M, Klosterkötter J, Riecher-Rössler A.